Chapter 10 Flashcards
instrumentation, equipment, and supplies
what are most instruments made of
stainless steel
carbon, chromium, and iron
may become magnetized
titanium
stronger, lighter weight, non magnetic
finishes on instruments
polish- cheapest
satin- little glare, doesn’t last
ebonized - when dealing with laser, non reflective
instruments classifications
read info in text
cutting/ dissecting
grasping/ holding
clamping/ occluding
retracting/ viewing
probing/ dialating
suturing
suctioning
accessory
subcategory instrument classifications
micro- instruments
endoscopic
cutting/ dissecting example
NTK scalpel handles blades combos
bookwalter retractor
self retaining OR retractor
greenburg retractor
self retaining OR neuro retractor
thompson retractor
self retaining abdominal retractor
used for smaller things like veins
attached to the OR table
instrument care and handling cycle pt 1
pre op care
-gather instruments
-come in sterilized sets
-open onto sterile field
-organize back table and may
-check for proper function
instrument care and handling cycle pt 2
intra op care
-anticipate needs of patient + team
-need a proper knowledge of
- anatomy + physiology
- pathology
- sterile technique
- watching team for sterile tech.
- environment concerns
instrument care and handling cycle
pt 3
post op care
- prepare instruments for reuse
- clean + decontaminate
- inspect + maintenance
- reassemble set
- sterilize
- storage
benefits of proper instrument care and handling
prevent injuries
extend instrument life
allow correct performance
complex and expensive to replace
don’t use for anything other than intended purpose
what is an instrument set
group of instruments assembled into pan + sterilized
- primary set, general
- secondary set, more specific
- individ. wrapped inst, peel pack
includes a count sheet, inst, list
what is instrument list/ count sheet
type and number of instruments
used by an assembler to minimize errors
handed to circulator at beginning of case for verbal/ visual count
count before each case + closure
cryotherapy units
uses gas to deliver extreme cold to diseased tissues
what chemicals does cryotherapy use
liquid nitrogen
freon
carbon dioxide
how does cryotherapy work
creates necrosis without damage to adjacent tissues
examples of cryotherapy units
remove tumors
repair retinal detachments
extract cataracts
irrigation/ aspiration units
phaco-emulsifier
- ultrasonic energy to remove diseased eye lenses
- liquifies tissue to suck it up
-pressure automatically adjusted in ant chamber of eye
piezoelectric machine
irrigation/ aspiration unit
uses electric impulses to generate heat, targets a single tissue then immediately cools down
what kind of instrument is used for ortho
power instruments
three kinds of power instruments
battery- chargeable battery
pneumatic
electric- power from wall
pulse lavage irrigator
trauma + total hip/ knee
irrigates wound w/ pressure hose
suctions while irrigating
insufflator
abdominal cavity
swells it up for MIS so scope can see
nerve stimulators
checks function of nerve
locates nerve
prevents severing nerves
pneumatic tourniquets
air flows through and blows up to cutoff blood flow
what are drapes for
barrier to isolate and protect surgical site
qualities of drapes
lint free
fluid resistant
antistatic
tear resistance
nontoxic
no retina body heat
non reflective color
flame retardant
drape materials fabrics: non woven
non woven
- disposable
- synthetic
- aluminum coated
- light + strong
drape materials fabrics: woven
woven
- reusable
- water repellent
- laundered and sterilized
three plastic adhesive drapes
incise
aperture
isolation
incise drape
apply after prep is dry
incision made through the drape
aperture drape
adhesive around the edges
for eyes and ears
allows surgeon to view landmarks
isolation drape
large drape for visualization of patient + c arm
used in hip procedures with fracture table
fenestrated drapes
contains opening specific to the area to be exposed
covers feet and anesthesia screen
non fenestrated drapes
used to “square off”
1st layer of draping
used to cover unaffected body parts
custom design to cover specific areas
ex: blue towel + stockinette
sterile packs
first item opened for procedure
placed on back table
commercial or created in house
basic + highly specialized cases
basic sterile pack examples
mayo stand cover
2 gowns
suture bags
4 sticky drapes
2 paper hand towels
functions of surgical sponges
absorb blood and fluid
blunt dissection
protect structures
all sponges are:
counted + radiopaque
lap sponges
pack of 5
large blood loss expected
moistened in saline
raytec sponge
pack of 10
small incision minimal blood loss
put on sponge stick for blunt dissection
cottonoid sponges
pack of 10
also called patties + neurosurgical
soaked in hemostatic agent- liquid cocaine
tonsil sponge
5 pack
round
loaded on tonsil/ Schmidt clamp
kitner sponge
5 pack
roll of cotton tape
used for blunt dissection
peanut sponge
5 pack
small gauze sponge
used for blunt dissection
functions of dressings
protect from trauma + microbes
absorb drainage
support incision
provide pressure- prevent swelling + bruise
tinctures to increase dressing adhesivness
benzoin
mastisol
application and changes of dressings are done in:
sterile conditions
remove outer gloves before handling
dressings vs sponges
no radiopaque mark
open after final count
dressings determines by
type, size, location of wound
amount of drainage expected
age and size
condition of surrounding skin
underlying medical conditions
biological dressings used to:
work on patients with burns trauma ulcers etc.
to protect wounds
prevent contamination
reduce fluid loss
temporary coverage
skin grafts applied to:
thermal injury, burn/ road rash
extensive skin loss
skin graft classifications
full thickness- composite grafts
split thickness
autograft- skin graft
autologous
taken from one part of body to another
homograft- skin graft
homologus
taken from cadaver or another person
heterograft- skin graft
xenograft
different species
usually porcine or bovine
(pig or cow)
one layer dressings include
transparent film w/ adhesive back
liquid collodion
hydrocolloids
skin closure tapes
adhesive sprays
foams or gels
derma bond
three layer dressings
expecting drainage
simple (bandaid) to very complex
3 components
- inner (contact) : primary
-intermediate (absorbent): secondary
-outer (securing): tertiary
examples of intermediate (absorbent) layer
kerlix fluffs, abd pads, 4x4 gauze sponge
what does the primary layer of dressings do
covers wound completely
wicking action
what does secondary layer of dressings do
absorbs any drainage
what does tertiary layer of dressings do
secures dressings to patient
3 types of primary layer dressings
non permeable (occlusive)
-fine mesh gaule
semipermeable (semi occlusive)
permeable (non occlusive)
pressure dressing
3 layer with additional material, causes compression
purpose
-support
-absorbtion
-pressure distribution
bulky dressings
3 layer dressing, no compression lots of support and padding
absorbs excessive drainage
rigid dressings
casts and splints
provide support/ prevent movement
made of
-plaster
-fiberglass
-molded plastic
-molded metal (aluminum)
rigid dressing: splint
applied to one side
provide support
prevent unidirectional movement
rigid dressings: cast
encircles body part
provide support
prevent any type movement
types:
-cylindrical
-body jacket
-walking cast
-spica cast (mold extremity to something else)
-minerva jacket
specialty dressings: bolster dressing
-tie over dressing
-sutured into position
-skin graft recipient site
-provide even pressure
- prevent fluid accumulation
- secure to contorted area
specialty dressings: wet to dry
wet gauze on wound removed after it dies
debridement (gravel)
burn victims put under anesthesia
specialty dressings: wet to wet
wet gauze on wound removed before it dries
-N.S.
-antibiotic
-dakins solution (bleach)
minimal wound debridement
less painful
specialty dressings: thyroid collar
(queen annes collar)
circumferential neck wrap to secure dressings
specialty dressings: ostomy bags
intestinal stoma to contain excretions
specialty dressing: drain dressing
4x4 with Y slit
specialty dressing: tracheotomy dressing
Y with cotton tape to tie around the neck
velcro strap (manufacture)
specialty dressings: eye pad
retains meds and keep lid closed
specialty dressings: eye shield
rigid oval shield
protects from pressure or trauma
specialty dressings: perineal pad
absorbs vaginal or perineal drainage
belt or mesh underpants to keep in place
packing material
assist with hemostasis
provide pressure
eliminate dead space
packs open wound
can use long strip of gauze
plain, antiseptic or radiopaque
negative wound pressure dressing
foam or gauze covered with an adherent plastic
-vacuum pump then connected
draws fluid out
increases microcirculation
encourages closure of wound edges
catheters tubes and drains are used for
diagnosis
restore function
promote Healing
prevent ocmplications
not easy to categorize
catheters
remove air/fluid
installation of meds
maintain lumen potency
monitor body functions
-urinary
-intravascular
-specialty
urinary catheter
drain urine
provide irrigation
retraction
scaling: 5 (infants) -30
urethral: non retaining/ self retaining
ureteral
suprapubic
urethral non retaining
function:
obtain urine specimens
decompress bladder
maneuver around obstruction
temporary, no drain bag
ex: straight + coude
urethral self retaining
(indwelling, foley)
function:
measures pee output
bladder decompression
uses a balloon, 5-30 cc
features:
2 way and 3 way ports
require drainage bag
suprapubic catheter
placed through opening in abd wall
types:
foley
pezzer
malcot
3 way, balloon inflation, urine drainage, irrigation
secure to skin to prevent dislodging
ureteral catheters
assistance of cystoscope
decompress/ drain kidney
tip: whistle, olive, cone
radiopaque+ drainage bag (if retained)
intravascular catheter
infuse fluids, diagnosis, monitor body
gauged or French sizing
single or double lumen
venous access IV
peripherally
upper extremity
angtiocath
centrally IV
subclavian or jugular vein
groshong
IV: fogarty
balloon tipped catheter
used to take out obstruction
specialty catheters: cholangiocatheter
-detects calculi w/ radiopaque dye
specialty catheters: central venous pressure monitoring catheter
longterm vascular access
monitor central venous pressure,
inserted into subclavian to monitor CVP
broviac/ swan ganz
dialysis
tenckhoff silicone catheter
peritoneal cavity
synthetic cuffs hold it in place
three types of tubes
GI tubes
airway
chest
functions of all tubes
removes air/ fluids
instillation of meds
maintain lumen patency
GI tubes
aspirate air/ fluids into GI tract
feeding tube
inserted into stomach via
-nose, mouth, rectum, percutaneous
3 lumen design
airway tubes
maintain patency of URT
oral airway
ET tube
nasal airway
tracheotomy tube (directly into neck)
chest tube
upper tube: evac air
lower tube: evac fluid
“Y” connecter for two tubes
closed water seal drainage system
maintains negative pressure for respiration
chest tube drain types
active + passive
active drain
negative pressure
connected to suction device
manual or mechanic
connected to collection device
passive drain
allows path for fluid to move form high pressure to low pressure
connected to gravity collection device
passive drain example
Penrose - * capillary action*
cigarette - wicking action
t-tube- biliary system bile bag
more passive drains
gastrostomy tube
cycstostomy tube - removes urine
nephrostomy tube - removes urine (from kidney)
active drains
chest tube water seal drainage system
hemovac - orthopedic
JP
stryker - batter power, orthopedic
irrigators + syringes functions
irrigate wounds/ aspirate fluids/ inject med
types of irrigators + syringes
plain- not secure
locking - locks needle into syringe
plastic or glass - most basic
irrigating syringe - bulb/ asepto, ear
size: 1-60, anesthetics
