Treatment Protocols Nurses
2 Treatment Protocols
These treatment protocols are essential for nurses at Nordic Health Group. You are expected to follow the procedures outlined here. Adhere to these guidelines in your practice, and refer to these protocols as needed to perform your duties
2.1 Identification and Patient Management
2.1.1
Purpose
This guide has been prepared to ensure correct identification and handling of patients at our private clinic. The aim is to minimize the risk of incorrect treatment, improve communication and create a safe treatment environment for our patients.
2.1.2 Patient Identification
In order to ensure that the correct identification of patients takes place prior to any healthcare service, so that relevant information, procedures and treatment are linked to the right patient and that all parts are present and have not exceeded the expiry date, the following checks are carried out on all patients:
2.1.2.1 Identification must be carried out prior to any action directed at the patient, be it in relation to the person, medical records, documentation or diagnostic material.
2.1.2.2 All patients covered by the above must, on arrival at the clinic, identify themselves with e.g. health insurance certificate and check of social security number and name.
2.1.2.3 For medical consultations as well as surgical interventions/treatments, the patient must always state his full name and personal security number.
2.1.2.4 When identifying prior to a patient-directed procedure, the patient must provide their name and personal security number.
2.1.2.5 The information is compared with the corresponding information on the surgical program, and the operating physician/consulting physician checks that this information matches the personally identifiable information in the patient record.
2.1.2.6 In the case of patients who are incapacitated, the patient's identity must be confirmed with the assistance of relatives present or others with in-depth knowledge of the patient.
2.1.2.7 Correct identification in the medication process is ensured at all stages. This is done by the same healthcare professional dosing medication, ensuring correct compliance with the prescription and carrying out patient identification.
2.1.3 Education and Training
2.1.3.1 All staff must undergo basic and regular training in patient identification and handling.
2.1.3.2 New employees must be instructed in the clinic's specific procedures and guidelines for patient safety.
2.1.4 Quality Control
Ongoing evaluations and audits must be carried out to assess compliance with the guidelines and identify any areas for improvement.
2.1.5 Closing
It is crucial that all employees in the clinic are aware of the importance of correct identification and handling of patients. By following these guidelines, we can ensure safe and effective treatment of our patients and maintain a high level of patient safety in our private clinic.
2.2 Preparation for Treatments
2.2.1 Purpose
To ensure correct and systematic preparation of surgical patients to minimize the risk of infections and complications.
2.2.2 Procedure
2.2.2.1 Preparation of the operating room:
• Cleaning and disinfection: Ensure that the treatment room is thoroughly cleaned and disinfected before the patient's arrival. All surfaces, equipment and instruments must be cleaned.
• Sterile field: Prepare a sterile field in the treatment room with the necessary equipment and instruments, depending on the treatment to be performed.
2.2.2.2 Identification of patient:
Verify the patient's identity using name and social security number in accordance with the clinic's protocol.
2.2.2.3 Medicinal preparation:
• Local anesthesia: Prepare the anesthetic fluid according to correct guidelines
• Sedative Medications: Dispense and administer sedation medications, if needed, according to correct guidelines and document the administration in the patient's medical record.
2.2.2.4 Disinfection of the surgical area:
• Skin disinfection: Disinfect the patient's skin in the surgical area with an alcoholbased disinfectant that covers a broad spectrum of bacteria. Allow the disinfectant to dry completely before covering. The covering follows the treatment protocol (1.3-1.5)
2.2.2.5 Preparation of patient:
• Instruct the patient to shower with plain soap on the morning of the day of treatment.
• Draping: Prepare the drapings. There should be one sterile drape 90x75 cm for the upper body, one or two foot-drape 50x50 cm and one sterile drape 175x150 cm for the legs.
1. Place the large drape (175x150 cm) under the leg(s).
2. Place the 50x50 cm drape around the foot (feet).
3. Place the medium drape (90x75 cm) over the patient’s torso.
2.2.2.6 Medical equipment:
• Prepare and place the medical equipment needed as described in the specific treatment protocol in the sterile field.
2.2.2.7 Communication and information:
• Information for the patient: Review the procedure with the patient and answer any questions. Briefly explain the process and what the patient can expect during and after the treatment.
• Consent: Ensure that informed consent is obtained and documented before the procedure begins.
2.2.2.8 Documentation:
• Recordkeeping: Document all preparation procedures, including disinfection, medication administration, and any special precautions in the patient's record.
2.2.2.9 Checking the patient's condition:
• Allergy: Confirm that there are no allergic reactions to any of the preoperative medications or disinfectants.
2.2.3 Follow-up
Monitor the patient for any reactions or complications during treatment and ensure they receive the necessary post-operative follow-up information. These guidelines must be followed to ensure a high standard of patient care and reduce the risk of post-operative infections.
2.3 Treatment Protocol for Laser Treatment (EVLT)
2.3.1 Purpose
This treatment protocol outlines the standardized procedures for performing Endovenous Laser Therapy (EVLT) for the treatment of varicose veins (varices) at NHG. The protocol ensures consistent, safe, and effective treatment in accordance with current standards.
2.3.2 Indications
2.3.2.1 Insufficiency of the Great Saphenous Vein (Vena Saphena Magna, VSM)
2.3.2.2 Insufficiency of the Small Saphenous Vein (Vena Saphena Parva, VSP)
2.3.2.3 Accessory Great Saphenous Veins
2.3.2.4 Perforator veins
2.3.3 Contraindications
2.3.3.1 Tortuous course of VSM/VSP.
2.3.3.2 Varices essential for venous outflow.
2.3.3.3 Arterial insufficiency or other contraindications to the use of compression bandaging.
2.3.4 Preparation
The following must be prepared:
2.3.4.1 Preparation of the Treatment Room
1. Sterile tray
2. Chlorhexidine digluconate 0.5% in 70% alcohol.
3. Ultrasound.
4. Laser machine.
5. Tumescent pump.
2.3.4.2 Infiltration Fluid
1. Local anaesthesia bag: 1000 ml NaCl 0.9% for infusion.
2. 40 ml Lidocaine 2%.
2.3.4.3 Equipment Selection
1. Standard treatment table.
2. Stainless steel table.
3. Sterile drape 90x75 cm.
4. Foot drape 50x50 cm.
5. Sterile drape 175x150 cm.
6. Sterile gloves.
7. Gauze 10x10 cm.
8. Infusion line for tumescent.
9. Infusion pump.
10. Green needle for tumescent.
11. Pink needle.
12. Sterile ultrasound cover.
13. Laser fibre.
14. Laser machine.
15. Introducer catheter for laser fibre
16. Chlorhexidine 0.5%.
17. Surgical tape for bilateral treatment.
2.3.5 Procedure
The following procedures must be followed:
2.3.5.1 Preoperative Measures
1. Position the ultrasound machine, laser, and infusion pump at an appropriate distance from the patient.
2. Place the instrument table near the patient.
2.3.5.2 Disinfection
1. Disinfect the treatment area according to the protocol.
2. Clean the treatment area with chlorhexidine.
2.3.5.3 Draping
1. Place a large drape under the leg(s).
2. Place a 50x50 cm adhesive drape around the foot and a medium drape over the patient’s torso.
2.3.5.4 Surgical Procedure
1. Puncture: Puncture the VSM or VSP under ultrasound guidance.
2. Catheter: Insert the catheter or sheath.
3. Laser Fiber: Insert the laser fibre through the catheter or sheath.
4. Positioning: Determine the position using ultrasound in relation to the deep system (> 2 cm).
5. Tumescent: Inject tumescent solution around the vein and laser.
6. Laser Activity: Activate the laser, moving 1 cm at a time until the end of the vein.
2.3.5.5 Laser Operation
1. Turn on the laser using the power button on the back.
2. Turn the key on the front.
3. Set the correct joule and watt settings on the machine.
4. The laser fibre can only be connected in one way.
5. Set the laser to standby mode using the standby button.
6. Activate with the foot pedal.
2.3.5.6 Postoperative Care
• Apply dressings and compresses to the wounds.
• Use a compression bandage, which should remain in place for 24 hours.
2.3.5.7 Potential Complications
• Deep Vein Treatment: Risk of deep vein thrombosis.
• Infection: Risk of wound infection.
• Others: Rare complications include nerve injury, pulmonary embolism, hematomas, post-implantation bleeding, and thrombophlebitis.
• Paresthesia: Temporary paresthesia (n. saphenus / n. suralis).
2.4 Treatment Protocol for Sclerotherapy/Foam Treatment
2.4.1 Purpose
This treatment protocol outlines standardized procedures for sclerotherapy and foam treatment at NHG. The protocol is designed to ensure consistent, safe, and effective treatment of venous diseases.
2.4.2 Indication Superficial varicose veins (varices)
2.4.2.1 Telangiectasias (capillary network)
2.4.2.2 Chronic venous insufficiency
2.4.3 Contraindications
2.4.3.1 Active or recent thrombophlebitis
2.4.3.2 Pregnancy or breastfeeding
2.4.3.3 Severe allergic reactions to sclerosing agents
2.4.3.4 Cardiovascular diseases that may impact treatment safety
2.4.3.5 Infection or inflammation in the area to be treated
2.4.4 Preparation
2.4.4.1 Preparation of the Treatment Room
1. Chlorhexidine digluconate 0.5% in 70% alcohol
2. Ultrasound (if necessary for guidance)
3. Sclerosing agent (e.g., Aethoxysklerol)
4. Injection equipment (needles, syringes)
5. Compression bandages or compression stockings
2.4.4.2 Equipment
1. Treatment table
2. Stainless steel table
3. Chlorhexidine digluconate 0.5%
4. Gauze 10x10 cm
5. Gloves (non-sterile)
6. Aethoxysklerol (0.5%, 1%, 3%)
7. Syringes (3 ml)
8. Three-way stopcock
9. Butterfly needles
10. Needles: pink draw-up needle
11. Sharps container
12. Band-aids
13. Tape
2.4.5 Procedure
2.4.5.1 Preoperative Measures
1. Explain the treatment, possible side effects, and aftercare to the patient.
2. Obtain informed consent.
2.4.5.2 Disinfection
1. Disinfect the area to be treated with chlorhexidine or another suitable disinfectant.
2. Ensure the area is completely dry before injection.
2.4.5.3 Injection Technique
1. Preparation of Sclerosing Agent: Fill the syringe with the correct amount.
2. Injection:
• Insert the needle into the vein.
• Inject the sclerosing agent along the superficial vein.
• Monitor for any reactions during the injection.
3. Compression: Apply compression bandages after injection to ensure effective venous closure.
2.4.5.4 Possible Complications
1. Hyperpigmentation: May occur as a result of the treatment.
2. Wound Infection: Risk of infection at the injection site.
3. Thrombophlebitis: Inflammation of the treated vein.
4. Allergic Reactions: Reactions to the sclerosing agent.
5. Pain Symptoms: Temporary pain or discomfort at the injection site.
2.5 Treatment Protocol for Phlebectomy
2.5.1 Purpose
This treatment protocol outlines standardized procedures for the removal of superficial varicose veins via phlebectomy at Nordic Health Group. The protocol is designed to ensure consistent, safe, and effective treatment of venous insufficiency.
2.5.2 Indication
2.5.2.1 Superficial varicose veins
2.5.2.2 Varices too large for sclerotherapy
2.5.2.3 Residual varices
2.5.2.4 Cosmetic reasons
2.5.3 Contraindications
2.5.3.1 Active infection in the treatment area
2.5.3.2 Severe cardiovascular diseases
2.5.4 Equipment
2.5.4.1 Treatment table
2.5.4.2 Stainless steel table
2.5.4.3 Phlebectomy set with Muller hook and 2 x forceps
2.5.4.4 Scalpel blade size 11
2.5.4.5 Sterile drape 90x75 cm
2.5.4.6 Foot cloth 50x50 cm
2.5.4.7 Sterile drape 175x150 cm
2.5.4.8 Sterile gloves
2.5.4.9 Infusion tube for tumescent
2.5.4.10 Infusion pump
2.5.4.11 Green needle for tumescent
2.5.4.12 Sterile gauze 10x10 cm
2.5.4.13 Chlorhexidine digluconate 0.5%
2.5.4.14 20 ml syringe
2.5.4.15 Pink needle
2.5.4.16 Lidocaine hydrochloride 20 mg/ml
2.5.4.17 Surface disinfectant
2.5.4.18 Coban compression bandage 10 cm x 5 m
2.5.4.19 Absorbent dressings
2.5.5 Procedure
2.5.5.1 Preoperative Preparations
1. Patient Preparation: The patient should remove shoes, socks, and pants or skirt.
2. Positioning: Place the patient on an exam table. Mark the varicose veins.
3. Disinfection: Disinfect the area with chlorhexidine 0.5% and cover the area with sterile drapes.
4. Equipment: Prepare the sterile set and arrange necessary materials according to the non-touch method.
2.5.5.2 Treatment
1. Positioning of Equipment: Ensure that the treatment table and lamp are correctly positioned.
2. Local Anaesthesia: Administer local anaesthesia in the area for phlebectomy.
3. Phlebectomy: The surgeon performs the phlebectomy with assistance from the nurse as needed.
4. Bandaging: After surgery, apply absorbent dressings and Coban compression bandage. Use additional dressings if necessary to prevent bleeding.
2.5.5.3 Postoperative Care
1. Instructions: The nurse provides the patient with aftercare instructions and confirms a follow-up appointment.
2. Cleaning: The nurse cleans the treatment room and disposes of used equipment.
3. Aftercare:
• Compression Bandage: Wear a compression bandage for 24 hours.
• Pain Relief: Paracetamol can be used as needed.
4. Possible Complications
• Risk of wound infection
• Risk of deep vein thrombosis
• Risk of pulmonary embolism
• Risk of bleeding
• Risk of irreversible nerve damage
2.6 Dressing
2.6.1 Purpose
To ensure proper dressing of the patient after varicose vein treatment to minimize the risk of complications, promote healing and ensure patient comfort.
2.6.2 Procedure
2.6.2.1 Preparation:
1. Hygiene: Make sure hands are thoroughly disinfected or washed.
2. Materials: Prepare necessary dressing materials: absorbent dressing, elastic bandages and possibly tape.
3. Patient position: Place the patient in a comfortable position so that the treated leg is slightly elevated.
2.6.2.2 Before Dressing:
1. Inspection: Examine the treated area.
2. Drying: Make sure the skin is not too wet from blood or anaesthetic fluid before applying the dressing.
2.6.2.3 Application of Dressing:
1. Absorbent Compress: Place a sterile compress over puncture sites or incisions where the varicose veins have been treated.
2. Compression: Start by applying a compression bandage. The compression should be even and firm, but not so tight that it inhibits blood circulation.
3. Fixation: Secure the dressing with tape if necessary and check that it fits securely without being uncomfortable.
2.6.2.4 After Dressing:
1. Patient Comfort: Ask the patient if the dressing feels comfortable and adjust if necessary.
2. Observation: Inform the patient to watch for signs of perfusion. If this occurs, the patient must make sure to connect with extra absorbent dressings.
2.6.2.5 Patient information:
1. Aftercare: Inform the patient to wear the compression bandage for the recommended period (24 hours), as well as any dressing changes as needed.
These guidelines must be followed to ensure a safe and effective dressing after varicose vein treatment.
2.7 Cardiac Arrest
2.7.1 Purpose
To ensure rapid intervention in the event of cardiac arrest and to ensure that all employees have the same basis for recognition, alerting and advanced treatment and after-treatment of unexpected cardiac arrest in adults.
2.7.2 Definition of Cardiac Arrest
Cardiac arrest occurs when the heart suddenly stops pumping blood efficiently, causing cessation of blood circulation and breathing. It requires immediate medical intervention.
2.7.3 Procedure
2.7.3.1 All clinics are equipped with defibrillators and employees are responsible for knowing the guidelines for cardiac arrest treatment as well as duties and responsibilities in the event of cardiac arrest.
2.7.3.2 A defibrillator hangs easily accessible, typically in the reception or near the clinic where there is always access to it, all employees at the applicable clinic know the location of the defibrillator.
2.7.3.3 All employees complete training in cardiopulmonary resuscitation upon employment, training in cardiopulmonary resuscitation is renewed at least every three years.
2.7.3.4 The guidelines are continuously updated based on the latest national guidelines.
2.7.3.5 Symptoms of Cardiac Arrest
1. No pulse or respiratory signals.
2. Unconsciousness.
3. Cyanosis (blue discoloration of the skin and lips).
2.7.3.6 Management of Cardiac Arrest
• Check the Patient's Condition: Check if the patient is unconscious and has no signs of breathing or a pulse.
2.7.3.7 Activation of Alarm:
1. Alert all staff present about the situation by using the clinic's internal alarm system or by shouting loudly.
2. Call 112 immediately to call an ambulance.
3. Provide accurate information about the patient's condition, location and clinic address.
2.7.3.8 Start cardiopulmonary resuscitation (CPR):
• Step 1: Call for help and start CPR immediately.
• Step 2: Place the patient on a firm, level surface.
• Step 3: Start chest compressions:
o Place your hands in the middle of the patient's chest.
o Perform strong and rapid chest compressions (approx. 100-120 compressions per minute) with a depth of approx. 5 cm.
• Step 4: If necessary, give artificial respiration (if trained):
o After 30 chest compressions, give 2 breaths, keeping the airway open.
o Inhale until the chest rises.
2.7.3.9 After cardiac arrest
1. Disclosure of Information:
• Hand the patient over to the ambulance staff on arrival.
• Provide detailed information about the CPR effort and the patient's condition.
2. Documentation:
• Document the incident, including the time of cardiac arrest, the CPR effort, use of the AED, and the patient's response in the clinic record.
3. Psychological Support:
• Offer support and advice to patients and relatives, as well as to employees who have been involved in the effort.
2.7.4 Training
2.7.4.1 All employees must undergo regular training in CPR and AED use.
2.7.5 Responsibility
2.7.5.1 Management: It is the management's responsibility to update and publish guidelines and to ensure that employees have access to relevant CPR training if the employee does not have access himself.
2.7.5.2 Employee: It is the employee's responsibility to familiarize themselves with these guidelines as well as the local regulations for alerting in the event of cardiac arrest, location of heart states and other local information.
This guideline is to ensure effective management of cardiac arrest and ensure that all employees are prepared to handle such critical situations.
2.8 Anaphylactic Shock
2.8.1 Purpose
To ensure a quick, effective and correct response in the event of anaphylactic shock to maximize patient survival and minimize the risk of serious complications.
2.8.2 Definition
Anaphylactic shock is an acute, life-threatening allergic reaction that can cause severe low blood pressure, airway obstruction and organ failure. It requires immediate medical intervention.
2.8.3 Symptoms
2.8.3.1 Rapid onset of dizziness or fainting.
2.8.3.2 Rash or swelling (especially of the face, lips, tongue and throat).
2.8.3.3 Difficulty breathing or stridor.
2.8.3.4 Fast pulse, low blood pressure.
2.8.3.5 Nausea, vomiting or abdominal pain.
2.8.3.6 Feeling anxious or restless.
2.8.4 Alarm Procedures
2.8.4.1 Activation of Alarm:
1. Alert all staff present about the situation by using the clinic's internal alarm system or by shouting.
2. Call 112 immediately to call an ambulance and inform about a possible anaphylactic reaction.
2.8.4.2 Call for Ambulance:
1. Provide accurate information about the patient's condition, location and clinic address.
2.8.5 Management of Anaphylactic Shock
2.8.5.1 Check the Patient's Condition: Check the patient for symptoms of anaphylactic shock and assess the severity of the condition.
2.8.5.2 Administer Adrenaline:
• Step 1: Find the available epinephrine pen in the clinic's emergency kit.
• Step 2: Inject epinephrine intramuscularly (IM) into the mid-thigh, preferably at a dose of 0.3-0.5 mg (0.3-0.5 mL of 1 mg/mL solution) for adults, and 0 .01 mg/kg for children, up to a maximum of 0.3 mg.
• Step 3: If there is no improvement after 5-15 minutes, a further dose can be administered.
2.8.5.3 Ensure Free Airway:
• Step 1: Check the airway and ensure that it is free of obstruction.
• Step 2: If necessary, administer oxygen or use respiratory protection.
2.8.5.4 Give Antihistamines: Give oral or intravenous antihistamine as recommended by the doctor.
2.8.5.5 Monitor the patient's condition closely and watch for signs of deterioration.
2.8.6
Finishing
2.8.6.1 Disclosure of Information:
• Hand the patient over to the ambulance staff on arrival.
• Provide detailed information about the treatment administered and the patient's condition.
2.8.6.2 Documentation:
• Document the event, including the time of anaphylactic reaction, medications administered, and the patient's response in the clinic record.
• Add a copy of the informed consent form signed by the patient to the medical record.
2.8.6.3 Psychological Support:
• Offer support and advice to patients and relatives, as well as to employees who have been involved in the effort.
2.8.7
Training
All employees must have up-to-date training in handling anaphylactic shock.
2.8.8
Responsibility
2.8.8.1 Management: It is the management's responsibility to update and publish guidelines and to ensure that there is access to emergency medicine at the clinic.
2.8.8.2 Employee: It is the employee's responsibility to familiarize themselves with these guidelines as well as the local regulations for alerting in the event of anaphylactic shock, location of emergency medicine and other local information.
This guideline ensures effective handling of anaphylactic shock and ensures that all employees are prepared to handle such critical situations.
2.9 General Infectious Disease Medicine Guidelines
2.9.1 Purpose
To ensure correct infection hygiene and minimize the risk of infections in connection with varicose vein treatments, by following current guidelines and National Infection Hygiene Guidelines.
2.9.2 General Precautions
2.9.2.1 Hand hygiene:
• Use hand sanitizer with at least 70% alcohol when hands are not visibly dirty. This is the preferred one
• Wash hands thoroughly with soap and water before and after contact with patients, after wearing gloves and after contact with body fluids.
2.9.2.2 Personal Protective Equipment (PPE):
• Gloves: Use disposable gloves when in contact with blood, body fluids, and when in direct contact with patients. Change gloves between patients and after contact with contaminated surfaces.
• Mouth-nose protection: Use masks for procedures that may generate splashes to the mouth and nose area.
• Gown: Use disposable gowns or other protection for procedures that require a sterile environment.
2.9.2.3 Disinfection:
• Disinfection: Clean and disinfect all surfaces in treatment rooms and other areas where there has been contact with blood or body fluids. Use approved disinfectants according to the manufacturer's instructions.
• Disposable items: Use disposable items where possible and ensure proper waste management.
2.9.2.4 Cleaning of Treatment Rooms:
• Clean and disinfect all surfaces, including treatment tables, chairs, and other equipment after each patient.
• Ensure that all items and equipment that cannot be sterilized are regularly disinfected.
2.9.3
Specific Precautions for Varicose Vein Treatments
2.9.3.1 Patient preparation:
• Hygiene: Clean the area where treatment is to be carried out thoroughly with an antiseptic, such as chlorhexidine 0.5% in alcohol.
• Dressing: Use sterile drapes during the procedure to maintain a sterile environment.
2.9.3.2 Procedures and Techniques:
• Instruments: Ensure that all surgical instruments are sterile packed and use them only in the sterile field.
• Technique: Follow standard procedures for sterile techniques when performing procedures, including proper handling and use of sterile techniques.
2.9.3.3 Storage of Medicines and Equipment:
• Store medication and equipment in a clean and dry area, protected from contamination.
• Check expiration dates on medications and replace outdated products.
2.9.4 Training
Ensure that you have received infection hygiene training and updates on current guidelines and procedures.
2.10 Hand Hygiene
2.10.1 Purpose
The purpose of this guideline is to ensure that hand hygiene is carried out correctly to ensure that the spread of infection is effectively prevented, that all conceivable routes of infection are interrupted, and that all healthcare workers know and can use good and correct hand hygiene, correct use of gloves, hand disinfection, and hand washing.
2.10.2 Procedure
2.10.2.1 Rings, bracelets, wristwatches or other hand jewellery may not be worn
2.10.2.2 Nails must be clean, whole and cut short
2.10.2.3 Nail polish and artificial nails must not be used
2.10.2.4 The skin on the hands, wrists and forearms must be kept intact and without signs of infection
2.10.2.5 Arm stockings, hand splints, finger bandages and the like must not be worn
2.10.2.6 The uniform must be short-sleeved, this may also apply supplement to the uniform
2.10.2.7 Hand Hygiene is Carried Out:
• Before clean/sterile procedure
• After unclean procedure
• Between unclean and clean task in the same patient
• Before handling sterile and disinfected equipment
• For handling medication
• After direct patient contact
• After using gloves
Hand disinfection is recommended over hand washing in connection with most procedures, if the hands are not wet and/or visibly contaminated, because:
• A greater reduction in the number of bacteria on the hands is achieved
• It is gentle on the skin
• It saves time
• It does not require a hand wash and can be performed close to the patient
2.10.3 Surgical Hand Washing with Disinfection
2.10.3.1 Must be carried out before the first invasive procedure of the day, surgical hand washing must be performed using hand soap followed by disinfection with a hand sanitizer.
2.10.3.2 In the case of two consecutive invasive interventions where wet contamination has occurred or visible contamination of the hands, wrists and forearms with blood, secretions, excreta or other biological material, surgical hand washing must be carried out with the use of hand soap followed by of disinfection with a hand disinfectant
2.10.4 Procedure for Hand Disinfection
2.10.4.1 Hand disinfection is performed on clean and dry skin
2.10.4.2 Use min. 2 ml hand sanitizer
2.10.4.3 The agent is distributed and rubbed everywhere on each finger, between fingers, on the back of the hand, on the palm and around the wrist until dryness is achieved. Also applies to the forearms if they have been in contact with the patient.
2.10.4.4 The skin must be kept moist with the product for at least 30 seconds
2.10.4.5 A hand sanitizer containing 70-85% ethanol and skin care agent is recommended.
2.10.5 Procedure for Hand Washing
2.10.5.1 Wet your hands under cold or lukewarm running water
2.10.5.2 Use soap dosing by a pump from a soap dispenser
2.10.5.3 Spread the soap on each finger, between fingers, on the back of the hand, on the palm and around the wrist
2.10.5.4 Fingertips, thumbs, between fingers, palms and wrists are processed in min. 15 seconds
2.10.5.5 Rinse off the soap under cold or lukewarm running water
2.10.5.6 Pat hands dry with disposable towels
2.10.5.7 If the tap is manually operated, close the tap with a disposable towel.
2.10.6
Procedure for Surgical Hand Washing with Disinfection
2.10.6.1 Surgical hand washing is carried out as hand washing – i.e. without routine use of sponge, brush or nail cleaner on hands, wrists and forearms. Using a sponge produces fewer skin lesions than using a brush.
2.10.6.2 Hands, wrists and forearms are rinsed under running temperate water, before the hand soap is applied.
2.10.6.3 Hand soap must be distributed on each finger, between fingers, on the backs of the hands, on the palms and around wrists and forearms, which are then mechanically processed.
2.10.6.4 Hand soap must be rinsed off carefully under running, temperate water the fingertips against the elbow.
2.10.6.5 Hands are dried immediately after hand washing.
2.10.6.6 Wiping or wiping off water must be done with a clean, skin-friendly and absorbent disposable towel.
2.10.6.7 Disinfection must be carried out on visibly clean and dry skin.
2.10.6.8 The hand sanitizer must be distributed and rubbed all over each finger, between fingers, on backs of hands, on palms, around wrists and forearms.
2.10.6.9 Enough hand disinfectant must be added to keep the skin moist the hand sanitizer for at least 2 minutes or according to the manufacturer's recommendation.
2.10.6.10 Hand sanitizer may need to be reapplied several times for durability skin moist for at least 2 minutes.
2.10.6.11 The hand sanitizer must be rubbed in until the hands are completely dry.
2.10.7 Sterile Disposable Medical Gloves
2.10.7.1 Used in aseptic procedures, e.g. operations and invasive procedures
2.10.8 Clean Disposable Medical Gloves
2.10.8.1 Used if there is a risk of contamination of the hands, e.g. with blood, secretions, excreta, mucous membrane medicine, disinfectants, chemicals and cytostatics, as well as contact with non-intact skin.
2.10.9 Glove Hygiene
2.10.9.1 Hands must be clean and dry before putting on the gloves.
2.10.9.2 Gloves must be changed if accidentally perforated. Hand hygiene must be performed before new gloves are put on.
2.10.9.3 Disposable medical gloves are for single use. This means that they must not be washed or disinfected.
2.10.9.4 The gloves must be changed between dirty and clean tasks in the same patient
2.10.9.5 Gloves are removed immediately when the work task is completed.
2.10.10 Choice of Gloves
2.10.10.1 Standard gloves for examination, care and treatment are latex gloves
2.10.10.2 Synthetic latex (nitrile, neoprene) gloves are recommended for latex allergy sufferers
2.10.10.3 Vinyl (PVC) gloves are not recommended as the quality is not good enough.
2.10.11 Hand Hygiene After Using Gloves
2.10.11.1 Hand hygiene must always be carried out - at least hand disinfection - after using gloves, because the skin's bacterial count increases in the warm, moist environment, and because via invisible holes in the glove (pinholes), contamination of the hands can occur from the outside of the glove.
2.10.11.2 Furthermore, it is difficult to avoid contaminating the hands when the gloves are removed.
2.10.11.3 Hand washing is only required if the hands are damp or visibly dirty. If the hands are washed, these must also be disinfected.
2.10.11.4 Disposable medical gloves must always be stored and dispensed from a box.
2.10.12 Training
Healthcare personnel must have received education and training in the guiding principles for hand hygiene:
• Requirements for hand hygiene
• How to carry out hand disinfection
• How to perform hand washing
• Hand hygiene
• Additional requirements and recommendations in the area
2.11 Handling of Sterile/Non-sterile Material
2.11.1 Purpose
To ensure correct handling, storage and use of sterile and non-sterile material to minimize the risk of infections and ensure high-quality in-patient care and clinical practice.
2.11.2 Definitions
2.11.2.1 Sterile material: Material that is free from all microorganisms and has been treated or processed to achieve this condition.
2.11.2.2 Non-sterile material: Material that has not been treated to remove microorganisms and is therefore potentially contaminated.
2.11.3 General precautions
2.11.3.1 Hand hygiene:
• Perform thorough hand washing or use alcohol-based hand sanitizer before and after handling sterile and non-sterile material.
2.11.3.2 Personal Protective Equipment (PPE):
• Wear appropriate PPE, including gloves, gown, and face mask when handling sterile material or working in the sterile area.
2.11.3.3 Maintenance of Sterility:
• Avoid touching the sterile field or equipment with non-sterile hands or equipment.
• Check regularly that the sterile material remains sterile throughout the procedure.
2.11.4 Non-Touch
Technique
2.11.4.1 Principles of Non-Touch Technique:
• The non-touch technique ensures that no non-sterile surfaces are touched by sterile objects or hands. It helps to maintain the level of sterility and minimize the risk of contamination.
• When using non-touch technique, all sterile equipment and material must be placed on sterile surfaces without direct contact with hands or non-sterile objects.
2.11.4.2 Application of Non-Touch Technique:
• Preparation: Ensure that all necessary materials are prepared and ready on sterile surfaces before starting the procedure. Use sterile instruments and materials without touching them with non-sterile hands.
• Placement Method: Use sterile techniques to place equipment in sterile areas. If it is necessary to move material, it should be done with sterile instruments or using aseptic technique.
• Handling of Equipment: When working with sterile equipment, avoid touching it with your hands. Use sterile tools or techniques to move or adjust equipment.
2.11.5 Handling and Storage of Sterile Material
2.11.5.1 Storage:
• Sterile material is stored dry, dust-free, and protected from sunlight and large temperature variations.
• The material must be stored in specially designed cabinets in the operating room or in other department cabinets that are only intended for sterile material.
• Sterile single-use products must be stored in their original, intact packaging to ensure purity.
• The products with the oldest expiration dates must be placed at the front so that they are used first (FIFO principle: "First In, First Out").
2.11.5.2 Transportation:
• Transport sterile material in a clean, closed container or trolley to avoid contamination.
• Avoid opening or touching sterile material during transport.
2.11.5.3 Control:
• Monthly check of expiry dates on all products. This includes all drugs, sterile and non-sterile products and other medical products that have a limited shelf life.
• Checking the cleanliness of storage areas and shelves must be disinfected with an alcohol-based disinfectant at least once a month and recorded in the log book.
• Temperature control of storage rooms, especially in extreme weather conditions. The temperature must not exceed 25 degrees Celsius.
• Inspection of packaging upon delivery to ensure that they are not damaged or damaged by moisture. Damaged sterile material must be discarded.
2.11.6 Handling and Storage of Unsterile Material
2.11.6.1 Storage:
• Non-sterile material must be stored separately from sterile material.
• Non-sterile material must be easily accessible and visible, and shelves must be kept clean and dust-free.
• Although non-sterile material is less sensitive to temperature variations, it must not be damaged by moisture.
2.11.6.2 Transportation:
• Transport non-sterile material in a clean, closed container. Avoid contact with sterile equipment or surfaces.
2.11.6.3 Control:
• Regular checking of expiry dates.
• Inspection of packaging upon delivery to ensure that they are not damaged or damaged by moisture. Damaged materials must be returned to the supplier.
• Regular checking of cleanliness in the storage areas.
2.11.7 Procedures in the Operative Area
2.11.7.1 Preoperative Areas:
• Prepare sterile kits and equipment in a clean area protected from contamination.
• Clean all equipment in accordance with applicable cleaning protocols.
2.11.7.2 Operative Areas:
• Maintain a sterile environment during surgical procedures. Everyone participating in the procedure must follow sterile techniques.
• Limit access to the sterile area and ensure that all necessary measures to maintain sterility are in place.
2.11.7.3 Postoperative Areas:
• Clean and disinfect the postoperative area after each procedure to prevent cross-contamination.
• Monitor and handle waste properly and disposal must be in accordance with clinic procedures.
2.12 Handling and Use of Work Uniform
2.12.1 Purpose
To ensure correct handling, cleaning and use of work uniforms to maintain a high standard of hygiene, prevent contamination and ensure a safe and professional working environment at Nordic Health Group.
2.12.2 Definitions
2.12.2.1 Work uniform: Clothing that is required for employees in the clinic, which typically includes overalls and footwear
2.12.2.2 Contamination: Transfer of microorganisms from one surface or person to another.
2.12.3 General Requirements
2.12.3.1 The work uniform must be made of materials that can be washed at high temperatures (min. 80°C) and withstand frequent washing and with short sleeves to avoid contamination.
2.12.3.2 Long hair and beards must be secured so that they do not hang or fall into the work area.
2.12.3.3 Jewellery such as rings, bracelets or wristwatches must not be worn. Earrings and other jewellery can be used if they do not hang down in the work area.
2.12.3.4 Nails must be short and free of nail polish and other artificial materials.
2.12.3.5 Bandages, plasters or the like must not be used on the hands and forearms.
2.12.3.6 Footwear is always considered contaminated and should therefore be able to be cleaned.
2.12.4 Use of work uniform
2.12.4.1 The work uniform must be put on at the beginning of the working day and taken off at the end of the working day.
2.12.4.2 The work clothes must be changed daily.
2.12.4.3 The work suit must be changed immediately if it becomes visibly contaminated with biological material or other substances.
2.12.5 Handling of work uniform
2.12.5.1 Washing and Cleaning:
• All laundry that has had patient contact is stored separately in closed plastic bags.
• The plastic bags are closed and transported to the washroom at the clinic. Here they are washed according to an approved procedure.
• Start and finish with hand hygiene according to current guidelines.
• It may be used disposable apron that is discarded after each completed washing process.
• Cleaning textiles are washed separately.
• All laundry is washed at a minimum of 80°C
• A pre-wash program and detergent with enzymes are always used.
• Clothes that have been in contact with patients are collected and washed separately.
• After washing and drying by tumbling, the clothes are put away in a clean cupboard.
• Clothes that have been removed from cupboards and not worn within 24 hours must be washed again.
• Clothes that touch the floor must be washed again.
• Uniforms are washed separately. Clean uniforms are kept in changing rooms and brought in clean bags. All employees must change work clothes daily.
2.12.5.2 Storage:
• Clean work clothes must be stored in a clean and dry cupboard or area separated from personal belongings.
2.12.5.3 Hygiene:
• Employees must perform proper hand hygiene before and after wearing work clothes.
• Hand disinfection must be available in areas where work clothes are taken off and on.
2.12.6 Responsibility
2.12.6.1 Employees:
• It is the individual employee's responsibility to ensure correct use and handling of the work uniform.
• Employees must report any problems or deficiencies with the work uniforms to their superiors.
2.12.6.2 Management:
• Management must ensure that there are clear and easy-to-understand instructions on the use and handling of work clothes.
2.13 Waste Management
2.13.1 Purpose
To ensure correct handling and disposal of waste in order to maintain a safe and hygienic workplace and minimize the risk of infection and contamination at Nordic Health Group.
2.13.2 Definitions
2.13.2.1 Waste: Any material that is no longer needed or wanted and must be disposed of.
2.13.2.2 Clinical waste: Waste that may pose a risk of infection or injury, including sharps, blood products, tissue samples and chemicals.
2.13.2.3 Non-clinical waste: Ordinary household waste that does not pose an infection risk.
2.13.3 General Precautions
2.13.3.1 Hygiene and Safety:
• Always wear personal protective equipment (PPE) such as gloves when handling waste.
• Wash hands thoroughly after handling waste.
2.13.3.2 Waste containers:
• Use properly labelled containers for different types of waste (clinical, nonclinical, sharps, chemicals).
• Make sure waste containers are tight-fitting and emptied regularly to avoid overfilling.
• Place waste containers close to work areas to minimize the transport of waste.
2.13.4 Procedure
2.13.4.1 Collection of Waste:
• Clinical waste, such as bloody dressings and tissue samples, must be placed in yellow bags/containers marked for clinical waste.
• Sharp objects, such as needles and scalpels, must be disposed of in sharps containers.
• Ordinary household waste is placed in ordinary waste bags.
2.13.4.2 Sorting and Marking:
• Sort waste at the source and label the waste bags clearly with the type of waste and possibly risk.
2.13.4.3 Transport of Waste:
• Transport waste in closed containers or bags to minimize the risk of spillage and contamination.
2.13.4.4 Storage of Waste:
• Store clinical waste in an enclosed and secure area away from patient and treatment areas.
• Waste storage areas must be clean, dry and free of vermin.
• Ensure that clinical waste is collected regularly.
2.13.4.5 Disposal of Waste:
• Clinical waste and sharps must be disposed of in accordance with local and national hazardous waste regulations (4.5.1.).
• Non-clinical waste is disposed of as normal household waste.
2.14 Handling of Cutting/Stabbing Waste
2.14.1
Purpose
The purpose of this guideline is to ensure the correct handling and disposal of cutting/stabbing waste, including scalpels, needles and other sharp objects, to protect both personnel and the environment.
2.14.2 Definitions
2.14.2.1 Cutting/Pinging Waste: Waste arising from the treatment of patients that may pose a risk of infection or injury, such as needles, laser fibres and other sharp objects.
2.14.3 Procedure for Handling Medical Waste
1. Collection
• Used needles, laser fibres and other sharp objects must be placed immediately after use in approved, impermeable and closable waste containers labelled "Medical waste" or equivalent.
• The containers must never be overfilled. Make sure that the lid can always be closed correctly.
2.14.3.1 Storage
• Medical waste must be stored in a locked and clearly marked waste room that is only accessible to authorized personnel.
• The waste must be stored in a way that prevents the spread of infection and injury to personnel.
2.14.3.2 Ordering Collection
• When a waste container is full, or at least once a month, collection must be ordered at the company that collects waste.
2.14.3.3 Pickup
• On the collection day, the waste containers must be ready and clearly marked for collection.
• The person you receives the waste must acknowledge the collection, and a copy of the receipt must be kept in the clinic's waste record.
2.15 MRSA
2.15.1 Purpose
This guideline aims to ensure proper management of patients with MRSA (Methicillinresistant Staphylococcus aureus) to prevent the spread of MRSA and protect both patients and staff.
2.15.2 Definition
MRSA is a strain of Staphylococcus aureus that is resistant to methicillin and other common antibiotics. MRSA infections can be localized or systemic and require special precautions to prevent spread.
2.15.3 Identification and Information
2.15.3.1 Identification and Risk Assessment:
• All patients must be screened for MRSA by anamnesis, especially if they have risk factors such as previous MRSA infection, hospitalization, or work in the healthcare sector.
2.15.3.2 Information and Communication:
• Inform the patient about MRSA status and necessary precautions.
• Note the MRSA status clearly in the patient's medical record.
2.15.4 Management of Patients with MRSA
2.15.4.1 Hand hygiene:
• Hand hygiene must be performed before and after any contact with MRSApositive patients, their surroundings and equipment, according to current guidelines (4.2.)
• Use alcohol-based hand sanitizer as the first choice or wash with soap and water. In the event of visible or wet contamination of the hands, wash hands followed by hand disinfection.
• Inform and involve the patient in good hand hygiene.
2.15.4.2 Personal Protective Equipment (PPE):
• Use gloves and disposable aprons when in contact with MRSA-positive patients or their surroundings.
• The use of masks and goggles may be necessary if there is a risk of splashing.
2.15.4.3 Patient location:
• MRSA-positive patients should, if possible, be treated in a separate room or at the end of the treatment day.
• Limit the patient's movement in the clinic to reduce the risk of infection.
2.15.4.4 Cleaning and Disinfection:
• Clean and disinfect all surfaces and equipment that have been in contact with MRSA-positive patients after each use.
• Use approved disinfectants with documented effectiveness against MRSA.
2.15.4.5 Waste management:
• All waste from the treatment of MRSA-positive patients must be handled and disposed of in accordance with current guidelines for handling waste
2.15.4.6 Work uniform:
• The clinic's work uniforms must be changed and washed daily at a minimum of 80 o C.
2.15.5 Procedure for Treatment of MRSA-Positive Patients
2.15.5.1 Preparation:
• All employees must be informed about the arrival of MRSA-positive patients.
• Ensure that all necessary protective equipment and disinfectants are available.
2.15.5.2 During Treatment:
• Limit the number of people in the treatment room.
• Avoid unnecessary contact with the patient's surroundings.
2.15.5.3 After examination and treatment:
• Contact points (e.g. handles, bearing surface, chair seat, armrests) with which the patient and staff have been in contact are then cleaned and disinfected with a suitable disinfectant.
• Surfaces that may be contaminated via splashes, splashes or contact by patients or staff are cleaned with ordinary cleaning agents.
• Spillage of blood and other biological material must be wiped up immediately so that all visible contamination is removed; use gloves.
• After drying up large amounts of blood or other tissue fluids (ie spills that cannot be removed in one operation), the site must be wiped with a suitable disinfectant.
2.15.6 Follow-up
Review infection control practices regularly to ensure compliance with guidelines.
2.16 Blood Borne Infection
2.16.1 Purpose
To ensure safe and effective treatment of patients with blood-borne infections such as HIV, hepatitis B and C at Nordic Health Group.
2.16.2 Definition
2.16.2.1 Bloodborne infection refers to the transfer of infectious microorganisms, such as viruses or bacteria found in the blood and other body fluids, from one person to another.
2.16.2.2 The most well-known blood-borne diseases include HIV (Human Immunodeficiency Virus), hepatitis B and hepatitis C.
2.16.3 Care of patients with blood infection
All patients should be treated using standard precautions as if they could potentially have a blood-borne infection. This includes the use of personal protective equipment, proper hand hygiene and careful handling of sharp objects.
2.16.3.1 Personal protective equipment (PPE):
• Use gloves, protective glasses, a mask and possibly a visor if there is a risk of splashing or contact with blood and body fluids.
• Change gloves between each patient and perform hand hygiene both before and after use.
2.16.3.2 Handling of sharp objects:
• Use simple techniques to minimize the risk of stabbing injuries. Avoid recycling needles and dispose of used needles and other sharps in approved, resistant containers.
2.16.4 Procedure for Treating Patients with Blood-borne Infection
2.16.4.1 Preparation of the Treatment:
• Confirm the patient's diagnosis of HIV, hepatitis B or C in the medical record and discreetly inform relevant clinic staff so that necessary precautions can be taken.
• Use only sterile and disposable equipment where possible. Reusable instruments must be thoroughly sterilized after use, in accordance with guidelines.
2.16.4.2 During the Treatment:
• Maintain aseptic technique throughout the procedure to prevent crosscontamination.
• In case of contact with the patient's blood or body fluids, avoid touching other surfaces and change gloves if necessary.
2.16.4.3 After the treatment:
• Dispose of all used equipment, gloves and disposable instruments in biological waste according to infection hygiene guidelines.
• Thoroughly clean and disinfect the operating room and equipment after use. Surfaces and objects that have been in contact with blood must be disinfected with a suitable disinfectant.
2.16.4.4 Managing Exposure:
• In case of puncture wounds or other exposure, follow the clinic's protocol for exposure.
2.16.4.5 Patient information and Stigmatization:
• Treat all patients with respect and confidentiality. Avoid stigmatizing or discriminating against patients with blood-borne infections.
• Inform patients about the precautions being taken for their safety and whether their disease status affects treatment.
By following these guidelines, it is ensured that patients with HIV, hepatitis B and C receive treatment in a safe way that protects both themselves and the clinic staff.
2.17 Medicine Handling and Storage
2.17.1 Purpose
The purpose of this guideline is to ensure correct handling, storage and administration of medicines to guarantee patient safety and comply with applicable legislation. Among other things, the guideline must ensure:
• That the clinics have routines that ensure that there are no expired medicines.
• That the clinics have routines that ensure order and cleanliness in the medicine room.
2.17.2 Receiving Medicine
2.17.2.1 When receiving medication, staff must check the delivery against the order to ensure correct type and quantity.
2.17.2.2 Check the expiry date and integrity of the packaging. Medicines with damaged packaging or a short shelf life are sent back to the pharmacy.
2.17.3 Storage of Medicine
2.17.3.1 Temperature: Medicines must be stored at the recommended temperature < 25 o C.
2.17.3.2 Safety: Medicines must be stored in locked cabinets or rooms accessible only to authorized personnel.
2.17.3.3 Procedure: Medicines must be kept in their original packaging and clearly labelled with name, strength, dosage and expiry date.
2.17.3.4 Every month, the refrigerator and medicine cabinet are cleaned with soap and water. This is signed in the logbook.
2.17.3.5 Medicine cabinets must be locked.
2.17.3.6 Vials are labelled with the date and time of opening.
2.17.4 Expiration and Disposal
2.17.4.1 Every 6 months, all medicines are reviewed regarding expiry dates.
2.17.4.2 Regular checking of expiry dates. Expired or damaged medications must be disposed of in accordance with the clinic's procedures for the safe disposal of medications.
2.17.4.3 A logbook is kept for checking the medicine cabinet.
2.17.5 Overview of Medicines
2.17.5.1 Aethoxysclerol: Store in a locked medicine cabinet at room temperature.
2.17.5.2 Stesolid: Store in a locked medicine cabinet at room temperature.
2.17.5.3 Lidocaine: Store in a locked medicine cabinet at room temperature.
2.17.5.4 Infusion fluid is stored in a cabinet at room temperature.
2.17.6 Administration of Medicines
2.17.6.1 Check the patient's identity by name and CPR number before administering medication.
2.17.6.2 Make sure the patient has no known allergies or contraindications to the medicine in question.
2.17.6.3 All medication administration must be documented in the patient's medical record with date, time, dose, route of administration and any comments.
2.17.6.4 Any side effects or complications must be reported and documented immediately.
2.18 Lidocaine
2.18.1 Purpose
The purpose of this protocol is to prepare an anaesthetic tumescent solution containing Lidocaine for administration in a safe and careful manner.
2.18.2 Marks
2.18.2.1 Xylocaine
2.18.2.2 Lidocaine
2.18.3 Form of Delivery
2.18.3.1 Vial with Xylocaine 20 mg/ml
2.18.4 Functional Therapeutic Group (FTG)
2.18.4.1 Anaesthetics for infiltration
2.18.5 Solvent
2.18.5.1 NaCl 0.9%
2.18.6 Preparation
2.18.6.1 Preparation of the tumescent mixture with Lidocaine/Xylocaine must be done on a clean surface. The following items must be used:
• NaCl 0.9% (1000 ml)
• Xylocaine (Lidocaine) 20 mg/ml
• 20 ml syringe
• Pink needle 1.20x50 mm 18G
2.18.6.2 Preparation of Tumescent Solution: 1. Perform hand hygiene with hand disinfection.
2. Attach the needle to the 20 ml syringe. Pull the plunger back to the desired dosing line on the syringe. This fills the syringe with air.
3. Insert the needle into the rubber top of the vial. Do not touch or bend the needle.
4. Press the air into the vial.
5. Draw the medicine from the vial into the syringe. Remove any air bubbles from the syringe.
6. Remove the needle from the vial and insert the needle into the NaCl container.
7. Repeat the action twice to get the correct dose.
2.18.7 Dissolution Ratio and Concentration
Administration road Vial (ml)
Infiltration 40 1000 1040 0.8
2.18.8 Labelling
2.18.8.1 When the mixture is ready, it should contain a total of 1040 ml of solution. Include information about the contents, date/time and initials of the person who prepared the solution on the label.
2.18.9 Administration
2.18.9.1 Infiltration: 5-10 ml of solution per 5-10 cm vein to be treated.
2.18.9.2 Maximum dose: For a body weight of 70 kg, 2.4 litres (1960 mg Lidocaine) per treatment.
2.18.10 Competence Level
2.18.10.1 Preparation: Nurse
2.18.10.2 Administration: Doctor
2.18.11 Durability
2.18.11.1 Undiluted: At room temperature, 5°C - 25°C, expiry date indicated on the vial.
2.18.11.2 Diluted: At room temperature, 5°C - 25°C, 1 day.
2.18.12 Contraindications and Precautions
2.18.12.1 Contraindication: Allergy to amide-type analgesics.
2.18.12.2 Precautions: Use caution when applying to the head and neck due to dense vascularization and risk of rapid absorption.
2.18.12.3 Acute Reactions:
• Common: Urticaria, bradycardia, dizziness, hypo/hypertension.
• Rare: Anaphylactic shock, arrhythmia, neuropathy.
Practical note: Exceeding 1 liter of tumescent infiltration for any treatment should be extremely rare. Less accurate infiltration around the vein is associated with a larger infiltration volume.
2.19 Aethoxysclerol
2.19.1 Purpose
The purpose of this protocol is to prepare a sclerosing foam solution (manufactured by Polidocanol) for administration in a safe and careful manner.
2.19.2 Trademark
Aethoxysclerole, Polidocanol.
2.19.3 Delivery form
2.19.3.1 Vial of Aethoxysclerole solution for intravenous (IV) administration
2.19.3.2 0.5% concentration (5 mg/ml) ampoule
2.19.3.3 1% concentration (10 mg/ml) ampoule
2.19.3.4 3% concentration (30 mg/ml) ampoule
2.19.4 FTG
2.19.4.1 Scleroserende middel for IV administration
2.19.5 Solvent
2.19.5.1 Room air
2.19.6 Preparation
2.19.6.1 The mixture according to the 'Tessari method':
2.19.6.2 Two syringes connected with a 3-way male, mixed to 2.5 ml of a uniform foam solution.
2.19.7 Administration road
2.19.7.1 IV: About 0.2 ml of foam solution per 1 cm of vein.
2.19.7.2 Maximum dosage of foam solution per day is 12.5 ml, regardless of concentration.
2.19.8 Competence level
2.19.8.1 Preparation: Nurse
2.19.8.2 Administration: Nurse, Surgeon
2.19.9 Durability
2.19.9.1 Undiluted: At room temperature, 5°C - 25°C, expiry date on the vial.
2.19.9.2 Diluted: At room temperature, 5°C - 25°C, 1 minute after mixing, after which it should be mixed into a uniform foam.
2.19.10 Contraindication/precautions
2.19.10.1 Contraindication:
• Acute shock state
• Acute DVT
• Advanced atherosclerosis
• Immobilization
• Thrombophilia
• Advanced hypertension
• Arterial insufficiency in the lower extremities
• Active phlebitis
• Acute fever
• Treatment with disulfiram, as the solution contains ethanol.
2.19.10.2 Precautions:
• Symptoms of microangiopathy or neuropathy
• Chronic inflammatory bowel diseases, e.g. Crohn's disease
• Inflammatory skin diseases in the treatment area
• Known hypercoagulability
• Known strong tendency to allergies
• Diabetes, as the peripheral circulation must be assessed before treatment
• Limited mobility
• Very poor general condition
• Arterial lack of drainage when treating varicose veins.
2.19.10.3 Acute reactions:
• Urticaria
• Local necrosis
• Thrombophlebitis
• Thrombosis
• Rare: anaphylactic shock, arrhythmia, visual disturbances, headache
2.20 Diazepam
2.20.1 Purpose
The purpose of this protocol is to administer Diazepam in a safe manner.
2.20.2 Delivery form
2.20.2.1 1 tablet contains 5 mg of Diazepam.
2.20.3 FTG
2.20.3.1 Anxiolytics in the benzodiazepine group.
2.20.4 Administration Road
2.20.4.1 Oral tablet.
2.20.4.2 5 mg Diazepam is taken 30 minutes before the procedure to reduce anxiety.
2.20.4.3 The tablets are taken with a glass of water.
2.20.4.4 Tablets can be crushed.
2.20.4.5 Crushed tablet can be suspended in water.
2.20.4.6 Crushed tablet can be placed on cold, soft food.
2.20.4.7 Can be taken with or without food.
2.20.5 Competence level
2.20.5.1 Administration: Nurse, doctor
2.20.6 Durability
2.20.6.1 See date on the packaging
2.20.7 Interactions
2.20.7.1 Erythromycin increases the AUC of diazepam.
2.20.7.2 Disulfiram reduces metabolism speed.
2.20.7.3 Theophylline counteracts the sedative and psychomotor effects.
2.20.7.4 Simultaneous use of benzodiazepines and opioids can result in respiratory depression, deep sedation, coma and death.
2.20.8 Urgent Reactions
2.20.8.1 Bradycardia, heart failure (incl. cardiac arrest), sedation, confusion, ataxia, tremor, respiratory depression, respiratory arrest.
2.20.9 Contraindications / Specifications
2.20.9.1 Patients with known hypersensitivity for diazepam.
2.20.9.2 Should not be used in cases of severe liver failure, as the risk of encephalopathy increases.
2.20.9.3 Respiratory insufficiency can be exacerbated. Benzodiazepines should be avoided in cases of severe respiratory insufficiency. Use caution with mild respiratory insufficiency, where dose reduction should be considered.
2.20.9.4 Myasthenia gravis
2.20.9.5 Sleep apnea syndrome
You should not drive car and / or operate machinery after intake of diazepam.
2.21 Control and Cleaning of Technical Equipment
2.21.1 Purpose
The purpose of this guideline is to ensure correct handling, cleaning and maintenance of technical equipment at Nordic Health Group in order to maintain a high standard of hygiene and functionality.
2.21.2 Area of Application
This guideline applies to all technical equipment used at Nordic Health Group, including ultrasound devices, laser machines and tumescent pumps.
2.21.3 Handling of Technical Equipment
2.21.3.1 Before Use:
• Check that the equipment is in good condition and works correctly.
• Ensure that daily functional and safety checks are carried out.
2.21.3.2 During Use:
• Follow the manufacturer's instructions for proper use of the device.
• Avoid contamination of the equipment by using appropriate protective equipment (gloves, overalls, etc.)
2.21.3.3 After Use:
• Switch off and disconnect the equipment correctly.
• Remove disposable items and waste materials from the equipment.
• Clean the equipment according to applicable instructions
2.21.4 Cleaning and Disinfection
2.21.4.1 Daily Cleaning:
• Start the day by cleaning all equipment
• Wipe all surfaces of the equipment with an approved disinfectant after each patient and remove visible stains and contamination immediately.
• Check that there are no liquids or other materials that could damage the equipment.
2.21.4.2 Monthly Cleaning:
• Carry out a thorough cleaning of all technical equipment, including removal of covers and cleaning of internal components, where it is possible and safe to do so.
• Document all cleaning and maintenance activities in the equipment's maintenance log book.
2.21.5 Responsibility
2.21.5.1 All personnel are responsible for correct handling and cleaning of the technical equipment they use.
2.21.5.2 Nurses and clinic assistants must ensure that the equipment is cleaned and disinfected in accordance with this guideline after each use.
2.22 Laser Machine
2.22.1
Purpose
The purpose of this guideline is to ensure the safe and effective use of the MedArt 710 laser machine for the treatment of varicose veins. It describes the necessary procedures for proper use, maintenance, and safety for both patients and staff.
2.22.2 Qualification Requirements for Operators
2.22.2.1 Training and certification: Only health personnel with relevant training and certification in the use of the MedArt 710 and in laser therapy in general may operate the machine.
2.22.3 Preparation of Patient and Equipment
2.22.3.1 Patient information: The patient must be informed about the procedure, including potential risks, side effects and expected results, and consent must be obtained.
2.22.3.2 Patient assessment: A thorough medical assessment of the patient's varicose veins must be performed to ensure that laser treatment is appropriate. This includes an ultrasound scan to assess venous insufficiency.
2.22.3.3 Equipment check: Before each treatment, the operator must check that the MedArt 710 is working correctly.
2.22.4 Treatment Procedure
2.22.4.1 Setting the laser parameters: Choose the correct parameters (Joules and watts) based on the size and depth of the varicose veins. See standard settings in protocol (1.3).
2.22.4.2 Treatment technique: Follow the recommended technique for varicose vein treatment based on the applicable treatment protocol.
2.22.4.3 Patient observation: During treatment, the patient must be observed for signs of discomfort or complications. Treatment should be stopped immediately if unexpected reactions occur.
2.22.4.4 Apply a compression bandage, if necessary, to minimize swelling and discomfort.
2.22.5 Maintenance of Equipment
2.22.5.1 Cleaning: The machine must be cleaned and disinfected after each use.
2.22.5.2 Regular service: The equipment must undergo regular service and calibration according to the manufacturer's recommendations to ensure optimal performance and safety.
2.22.6
Safety
2.22.6.1 Recording of incidents: All incidents or accidents must be documented and reported according to the clinic's policies to ensure ongoing improvements in safety and quality.
2.23 Tumescent Pump
2.23.1 Purpose
This guideline has been prepared to ensure safe and effective use of tumescent pump Dispenser DP 30 from Nouveau for administration of local anaesthesia.
2.23.2
Education and Certification
2.23.2.1 Only clinical staff, that as have reviewed specific education and certification in the use of Dispenser DP 30, can operate the pump.
2.23.3 Preparation of Equipment
2.23.3.1 Equipment Control: Before each use, the operator should inspect the Tumescent Pump Dispenser DP 30 to ensure it is functioning correctly. Check that all components, including hoses, cannulas, and the container for tumescent liquid, are properly assembled and intact.
2.23.3.2 Sterilization: All equipment that comes into contact with the tumescent liquid or the patient's skin must be sterile. The pump's hoses and cannulas should either be disposable or sterilized according to the manufacturer's instructions.
2.23.3.3 Preparation of Tumescent Liquid: The tumescent liquid should be prepared according to the doctor's prescription and must consist of the correct proportions of local anaesthetic and NaCl.
2.23.4
Patient Preparation
2.23.4.1 Patient Information: The patient should be thoroughly informed about the procedure, including potential risks, side effects, and expected results. Written consent must be obtained before the treatment begins.
2.23.4.2 Medical Evaluation: An assessment of the patient’s general health condition, medical history, and any allergies should be conducted. Special attention should be given to the patient’s tolerance for local anaesthetics
2.23.4.3 Marking of Treatment Areas: The areas to be treated should be precisely marked on the patient’s skin. The necessary volume of tumescent fluid should be calculated based on the patient’s needs and the treatment area.
2.23.5 Administration of Tumescent Anaesthesia
2.23.5.1 Setting of Pump Parameters: The operator should set the Dispenser DP 30 according to the procedure requirements.
2.23.5.2 Infiltration Method: Use a technique that ensures even distribution of the tumescent liquid in the subcutaneous tissue.
2.23.5.3 Monitoring of the Patient: The patient should be monitored carefully during the administration. This includes observing for signs of discomfort, allergic reactions, or other complications.
2.23.6
Maintenance of Equipment
2.23.6.1 Cleaning and Sterilization: After each use, the Dispenser DP 30 should be cleaned thoroughly.
2.23.6.2 Regular Service: The tumescent pump should undergo regular maintenance and calibration by a qualified technician to ensure optimal performance. Service intervals should follow the manufacturer’s recommendations.
2.23.7
Security Measures
2.23.7.1 Registration of Events: Any unexpected events, complications, or side effects should be documented and analysed to ensure continuous improvement in procedures and safety.
2.24 Ultrasound
2.24.1
Purpose
This guideline has been prepared to ensure the safe, efficient, and standardized use of the Wisonic ultrasound system in the clinic. It includes procedures for preparation, application, maintenance, and safety for both patients and staff.
2.24.2 Qualification Requirements
2.24.2.1 Only healthcare personnel with relevant training in ultrasound diagnostics and certification in the use of the Wisonic ultrasound system may operate the equipment.
2.24.3 Preparation of Equipment
2.24.3.1 Equipment Inspection: Before each use, the operator should inspect the Wisonic ultrasound system to ensure it is functioning properly. This includes checking the system's hardware, software, and ensuring all necessary probes and accessories are present and in good condition.
2.24.3.2 Software Update: The system must be regularly updated with the latest software version provided by the manufacturer to ensure optimal performance and safety.
2.24.3.3 Hygiene: Probes and all accessories that come into contact with the patient's skin must be cleaned according to current guidelines before and after each use to prevent cross-contamination.
2.24.4 Use of the Ultrasound System
2.24.4.1 Setting Parameters: The operator must adjust the system's parameters (e.g., depth, frequency, gain) based on the specific area and type of tissue to be examined.
2.24.5 Cleaning
2.24.5.1 After use, probes and other equipment must be cleaned and disinfected according to the manufacturer's instructions to prevent cross-contamination between patients.
2.24.6 Maintenance of Equipment
2.24.6.1 Regular Maintenance: The Wisonic ultrasound system must undergo regular maintenance by qualified technical personnel according to the manufacturer's recommendations. This includes calibration, function tests, and replacement of worn parts.
2.24.6.2 Troubleshooting and Repair: Any errors or problems with the system must be reported immediately, and repairs must be carried out by qualified technicians to ensure the safety and functionality of the system.