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Practice Statements
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The Victorian Surgical Consultative Council (VSCC) has traditionally sent hard-copy practice statements (on paper) to all surgeons in Victoria. However, many surgeons may now prefer to receive our VSCC updates and practice statements electronically. Please indicate your preference for, and comments on, future VSCC mail outs via the online form.
A
Acute Cholangitis and Availability of Urgent ERCP Services - VSCC Approved: August 2006
Includes information and recommendations that should assist surgeons confronted with similar cases.
Acute Cholangitis and Availability of Urgent ERCP Services - VSCC Approved: August 2006 (PDF - 43.9 KB)
Acute Mesenteric Ischaemia - VSCC Approved: February 2008
Acute mesenteric ischaemia is an uncommon but catastrophic acute surgical emergency. It carries a high morbidity and mortality. It represents a diagnostic challenge, and therefore a high index of suspicion is required, as patients often present with a paucity of physical signs despite severe abdominal pain.
Acute Mesenteric Ischaemia - VSCC Approved: February 2008 (PDF - 39.5 KB)
Adverse events: Immediate counselling for surgeons - VSCC Approved: May 2008
This is a very serious and important issue. Help and support should be immediately available for surgeons when they have been involved in a serious adverse event.
Adverse events: Immediate counselling for surgeons - VSCC Approved: May 2008 (PDF - 16.2 KB)
Air Embolism Associated with the use of Hydrogen Peroxide - A Warning - VSCC Approved: October 2005
Recently the Victorian Consultative Council for Anaesthetic Mortality and Morbidity (CCAMM) reviewed a case involving oxygen embolism, associated with the irrigation of external fixator pin sites with hydrogen peroxide. The collapse was very dramatic but with aggressive and timely resuscitation there was a good outcome.
Air Embolism Associated with the use of Hydrogen Peroxide - A Warning - VSCC Approved: October 2005 (PDF - 39.3 KB)
B
Bariatric Surgery - VSCC Approved: August 2009
A recent death in a patient undergoing bariatric surgery in regional Victoria was reviewed by VSCC. The discussion process raised questions as to the quality and safety aspects of bariatric surgery.
Bariatric Surgery - VSCC Approved: August 2009 (PDF - 19.0 KB)
C
Canadian C-Spine Rule
Canadian C-Spine Rule (PDF - 42.9 KB)
Case of fat embolism following total knee replacement (TKR) - VSCC Approved: November 2009
The VCCAMM reviewed a case of a 61 y.o. woman who suffered profound neurological deterioration after bilateral total knee arthroplasty.
Case of fat embolism following total knee replacement (TKR) - VSCC Approved: November 2009 (PDF - 17.1 KB)
Cases Of Sudden Death Following Lumbar Spinal Surgery In The Elderly - VSCC Approved: August 2004
Spinal canal decompression operations are performed frequently for the relief of symptoms arising in patients with spinal canal stenosis. Death on the table or immediately post operation should be extremely rare.
Cases Of Sudden Death Following Lumbar Spinal Surgery In The Elderly - VSCC Approved: August 2004 (PDF - 35.6 KB)
Cervical spine injury (soft tissue) - VSCC Approved: May 2009
Over the past 10 years, two different ?decision rules? have been independently developed and trialled in prospective studies to aid clinicians in the selection of patients for cervical spine radiography and more rapidly rule out injury to the cervical spine using clinical assessment.
Cervical spine injury (soft tissue) - VSCC Approved: May 2009 (PDF - 16.1 KB)
Cervical spine injury - New England Journal of Medicine
Cervical spine injury - New England Journal of Medicine (PDF - 79.2 KB)
Clean Hands Save Lives - VSCC Approved: June 2010
The VSCC has created guidelines for hand hygiene in hospitals.
Clean Hands Save Lives - VSCC Approved: June 2010 (PDF - 152.0 KB)
Clinical Handover - VSCC Approved: July 2010
The VSCC commends clinical handover to surgeons as an essential component of care in the hospital system. Especially in need of our encouragement is the effective “shift to shift” handover between junior medical staff.
Clinical Handover - VSCC Approved: July 2010 (PDF - 16.1 KB)
Code Crimson - VSCC Approved: February 2009
The VSCC has discussed this particular initiative, which is a "life saving measure to treat exsanguinating surgery in trauma".
Code Crimson - VSCC Approved: February 2009 (PDF - 16.5 KB)
Comment on Post-Operative Bleeding and Anticoagulants - VSCC Approved: November 2009
The VSCC receives reports of postoperative bleeding difficult to control in association with anticoagulant or antiplatelet therapy.
Comment on Post-Operative Bleeding and Anticoagulants - VSCC Approved: November 2009 (PDF - 19.3 KB)
Complications of ERCP - VSCC Approved: April 2007
Significant specific related complications occur in 1.8% of all ERCP's performed, with an overall mortality of 0.6%.
Complications of ERCP - VSCC Approved: April 2007 (PDF - 42.8 KB)
Component selection practices - VSCC Approved: June 2005
Describes the component selection practices in preparation of surgical procedures.
Component selection practices - VSCC Approved: June 2005 (PDF - 39.8 KB)
Correct level in Spinal Surgery - VSCC Approved: November 2009
The VSCC has recently reviewed a number of cases where the operation occurred at the incorrect level mainly at the lumbar spine level but also in the cervical spine.
Correct level in Spinal Surgery - VSCC Approved: November 2009 (PDF - 26.9 KB)
Correct Side and Correct Site Surgery Guidelines
These new guidelines were developed by a dedicated working party of the Royal Australasian College of Surgeons (RACS), which included a representative from the VSCC. These guidelines supersede all previous guidelines regarding correct side and correct site surgery released by the RACS and the VSCC .
Correct Side and Correct Site Surgery Guidelines (PDF - 188.9 KB)
CVC Guidewires on the loose- “Carpe wirem”-VSCC Approved: January 2011
CVC Guidewires on the loose- “Carpe wirem”
CVC Guidewires on the loose- “Carpe wirem”-VSCC Approved: January 2011
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Decompression laminectomy and venous emboli - sample case - VSCC Approved: May 2007
This report relates to the case of an elderly patient who died during the course of a multi-level decompression laminectomy undertaken for marked spinal stenosis.
Decompression laminectomy and venous emboli - sample case - VSCC Approved: May 2007 (PDF - 23.3 KB)
Diverting end stomas - VSCC Approved: March 2008
Two cases have been reported to the VSCC concerning laparoscopic surgery. They involve the inadvertent closure of the proximal instead of the distal segment of the bowel with resultant mechanical bowel obstruction.
Diverting end stomas - VSCC Approved: March 2008 (PDF - 13.8 KB)
Documentation in the Medical Record - VSCC Approved: November 2009
The VSCC has been concerned about the standard of documentation in the medical record made by all attending medical officers whether they be junior or senior.
Documentation in the Medical Record - VSCC Approved: November 2009 (PDF - 26.2 KB)
E
Endograft repair of abdominal aortic aneurysms (EVAR; Endovascular Aneurysm Repair) - Approved: June 2010
When endograft procedures for abdominal aortic aneurysms first became available, an audit was carried out by ASERNIP-S for MSAC. Australian data released in 1999 confirmed the comparative safety of endografting.
Endograft repair of abdominal aortic aneurysms (EVAR; Endovascular Aneurysm Repair) - Approved: June 2010 (PDF - 17.0 KB)
Endoscope - An unusual problem - VSCC Approved: June 2005
An unusual problem encountered with the use of an arthroscopic shaver.
Endoscope - An unusual problem - VSCC Approved: June 2005 (PDF - 20.2 KB)
F
G
Guidelines for Emergency Gastrostomy replacement - replacement with balloon tube - VSCC Approved: January 2008
If an existing Gastrostomy tube has fallen out, or been accidentally pulled out, the stoma will close quickly, often in the space of a few hours. The appropriate clinician should be contacted immediately and they may delegate the reinsertion of the tube. It is important that a tube is reinserted as soon as possible to prevent the stoma closing. If a Gastrostomy tube is not available a urinary catheter can be used.
Guidelines for Emergency Gastrostomy replacement - replacement with balloon tube - VSCC Approved: January 2008 (PDF - 45.6 KB)
Guidelines for handing a fire in the operating theatre - VSCC Approved: January 2011
Handing a fire in the operating theatre
Guidelines for handing a fire in the operating theatre - VSCC Approved: January 2011
Guidelines for the management of bile duct stones - VSCC Approved: June 2004
There are various ways of managing bile duct stones with the two main variables that determine management being the mode of presentation and local expertise/ preference. Whilst it is therefore difficult to be prescriptive about the management of duct stones, there are guiding principles.
Guidelines for the management of bile duct stones - VSCC Approved: June 2004 (PDF - 31.7 KB)
Guidelines for the Management of Upper Gastrointestinal Bleeding: August 2006
Provides information for the management of upper gastrointestinal bleeding.
Guidelines for the Management of Upper Gastrointestinal Bleeding (PDF - 91.3 KB)
H
Hand Ischaemia associated with Upper Limb arterial procedures - VSCC Approved: February 2009
Over recent years, two cases of hand ischaemia following arterial surgery in the Upper Limb have been considered by the Victorian Surgical Consultative Council and Council felt it was appropriate to report these to all surgeons in the state.
Hand Ischaemia associated with Upper Limb arterial procedures - VSCC Approved: February 2009 (PDF - 20.6 KB)
I
Incorrect IOL Implantation - VSCC Approved: April 2009
Following review of a case where an incorrect Intra-Ocular Lens (IOL) was inserted, this statement was sent to all Ophthalmologists (including trainees) in the State.
Incorrect IOL Implantation - VSCC Approved: April 2009 (PDF - 21.3 KB)
Inter-hospital Transfer of Unstable Surgical Patients: June 2009
The VSCC was recently forwarded a report of a patient needing to be transferred to another hospital as there were no ICU beds available at the first hospital.
Inter-hospital Transfer of Unstable Surgical Patients (PDF - 12.8 KB)
Intern Manual - Immediate management of surgical emergencies (3rd edition)
The notes in this manual are intended as a guide to assist junior medical staff to manage/initiate treatment of serious conditions.
Intern Manual - Immediate management of surgical emergencies (3rd edition)
K
Key Principles for the Management of Specimens - VSCC Approved: October 2007
Key principles for the management of specimens for pathological diagnoses.
Key Principles for the Management of Specimens - VSCC Approved: October 2007 (PDF - 43.0 KB)
Knee Replacement, Epidural Anaesthesia and Myocardial Infarction - VSCC Approved: August 2004
Two cases have been reported to the Victorian Surgical Consultative Council (VSCC) where patients having knee replacement under epidural anaesthesia have died about 24 hours post-operatively from myocardial infarction.
Knee Replacement, Epidural Anaesthesia and Myocardial Infarction - VSCC Approved: August 2004 (PDF - 18.5 KB)
L
Laparoscopic Vascular Injuries - The Veress Debate - VSCC Approved: June 2010
The Veress needle has long been used by many gynaecologists, while many surgeons prefer the Hasson or other open entry techniques.
Laparoscopic Vascular Injuries - The Veress Debate - VSCC Approved: June 2010 (PDF - 17.0 KB)
M
Medicolegal Death Investigation in Victoria - VSCC Approved: May 2006
Clinicians involved in the care of the deceased may be able to attend the autopsy if they wish, particularly in complex cases, and this is often of great benefit to the clinicians and the pathologist alike.
Medicolegal Death Investigation in Victoria - VSCC Approved: May 2006 (PDF - 54.3 KB)
Megacolon and colonic perforation - VSCC Approved: June 2007
A case recently reported by the coroner described a death due to faecal peritonitis from colonic perforation secondary to acute on chronic constipation with associated megacolon.
Megacolon and colonic perforation - VSCC Approved: June 2007 (PDF - 24.3 KB)
Mesenteric Ischaemia in Endografting for Abdominal Aortic Aneurysm (AAA) - VSCC Approved: September 2005
Bowel ischaemia may occur as a complication of AAA repair - whether repair is by an open or an endovascular technique. In this regard, a patent Inferior Mesenteric Artery (IMA) may be of particular importance if the Superior Mesenteric Artery (SMA) is compromised.
Mesenteric Ischaemia in Endografting for Abdominal Aortic Aneurysm (AAA) - VSCC Approved: September 2005 (PDF - 28.3 KB)
N
Nursing staff concerns over retained instruments - VSCC Approved: June 2008
In the past 12 months the VSCC has considered 12 cases where an instrument or material, such as a swab or a pack, has been retained at operation. If a scrub nurse has some concern about the count, it is essential that we listen and take appropriate action.
Nursing staff concerns over retained instruments - VSCC Approved: June 2008 (PDF - 12.5 KB)
P
Patients who self discharge or refuse treatment - VSCC Approved: October 2008
Council has reviewed two cases where patients left hospital against the advice of the doctor and subsequently died. This is a difficult issue as it often involves junior medical staff in the Emergency Department or on the wards.
Patients who self discharge or refuse treatment - VSCC Approved: October 2008 (PDF - 13.6 KB)
R
Reaction to Protamine Sulphate - VSCC Approved: 29 September 2004
A short statement has been made by the Council about the importance of the rare complication of an anaphylactic reaction to protamine sulphate.
Reaction to Protamine Sulphate - VSCC Approved: 29 September 2004 (PDF - 18.3 KB)
Reporting Surgical Deaths - Potential Model - VSCC Approved: 18 December 2003
Provides a flow chart of a potential model for reporting surgical deaths.
Reporting Surgical Deaths - Potential Model - VSCC Approved: 18 December 2003 (PDF - 13.1 KB)
Retained Raytec Swab ('Gossypiboma') - VSCC Approved: November 2009
There is a small and developing literature on the issue of 'surgical counts' and 'retained foreign bodies'. The problem of discrepancies in the surgical count is relatively common.
Retained Raytec Swab ('Gossypiboma') - VSCC Approved: November 2009 (PDF - 24.6 KB)
Ruptured Abdominal Aortic Aneurysm- VSCC Approved: January 2011. Revised: June 2011
Guidelines for the Management of Ruptured Abdominal Aortic Aneurysm
Ruptured Abdominal Aortic Aneurysm
S
Sepsis following colorectal surgery - VSCC Approved: May 2005
A serious complication following colorectal surgery is anastomotic leak and intraabdominal sepsis.
Sepsis following colorectal surgery - VSCC Approved: May 2005 (PDF - 23.0 KB)
SOII Paragraph Summaries October 2008 - October 2009
Procedures investigated by SOII for the period October 2008 - October 2009 - graphical representation.
SOII Paragraph Summaries October 2008 - October 2009 (PDF - 355.6 KB)
SOII Table October 2008 - October 2009
Procedures investigated by SOII for the period October 2008 - October 2009 - represented in a table.
SOII Table October 2008 - October 2009 (PDF - 29.7 KB)
Strangulated Small Bowel Obstruction - VSCC Approved: April 2005
The VSCC has recently been referred a case in which a patient died whilst undergoing surgery for a strangulated femoral hernia. The presumed cause of death was aspiration of gastric content.
Strangulated Small Bowel Obstruction - VSCC Approved: April 2005 (PDF - 19.6 KB)
Support for surgeons following an adverse event - VSCC Approved: May 2007
Over the past few years the Victorian Surgical Consultative Council (VSCC) has looked at a number of serious adverse events, such as 'wrong site surgery', where the surgeon involved has had a major psychological reaction to the situation but has not sought any help and has not been directly offered any help.
Support for surgeons following an adverse event - VSCC Approved: May 2007 (PDF - 22.6 KB)
Surgeon Reponsibility - VSCC Approved: January 2011
Surgeon Reponsibility
Surgeon Reponsibility - VSCC Approved: January 2011
Surgery in Adult Patients with Cystic Fibrosis - VSCC Approved: 24 September 2004
Provides information in performing surgery on adult patients with cystic fibrosis.
Surgery in Adult Patients with Cystic Fibrosis - VSCC Approved: 24 September 2004 (PDF - 9.4 KB)
Surgical Patient Status System - VSCC Approved: July 2004
Although the status of a patient is of obvious importance, a change in a patient's status during the course of his or her inpatient stay should precipitate an identifiable and predictable response.
Surgical Patient Status System - VSCC Approved: July 2004 (PDF - 48.4 KB)
T
The use and care of quivers in the surgical setting - laparoscopic surgery - VSCC Approved: August 2008
Electrical burns to the patient have been reported to Council and it is important that surgeons are aware of the dangers that can occur if multiple instruments are kept in a quiver, or holder, during an operation.
The use and care of quivers in the surgical setting - laparoscopic surgery - VSCC Approved: August 2008 (PDF - 20.9 KB)
Trade Representatives in the Operating Suite - VSCC Approved: February 2005
The Victorian Surgical Consultative Council acknowledge that the presence of trade representatives in the operating theatre can be of great assistance in selecting specialised instruments that are available or in assisting the surgeon in the matter of appropriate component selection.
Trade Representatives in the Operating Suite - VSCC Approved: February 2005 (PDF - 36.0 KB)
Transesophageal echocardiography in cardiac surgery - VSCC Approved: June 2009
Over the past few years the Victorian Surgical Consultative Council (VSCC) has received reports of complications occurring as a result of the use of transoesophageal echocardiography in cardiac surgery. It was decided to refer the issue to the Victorian Consultative Council on Anaesthetic Mortality and Morbidity (VCCAMM) and it has undertaken a detailed study on the matter, briefly summarised here. Please also see discussion of the issue is available on the VCAMM website.
Transesophageal echocardiography in cardiac surgery - VSCC Approved: June 2009 (PDF - 16.6 KB)
U
V
Venous Thrombo-Embolism Prophylaxis - letter to CEOs November 2005
For some time the Victorian Surgical Consultative Council has been considering this difficult topic. After the review of a specific case, approximately twelve months ago, the Coroner recommended that in all peri-operative orders there should be written a clear statement about the appropriate prophylactic measures to be undertaken to minimise the risk of deep vein thrombosis and pulmonary embolism.
Venous Thrombo-Embolism Prophylaxis - letter to CEOs November 2005 (PDF - 24.2 KB)
Venous Thrombo-Embolism Prophylaxis - Risk Assessment form - please consider in reference to letter to CEO as above
A risk assessment form for Thrombosis risk assessment for surgical and medical patients.
Venous Thrombo-Embolism Prophylaxis - Risk Assessment form - please consider in reference to letter to CEO as above (PDF - 98.6 KB)
Venous Thrombo-Embolism Prophylaxis - VSCC Approved: February 2008
Recently the NHMRC have published a Clinical Practice Guideline for the prevention of venous thrombo-embolism (deep-vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals.
Venous Thrombo-Embolism Prophylaxis - VSCC Approved: February 2008 (PDF - 18.1 KB)
Venous Thrombo-Embolism Prophylaxis - VSCC Approved: November 2009
The Victorian Surgical Consultative Council strongly endorses the document published by the National Institute of Clinical Studies (a body of the National Health and Medical Research Council) entitled 'Stop the Clot'. Copies of the 'Stop the Clot' guides and associated resources, including translations of the patient brochure, are available for download from the NICS website. Follow the links to 'programs' and 'VTE prevention'.
Venous Thrombo-Embolism Prophylaxis - VSCC Approved: November 2009 (PDF - 37.9 KB)
NICS Venous Thromboembolism Risk Assessment Form - Version 1 2007 (PDF - 33.7 kb)
Victorian Surgical Consultative Council Inaugural Report 2001 - 2004 - November 2004
The Victorian Surgical Consultative Council (VSCC) was established in October 2001, by the then Minister of Health, the Hon John Thwaites MP with the aim to continuously improve the safety and quality of surgery in the state of Victoria.
Victorian Surgical Consultative Council Inaugural Report 2001 - 2004 - November 2004 (PDF - 221.3 KB)
Victorian Surgical Consultative Council Triennial Report 2005-2007
Over the past three years, the VSCC's work has increased considerably. In this report we have presented 21 clinical practice statements or guidelines, all of which relate to specific cases that Victorian surgeons have voluntarily reported to the VSCC.
Victorian Surgical Consultative Council Triennial Report 2005-2007 (PDF - 582.4 KB)
W
Warning re: New Anti-Platelet Drugs and potential hazards of Surgery and Major Regional Intraspinal Analgesia
A warning re: New Anti-Platelet Drugs and potential hazards of Surgery and Major Regional Intraspinal Analgesia.
Warning re: New Anti-Platelet Drugs and potential hazards of Surgery and Major Regional Intraspinal Analgesia (PDF - 7.9 KB)
