Open Forum

We have some providers interested in performing these procedures and I'm wondering if anyone of my colleagues in ambulatory perform these versus an outpatient surgery setting:

• Carpel Tunnel Release
• Trigger Finger Release
• Lesion removal (ie: small cancerous/benign skin lesions, wart removal, punch biopsies, etc.)
• Hard ware removal (ie: percutaneous pins removal, etc.)

Can you provide some insight on the following questions?

1. How do you staff these procedures?
2. Do staff require any special certifications?
3. Are there any competencies you require for staff onboarding related to these procedures?
4. What type of anesthesia do you use?
5. What equipment do you use?
6. Are there any policies or protocols that you follow?

Thanks in advance for your insight!

Jami Kyle BSN, RN, AMB-BC

Nurse Manager Ambulatory

UK Healthcare

Family and Community Medicine 

Urgent Care Clinic

859-218-6115

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Jami Kyle BSN RN AMB-BC
UK Healthcare
Versailles KY
(859)553-0899
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Hi Jami,

Our outpatient pediatric orthopedic practice does percutaneous pin removal in clinic. This procedure is done only by certified orthopedic technicians and is part of their onboarding competency and a skill they are taught in school. The patient is examined first by the provider who orders the pin removal if appropriate for clinic. The ortho tech is expected to review the previous x-ray and operative note for pin count and angle of insertion to help guide their removal. They cover the wound with a simple dressing and instruct the family to keep clean and dry. There is no anesthesia given and the procedure is generally well tolerated. Our biggest problem is actually parents fainting when watching 🙃 There has been an evolving conversation around equipment as pin pullers require a certain level of disinfection. I no longer work in this specific department, but the last time I was updated they were investigating disposable options as sterilization is challenging in clinic sites not located near the hospital. 

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Brandy Williamson MSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Brookhaven GA
(404)785-8978
brandy.williamson@choa.org
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Excellent, this information is very helpful! Thank you Brandy

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Jami Kyle BSN RN AMB-BC
UK Healthcare
Versailles KY
(859)553-0899
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Original Message:
Sent: 09-01-2023 09:31
From: Brandy Williamson
Subject: Does anyone perform these procedures in your clinic?

Hi Jami,

Our outpatient pediatric orthopedic practice does percutaneous pin removal in clinic. This procedure is done only by certified orthopedic technicians and is part of their onboarding competency and a skill they are taught in school. The patient is examined first by the provider who orders the pin removal if appropriate for clinic. The ortho tech is expected to review the previous x-ray and operative note for pin count and angle of insertion to help guide their removal. They cover the wound with a simple dressing and instruct the family to keep clean and dry. There is no anesthesia given and the procedure is generally well tolerated. Our biggest problem is actually parents fainting when watching 🙃 There has been an evolving conversation around equipment as pin pullers require a certain level of disinfection. I no longer work in this specific department, but the last time I was updated they were investigating disposable options as sterilization is challenging in clinic sites not located near the hospital. 

------------------------------
Brandy Williamson MSN RN CPN
Ambulatory Nursing Manager
Children's Healthcare-Atlanta
Brookhaven GA
(404)785-8978
brandy.williamson@choa.org
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