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This Card is to be used for any case with adjacent tissue transfer
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Dr. Brown:
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Gown – XL, XL Length
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Gloves – 8 Indicator Glove, 7.5 Biogel Glove
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Dr. Chandler:
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Gown – L
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Gloves – 5.5, 6.0 if 5.5 unavailable
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Sean Kirby PA-C:
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Gown – XL
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Gloves – 7.5 Indicator Glove, 7 Nonlatex Glove
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Pre-operative Medications:
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None
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Intra-operative Medications
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Ancef 2 grams IV or Vancomycin 1g IV to be administered in pre-op prior to procedure
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Infiltration Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS):
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NS or LR 500 mL
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Ropivicaine 300mg
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Clonidine 0.3mg
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Dexamethasone 4mg
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Patient Position
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Will depend on location of wound
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One pillow under patient’s knees
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Foam pad wrapped around patient’s heel
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Bed Attachments
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Arm boards with purple pads underneath arms and then wrap the arms in Kerlix
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Patient Warming
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Blanketrol, Arctic Sun, or underbody warmer
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IV fluid warmer
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Sterile fluid warmer with 2L of Normal Saline
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DVT Prophylaxis
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Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.
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Foley Catheter
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No
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Instrument Sets
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Will depend on location of wound
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Surgical Packs
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Will depend on location of wound
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Surgical Prep
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Chloraprep x 3 – place in fluid warmer prior to use
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If the wound is on the face – Iodine Solution 5% – approximately 100mL
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Irrigation Solutions
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Warmed Normal Saline (as mentioned in patient warming)
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1L sterile water in basin for washing instruments
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Iodine/Antibiotic Solution:
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Ancef 2g
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Gentamycin 160mg
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100mL of full strength 10% stock providone-iodine (This is PAINT not scrub)
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Mixed into 1L Normal Saline
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Suction
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Medium suction with Yankeur suction
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Blades
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10 x 2
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15 x 2
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11 x 1
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Bovie
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Short Protected ENT tip x 1
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Long Protected ENT tip x 1
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Set at coagulate 40 fulgurate / cut 40 pure
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Drains
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Will depend on size of the wound
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Please have one 15Fr round JP drain and one 100mL bulb in the room if needed
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Additional Supplies
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Marking pen x 6
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Paper Ruler x 2
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Dressing
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Mastisol x 4
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1 inch steri strips x 3 packs