Chapter 18 Flashcards
Define Aseptic
Product or method free of microbiological organisms
What is Surgial Asepsis?
Protection from infection using sterile technique before, during and after surgery
What radiography exams is sterile technique required for ?
Angiography
Arthrography
Hysterosalpingogram
Opearting room
Myelogram
What is angiography used for?
Stints, clear out blood vessels
What is Arthrography?
Inject the joint with gadolinium and lidocane
What is a Hysterosalpingogram?
Exam fallopian tubes
What is a Myelogram?
Used to exam the spine by putting a spinal needle into lower back
What is Medical Asepsis? What technique is used?
Reduction of infection agents - decrease probability of infection but not to zero.
Uses clean technique.
Is barium enema a sterile technique?
No, don’t want to eliminate the good bacteria
Goal of sterile technique?
Protect patient from infection and eliminate ALL harmful microorganisms
What is the number one priority for sterile technique?
Hand washing
What is the first step to making sure a packing is sterile?
Check expiration date and check to see if it is clean and dry
When opening a sterile packing, which way do you place package on the surface?
Top flap opens away from you
Can you reach over the sterile package to open flaps?
No, you must reach around
What hand should you use on each side when opening sterile package?
Right hand on right side, left hand on left side
Do you have to wear gloves when opening the sterile package?
No
Can sterile items be added to sterile tray after it has been opened? How?
Yes, drop contents on the field about 6 inches and at an angle
Where are sterile solution bottles considered sterile?
Inside the bottle only
Once the sterile solution bottle is set down, is it considered sterile?
No
What should you check on a soltuion bottle?
Name, concentration, and expiration date
How many times should you check a solution bottle?
3 times
Who should you show the solution bottle to?
Physician or radiologist performing the exam
How should you place the top of the sterile solution bottle?
Top side down
How high above the bowl should you hold the solution bottle?
1-2 inches
What happens if the sterile field gets wet?
Allows microorganisms can move from unsterile field
What are other procedures we might use sterile technique on?
Biopsies, hip injections
If in doubt about the sterility of an object, consider it:
unsterile
Purpose of surgical scrubbing
Removes debris and transient microorganisms from hands and nails
Reduce resident microbial count to a minimum
Inhibit rapid rebound growth of microorganisms
What are the two methods of surgical scrubbing?
Numbered stroke - certain number of brush strokes used
Timed scrub - certain amount of time
How long should you scrub fingers and hands?
3 minutes
How far above the elbow should you scrub?
3 inches
How should you dry your hands and elbows?
Wrist to elbow, using blotting-rotating motion, don’t revist an area
How far should you be from the sterile area when picking up the sterile gown?
12 inches
Difference between open and closed gowns?
Closed - hands don’t go all the way through
Open - hands come out (more in radiology dept)
Who is the person who ties the gown?
Circular
When do you put on sterile gloves?
After gowning
What is the closed method of gloving?
Fingers covered by gown, and pick up gloves
Use non-dominant hand to pick up opposite glove (left hand to pick up right glove)
Place glove on hand with palm down and fingers facing toward you
Fingers grasp the bottom of the cuff and assistant hand pulls glove over hand to be gloved
What is the open method of gloving?
Opposite hand picks up glove - do not touch outside surface of glove
Dominant hand gets gloved first
Sterile glove hand picks up the other glove by reaching under the cuff
Sterile glove on first must touch only the outer surface
How to gown another:
Sterile picks up at neckband, arms length away holding gown, allows unfold.
Holds at shoulder seams w outside facing sterile person
Circular (not person who started the gowning process) adjusts gown in back and ties.
Sterile person pulls cuffs over person’s sleeves, not touch person being gowned hands.
Gloving another
Sterile person opens the package and picks up the right glove
Sterile person slides fingers under cuffs and spreads cuffs. Good grip.
Person to be gloved thrusts hand in.
Sterile person releases cuff gently and rolls cuff over wrist area.
How often must the sterile field be watched?
Continuously
What is the time factor when setting up sterile technique?
The longer the pack is open, the more likely it is to be come unsterile
Anything below the waist is sterile/unsterile?
Unsterile
What portions of the gown are sterile?
Arms and front
How must sterile peope pass each other?
Butt to butt
Can you redrape an unsterile field?
Yes
Where must gloves be kept?
In sight and above waist
What is the best way to communicate with a trach patient?
Yes/no questions, hand signals, simple sign language
What is a tracheostomy done for?
Upper airway obstructions
What level of Maslow’s Hierarchy is a Trach patient?
Physiological
Who does the suctioning for trach?
Nurse or respiratory therapist
What needs to happen before suctioning a trach pateint?
Aerate with 5-10 breaths of oxygen using an Ambu bag
Patency of the catheter must be tested
How to test the patency of catheter?
Saline
How do you insert catheter for trach patient?
Insert until resistance met, then withdraw 1 cm
Apply suction immediately while withdrawing in rotating motion
Never suction a trach patient more than:
15 seconds
After inserting a catheter into a trach, how do you assess the airway?
Auscultation - using the stethoscope to listen to internal sounds
What are chest tubes used for?
Atelectasis, pneumothorax, thoracotomy, and open heart surgery
What is a chest tube?
Tube inserted into pleural cavity to remove fluid, blood, air
What does the chest drainage system include?
Collection chamber
Water seal chamber - prevents air from entering chest
2nd water chamber - controls amount of suction
Where must chest tubes be located?
Be at or below level of the chest
If a patient has a chest tube and you are with them for more than an hour, what must be reported?
Drainage of excess of 100mL per hour
Change of fluid from a serous fluid to a dark red color
Type of urinary catheters:
Foley and straight
What is a Foley catheter?
Has a balloon and must fill it with sterile water
What is a catheter called that remains in place/stays in the body?
Indwelling catheter
What are urinary catheters used for?
Emptying bladder
Relieve retention of urine
Irrigate the bladder or put in drugs
Permit accurate measurement of urine output
Relieve incontinence
What unit are catheters measured in?
French unit
What is the diameter range of catheters?
8-18 french units
What are the different type of catheters based on duration used?
Plastic - short term
Latex - 2-3 weeks
Polyvinyl - 4-6 weeks
Silicone - 2-3 months
Things to watch for with urinary catheters?
Keep collection bag below the bladder (prevent reflux and infection)
Never drag bag on the floor
Be sure to cut opening to drain sterile water before trying to remove
If you empty or give fluids- be sure to document
What are foley catheters used for frequently?
Voiding cystograms
Urinary catheter kit includes:
Sterile gloves
Antiseptic solution
Cotton balls and forceps
Lubricant
Container to receive urine
Sterile drape
What is the lithotomy position?
Supine, knees bent, genitalia exposed
Where does the sterile drape go for catheter insertion?
Men - under the penis
Women - under the buttocks
How to test the balloon in a Foley?
Inject sterile water
What hand do you use to expose the urinary meatus?
Non-dominat hand
What hand do you use to insert catheter?
Dominant hand
How far do you insert urinary catheter?
Until urine flow
Women - .5 inches
Men - 6-8 inches
What should you do if you meet resistance when removing the catheter?
Notify nurse or physician
What is a voiding cystourethrogram?
Radiography of urethra and bladder before, during, and after voiding
What is a Suprapubic catheter?
Closed drainage system above pubic symphysis; used for gynecology surgeries and urethral injuries
What is a condom catheter?
Used for males for incontinence
Central venous lines require what technique?
Sterile technique
Technique required for tracheostomies?
Sterile technique
What technique is used for catheter insertion?
Aseptic technique
Where are pacemakers placed?
Underneath the skin on the chest (pectoral fascia)
Apex of right ventricle
What does a pacemaker do?
Regulates heart reat - prevents brachycardia
What senses the heartbeat on a pacemaker? And what does it do?
Electrode - sends impusles to make the heart contract
What vein is used to access where the electrode will go?
Subclavian vein
What does a radiographer do for insertion of pacemaker?
Run fluoroscopy while physician positions guidewire
What kind of technique is used to insert a pacemaker?
Sterile technique
How is a pacemaker inserted?
Guidewire is inserted to provide pathway
Introducer sheath is used to place the pacing lead into subclavian vein
Under fluoro, the lead is advanced to the right atrium
Sheath withdrawn and lead placed at apex of right ventricle
What is the one constant in the operating room?
Sterile corridor between patient drape and instrument table
What is used to keep C-arm sterile?
Snap cover - most common - image intesifier and C-arm covered and tension bands hold in place
Shower curtain approach - sterile plastic wall with hole; hip pinnings, fermur rod
Stop gap approach - drape site with additional sterile cloth and C-arm brought over area of interest. Used only when physician doesn’t manipulate C-arm
How to reduce contaminants in neonatal unit?
Hand washing
Keep multiple peices of lead in unit and sterilize after use
Cover lead with pillow case
Assign a piece of lead to each crib
Types of neonatal shielding and the advantages/disadvantages
Shadow - lay on top of bassinet - less cross of infection/ambient lighting
Contact - lay directly on baby - regular lighting/more chance of infection
