My Procedure Plan
I plan to perform implantation myself - I've heard the warnings, I don't need to hear them again. However, I would value input on my surgical plan. I've gotten feedback from an RN who says it looks sound, but I always want more eyes looking over things. I will have two assistants also with sterile gloves on to assist as needed. I'm planning on doing it a week from tonight.
I'm sure I'm going BEYOND overboard with what's really necessary in terms of sterility but better safe than sorry (or necrotic). Plan below. All tools except scissors and hemostats are individually packaged and sterile.
--------------------------------------------------------------------------
Surgical Plan
YOU WILL NEED:
Sterile Scalpels (#11 recommended)
Snub nosed surgical scissors
Plastic tweezers
Multiple syringes and luer lock needles
Sterile Saline
Super Sani-Wipes
Lidocaine 2% solution
Chlorhexadine prep swab
Fresh tube CA glue
Sterile latex gloves
Good familiarity with digital block techniques, digital anatomy, sterile procedure
A strong stomach
-----------------------------------------------------------------
PRE-PREP
24 hours before surgery, test a saniwipe treated magnet in hypertonic saline to ensure parylene coating integrity remains intact.
AREA PREP
Scrub down all exposed skin surfaces with soap and water. Don sterile gloves. Prep all flat surfaces in room by occluding airflow and clean with soapy water, then with saniwipes. Take off gloves. Don new ones. Lay down a clean towel. Take off gloves. Don new ones. Use wrapping from gloves as operating surface, although treat any tool or sharp that touches the surface as contaminated and discard.
Draw up sterile saline into syringe for irrigation.
MAGNET PREP
Prepare an assistant to don sterile gloves and wipe down magnet with steri-wipe immediately prior to insertion. Ensure it is given ample time to dry.
INCISION PREP
Take off gloves. Mark lateral crease points, and extend lines laterally to create Littler's diamond to indicate safest locations for lateral incisions. Mark point of incision and desired magnet location. Scrub down with soap and water. Dry thoroughly. Wipe down with sani-wipes. Dry thoroughly. Don sterile gloves. Lay out wrapped tools and lido ampule with sterile, guarded needle, with scissors and tweezers sterilized as needed if not individually packaged. CAREFULLY cut tip off of left ring finger glove to expose incision site and lido injection sites with sterile scalpel.
Clean lido injection site with alcohol prep pad and proceed with digital nerve block by drawing up lido and creating a wheel on skin lateral to the knuckle on the palmar surface to the left and right lateral sides of the knuckle, then, using aspiration as an indicator of blood vessel intrusion, proceed with 1-2cc injection as close to the bone as safely possible. Repeat deep injections until all 5cc are injected. [Advice from my nurse friend, who said this is essentially a digital block for dummies.]
As numbness grows, scrub incision site with chlorhexadine solution and allow to dry.
[cont. in comments]
Tagged:
Comments
He lists a couple issues in the video.
The only thing I would add to your list is a decent size, sterile magnet. That way if you can't get it far enough in the pocket you can use the magnet, or if you need to get it out for some reason it will be a lot easier with a magnet than tweezers.
Check and prep a few magnets beforehand. You can check the magnets for damage before hand by dropping them in a glass of water for a couple hours. If they make bubbles (beyond the one on the surface when you drop it in) then they have a hole. I wouldn't want to be checking/sterilizing magnets while my finger is bleeding, which is what it seems like your process is..