Cerebral Aneurysm—Treatment and Perioperative Nursing ... - AORN

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JUNE 2007, VOL 85, NO 6Wrightbe performed; so ideally, the surgical procedureis performed in a room that hasangiographic capability. No matter whichprocedure will be performed, one backtable is prepared for cerebral angiography.The angiography back table includes• an angiography pack,• a gown and gloves for the neurosurgeon,• a syringe and needle for administeringlocal anesthesia,• a percutaneous entry needle,• an arterial pressure monitoring kit,• a customized kit for delivering heparinizedsaline,• extension tubing,• a femoral-artery introducing sheath,• a selection of arterial sealing devices,• angiographic guide wires and catheters,and• contrast dye and heparinized salinein labeled containers.CRANIOTOMY FOR ANEURYSM CLIPPING SETUP. Asecond back table is prepared for a craniotomy.The table includes• a craniotomy instrument set;• a craniotomy pack;• a drill with accessories;• a selection of suction tips;• aneurysm clips and clip appliers(Figures 3 and 4);• a micro-Doppler probe;• monopolar and bipolar electrosurgeryunit (ESU) supplies;• physician-preferred retractors anddissectors; and• various sizes of cottonoids and hemostaticagents (eg, wax, hemoclips,hemostatic sponges).The circulating nurse ensures thatdura repair supplies and materials arereadily available but not opened untilthey are needed. The circulating nurseaseptically delivers medications intocontainers that the scrub person has labeledon the back table, including• the physician’s preferred local anesthesia,• antibiotic irrigation, and• thrombin mixed with gelfoam.The circulating nurse ensures that thefollowing equipment is in the room andfunctioning properly before the patientis brought into the room:• a radiolucent OR bed designed forboth angiographic and craniotomyprocedures;• a radiolucent, neurosurgical, threepointheadrest and table attachment;• a microscope;• monopolar and bipolar ESUs; and• a foot pedal for the drill.ENDOVASCULAR COILING SETUP. The risk ofaneurysm rupture during an endovascularcoiling procedure is low; however, thecirculating nurse and scrub personshould have supplies for a ventriculostomyreadily available should a ruptureoccur. In addition to a cerebral angiographypack, the circulating nurse and scrubperson open• gowns and gloves,• a femoral artery introducing sheath,• a percutaneous entry needle, and• an arterial pressure monitoring kit.They also ensure that a full supply ofendovascular wires, catheters, coils,and stents are available. The circulatingnurse aseptically delivers medicationsinto containers that the scrub personhas labeled on the angiographyback table, including• local anesthesia as requested by thesurgeon,• contrast dye, and• heparinized saline for irrigation.The circulating nurse prepares additionalheparinized saline for patientsystemic heparinization during theprocedure. The circulating nurse deliversthis additional heparinizedsaline to the surgical field via tubingthat is attached to sterile extensiontubing and a delivery kit on the surgicalfield. The surgeon will administerthis systemic heparinized solution viathe femoral artery.1176 • AORN JOURNAL
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Page 15: Learner EvaluationCerebral Aneurysm

Cerebral Aneurysm—Treatment and Perioperative Nursing ... - AORN

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