Stavanger, Norway | 12 - 15 May 2022 10th EORNA Congress Clinical Case Studies 35 Clinical Case Studies CL01 Perioperative nursing care for craniopagus twins’ separation B. Fortunati1, I. Pannacci2, M. Bishop3, M. Ferro3, G.M. Barra3, F.P. Gagliano3 1Ospedale Pediatrico Bambino Gesù, Operating Room, Roma, Italy, 2Ospedale Pediatrico Bambino Gesù, Intensive Care Unit and Operating Room, Roma, Italy, 3Ospedale Pediatrico Bambino Gesù, OR, Roma, Italy Craniopagus is a clinical condition characterized by incomplete separation of the skull and contained structures of conjoined twins; surgical separation has always proved to be a failure until 1952. A multi-step surgical approach, favouring progressive adaptation of cerebral circulation in both twins has been key to success in the last decades. We describe the experience of our multidisciplinary group at Bambino Gesù Children’s Hospital, that recently succeeded in surgical separation of total angular craniopagus twins. To simplify patient’s identification, in the acceptance phase, a unique colour code was assigned to each twin. In order to share collected data, periodic updates were foreseen, involving all allocated medical and nursing staff. In the diagnostic phase, extensive neuroimaging was performed, requiring coordinated action by neurosurgery, imaging and anaesthesiology nursing staffs. Since diagnostics required sedation procedures, a dedicated medical-nursing team was established for each twin. During the pre-surgical phase, the perioperative nursing staff was involved in the multidisciplinary briefing. Dedicated anaesthesiology and operating room nursing teams were defined for each twin and all details were discussed. Two adjacent operating rooms was prepared with all the necessary material the day before surgery. On the day of surgery, patients were accepted in the operating room and prepared for craniotomy. Anaesthesia induction was performed sequentially, as was hemodynamic monitoring and infusion lines and additional devices’ positioning. At the end of each procedure, patients were transferred to the intensive care unit. After each surgical step a debriefing was performed, covering all the aspects about the twins’ path. Therefore, such surgical procedures required the formation of a coordinated multidisciplinary nursing team able to carry out a holistic care management but at the same time personalized for both twins. We cannot overemphasize the role of cooperation and development of specific technical skills to accomplish successful craniopagus separation. CL02 Prevention of electrosurgical burn injuries related to the grounding pad M. Yavuz van Giersbergen1, Y. Uslu2 1Ege University, Nursing Faculty, İzmir, Turkey, 2Acibadem University, Health Sciences Faculty, İstanbul, Turkey Introduction: Complications related to grounding pads are often reported. The grounding pad is the common name of a rotating electrode placed on the patient to direct the current out of the body. The grounding pad is usually placed by interns or nurses. Electro surgery grounding pad problems can lead to local skin reactions ranging from blisters to burns. Burns due to the grounding pad also cause morbidity in the patient and medicolegal, economic, physical, financial and psychological effects on patients and their families. Objectives: In this presentation, current recommendations will be examined to prevent burns to operating room nurses with grounding pads. Methods: In this statement, the guides of the official organisations published on this subject, the recommendations of the material manufacturers and the published studies were examined in order to prevent burns with the grounding pad. Results: When the recommendations related to prevention are examined; choosing a place for the return electrode/ dispenser pad as close as possible to the surgical site, clean and dry, well-vascularized and on a large muscle mass Avoiding bone protrusions, adipose tissue, scar tissue, skin on implanted metal prostheses, furry upsets and pressure points If necessary, shaving the multi-haired skin in the pad area is moist and evenly spreads throughout the contact area of the patient Removing metal jewellery on the patient to prevent complications from possible current leakage to ensure that it provides equal contact with the skin If the electro surgery circuit is activated for 10 seconds, it is recommended to use a larger and bendable ground pad to prevent burn injury. Conclusions: The primary goal of the patient intervention is to provide a safe and positive operative experience. Burn injuries due to the grounding pad can be easily prevented by taking the necessary precautions.
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