PERIOPERATIVE CARE

The Significance of Safe Perioperative Care of a Patient Undergoing Liver Resection

The Significance of Safe Perioperative Care of a Patient Undergoing Liver Resection

Introduction

Perioperative nursing is a type of care where nurses provide care to patients within Perioperative environment. Originally, this environment was called 'Operation Theatre'; however, the environment has now become dynamic and encompasses day procedure units and pre-admission clinics, as well as operating suites and interventional suites.

Perioperative nurses are part of team which is multidisciplinary undertaking planning, implementation and evaluation of patient's care and treatment through, Preoperative, intra-operative and postoperative phases of treatment. Nurses in Perioperative environment are specialized as scrub nurse (instrument nurse), circulating nurse (scout), anaesthetic nurse and the day procedure nurse (Woodhead & Wicker 2005, pp.212).

Critically Analysis: the Significance of Safe Perioperative Care of a Patient Undergoing Liver Resection

In the past decades the trend has changed towards minimally invasive liver surgery. Advances in laparoscopic techniques have made this method feasible and safe, after initial limitation by technical challenges (National Institute for Health and Clinical Excellence 2005, pp.2). However, with increasing health care costs up to 50% of provincial budget, it was important that any surgical innovation has justifiable benefits against costs (Taylor 2008, pp. 2). To optimize patients' stay length in hospital with introduction of standardized postoperative liver resection, the advantages of OLR (open liver resection) compared with the advantages of LLR (laparoscopic liver resection) and resource usage are not well defined. It is still unclear if LLR is more advantageous to OLR through these measurements (Wicker & Neill 2006, pp.66).

Initially, LLR (laparoscopic liver resections) were inadequate due to technical challenges but certain technological advances in laparoscopic instrumentation and techniques have made this treatment applicable. There are number of devices which were introduced and have enabled easier parenchymal dissection and control over biliary and vascular pedicles. These instruments include coagulator devices, ultrasonic dissectors, and stapler devices for laparoscopic use (Buell 2005, pp.200).

Additionally, use of laparoscopic ultrasound probes enables mapping liver lesions and its relationship with intrahepatic structures. Furthermore, use of hand ports will result in improvement in surgeon's confidence to maintain vascular control. All of these improvements enable the application of laparoscopic approach for liver surgery equivalent and parallel to OLR (Open Liver Resection). A number of case series and nonrandomized reports have proved that intermediate to short results are similar to OLR in LLR treatment. The studies also suggest, in general, that LLR is more beneficial than OLR in term of LOS (length of stay), blood transfusions requirement and complication rate (Lee et.al 2007, pp.13).

Nevertheless, as costs of healthcare have approached up to 50% of provincial budgets, therefore, any innovation in surgical treatment must provide more benefit than its costs. Enhancement in technology and improved selection of patients, as well as preoperative management for undergoing OLR or LLR has resulted in lower mortality and morbidity. Furthermore, with the usage of standardized postoperative liver resection LOS for patients undergoing OLR has reduced.

Peri-operative nursing for Liver Resection (Laparoscopic)

Liver is located in a concealed ...