Standards & Universal Preferences
Standing principles and universal preferences that apply across this program.
Universal standing preferences (apply to every card)
Size 8 gloves — Biogel underneath + size 8 white gloves on top · Size XL gown ×3
Antifibrinolytic: tranexamic acid (TXA) — 30 mg/kg loading dose + 1 mg/kg/hr infusion throughout the operation.
Hemostasis pick-list:
| Agent | Vendor / Catalog | Use |
|---|---|---|
| Floseal Hemostatic Matrix | Baxter — 10 mL 045773; prep kit 1503350 | |
| Recothrom thrombin topical 5000 u | Baxter | On cottonoids |
| Tisseel fibrin sealant | Baxter 1504515 | PRN |
| Surgifoam | Ethicon/J&J 1974 | Soak with thrombin; or Surgifoam + 4 mg dexamethasone combo |
| Gelfoam absorbable sponge size 100 | — | Small Gelfoam + Decadron; small Gelfoam + thrombin |
| Surgicel original | Ethicon/J&J 1951 | PRN |
| Bone wax / HemaSorb Plus bone putty (2 cc) | — | Bony bleeding |
| QuikClot dressing + fibrin sealant patch | — | On hold / available for major bleeding |
Circulator note carried from source cards: do not mix Floseal with Gelfoam — confirm with surgeon first.
Power: Stryker Sumex Pi Drive 2+ is primary (#1); Midas Rex MR8 is the alternative. (Peds deformity also carries Misonix ultrasonic + slow-speed battery drill — see peds cards.)
Navigation: Stealth reference tray is default-open on navigated cases; NavLock instruments open with it. Reference *Revision* tray is PRN (navigating off an existing rod/screw). Passive spheres 8801075 ×3 packs.
Positioning (posterior/prone default — most-elaborate team instructions retained):
- Jackson table w/ prone bolsters (open). Allevyn pads placed on iliac crests before flipping.
- Arms above head, wrist restraints, foam arm pads. C-spine precautions: neck flexed slightly (sling for cervical).
- Headrest: foam prone pillow / ProneView. Black rolls; gel pads. Safety strap ×2.
- Anterior/supine and peds positioning defined per-card.
Closure / dressings (merged default — refine per card):
- Local: Bupivacaine/Marcaine 0.25% w/ epi 1:200,000 — dose ≈ patient weight in kg (or 0.5% w/ epi).
- Fascia: 0 Polysorb/Vicryl tapered (GS-21) or Stratafix 0.
- Subcutaneous/dermis: 2-0 then 3-0 Polysorb/Vicryl (GS-10 cutting).
- Skin: 4-0 Monocryl, or 4-0 Prolene running with an escape stitch in the middle.
- Drain: Penrose out through the incision, safety-pinned to fluffs (per case).
- Dressing (standing default): Sylke dressing + 4×4 + Tegaderm.
- Rigid collar (when indicated): Aspen.
- Dura-repair needle holder: Castroviejo.
Retractor decision map
| Procedure | Primary | Alternative / PRN |
|---|---|---|
| Anterior cervical fusion (ACDF) | Phantom CS | Shadowline ACF |
| Anterior cervical disc replacement | Thompson + custom bone levers | Phantom CS / Shadowline ACF |
| Posterior cervical | none | Phantom CS — PRN, open only if needed |
| Posterior lumbar decompression | Phantom CS most cases | ClearLine L — PRN deep/obese; or McCullough retractor set |
| ALIF / LLIF | Rep-provided (industry brings retractor – ie Nuvasive MaXcess for XLIF and MaXcess for ALIF) | — |
| Anterior lumbar disc replacement | Thompson + long custom bone levers | — |
Open for EVERY spine case
| Item — exact product | Size | Vendor | Catalog # | Open | PRN |
|---|---|---|---|---|---|
| Positioning · warming · DVT prophylaxis (open in room, non-sterile) | |||||
| Sequential compression device (SCD) pump | Cardinal / Kendall | SCD 700 | 1 | ||
| SCD compression sleeves (Vasopress), size to patient | M / L | Cardinal | VP501MG / VP501LG | 1 pr | |
| Forced-air warming blanket, upper body (Bair Hugger) + unit | 3M | 52200 | 1 | ||
| Foam positioning kit / arm pads / gel rolls | Xodus | SPK10113 | 1 | ||
| Surgical skin marker (black, on patient) + field marker (purple) | Viscot | 1450XL | 1 | ||
| Skin prep · antisepsis | |||||
| Chlorhexidine (Hibiclens) scrub brush | 1 | ||||
| ChloraPrep applicator — 2% CHG / 70% IPA, tinted | 26 mL | BD (CareFusion) | 930815 | 2 | |
| BD Surgiphor wound irrigation — 0.5% PVP-I [every card EXCEPT anterior cervical] | 450 mL | BD | 910110 | 1 | |
| Major basin pack (RSP) | Novo Health | 124514C | 1 | ||
| Mastisol liquid adhesive vial | 0.66 mL | Ferndale | 52348 | 1 | |
| Draping | |||||
| Blue OR towels (per pack) | 17×30 in | Medical Action | 7048 | 2 | |
| Steri-Drape impervious towel drape ('1010') | 23×35 in | 3M | 1010 | 4 | |
| Medline Sterile Surgical Utility Drapes with Tape, 200 EA/CS | 38 x 66 cm | Medline | DYNJP2405 | 4 | 2 |
| Medline InvisiShield towel drape ON ROLL (prep stand) | 18×12 in | Medline | DYNJSD1000RL | 1 | |
| Ioban 2 antimicrobial incise drape (iodophor) | 33×35 in | 3M | 6651EZ | 1 | 1 |
| Spine custom pack (PPMC) | Medline | DYNJ69083 | 1 | ||
| Split-sheet drape | 77×120 in | Medline | DYNJP8304 | 1 | |
| 3/4 sheet drape | Medline | DYNJP2414 | 1 | ||
| Pocketed CV top drape — bilateral pouches [pocketed cases] | Medline | DYNJP4220 | 1 | ||
| Instrument pouch — adheres to drape [pocketed cases] | 10×11 in | Microtek / Medline | 8918 | 2 | |
| C-arm drape (PPMC Ecolab / CCH Tidi C-Armor) | 27×60 in | Ecolab / Tidi | 4951 / 5523 | 1 | |
| Leg-cover drape [anterior approaches] | 31×48 in | Medline | DYNJP2460 | 2 | |
| Skin stapler | 35 W | Covidien Appose | 8886803712 | 1 | |
| Sponges | |||||
| Raytec gauze sponge, 12-ply, X-ray detectable | 4×4 in | Cardinal Health | 6939 | 1 | |
| Laparotomy sponge (lap pad), X-ray detectable | 18×18 in | Medline | MDS72038 | per card | |
| Lap-tape sponge (long/thin), X-ray detectable — narrow channels / gutters | 4×18 in | Medline | MDS251504LF | per card | 2 |
| Cottonoid patty (neuro) | 0.5×0.5 in | Integra | 801400 | 1 | |
| Sharps · needles · syringes | |||||
| Surgeon's blade #10 / #15 | #10 / #15 | Aspen | 371110 / 371115 | 1 ea | |
| Surgeon's blade #11 | #11 | Aspen | 371211 | 1 | |
| Hypodermic needle 22G | BD | 305127 | 1 | ||
| IV catheter / angiocath 18G (local / irrigation) | 18G | BD | 381454 | 1 | |
| Luer-lock syringe 10 cc / 20 cc | BD | 302995 / 302830 | 1 ea | ||
| Spinal needle — level localization, 18G | BD | 405181 | 1 | ||
| Needle counter box, magnetic | 40-ct | Medline | NC40FBR | 1 | |
| Hemostasis | |||||
| Bone wax, sterile | 2.5 g | Medtronic / Covidien | BW25G | 1 | |
| Floseal hemostatic matrix | 10 mL | Baxter | 1503350 | 1 | |
| Recothrom thrombin topical | 5000 u | Baxter | ADS202110 | 1 | |
| Surgifoam / Gelfoam absorbable gelatin | Ethicon | 1974 | 1 | ||
| Aquamantys bipolar sealer wand + cover | Medtronic | 01-0020 | 1 | ||
| Cautery & suction | |||||
| ESU pencil + integrated holster | Valleylab / Bovie | E2515H / ESPH | 1 | ||
| Bovie tip scratch pad | Bovie | ESSP | 1 | ||
| Bipolar forceps cord + adaptor (Storz) + pedal | Storz | — | 1 | ||
| Grounding pad / return electrode (REM) | Medtronic | 7507 | 1 | ||
| Yankauer suction tip (+ Poole on anterior cases) | Sage | 006629 | 1 | ||
| Disposable plastic Frazier suction tips (assorted Fr) 16Fr for open lumbar cases x2, 12Fr x2 for all cases | 1 | ||||
| Neptune 2 Ultra suction unit + tubing + canister | Stryker | — | 1 | ||
| Closure · drains · dressing | |||||
| Suture set: Vicryl #1 for fascia, Vicryl #2 for dermis, V-loc/clear stratafix 3-0 for skin. | Ethicon / Covidien | — | set | ||
| Dermabond / skin glue | Ethicon | DNX12 | 1 | ||
| Steri-Strips | 0.25×4 in | 3M | R1547 | 1 | |
| JP drain 19 Fr + drainage bulb (100 / 400 mL) | 19 Fr | BD | — | 1 | |
| Penrose drain [anterior cervical] | 3/8×18 in | Medline | DYND5042 | 1 | |
| Biopatch CHG disc (drain site) | Ethicon | — | 1 | ||
| Dressing: Sylke + Telfa + Tegaderm | 1624W | 3M / Covidien | 1624W | 1 | |
| Aspen rigid collar [cervical] | Aspen | — | 1 | ||
| Cautery settings: cervical = Bovie 20/20 cut-coag, Bipolar 20 · posterior & lumbar = Bovie 35/35, Bipolar 35. Meds (pharmacy): TXA, cefazolin, vancomycin powder (ask before opening), bupivacaine-epi, bacitracin. | |||||