Practice matters

 

How to set up a trolley

In this video, we will look at how we set up our trolley prior to doing our dermal filler procedures, and this is the same set up that we use every time we treat a patient in the clinic. As we know, these procedures are not performed under truly aseptic conditions, but we must try and keep them as clean as possible. Accordingly, I like to divide my trolley into a sterile and a non-sterile area. I begin by taking a sterile pack and opening it out to create a sterile area on one side of my treatment trolley. I now have some sterile gauze, and this is useful for ongoing cleaning during the procedure. I also have my skin cleanser here, and I like to use chlorhexidine in alcohol in a spray bottle as it is more convenient and helps avoid contamination. I will then spray the sterile gauzes ready for use. Everytime we touch the patient we contaminate the skin, so to keep the procedure clean I have some alcowipes containing chlorhexidine and ethanol. You will notice on some videos that there are times when we need more sterility for the patient, and in doing so I like to use these sterile towels, and that way I can use them to drape over the patients’ face, particularly if I am going over the hairline.

 

Next, I have my non-sterile gloves, and I prefer nitrile or vinyl because some patients have documented latex allergies. I am a huge fan of marking patients every time we treat them, and accordingly I will use a variety of skin marking pencils to make these marks on the patients prior to the treatment. Then, I will have the product itself, which I will open up ready for use. As you know, the product itself will come with some pre-packaged needles, and there are times when we use those needles themselves, however in some more delicate areas we may prefer to use cannulas. Accordingly, I will then also take a selection of cannulas for use. Here, I have got a 25 gauge cannula and also the needle that comes with it to make the entry hole. I find these cannula stands very useful, because what it allows you to do mid-treatment, especially if you are working on your own, is to pop the syringe and cannula down without contaminating it. If we need to remove the needles or the cannula from the syringe it can be very useful to have a pair of artery forceps to do that with. I also use some sterile swabs on a stick like these to stop bleeding, especially if we are using a cannula as sometimes we get bleeding from the entry hole. In many procedures, I like to measure the patients, and I use these particular rulers, which can be found inside the sterile marker pen packs. After perioral procedures on the lips, I use petroleum jelly with a spatula, and this can be very useful for massaging. For the face, I use a variety of different creams, and it doesn’t really matter which cream you use, some people prefer arnica, but I don’t think it matters what’s inside as long as the cream allows you a little bit of lubrication.

 

To keep the patient’s mind off the procedure I use a little stress ball which they can squeeze, and I keep a hand mirror so I can show the patient the result at the end of the procedure. One thing I like to do for patient comfort is to use ice in a sterile glove. You will notice that these gloves are vinyl, not latex, again because of the risk of allergy, and what I do with these is pop a little piece of ice in there, as demonstrated here, and tie off the end. I can then use the ice to numb the skin a little bit, but as well as numbing the skin, the other advantage is that it causes a degree of focal vasoconstriction, which means that the patient is less likely to bruise following the injections. When I take the ice off, I can simply clean with the alcowipes before proceeding to inject. Last, but certainly not least, one of the most important items is the hyalase, and the saline that we use to reconstitute it with, and it’s good practice to have this close at hand during filler procedures alongside the appropriate needle and syringe. If we now pan out, we can see that this is what would be the basic contents of the trolley all set up for a dermal filler procedure.