Endoscopic and MIS, Environmental Sanitatio and Terminal Cleaning, Hemostasis Sponges and Drains

Question 1

What are the five Absolute Contraindications to having Laparoscopic Abdominal Surgery?

Answer 1

1) Advanced generalized peritonitis
2) Massive abdominal distention with evidence of bowel obstruction
3) Irreducible hernia
4) Coagulopathy
5) Patient’s inability to tolerate formal laparotomy

Question 2

What are the eight Relative Contraindications to having Laparoscopic Abdominal Surgery?

Answer 2

1) Prior abdominal or pelvic surgery
2) Previous generalized peritonitis
3) Obesity (except bariatric surgeries)
4) Advanced cardiac disease
5) Pregnancy
6) Abdominal aortic aneurysm (AAA)
7) Umbilical abnormalities
8) Surgeon’s lack of experience

Question 3

What is the difference between a negative/objective lens and an ocular lens located inside of a medical telescope?

Answer 3

1) Negative/Objective Lens - Creates the image at the operative site
2) Ocular Lens - Magnifies the image

Question 4

Describe the two principle types of light sources used in endoscopy?

Answer 4

1) Metal Halide - Emits a continuous blue light and is less expensive but not as bright as xenon light sources.
2) Xenon - Emits a pulsing, high-intensity white light and is more expensive but extremely bright

Question 5

Where should the insufflator be positioned in relation to the patient during a laparoscopic procedure and why?

Answer 5

The insufflator should be positioned on the cart at the level of the patient’s heart or higher to prevent intra-abdominal fluids or gases from contaminating the device.

Question 6

What are the 11 main complications associated with laparoscopic abdominal surgery?

Answer 6

1) Dysrhythmias
2) Hyper/hypotension
3) Hypoxemia
4) Extraperitoneal insufflation
5) Subcutaneous emphysema
6) Hypercarbia
7) Gas embolism
8) Instrumentation injuries
9) Peritonitis or wound infection
10) Delayed hemorrhage
11) Capacitive coupling of surrounding tissues

Question 7

Identify some methods used to maintain a sterile camera head

Answer 7

1) Put the camera head in a sterile pouch

2) Gas-sterilize the camera head

Question 8

What are the 4 advantages of using CO2 as the gas of choice for laparoscopic procedures?

Answer 8

1) It’s inexpensive
2) It’s readily absorbed by the body without serious side effects
3) It’s rapidly eliminated
4) It Suppresses combustion

Question 9

What are the AORN Recommendations I through V regarding Environmental cleaning?

Answer 9

1) The patient should be provided a clean, safe environment
2) A safe, clean environment should be reestablished after each surgical procedure
3) Contaminated disposable and reusable items should be handled safely according to state and federal regulations.
4) Surgical and invasive procedure rooms and scrub/ utility areas should be terminally cleaned daily
5) All areas and equipment in the surgical practice setting should be cleaned according to an established schedule

Question 10

What are the AORN Recommendations VI through VIII regarding Environmental cleaning?

Answer 10

6) All personnel should take precautionary measures to limit transmission of microorganisms when performing routine environmental cleaning and disinfection activities
7) Procedures for environmental cleaning and disinfection and PPE use should be established for circumstances that may require contact or airborne precautions.
8) A containment, cleaning and disinfection, and surveillance process should be in place during construction, renovation, remediation, repair, or demolition

Question 11

What are the AORN Recommendations IX through XI regarding Environmental cleaning?

Answer 11

9) Personnel should receive initial education, training, and competency validation on proper environmental cleaning and disinfection methods, agent selection, and safety precautions
10) Policies and procedures for environmental cleaning and disinfection should be written, reviewed annually, and readily available in surgical practice settings
11) A quality management program should be in place to evaluate products, processes, and outcomes of the environmental cleaning and disinfection program

Question 12

Which 3 methods are mainly used to clean the surgical suite?

Answer 12

1) Cloth - Soft, absorbent, and low-lint cloth
2) Vacuum - Wet vacuum
3) Mop - Wet mop

Question 13

Tuberculocidals are a special class of disinfectants. In order to be labeled ‘Tuberculocidal’, products need to have demonstrated potency against ____________?

Answer 13

Mycobacteria

Question 14

A hospital disinfectant must pass the potency test for activity against which three (3) microorganisms?

Answer 14

1) Pseudomonas aeruginosa
2) Staphylococcus aureus
3) Salmonella cholerae suis

Question 15

______________ recommend prompt clean-up of items stained with blood, tissue, or body fluids.

Answer 15

Confine and containment principles

Question 16

What are the 3 alternative methods (non-clotting methods) used to control bleeding?

Answer 16

1) Chemical - using chemicals such as topical powders on the wound to stop the blood flow (Absorbable gelatin, collagen, tannic acid, and silver nitrate)
2) Thermal - Using the (ESU, cryosurgery, and argon beam) to coagulate bleeding points
3) Mechanical - applying physical pressure on the wound to stop the blood flow (ligating clips, manual pressure and tourniquets).

Question 17

Which type of sponge provides blunt dissection as it absorbs fluids?

Answer 17

Cherry Dissectors

Question 18

What are the 2 categories of drains?

Answer 18

1) Passive - Penrose drains, T- Tubes, and Gastrostomy tubes

2) Active - Jackson-Pratt and Hemovac drains

Question 19

Microfibrillar collagen sponges should not be used with which substance and why?

Answer 19

Microfibrillar collagen sponges should not be used with methyl methacrylate because it may reduce the bond strength.