Block teams

[narcusprince]

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So I am trying to lobby to have a nurse present while we do our nerve blocks. Typically the blocks are done in a block bay but their is no nurse with the patient while the patient gets a block. I am trying to propose that for all nerve blocks a nurse must be with the patient until handoff to the OR nurse. Right now the blocks are done prior to the OR case completion. Is this in your OR SOP or does Asra have a statement about block teams?

 

[deleted162650]

I'm not sure I would want to add a nurse to anything if I could help it.

 

[dhb]

I do my blocks by myself so i don't need anybody, now if you want someone to prepare drugs and equipment then ok.

 

[deleted87051]

My buddy at another hospital was just written up because he and the anesthesia tech did a block timeout without the preop nurse present. At his facility and mine, a nurse is required to be present for a timeout before a block can proceed. Kinda nuts.

 

[narcusprince]

Sounds like a fight I should not get in to.

 

[Hoya11]

So I am trying to lobby to have a nurse present while we do our nerve blocks. Typically the blocks are done in a block bay but their is no nurse with the patient while the patient gets a block. I am trying to propose that for all nerve blocks a nurse must be with the patient until handoff to the OR nurse. Right now the blocks are done prior to the OR case completion. Is this in your OR SOP or does Asra have a statement about block teams?

you dont want to demand they provide the nurse as this may create a staffing stress for them. just leave the curtain open and pulse ox beeping.

 

[Arch Guillotti]

I'm not sure I would want to add a nurse to anything if I could help it.

Do you have someone else to help you with blocks?

 

[Ezekiel2517]

A nurse is required to be present for blocks at every hospital I go to. It's more laid back for blocks done at the surgicenters I go to.

 

[narcusprince]

It seems weird to me the nurse does the universal precautions and timeout then leaves the block bay. Also we do not have preop nurses. One nurse checks in all the patients in the preop bay. The universal precautions is done by the OR nurse.

 

[deleted162650]

Do you have someone else to help you with blocks?

Ya. A nurse or a tech or one of my partners. I would just hate to initiate some institutional rule that mandated a nurse be present for blocks. That's only gonna slow things down and create headaches.

 

[GA8314]

We have a dedicated block room with nursing support in the block room. We draw up all meds and of course only docs to blocks, but nurses program patient data into US machine, help get patients connected to monitors, and assist in injecting the syringe, as well as assisting in time outs and monitoring patients after blocks. They take pics and we fill out block forms of course. It is hugely helpful but we are a very high volume block place with catheters in 30% of patients.

If you do high volume ortho, then having a well designed block room is critical to success and efficiency.

 

[Ezekiel2517]

If you have a separate block team with a doc dedicated to doing blocks all day, obviously that'll make it very efficient. But if I'm doing a bunch of tka's and doing the blocks myself between cases, just having a nurse dedicated to blocks helps greatly. The nurse will have the next pt ready to go hooked up to monitors and the ultrasound machine completely ready and meds all drawn up. I can just do the block and go

 

[GA8314]

A huge advantage to an ACT model is for high regional/PNB practices. Efficiency is huge. Alternative is 1-2 docs dedicated to blocks in MD only, but it may very well require 2 dedicated docs depending on volume....

 

[caligas]

Those if you that don’t use help, what are your pearls for injecting?

I have been doing ACBs by letting go of the needle and using that hand to aspirate and inject. with 2+ inches of needle in the thigh I find the needle doesn’t really move. I know some guys do solo blocks with a spinal needle on a 30 cc syringe but I find this awkward.

This feels like de ja vu, have we already talked about this?

 

[deleted162650]

Those if you that don’t use help, what are your pearls for injecting?

I have been doing ACBs by letting go of the needle and using that hand to aspirate and inject. with 2+ inches of needle in the thigh I find the needle doesn’t really move. I know some guys do solo blocks with a spinal needle on a 30 cc syringe but I find this awkward.

Somebody posted a link on this a while back. For me, the easiest way to do it is to palm the syringe gripping it with your 4th and 5th fingers and the plunger pointing upward. You hold the needle between your middle finger and thumb. You then have your index finger free to both push up on the plunger to aspirate and push down on the plunger to inject.

 

[caligas]

Somebody posted a link on this a while back. For me, the easiest way to do it is to palm the syringe gripping it with your 4th and 5th fingers and the plunger pointing upward. You hold the needle between your middle finger and thumb. You then have your index finger free to both push up on the plunger to aspirate and push down on the plunger to inject.

Will try.

 

[dhb]

I only aspirate if i think i might be in a vessel.
I like to let go of the needle and use my thumb to push on the plunger holding the syringe like Salty describes.

 

[deleted126335]

It seems weird to me the nurse does the universal precautions and timeout then leaves the block bay. Also we do not have preop nurses. One nurse checks in all the patients in the preop bay. The universal precautions is done by the OR nurse.

Not at all. A block on the wrong patient or wrong side is an administrative nightmare for the hospital. You struggling to place a block alone doesn't mean ****. We are fortunate. We place all of our blocks in preop and have two nurses present when we place the block. One is on the opposite side of the bed charting and adjusting the dial PRN on the U/S. The other is holding the Syringe and aspirates and injects as we direct them to. We have one hand on the u/s probe and the other on the needle.

 

[anbuitachi]

I do my blocks by myself so i don't need anybody, now if you want someone to prepare drugs and equipment then ok.

What is your technique on blocking on your own? How do you hold the ultrasound probe, needle, and syringe by yourself?

 

[dhb]

What is your technique on blocking on your own? How do you hold the ultrasound probe, needle, and syringe by yourself?

 

[anbuitachi]

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Is that all you give? Just 1 syringe?

 

[BLADEMDA]

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No gloves? Seriously?

 

[dhb]

Is that all you give? Just 1 syringe?

1 or 2 depends
Gloves are for p...ies

 

[GaseousClay]

No gloves? Seriously?

hahaha That technique is not easy with a 20-30cc syringe. easier to do one handed with big syringe if you have 17 or 18G tuohy directly on the syringe with no tubing. you can easily control the needle and injection with one hand.

 

[Hoya11]

hahaha That technique is not easy with a 20-30cc syringe. easier to do one handed with big syringe if you have 17 or 18G tuohy directly on the syringe with no tubing. you can easily control the needle and injection with one hand.

I think its easier to just ask for help for a few minutes... in case you need something you didnt realize, pager goes off during it, plus the extra set of hands

 

[deleted162650]

Can also do 2 10cc syringes on a stopcock. Many ways to skin this cat.

 

[Lecithin5]

I will say that the downside to having someone else inject on your behalf is not having that tactile feel. I always tell nurses to let me know if there is a lot of resistance so that I may readjust. They always tell me there isn't, but sometimes when I'm peeking at them, I may see that they're injecting with all of their might!

Granted, patient feedback and good ultrasound visualization is 99% of a good block...

 

[anbuitachi]

Can also do 2 10cc syringes on a stopcock. Many ways to skin this cat.

how do you turn the stop cock with one hand on the probe and one hand on the needle?

 

[Arch Guillotti]

how do you turn the stop cock with one hand on the probe and one hand on the needle?

Take your hand off the needle.

 

[Southpaw]

Doing a block without help isn’t difficult. In many ways I prefer it. In residency we had a ‘team’ complete with a nurse who did the time out, etc. she wasn’t always easy to find. Looking back at it now, the ‘team’ was a complete waste of time and resources.

 

[deleted126335]

Doing a block without help isn’t difficult. In many ways I prefer it. In residency we had a ‘team’ complete with a nurse who did the time out, etc. she wasn’t always easy to find. Looking back at it now, the ‘team’ was a complete waste of time and resources.

Shush. Not so loud. They make my life easier. The prepare the tray and draw up all the meds. Finish the dressing. Add the hard copy picture to the chart. Clean up the mess I make. If only my wife did sh1t like that for me.

 

[Psai]

Shush. Not so loud. They make my life easier. The prepare the tray and draw up all the meds. Finish the dressing. Add the hard copy picture to the chart. Clean up the mess I make. If only my wife did sh1t like that for me.

Marry the nurse

 

[Southpaw]

Marry the nurse

Well of course then she’d stop doing it!

@dr doze nurses from where I trained would never concern themselves with actually helping get the work done. They just wanted to ensure the stupid docs didn’t block the wrong side. Where I work now the nurses are great and are willing to help with whatever is needed to keep the flow going. But I still do plenty of blocks all alone (after hours or don’t feel like searching for someone to help me out).

 

[deleted126335]

Marry the nurse

cost/benefit ratio doesn't quite get there.

 

[The Physician Philosopher]

So I am trying to lobby to have a nurse present while we do our nerve blocks. Typically the blocks are done in a block bay but their is no nurse with the patient while the patient gets a block. I am trying to propose that for all nerve blocks a nurse must be with the patient until handoff to the OR nurse. Right now the blocks are done prior to the OR case completion. Is this in your OR SOP or does Asra have a statement about block teams?

I work at an academic medical center, but am one of the regional anesthesia faculty. We do have nurses present at every block, and have not had a wrong sided block or procedures in years. We were having about three per year prior to that (if you look back at your stats, probably not much different if you account for volume). We have a dedicated regional area with dedicated bays. It is highly efficient.

Nurse does several things: 1) Documents meds given (multi-modal analgesics and sedation), 2) provides sedation, 3) helps position patient, 4) aspirates/injects for us while we do the blocks.

At our joint hospital (where we don't have residents/fellows), they also gather all of our supplies, set up our kits, etc.

I agree with the above mentioned idea that a wrong sided block or wrong procedure is worth the hassle of having a nurse present for a timeout and to help with the procedure.

 

[jwk]

We have a dedicated block room with nursing support in the block room. We draw up all meds and of course only docs to blocks, but nurses program patient data into US machine, help get patients connected to monitors, and assist in injecting the syringe, as well as assisting in time outs and monitoring patients after blocks. They take pics and we fill out block forms of course. It is hugely helpful but we are a very high volume block place with catheters in 30% of patients.

If you do high volume ortho, then having a well designed block room is critical to success and efficiency.

This is what we do as well. Some days 20 or more.