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| The Surgical Technologist | SEPTEMBER 2016 404 increase the quality of life. In this article, a brief presen- tation of surgical procedures performed to treat the side effects of EB and increase the patient’s quality of life will be explored. G E N E R A L C O N S I D E R A T I O N S W H E N P R E P A R I N G T H E S U R G I C A L P A T I E N T Since EB is a rare condition it is rarely encountered in a surgical setting. Nevertheless, the surgical technologist must have a basic understanding of the condition and the major concerns regarding the patient with EB, namely shearing and new bullae formation since these can lead to chronic wound infection, loss of airway and the inabil- ity to maintain proper nutrition. By following some basic guidelines of patient prep, patient positioning and case set up, the surgical technologist will help reduce the possibil- ity of these injuries. Several factors need to be considered when setting up the room and gathering supplies and equipment. The surgical technologist will need to focus on how to reduce any sort of shearing, bruising or blistering of the skin of an EB patient. They will also need to secure and maintain the airway of the patient during induction and intubation. Since patients with EB are more likely to suffer injury, the surgical team will need to take extra precautions to ensure that communication is clear, and that members of the OR team understand the plan before bringing the patient into the room as to avoid mistakes and injury to the patient. R O O M S E T U P A N D P A T I E N T P O S I T I O N I N G When setting up the room, the circulator and surgical technologist will need to make a clear path to move the stretcher into the room without rolling over any cords or tubing. The room will need to be set up so that there is as little movement as possible. In some cases, leaving the patient on the stretcher may be the best option. If at all possible, allowing the patient to remain in his or her own clothes during the procedure may help reduce any dam- age that might be caused by changing clothes. 6 Often the patient has acquired seamless clothing, which can reduce friction and shearing. 3 Once the patient is in the room, moving and position- ing will need to be as slow and coordinated as possible so that the skin does not tear or blister. The most effective way is to lift the patient using a draw sheet and at least four people; however, a using a patient transfer needs to be used with extreme caution. The suggested guideline for pediatric patients is to use sheepskin. It may be placed underneath the child for padding, as well as used for moving the patient to help avoid injur- ing the skin. 6 While healthier surgi- cal patients often can move themselves from the stretcher to the OR bed before the surgery, it is not recommended for patients with EB, as lateral movement from one bed to another may create acci- dental shearing. 6 Padding used will need to be gener- ous and well positioned over pressure points. Using soft cotton dressings will be needed to wrap pressure points. Gel posi- tioning and pressure relief products will need to be used as they are less likely to slip than foam and provide a better bar- rier between the patient and the surgi- cal equipment. Any sort of adhesive tape will need to be avoided, if at all possible, as nearly all EB patients are extremely sensitive to the tape, which can cause damage to the epidermal layers. Instead, cotton dressings will need to be used to help secure the patient or safety straps and offer a layer of protection between the straps and the patient’s skin. While sequential compression devices are rec- ommended for most patients, it is typi- cally contraindicated in patients with EB, as the constant compression can damage the patient’s skin on their legs. 1 If at all possible, monopolar electro-cautery should not be used as the patient will be more prone to peripheral tissue damage, and the grounding pad for monopolar cautery also may cause damage to the tissue. Currently, there is no consensus on what to do if monopolar cautery is needed for these cases. If it is necessary, finding an area of skin for the grounding pad with little or no bullae formation may be used. When monitoring the patient, the same attention to care needs to be taken. The soft cotton dressings will need to be applied to the extremity where the blood cuff will be placed. To help reduce risk of epidermal damage, the cycling of the blood pressure cuff can be reduced so that it moni-