Chapter 31 - Intraoperative techniques book notes

Question 1

Attention to _____ during hemostasis and suturing can lead to improved surgical ____.

Answer 1

detail, outcomes

Question 2

_____ handles or sterile ____ covers should be placed after the patient has been draped.

Answer 2

Light, light

Question 3

What is used to attach tubing (used for suction during surgery) to the surgical drapes?

Answer 3

Allis tissue forceps

Question 4

What instrument is used to attach a scalpel blade onto the scalpel handle?

Answer 4

needle holder

Question 5

Three primary grips, may be used to hold the scalpel?

Answer 5

pencil grip, fingertip grip, and palm grip

Question 6

The scalpel blade should be passed with the blade ____ from the surgeon’s hand to prevent accidental injury.

Answer 6

away

Question 7

What does ligate mean?

Answer 7

tie up

Question 8

Hemostasis can be achieved through a variety of techniques; what are they?

Answer 8

• applying pressure via gauze sponges may be sufficient for certain bleeding vessels
• blot instead of wiping when using gauze
• hemostats can be placed directly onto a vessel when the vessel is being removed

Question 9

When gauze is used, it is critical to ____ rather than _____ the area of interest, because wiping removes blood clots that have been established.

Answer 9

blot, wipe

Question 10

The ____ of hemostats should be used to clamp the vessel to prevent clamping a nontarget vessel.

Answer 10

tip

Question 11

With vessels that are slightly larger, the use of ____ ligation, ____ clips, or ______ may be warranted.

Answer 11

ligation
vascular
electrocautery

Question 12

When ligating a blood vessel, hold the vessel ___ from the body (using _____ or _____) to allow surgeon access the vessel with suture.

Answer 12

away
hemostats
forceps

Question 13

Gentle ____ of the vessel is necessary to prevent ____ of the vessel or release of the vessel back into the surgical wound.

Answer 13

manipulation

tearing

Question 14

Vascular clips can be placed with the use of a ____ applier.

Answer 14

clip

Question 15

_____ of blood vessels via _____ is an excellent technique for controlling blood loss and decreasing surgical time.

Answer 15

Cauterization, electrocautery

Question 16

What is electrocautery?

Answer 16

a process by which heat is conducted through a metal probe by an electrical current with the goal of destroying bleeding time.

Question 17

Electrocauterization can be performed with ____ or ____coagulation devices.

Answer 17

monopolar or bipolar

Question 18

What does monopolar electrocautery involve?

Answer 18

the use of a handpiece that passes a current through the target tissue (bleeding vessel) and disperses the current through the patient to a ground pad underneath the patient’s body

Question 19

When monopolar electrocautery is used, the patient is acting as part of the ____ circuit.

Answer 19

electrical

Question 20

Monopolar electrocautery are equipped with both ____ and _____ modes.

Answer 20

cutting

coagulation

Question 21

For best functioning of monopolar electrocautery, a _____ surgical site is necessary.

Answer 21

dry

Question 22

Removing ___ first allows monopolar electrocautery to work with greater efficiency.

Answer 22

blood

Question 23

What does a bipolar electrocautery do?

Answer 23

passes a current between two tip forceps. the current is controlled by a foot switch

Question 24

Several hemostatic agents have been designed to assist with control of intraoperative bleeding, what are they?

Answer 24

Bone wax
Gelatin foams (Gelfoam)
Oxidized cellulose (Surgicel)

Question 25

What is bone wax?

Answer 25

a mixture of beeswax, parraffin, isopropyl palmitate, and a wax-softening agent that can be applied to actively bleeding bone

Question 26

Bone wax functions by?

Answer 26

occluding the bleeding channel from medullary bone or from within a cut bone

Question 27

Where can gelatin foams be placed?

Answer 27

in regions of bleeding and provide a framework for the initiation of clotting

Question 28

Gelatin foams can be cut or torn into ____ that can be place more effectively into a ____ site.

Answer 28

pieces | bleeding

Question 29

Gelatin foams are ____ over time.

Answer 29

absorbed

Question 30

How is Oxidized cellulose made?

Answer 30

it is made into a sheet that can be laid on organ surfaces and cut to specific sizes. It most likely works by generating artificial clots

Question 31

The ___ of ____ scissors should be used to prevent trauma to adjacent normal tissue.

Answer 31

tips | suture

Question 32

Lavage fluids should be ____ and _____.

Answer 32

sterile | iso-osmotic

Question 33

What are some examples of lavage fluids?

Answer 33

lactated Ringer's and normal strength saline

Question 34

Suction tubing can be attached to suction tips that have different configurations and functions, what are they?

Answer 34

Poole tip | Frazier tip

Question 35

What is a Poole tip and what does it do?

Answer 35

A large suction tip with multiple holes. | Are effective for suctioning large amounts of fluids that may accumulate in the abdominal area or thoracic cavity

Question 36

What is a Frazier tip and what does it do?

Answer 36

smaller suction tip with a single end-on hole. | May be used for more focal suctioning, such as that required during many neurosurgeries

Question 37

The liver is fairly ____ organ consisting of ___ major lobes.

Answer 37

mobile | six

Question 38

The pancreas consists of ___ and ___ limbs.

Answer 38

right and left

Question 39

The right limb of the pancreas is easily visible because of its close up association with the _____.

Answer 39

duodenum

Question 40

The left limb of the pancreas is lcoated?

Answer 40

caudal to the stomach and can be viewed by entering the omental bursa

Question 41

The spleen can vary in size even within the same animal because it can ___ and ____.

Answer 41

contract and expand

Question 42

The spleen is a?

Answer 42

highly mobile organ and can often be lifted out of the abdomen

Question 43

Surgical gloves should be ____ when abdominal organs are touched.

Answer 43

wet | because dry gloves can cause drying of the organs or tearing of the serosal layer

Question 44

It is the surgical assistant's responsibility to not let _____-____ intestinal contents get into the abdominal cavity.

Answer 44

microbe-rich

Question 45

What are stay sutures?

Answer 45

sutures that are placed into the lumen of a hollow organ , such as the stomach or the bladder, to allow that organ to be manually manipulated.

Question 46

When stay sutures are used, the assistant is responsible for ____ the free ends of the suture together with a _____ and cutting the suture ends for removal.

Answer 46

clamping | hemostat

Question 47

Over-manipulation of the heart or lungs can result in ____ - _____ consequences.

Answer 47

life-threatening

Question 48

Large ____ (such as malleable ____) are often used in the thorax.

Answer 48

retractors | retractors

Question 49

Assistant should surround the malleable retractor with a ______ laparotomy pad to decrease the chance of _____ trauma to intrathoracic organs

Answer 49

moistened | iatrogenic

Question 50

What is iatrogenic?

Answer 50

of or relating to illness caused by medical examination or treatment.

Question 51

What are some examples of permanent implants?

Answer 51

plates, pins, wires, and screws

Question 52

______ are likely the most common temporary implant used in veterinary medicine.

Answer 52

Drains

Question 53

What are drains?

Answer 53

devices inserted into post-surgical wounds or body cavities to allow for drainage of fluid accumulations and to help eliminate dead space

Question 54

Drains are classified as?

Answer 54

passive or active

Question 55

Drains are not ____, and when present in tissue, they may stimulate ____ production.

Answer 55

benign | fluid

Question 56

Passive drains are used most often to?

Answer 56

drain subcutaneous wounds

Question 57

Passive drains should never be used to drain the _____.

Answer 57

abdomen

Question 58

What is the most common passive drain?

Answer 58

Penrose - made of soft latex and in a variety of sizes

Question 59

Passive drains are ____ dependent, requiring that they be in a dependent location.

Answer 59

gravity

Question 60

Active drains use ____ pressure to suction fluid and air from a wound.

Answer 60

negative

Question 61

What is the drain of choice for abdominal drainage?

Answer 61

active drain

Question 62

Both passive and active drains need to be ____ to the skin to prevent premature removal.

Answer 62

secured