The Pre-Anaesthetic Limb (PAL) Sleeve, reduces manual handling by the Theatre team and allows for a greater wet-skin contact time for antiseptic solutions – leading to a reduced risk of Surgical Site Infection. Furthermore, due to pre-anaesthetic preparation, costly theatre time can be reduced.
The operative site is usually prepared for limb surgery by “painting” the area using a sponge or gauze square in a sponge forceps whilst a non-scrubbed member of the team lifts the limb. Lower limb surgery usually requires theatre staff to lift an anaesthetised leg, sometimes at full arm stretch with the possibility of back and shoulder injury. Although no figures are available specifically for theatre workers, the HSE in 2014 reported 120.8 lifting injuries per 100,000 employees among Nurses and Health Care Assistants (HSE 2014).
Lifting an anaesthetised limb is a major problem for many theatre staff. With the increase in obesity, limbs are getting heavier and more ungainly. Whilst there are techniques to keep the leg locked at the knee they almost all contravene health and safety lifting criteria and in the United States have almost completely been outlawed.
The PAL Sleeve
Pentland Medical have developed an innovative antiseptic application system – The PAL Sleeve (Pre-Anaesthetic Limb) Sleeve.
The device can be applied to the limb any time after arrival in the operating suite, most commonly in the anaesthetic room prior to induction of anaesthesia. This allows the patient to be an active part of the application procedure and reduces lifting by theatre staff.
The PAL Sleeve is a sealed system which includes a transparent cover and a standard portal to instil antiseptic. As it is applied before the induction of anaesthesia, the patient can lift their limb, thereby minimising the need for staff to lift the limb. It is applied sock-like to the distal edge of the tourniquet and 50ml of antiseptic solution instilled; the limb remains in contact with the antiseptic until it sleeve is removed in theatre.
The main aims of the PAL Sleeve are to:
- Minimise manual handling so that we reduce and remove any possibility of lifting injury
- To provide total contact of the antiseptic medium in a liquid state to the surface of the skin for a period that was long enough that penetration into the hair follicles and sweat glands could occur and produce a step-change reduction in the bacterial load – leading to a reduced risk of SSI.
- Allow the limb preparation to occur in the anaesthetic room where there is often a period of waiting whilst the preparation of the operating theatre is completed. Utilising this time to allow limb preparation maximises the useful time in theatre.
Conclusion
PAL is a cost-effective, improvement in current orthopaedic surgical preparation. Reducing the need for the theatre staff to lift the limb significantly reduces the risk of a back injury, which is an obligation on all employers. The reduction in skin bacteria and the theatre time-saving potential will improve current clinical practice, whilst reducing costs.
You can see the PAL Sleeve on the Pentland Medical stand at the AfPP Residential, York University on August 9-10. Contact Pentland Medical for further information on 0131 467 5764, or email mail@pentlandmedical.co.uk. Further information is online at www.pentlandmedical.co.uk
