Open Hartmann Procedure Periprocedural Care

Updated: Jun 02, 2017
  • Author: Angel Mario Morales Gonzalez, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Equipment

The following equipment is needed to perform a Hartmann procedure:

  • Standard exploratory laparotomy tray
  • Sterile gloves and gowns
  • Sterile drapes
  • Skin preparation solution (the authors prefer ChloraPrep [CareFusion, San Diego, CA], which consists of 2% chlorhexidine gluconate and 70% isopropyl alcohol)
  • No. 10 blade
  • Bovie electrocautery
  • Bookwalter retractor (Codman & Shurtleff, Raynham, MA) or other self-retaining retractor
  • Fiberoptic retractor to facilitate visualization of the pelvic structures
  • Several types of sutures and ties, including chromic, polyglactin, polypropylene, and polydioxanone
  • Sterile sponges and laparotomy pads
  • Sterile irrigation solution (water and normal saline)
  • Suction system
  • Linear cutting staplers of various sizes (30 mm, 60 mm, 90 mm)
  • Drain (sometimes used; the authors prefer the Jackson-Pratt)
  • Skin stapler
  • Ostomy wafer and bag
Next:

Patient Preparation

Anesthesia

General anesthesia is required for a Hartmann procedure. Once the patient is asleep and the endotracheal tube is in place, the patient can be positioned.

Positioning

The supine position is employed. Often, the patient can be placed in a mild Trendelenburg position to facilitate visualization of the pelvic structures and retraction of the small bowel.

To ensure correct anatomic positioning, the patient's arms should be tucked at the sides, with the palms facing toward the thigh and the thumb facing in a relaxed upward position. The hands must be completely and securely encased in the wrap. To avoid compromising perfusion to the fingertips, care should be taken not to wrap the hands too tightly.

Next, a warming blanket, such as the Bair Hugger (Arizant, Eden Prairie, MN), is placed at the nipple line on the top portion of the patient. The patient’s feet must be uncrossed. A blanket is placed on the patient from the midthighs to the toes and secured with a patient safety belt. It is important to ensure that the patient does not come into contact with metal at any time.

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