Of Best Laid Plans: The Unpredictable Effects of Knee Surgery on a Wound Care Blog

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by Karen Zulkowski DNS, RN, CWS

The past few months I have written about legal cases and palliative care. My plan was to combine them for March. However, my husband had a partial knee replacement at the end of February and I wanted to write about that. My apologies for no March column.

My husband, John, had never stayed in a hospital overnight and was scared of having any surgery. He had a colonoscopy but in his mind he came right home - so no big deal. To complicate matters, his orthopedic doctor was out of system for our health insurance, as was the hospital he normally operated in. So as a favor he was willing to do the surgery at the hospital that was in system. He did have privileges there. Both hospitals have excellent reputations for quality care. My daughter arranged to come from Cleveland to help for the week, so we were all set. Well, not really.

John reported to the surgery department and was taken back to be admitted. However, the staff was unclear which knee was to be operated on and had not called to clarify it, so the consent form had to wait for the orthopedic doctor to arrive. In the meantime, John had his I.V. started, was premedicated and taken to the operating room (OR) holding area. The surgeon arrived; they completed the paperwork and initialed his knee. He was taken to the OR and given a spinal and general anesthetic as well as two I.V. antibiotics. All of these actions are standard in a knee replacement. Unfortunately, when the packet with his leg positioner was opened, it had not been sterilized properly and had blood on it, thereby contaminating the entire sterile field. The surgeon decided to flash sterilize the partial knee kit as it was the farthest away, and sent for another total knee kit. In setting the instruments up the second time there was another break in the sterile field.
Since John had now been under anesthesia so long the surgery had to be cancelled. However, because John had a spinal, he had to stay in the hospital overnight. He also ended up having a reaction to either one of the antibiotics or anesthesia, and had vomiting and itching. His Foley catheter was not secured to his leg and this became painful when the spinal wore off. The hospital did apologize and there were no charges.

John went back ten days later and had a much better experience. For those ten days he was a basket case about going through everything again. It was interesting that different disciplines attributed the cause of his allergic reaction differently. Anesthesia was sure that was it. The nurses thought it was the Anceff and my daughter the PA thought it was the second antibiotic. Since everything was different the second time, he did much better and is recovering well.
The moral of this story is no matter how much you plan, or how much you know, or how well respected the hospital is, things can and do go wrong. This is true of both patients and health care professionals. Post what has happened in your life.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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