VSCC guidelines & 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
Includes information and recommendations that should assist surgeons confronted with similar cases.
Acute Cholangitis and Availability of Urgent ERCP Services (PDF - 43.9 kb)
Acute Mesenteric Ischaemia
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 (PDF - 39.5 kb)
Adverse events: Immediate counselling for surgeons
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 (PDF - 16.2 kb)
Air Embolism Associated with the use of Hydrogen Peroxide - A Warning - 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 - October 2005 (PDF - 39.3 kb)
Assistance at Difficult Operations - April 2005
In many surgical disciplines, from time to time, difficult cases are encountered when the help of an experienced colleague would be of benefit to both the patient and the surgeon.
Assistance at Difficult Operations - April 2005 (PDF - 21.4 kb)
C
Canadian C-Spine Rule
Canadian C-Spine Rule (PDF - 42.9 kb)
Cases Of Sudden Death Following Lumbar Spinal Surgery In The Elderly - 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 - August 2004 (PDF - 35.6 kb)
Cervical spine injury (soft tissue)
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) (PDF - 16.1 kb)
Cervical spine injury - New England Journal of Medicine
Cervical spine injury - New England Journal of Medicine (PDF - 79.2 kb)
Code Crimson
The VSCC has discussed this particular initiative, which is a "life saving measure to treat exsanguinating surgery in trauma".
Code Crimson (PDF - 16.5 kb)
Complications of ERCP - 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 - April 2007 (PDF - 42.8 kb)
Component selection practices - June 2005
Describes the component selection practices in preparation of surgical procedures.
Component selection practices - June 2005 (PDF - 39.8 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)
D
Decompression laminectomy and venous emboli - sample case - 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 - May 2007 (PDF - 23.3 kb)
Diverting end stomas
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 (PDF - 13.8 kb)
E
Endoscope - An unusual problem - June 2005
An unusual problem encountered with the use of an arthroscopic shaver.
Endoscope - An unusual problem - June 2005 (PDF - 20.2 kb)
F
Fatigue during long operations
The Australian Council for Safety and Quality in Health Care, the Australian Medical Association, and various government bodies have drawn attention to the relationship between fatigue and adverse events.
Fatigue during long operations (PDF - 29.8 kb)
G
Guidelines for Emergency Gastrostomy replacement - replacement with balloon tube
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 (PDF - 45.6 kb)
Guidelines for the management of bile duct stones - 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 - June 2004 (PDF - 31.7 kb)
Guidelines for the Management of Ruptured Aortic Aneurysm - June 2004
50% of patients who rupture an AAA do not reach hospital alive. Of those who reach hospital alive in Victoria, 35% will succumb despite urgent surgery and resuscitation. The question may arise as to whether attempted salvage by an urgent operation should be undertaken.
Guidelines for the Management of Ruptured Aortic Aneurysm - June 2004 (PDF - 31.2 kb)
Guidelines for the Management of Upper Gastrointestinal Bleeding
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
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 (PDF - 20.6 kb)
I
Incorrect IOL Implantation
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 (PDF - 21.3 kb)
Informed Consent - Checklist - April 2005
A checklist for the person obtaining consent, prior to obtaining consent.
Informed Consent - Checklist - April 2005 (PDF - 40.1 kb)
Inter-hospital Transfer of Unstable Surgical Patients
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 (2nd edition)
The notes in this manual are intended as a guide to assist junior medical staff to manage/initiate treatment of serious conditions. This is the second edition of the manual, published December 2008.
Intern manual - Immediate management of surgical emergencies (2nd edition) (PDF - 1.4 mb)
Intern manual - Immediate management of surgical emergencies
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 (PDF - 1.3 mb)
K
Key Principles for the Management of Specimens - October 2007
Key principles for the management of specimens for pathological diagnoses.
Key Principles for the Management of Specimens - October 2007 (PDF - 43.0 kb)
Knee Replacement, Epidural Anaesthesia and Myocardial Infarction - 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 - August 2004 (PDF - 18.5 kb)
M
Management of Fluid Overload in Endometrial Resection and Hysteroscopic Surgery - March 2005
Fluid absorption during hysteroscopy surgery can lead to hyponatraemic encephalopathy and death.
Management of Fluid Overload in Endometrial Resection and Hysteroscopic Surgery - March 2005 (PDF - 23.0 kb)
Medicolegal Death Investigation in Victoria
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 (PDF - 54.3 kb)
Megacolon and colonic perforation - 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 - June 2007 (PDF - 24.3 kb)
Mesenteric Ischaemia in Endografting for Abdominal Aortic Aneurysm (AAA) - 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) - September 2005 (PDF - 28.3 kb)
N
Nursing staff concerns over retained instruments
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 (PDF - 12.5 kb)
P
Patients who self discharge or refuse treatment
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 (PDF - 13.6 kb)
R
Reaction to Protamine Sulphate - 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 - 29 September 2004 (PDF - 18.3 kb)
Reporting Surgical Deaths - Potential Model - 18 December 2003
Provides a flow chart of a potential model for reporting surgical deaths.
Reporting Surgical Deaths - Potential Model - 18 December 2003 (PDF - 13.1 kb)
S
Sepsis following colorectal surgery - May 2005
A serious complication following colorectal surgery is anastomotic leak and intraabdominal sepsis.
Sepsis following colorectal surgery - May 2005 (PDF - 23.0 kb)
Strangulated Small Bowel Obstruction - 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 - April 2005 (PDF - 19.6 kb)
Support for surgeons following an adverse event - 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 - May 2007 (PDF - 22.6 kb)
Surgery in Adult Patients with Cystic Fibrosis - 24 September 2004
Provides information in performing surgery on adult patients with cystic fibrosis.
Surgery in Adult Patients with Cystic Fibrosis - 24 September 2004 (PDF - 9.4 kb)
Surgical Patient Status System - 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 - July 2004 (PDF - 48.4 kb)
T
The use and care of quivers in the surgical setting - laparoscopic surgery
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 (PDF - 20.9 kb)
Trade Representatives in the Operating Suite - 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 - February 2005 (PDF - 36.0 kb)
Transesophageal echocardiography in cardiac surgery
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 (PDF - 16.6 kb)
U
V
Venous Thrombo-Embolism Prophylaxis
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 (PDF - 37.9 kb)
NICS Venous Thromboembolism Risk Assessment Form - Version 1 2007 (PDF - 33.7 kb)
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)
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)