Nail surgery procedures in private practice

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Hi!

I am a newly qualified Podiatrist working in private practice in a physio clinic. There are no other Podiatrists or assistants working with me. My manager would like me to do nail surgery procedures asap, but I am unsure where I stand as to if I require an assistant or need a more experienced Podiatrist working with me. Does an assistant need to be a qualified Podiatry assistant?

Any replies would be appreciated!

Thanks!

 

While it maybe different from Country to Country.

- if you have a licence for local. ( ie I have in Australia but not in Sweden)

- Sterile instruments and the instruments you require

- are confident in your technique and ability to create a " sterile field"

You can do this on your own, but if your not confident find a mentor who may help get you up to speed. But if you have done a few at school and feel confident and can set your procedure requirements, follow up procedure and room up. Go for it.

Good luck

 

Thank you for your advice!!

 

Hi VT1311

I can still remember the very 1st PNA I did in private practice. I was very nervous despite 3 years post grad and coordinating the NHS PNA service!!! My assistant was my dearly beloved! I think that's what made me nervous....

I work in PP in the UK and 25 years on it is nice to know that there is a receptionist about the practice to call on incase of problems which seldom occur...hmmm have never occured. I have no concerns about carrying out a PNA without an assistant available. There is no legislation to say you must have qualified help available whilst you carry out nail surgery.

One tip though, have everything prepped or to hand. Just occasionally you will get a no show patient so don't do the final set up until the LA is in that foot. If you pre set up before patient arrival, all that stuff goes to waste with a no show. During the time that the LA is taking effect get that sterile field set up. I liken it to an actor setting the scene and I explain to the patient what I am doing. It also instills confidence as they see sterile packs being opened and the stage being carefully set.

It is a good bit of time to chat to the patient and it really does help them relax after the LA has gone in. Watching you work is a bit of a distraction.

If your manager is asking you to do nail surgery, ask him/her to be your assistant. Good management PR with the patient and they can do the necessary timings for you - torniquet time etc.

Another tip - a nice big clock directly in your vision!

GB

 

Hi vt1311

As usual, very sound advice from George! I would add a couple of points, as a lone practitioner within a GP surgery. Although I work alone, there is plenty of back up in the building, and I get well organised so that everything is to hand. I give the patient a watch with a second hand because I dont have a clock in the room, and that gives them something to do!

After your first lone proceedure you will go over and over it in your head-replaying the whole thing and thinking-did I take the tournicot off? did I get all the nail out ? did I do this ,did I do that? And then something else comes along and you forget all about it and the phone doesnt ring over the weekend, and the patients toe hasnt dropped off and they havent bled to death................all that worry for nothing!

Here I am 16 years on , much more relaxed about it all now, I cant believe I ever worried about doing it alone.

Best of luck, you will be fine!


Cornmerchant

 

...Oh and another tip...

On your post op advice sheet put your mobile number and stress that they can phone you day or night. I can't exactly remember when I first started doing this - how long have we had mobile phones small enough to carry with us? A decade? In that time I have had one phone call at about 10am when the decorators were in at the practice. I couldn't see the lady but I organised her to see a colleague.

It is one of those touch stones of security that we can offer patients in PP and to date that touch stone has never been abused. Patients worry about who to contact in case of an emergency if they have no one to contact but if they do, they don't worry and emergencies just don't happen.

GB

 

Hi vt1311

Michael and George give good advice contact number and patient information - however on the issue of doing this work without any assistant I must disagree.

I think it is not just a good idea but actually essential to have an assistant.

It is true that there is no legislation to say you must have qualified help available whilst you carry out nail surgery (although there is a common law requirement to have the resources you need to perform treatment safely). It would be difficult to defend the lack of an assistant if there was a problem and you had to leave the patient untreated while you phone the ambulance.

The assistant should be competent for the tasks you require of them (does not have to have a professional qualification just needs to have been adequately trained by you to safely do what you ask of them). One of the main things they would do in an emergency would be to get help from your colleagues in the physio clinic and call the ambulance (while you would remain free to look after the patient). It would help to have a card stuck by the phone with the procedure to make it easier for the assistant and the ambulance control – as such a time of stress is not the ideal moment to think of what needs to said and what the address to come to is. The assistant can also then be at the door to assist the paramedic get to you in your room without delay.

Now the chances of an emergency happening are almost nil – but it would be negligent not to have considered it occurring and having procedures thought out in advance (and practiced and agreed with your assistant). I would suggest you update your training in Basic Life Support and Anaphylaxis regularly which will ensure you have considered all sensible precautions. If nobody else in your building has Immediate Life Support training then really that would be best for you.
I would also ensure you have oxygen and adrenaline (epinephrine) and check it regularly.

I am not trying to be negative here (I have thankfully given many thousands of toe blocks, ankle blocks and popliteal blocks and never had such an occurrence – but I have always worked on the basis prepare for the worst by taking all reasonable precautions).

After all our profession fought hard to preserve the right to give LA and it is our duty to keep out.

Also on the tourniquet advice – very sound I would advise use of the Tournicot from Canonbury (no financial link with me) as it would be almost impossible to leave it on.

I wonder what professional body you are in – as they would be the best source for all this information.

Good Luck

Tom

 

Hi vt1311

I totally agree with Tom always have an assistant with you. i always have a asisstant with me when doing toenail surgery you maintain your sterile field.
We have guide lines up on the wall. i.e instructions of what to do in an emergency.
You should have current CPR training also.

jaynes