Chapter 31 - Intraoperative techniques book notes Flashcards
Attention to _____ during hemostasis and suturing can lead to improved surgical ____.
detail, outcomes
_____ handles or sterile ____ covers should be placed after the patient has been draped.
Light, light
What is used to attach tubing (used for suction during surgery) to the surgical drapes?
Allis tissue forceps
What instrument is used to attach a scalpel blade onto the scalpel handle?
needle holder
Three primary grips, may be used to hold the scalpel?
pencil grip, fingertip grip, and palm grip
The scalpel blade should be passed with the blade ____ from the surgeon’s hand to prevent accidental injury.
away
What does ligate mean?
tie up
Hemostasis can be achieved through a variety of techniques; what are they?
- 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
When gauze is used, it is critical to ____ rather than _____ the area of interest, because wiping removes blood clots that have been established.
blot, wipe
The ____ of hemostats should be used to clamp the vessel to prevent clamping a nontarget vessel.
tip
With vessels that are slightly larger, the use of ____ ligation, ____ clips, or ______ may be warranted.
ligation
vascular
electrocautery
When ligating a blood vessel, hold the vessel ___ from the body (using _____ or _____) to allow surgeon access the vessel with suture.
away
hemostats
forceps
Gentle ____ of the vessel is necessary to prevent ____ of the vessel or release of the vessel back into the surgical wound.
manipulation
tearing
Vascular clips can be placed with the use of a ____ applier.
clip
_____ of blood vessels via _____ is an excellent technique for controlling blood loss and decreasing surgical time.
Cauterization, electrocautery
What is electrocautery?
a process by which heat is conducted through a metal probe by an electrical current with the goal of destroying bleeding time.
Electrocauterization can be performed with ____ or ____coagulation devices.
monopolar or bipolar
What does monopolar electrocautery involve?
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
When monopolar electrocautery is used, the patient is acting as part of the ____ circuit.
electrical
Monopolar electrocautery are equipped with both ____ and _____ modes.
cutting
coagulation
For best functioning of monopolar electrocautery, a _____ surgical site is necessary.
dry
Removing ___ first allows monopolar electrocautery to work with greater efficiency.
blood
What does a bipolar electrocautery do?
passes a current between two tip forceps. the current is controlled by a foot switch
Several hemostatic agents have been designed to assist with control of intraoperative bleeding, what are they?
Bone wax Gelatin foams (Gelfoam) Oxidized cellulose (Surgicel)
What is bone wax?
a mixture of beeswax, parraffin, isopropyl palmitate, and a wax-softening agent that can be applied to actively bleeding bone
Bone wax functions by?
occluding the bleeding channel from medullary bone or from within a cut bone
Where can gelatin foams be placed?
in regions of bleeding and provide a framework for the initiation of clotting
Gelatin foams can be cut or torn into ____ that can be place more effectively into a ____ site.
pieces
bleeding
Gelatin foams are ____ over time.
absorbed
How is Oxidized cellulose made?
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
The ___ of ____ scissors should be used to prevent trauma to adjacent normal tissue.
tips
suture
Lavage fluids should be ____ and _____.
sterile
iso-osmotic
What are some examples of lavage fluids?
lactated Ringer’s and normal strength saline
Suction tubing can be attached to suction tips that have different configurations and functions, what are they?
Poole tip
Frazier tip
What is a Poole tip and what does it do?
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
What is a Frazier tip and what does it do?
smaller suction tip with a single end-on hole.
May be used for more focal suctioning, such as that required during many neurosurgeries
The liver is fairly ____ organ consisting of ___ major lobes.
mobile
six
The pancreas consists of ___ and ___ limbs.
right and left
The right limb of the pancreas is easily visible because of its close up association with the _____.
duodenum
The left limb of the pancreas is lcoated?
caudal to the stomach and can be viewed by entering the omental bursa
The spleen can vary in size even within the same animal because it can ___ and ____.
contract and expand
The spleen is a?
highly mobile organ and can often be lifted out of the abdomen
Surgical gloves should be ____ when abdominal organs are touched.
wet
because dry gloves can cause drying of the organs or tearing of the serosal layer
It is the surgical assistant’s responsibility to not let _____-____ intestinal contents get into the abdominal cavity.
microbe-rich
What are stay sutures?
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.
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.
clamping
hemostat
Over-manipulation of the heart or lungs can result in ____ - _____ consequences.
life-threatening
Large ____ (such as malleable ____) are often used in the thorax.
retractors
retractors
Assistant should surround the malleable retractor with a ______ laparotomy pad to decrease the chance of _____ trauma to intrathoracic organs
moistened
iatrogenic
What is iatrogenic?
of or relating to illness caused by medical examination or treatment.
What are some examples of permanent implants?
plates, pins, wires, and screws
______ are likely the most common temporary implant used in veterinary medicine.
Drains
What are drains?
devices inserted into post-surgical wounds or body cavities to allow for drainage of fluid accumulations and to help eliminate dead space
Drains are classified as?
passive or active
Drains are not ____, and when present in tissue, they may stimulate ____ production.
benign
fluid
Passive drains are used most often to?
drain subcutaneous wounds
Passive drains should never be used to drain the _____.
abdomen
What is the most common passive drain?
Penrose - made of soft latex and in a variety of sizes
Passive drains are ____ dependent, requiring that they be in a dependent location.
gravity
Active drains use ____ pressure to suction fluid and air from a wound.
negative
What is the drain of choice for abdominal drainage?
active drain
Both passive and active drains need to be ____ to the skin to prevent premature removal.
secured
