EXAM 1: Lecture 4 - General surgery etiquette / procedures Flashcards
What are surgical staff barriers of infection
surgeon and ancillary staff
What are patient barriers of infection
draping and skin prep
What are environmental barriers of infection
surgical suite (OR) and equipment/instruments
what type of patient prep is there in small animal
no extra cleaning prior to inducing unless the animal is filthy
what are the benefits of bathing prior to surgery
it does reduce bacterial counts on skin
what are the disadvantages of bathing prior to surgery
liberates deeper bacteria through open pores, dries out skin, and hair must be dried prior to clipping
how can you prepare a horse for surgery
grooming and pick feet prior to induction
cover feet before starting skin prep
may clip/rough prep while standing
How do you prepare food animal for surgery
tie the tail, clip/prep, block
how do you prepare food animal for surgery in an OR
similar to horse
when is the initial prep and final prep for surgery done
clipping and initial prep should be done in prep/any other room than the OR
final prep is in OR
what is the purpose of initial prep for sx
remove grossly visible dirt, blood, etc
remove grease
clean skin
explain what you need to do when clipping a patient for prep
- sterilize/clean the clipper blades
- size 40 clippers gets closest to skin
- clip only at time of sx
- at least 20 cm on either side of surgical site
- vacuum hair
Why is the size of the clip for prep important??
because incisions often need to be extended
what are some special consideration for initial prep
hang the limb, preprep feet
do opthalamic/dentals require initial prep
no!
what are the rules of a sterile skin prep
person performing the scrub must have a cap and mask, NO lab coat, and sterile gloves
what is the technique of sterile skin prep
start from the site of the incision and move outward (DO NOT GO BACK IN TOWARDS INCISION), one 4x4 per scrub
what is the MOST important time of sterile skin prep
CONTACT TIME!!!
what is this image showing
sterile prep
how do you prep for optho sx
dilute povidone-iodine solution and never use chlorhex or alcohol
why should you never use chlorhex or alcohol for optho sx
it melts the cornea
what is important to remember for draping
it is an effective bacterial barrier, lint free, tear resistant, sterile, effective fluid barrier, and breathable (if too its not effective, if not it can create bacterial growth)
finish this statement in regards to draping material: “Higher thread count = ___1___ weave = __2__ barrier”
- tighter weave
- better barrier
is cotton muslin a good draping material
it is inadequate microbial barrier when wet or dry
when is prima cotton an inadequate barrier
when it is wet
when is prima cotton an adequate barrier
it is adequate for skin shedding
what is the disadvantages of fabric
there can be damage from punctures that disrupt barriers
what are the types of disposable draping materials
cellulose, wood pulp, polyesters, synthetic polymers fibers bonded into sheets
what MUST disposable draping materials have
must be reinforced with polyethylene or plastic film to be water resistance
why do we cover all visible surfaces of the patient when draping
it prevents aerosolization from unprepared areas
what is the drape out technique
when you drape the smallest area possible with enough room for your incision
what is important to remember about draping quadrants and towel clamps
once a clamp has penetrated the drape, it is now contaminated
T/F: When you are draping, you want all of the layers to be the same shape and same hole
true!
What do we use to drape limbs
ioban and vetwrap
list the steps in order for patient prep
- clip
- initial scrub
- move to OR
- sterile scrub
- drape
how do you position the instrument table to reduce contamination
close to the surgeon if there is no assistant or close to the assistant
T/F: anyone in the OR can walk between the table and the surgery site
FALSE!! Only sterile/scrubbed in people can
can a non-scrubbed person extend their arm over a sterile field even if they do not touch anything?
no they cannot! It breaks the sterile field
what is the typical layout of the SA surgical area
surgeon and assistant on opposite sides of the table, anesthesia by the head, and technician towards the back of the room
for large animal, what are the limitations when positioning a patient
there are not a lot of options because the patient takes up the entire table, there must be a lot of padding
what should you always ask before you start the procedure??
am i ok to cut anesthesia??
are surgical assistants just for looks??
no!!! moral support, supervision
what are the roles that an assistant has
organize the table, count gauze, count instruments, hand instruments, retract, hold, cut and run suture
why do we need to count gauzes?
so you know if there is a missing gauze BEFORE closing
T/F: You can use any type of gauze for abdominal procedures
false!! Must be radiopaque
what type of scissors do you use to cut suture
suture or general purpose scissors, NOT mayo
explain how running suture works
surgeon places the bite, surgeon gathers suture and then hands excess to assistant. Assistant then holds excess suture out of the way
what are the general rules of writing a surgery report
accurate report of what occurred during the procedure, details are important (lengths, suture, and instruments), use proper medical terminology
what are parts of a medical record
- how was animal anesthetized/restrained/positioned
- describe the prep and how it was prepped
- describe what area was prepared
- describe the approach
- describe the major findings
T/F: in your medical record/report, you do not need to put all of the events in order as long as they are all in there
FALSE! They should be in the order of which they were completed
what should you end your medical record/report with
how the animal recovered from anesthesia
