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Re: Marking surgical site for c/s and BTLFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Mon May 5 15:20:50 2003
We were told the same thing recently, as "something that will come us soon", and thought it just as silly as you did. I suggested marking a big oval around the entire lower half of the abdomen but was told that part of the issue being dealt with was legal concerns about vertical vs transverse skin incisions. I'm still mulling over how I feel about that response. Is there really no instance during which one might change an incision intraoperatively? One might, for example, need to "T" the skin during a section for distress if there were really difficult adhesive disease. Doing this could save mom from an inadvertent bladder injury and/or deliver the baby more expeditiously in an urgent situation. I wouldn't want to feel limited by the sterile marker under those circumstances. I'm sure other listers can think of other examples. So I still favor the "big circle" method of marking the abdomen preoperatively. If we must do this, we have a short window of time to start doing it in a way that won't interfere with good surgical judgement calls, before it becomes "the way we always do it here". I don't think "surgical site marking", invented to prevent wrong-site surgery, should be transformed into a promised incision type and length when we all know that that's a promise it won't always be safe to keep. Good luck,
-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA
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