Chapter 16 Minor Procedure Room Setup

10.1055/b-0037-142187

Chapter 16 Minor Procedure Room Setup

Donald H. Lalonde, Geoff Cook

With the advent of WALANT and field sterility, we perform most of our hand surgery in minor procedure rooms outside of the main operating room. In this chapter, we provide videos and descriptions of the minor procedure room setup in two hospitals and one surgeon′s office where we perform these procedures in Saint John, New Brunswick, Canada.

PHYSICAL SPACE

A reception area with seating and a receptionist to manage this area is essential. After you inject patients with local anesthetic, most can go back to sit in the reception area to wait for their procedure with their families. This allows a half hour between injection of the local anesthetic and the onset of optimal numbing and epinephrine vasoconstriction.1

Our Facilities in Saint John, New Brunswick, Canada

We have performed wide awake hand surgery for more than 30 years in our facility with a relatively modest investment of money, space, equipment, and staffing for our accredited minor procedure rooms.

Clip 16-1 Clinic consultation and minor procedure room setup at the Saint John Regional Hospital.

Clip 16-3 Minor procedure accredited operating room at Dr. Lalonde′s office.

Minor Procedure Rooms

Our office minor procedure room in Canada is accredited by the Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF), http://caaasf.org, for pure local anesthesia (no sedation).
In the United States, as in Canada, you can have a minor procedure room in your office accredited for pure local anesthesia (no sedation) by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), http://www.aaaasf.org, more easily and with much less cost than you would need for accreditation for performing procedures with sedation or general anesthesia.
It is ideal to have two or more stretchers in addition to the procedure table on which to inject lying-down (supine) patients, but one is sufficient. We do injections with the patient lying down instead of sitting up to decrease the risk of fainting (see Chapter 6).
In one of our hospitals, we have access to only one procedure room most of the time. In this situation, we inject patients on stretchers in other rooms down the hall. After we inject the local anesthetic, most patients can then sit with their relatives for 30 minutes or more before surgery while the local anesthetic achieves optimal numbing and vasoconstriction. If patients need to remain lying down because of fainting or other issues, we let them lie on their stretcher until we move them to the procedure room.
All you really need in a procedure room is a stretcher that can be adjusted to the Trendelenburg position (head down, feet up), an arm board, and a good light (fixed or portable). All hospitals have these facilities.
Cleaning staff wash the minor procedure room floors in the evening, but not between cases, unless there is an infection issue such as abscess drainage or a patient who has been identified as having a methicillin-resistant Staphylococcus aureus (MRSA) infection.