Advanced SX Lecture 1: Operating Room Protocol Flashcards

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1
Q

What are the 3 distinct and separate areas of the surgery suite?

A

1) Preparation area
2) Scrub area
3) Surgery room

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2
Q

Preparation area:

A
  • Clipping and initial scrub
  • Storage of surgical supplies
  • “Dirty” procedures
  • Tx of impacted anal sacs
  • Debridement of old wounds
  • Tail docking, declaw
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3
Q

What happens in the Scrub area?

A
  • Scrub sink
  • Autoclave
  • Room to put on gown and gloves
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4
Q

Surgery Room

A
  • Only for surgery, dedicated room for sterile surgical procedures
  • Closed off from the rest of the hospital
  • Door closed
  • Cabinets for sterile supplies:
    Nonporous material
    Have doors that can be closed
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5
Q

What does Sterile mean?

A

Absence of all living microorganisms, including spores

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6
Q

What does sterilization mean?

A

The use of physical or chemical procedure to destroy all microorganisms including resistant bacterial spores

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7
Q

What does Asepsis mean?

A

A state of being free of disease-causing microorganisms

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8
Q

What is Aseptic technique?

A

The prevention of contamination from harmful microorganisms. (Hygienic rules, limit risk of infections)

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9
Q

What is Sterile technique?

A

A set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (By not contaminating it with non-sterile objects)

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10
Q

What is considered a sterile field?

A

Any area that has been covered with a sterile barrier.

  • Gown
  • Sterile table cover
  • Drape(s)
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11
Q

What are the main members of a complete veterinary surgical team?

A
  • Surgeon
  • Surgical assistant
  • Monitoring nurse
  • Circulating nurse(s) (Only nurse allowed in and out of the surgery room)
  • Recovery nurse (s)
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12
Q

What are considered the sterile areas?

A
  • The scrubbed personnel’s gowns in front from the chest to the waist or level of the sterile field.
  • The sleeves of the sterile gown are sterile from 2” above the elbow to the top of the edge of the cuff.
  • Up to 1” of where the drape contacts the nonsterile surface (Ideally table edge)
  • Any double draped table (Instrument table, mayo stand)
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13
Q

What are the 9 Principles of Surgical Asepsis Technique?

A

1) All materials in a sterile field must be sterile. All objects added to your sterile field must also be sterile.
2) A sterile barrier that has been compromised by punctures, tears, or moisture has to be considered contaminated.
3) Once a package is opened, a 2.5cm (1inch) border around the edge is considered unsterile.
4) Tables draped as part of a sterile field are considered sterile only at the table level. Therefore, the table legs, underside of the table, or any shelves below the table are to be considered unsterile.
5) If there are any questions or doubts about an object’s sterility, the object should be considered unsterile.
6) Sterile people and objects should only come into contact with sterile fields, and unsterile people and objects only come into contact with unsterile areas, such as the 2.5cm border.
7) Movement around or in the sterile field must not compromise or contaminate the sterile field.
8) Anything out of your range of vision or below waist level is considered contaminated and unsterile.
9) A sterile object or field can become contaminated by lingering exposure to air.

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14
Q

What is the surgical conscience?

A

Commitment of the surgical personnel to adhere strictly to aseptic technique.
- To prevent potential risk of infection, resulting in harm to the patient
- Be aware of your surroundings… Watch your hands and gown!
- Report any break in aseptic technique and addressed or corrected

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15
Q

What are some general rules for maintaining sterility?

A
  • Keep sterile things (hands, instruments) within sterile field, and contaminated items outside sterile field.
  • When moving in surgery room: turn sterile towards sterile and contaminated towards contaminated
  • Minimize air currents to prevent airborne microorganisms settling on the incision and surgical field. - Minimize talking and traffic within operating room
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16
Q

What are some rules for movement to maintain sterility?

A
  • Keep sterile field in sight**

Scrubbed personnel:
- Should not walk away from the sterile field.
- Keep hands within the sterile field, keep together in “prayer” position or closed-fist at mid chest when outside sterile field

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17
Q

How do you move when passing between two sterile fields?

A

Walk straight through so sides face sterile fields

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18
Q

How do you move when passing between a sterile and a contaminated area?

A

Turn sterile front to sterile area, and back to contaminated area

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19
Q

How should sterile people pass, with hands clasped?

A
  • Back to back
  • Front to front
20
Q

How can an unscrubbed (Non-scrubbed-in) personnel maintain sterility?

A
  • Always face sterile field
  • Should not walk between two sterile fields (Example: Between draped patient and sterile equipment table)
  • Maintain safe distance from the sterile field
21
Q

What are 5 basic rules for scrubbed personnel?

A

1) Hands above your waist at all times and in view - Clasp them in front of you at chest level when idle
2) If you’re not sure, don’t touch it
3) In the O.R? Mask and cap on… no exception
4) Be aware of your surroundings and move with care and caution
5) Ask for assistance - Nose scratcher, eyeglass pusher-uperer, and sweat wiper

22
Q

What is Intubation equipment?

A

Laryngoscopes
- Light source
- Increase visibility of larynx
- Blades depress tongue & epiglottis - Miller = straight
- Macintosh = curved

23
Q

Thermal support: Circulating warm water blanket: Benefit & Challenge:

A

Benefit: Little risk and good for all procedures; can go in cage

Challenge:
- Not puncture proof
- May leak
- Do not place patient directly on the blanket to prevent thermal burns

24
Q

Thermal Support: Bair Hugger Benefit & Challenge:

A

Benefit:
- Different sizes of disposable blanket
- Very mobile
- less risk of puncture because the blanket in not placed until the patient is anesthetized

Challenge/Controversy:
- Forced warm air may spread bacteria that is involved in infection acquired in hospitals
- May contaminate sterile air being used around the patient
- Not puncture proof’

25
Q

Thermal Support: Hot Dog Warmer Benefit & Challenge:

A

Benefit:
- Can wrap around patient
- Can go in cage
- Sensor to regulate temperature, easy cleanup
- Less wasted heat than forced-air warming (FAW)
- Better warming due to conductive heat transfer and larger surface area of simultaneously heating

Challenge:
- Not puncture proof

26
Q

What is the purpose of suction?

A
  • Clear surgical field of blood
  • Remove flush
  • Reduce effusion
27
Q

What are the benefits of Suction?

A
  • Measure fluid loss
  • clear view of site
28
Q

Important things to note about suction:

A
  • Finicky - Clogs; pressure changes
  • High vacuum: potential damage to delicate tissue
  • Low vacuum: Inadequate suction
  • Opened and unused tubing can be re-sterilized
29
Q

What is Arthroscopy?

A

Endoscope used to explore and treat various joint disease.
- Confirm torn CCL
- Remove osteophytes
- Identify and provide treatment for meniscal tears
- Improve visualization of important anatomic structures during surgery

30
Q

How does Arthroscopy work?

A
  • Patient is sedated or anesthetized
  • Small incision made in the joint through which the arthroscope is inserted
  • Light source and camera lens projects the image of the joint onto a monitor.
  • Vet surgeon can see the joint on the monitor and determine if any abnormalities exist.
  • If surgery is required, surgeon will watch the monitor while performing surgery on the diseased joint.
31
Q

What are some advantages of using Arthroscopy?

A
  • Small incision
  • Less post-pain
  • Shorter post surgical recovery time
  • Maintenance of more muscle mass after surgery

Not for all procedures, may require CT or MRI prior to procedure.

32
Q

What is Electrosurgery? Benefts?

A
  • The use of electricity, transmitted through a special hand piece to cut or coagulate vessels.

Benefits:
- Reduce operative times
- Blood loss
- Reduce anesthesia time

33
Q

Electrosurgery: What is monopolar?

A
  • Most commonly used because of its versatility and effectiveness. - Cut tissue and coagulate bleeding
  • Pencil tip
  • A ground plate is used under the patient - Current from generator > Handpiece > Target tissue > Ground plate > Generator
34
Q

Electrosurgery: What is Bipolar?

A
  • Electrodes are often at the tip of a pair of forceps or scissors
  • Limited ability to cut and coagulate large bleeding areas
  • Ideally used for tissues; can be easily grabbed on both sided by the forceps electrode
    Ex: Neurosurgery, procedures around eyes or eyelids
  • No ground plate used under the patient - Current from generator > One side of the handpiece > Target tissue > The other side of the handpiece > Generator
35
Q

What is Biomedical (Surgical) Laser?

A

Uses light beams instead of instruments for surgical procedures

36
Q

What is the purpose of Biomedical (Surgical) Laser?

A
  • Ablation
  • Incision and excision of soft tissue

2 Most common:
- CO2
- Diode

37
Q

Benefits of Biomedical Surgical laser?

A
  • Precise incision
  • Hemostasis
  • Reduced risk of surgical infection
  • Reduced inflammation
  • Less post-op pain
  • Faster recovery
  • Less tissue trauma
38
Q

What are some disadvantages of Biomedical (Surgical) laser?

A
  • Delayed wound healing
  • Safety (Eyes especially)
  • Smoke inhalation
39
Q

What are some laser procedure in veterinary medicine?

A
  • Lump removal
  • Castration
  • Amputation
  • Cystotomy
  • Thoracotomy
  • Ophthalmic procedures
  • Oncologic procedures
40
Q

A record should be kept for each procedure performed:

A
  • Procedure type
  • Power
  • Duration setting
41
Q

What are some laser hazards?

A
  • Eye hazards
  • Skin hazards
  • Smoke plume hazards
  • Fire hazards
42
Q

How do you avoid eye hazards?

A
  • wear specific eye protection goggles to prevent corneal or retinal damage for everyone, including the patient
  • Cover the patient’s eyes with moistened sponges
43
Q

What causes skin hazards and how do you avoid them?

A
  • From direct or scattered laser beams
  • Optional gloves and gowns for added protection
44
Q

What causes and how to avoid smoke plume hazards?

A
  • Emitted smoke contains toxic and carcinogenic chemicals
  • Bacterial and viral particles
  • Always perform laser procedure with an evacuation system
  • Use laser surgical masks
45
Q

What causes and how to avoid fire hazards?

A
  • From drapes, anesthetic agents, oxygen, patient’s fur, alcohol products, even from flatulence!
  • Use nonalcohol surgical prep
  • Ensure the cuff of the ET tube is inflated properly
  • Use laser-safe ET tube (Non-PCV), or moistened sponges around the standard ET tubes
  • Moistened sponges within the rectum