Re: Marking surgical site for c/s and BTL

From: art fougner, md (evsono@pipeline.com)
Tue May 6 07:12:42 2003

Here's a thought - why not a collective statement from ACOG, AMA, ACS concerning the wisdom ( lunacy) of such micromanaging overregulation? can't wait for someone to draw a smiley around the umbilicus prior to laparoscopy.

art

At Mon, 5 May 2003, Barbara Nicol MD wrote: >
>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
>

--
art fougner, md
ich bin ein New Yorker



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