Care In The Operating Room Flashcards
What number should infectious patients be on the list
Last to avoid contamination
WHO surgical safety checklist
1- prelist briefing 2- sign in 3- time out 4- sign out 5- post list briefing
Sign in
Should be done prior to induction of anesthesia
1- has patient confirmed their identity and surgery
2- is the surgical site marked?
3- is the anesthesia machine and medication check list complete?
4- does patient have any allergies?
5- is there airway obstruction or aspiration risk?
6- is there risk of >500 ml blood loss(>7ml/kg in children)
7- antibiotics 8- venous thromboembolism prophylaxis
9- monitoring
Also removal of dentures and jewellery and confirmation of any implanted metal
Antibiotics
To be given less than an hour before surgery.
Discontinued within 24 hours.
Not used in clean non-prosthetic surgery
VTE prophylaxis
Mechanical via graduated compression stockings. Pneumatic compression devices and foot impulse devices.
Also by medications
Risk of vte greater in which type of anesthesia
General
Ventilation in OT
Atleast 20 air changes per hour.
In laminar flow it is 100-200
Temperation in ot
20-24 degree Celsius
Humidity in Ot
50 to 60 percent
Who oversees patient transfer and positioning
Surgeon and anesthetist
Transfer is aided through
Sliding boards
Friction free sliding sheets
Pressure areas to be given special care during positioning of patient
1- skin over bony prominences
2- superficial nerves like common peroneal nerve
3- stretchable nerves like brachial plexus
4- areas at risk of developing compartment syndrome
5- eye protection
Intraoperative radiological imaging requires
Lead shielding of patient and radiolucent table
Where should monopolar diathermy dispersal electrode be applied
Clean dry hairless skin. Situated over well perfused muscle. Away from scars. Bony prominences. Areas distal to tourniquet. Implanted metals
Implanted devices that may be affected by diathermy
Cochlear implants
Spinal cord stimulation
Pacemakers
Implanted defibrillators
Complications of tourniquet use
Neurovascular compression
Direct skin compression
Chemical burns by fluids that leak under the tourniquet
Distal ischemia and reperfusion injury
Tourniquets are avoided in which patients
Those of sickle cell disease
And
Peripheral vascular disease
Max pressure of tourniquet
Above 100 mmHg in upper limb surgery
And above 150 in Lower limb
Principles of application of tourniquet
Apply it as proximally as possible.
Exsanguinate Limb prior to inflation.
By elevation. Esmarch bandage. Roll cylinder.
Note time of application and removal of tourniquet.
Always apply padding.
Max time of tourniquet usage
1.5 hours
Time out
Prior to surgery. Verbal confirmation of patients identity. Confirmation of antibiotic prophylaxis. Temperature control. Hair removal. Glycaemic control. Infection control.
Temperature control
Use warm IV fluids. Warm blankets. Change OT ambient temperature. Avoid excessive patient exposure.
Glycaemic control
Hyperglycaemia perioperatively increases risk of postoperative infections
Scrubbing up
Jewellery removed prior to scrubbing.
Nails and deep skin creases cleaned with brush.
Hands and firearms cleaned atleast 3 times.
Dried from distal to proximal with sterile towel.
Hands should remain inside gown till gloves are applied either by one person or two person technique. Hands should remain above waist level this point forward
Scrub solutions
1- 2 percent chlorhexidine
2- 7.5 percent povidine iodine
3- alcohol
Chlorhexidine
Lasts for 4 hours.
Poor against tubercle bacilli
Povidine iodine
Shorter duration of action
Alcohol
Ineffective against spores
Movement of scrubbed personnel in OT
Hands at Operating table at all times.
Keep hands away from faces.
Not lean over unsterile areas.
Pass each other back to back or front to front.
Pre-prep
Required in visible debris.
Cleaned first with soapy detergent.
Then water.
Then with surgical detergent.
Prepping
Done with same solutions. At surgical site and area adjacent. Use 2 coats. Avoid excessive use to prevent chemical burns. Groin. Perineum. Axilla are cleaned last
Draping
Drapes held only by sterile personnel
Once put in place shouldn’t be removed
Diathermy and suction equipment can be held in place over the drapes.
Sign out
Record operation.
Count the number of instruments and swabs used.
Note that there have been no equipment problems that require fixing.
Note the key concerns for the post-op care of the patient.
Operation Note
Should include Time and date of operation. Type of operation. Type of anesthesia. Patient positioning. Surgeon name. Anesthetist names Use of diathermy. Tourniquet application. Antibiotics given. Skin prep and draping. Incision. Findings. Operation details. Any implants used. Closure and suture material. Complications. Postoperative instructions. Time line for normal recovery as in when to mobilise patient. Start oral feed. Dressing changes. Discharge and follow up details.
