Here is an example of the prep stand set up for a functional endoscopic sinus surgery with stealth navigation. This is typically the circulating nurse’s responsibility.
ENT Stealth
Now that you’ve seen what’s required for the set up, let’s walk through the process!
After the patient is intubated the RN will begin to get the patient ready for surgery. Here are the steps I follow
1st: With the help of anesthesia, turn the bed 90 degrees. (set up photo below).
2nd: Place the bracket for the emitter hold attachment on the bed at the level of the patient's shoulder on the opposite side of where the surgeon will stand. (The bracket is attached to the attachment in this photo).
3rd: Place the emitter in the attachment, ensure it is projecting to the tip of the nose to the base and including all the sinuses. (emitter is not shown in picture).
4th: Place the patient tracker on the patients forehead at the level of the hairline, plug in.
5th: Plug in the trackable instrument.
6th: I like to try to squeeze in a tracing before the surgeon strolls in and has a tracing with MUCH higher accuracy.
Getting started
Now it's time for the surgeon to do their part. The surgeon will use this set up to localize the patient as well as sync the CT images before the procedure starts. The surgeon will trim nose hairs with the blunt scissors, inject lidocaine with epinephrine administer cocaine (ALWAYS) topically, and then perform the tracing for stealth. These "big" sinus cases use to scare me when I was a brand new surgical tech, but now they are one of my favorites. There are so many specialized instruments that look similar to each other making it hard to differentiate them, especially when the lights go off during the case! Stay tuned for my back table and mayo stand set up for a FESS!
Next up..
For those of you asking what tracing is... this is where you sync the CT images to the patient's anatomy. You use the patient tracker and the trackable instrument to trace the nose and forehead as directed on the stealth machine. The lower the result the better the tracing! 2.0 or less is preferred by most surgeons.
Don't forget the headlight!
Don't toss those hypos or cottonoids! They should be part of your count.
If there is any topical cocaine left, ensure you dispose of it per facility policy.
Make sure you request a copy of the patients sinus CT scans - do it the day before if possible!
Dependent on your room set up, place the bracket for the emitter on the bed prior to the patient entering the room.
Most surgeons prefer sleds for arm securement as they keep the patient's arms close to their body allowing the surgeon to be closer to the operative field.
If using a microdebrider, don't forget the trap on the suction for collecting the specimen!
