General Surgery Etiquette & Procedures (4) Flashcards
Dr. Anderson
What is the patient barrier of infection?
draping
skin preparation
What is the primary difference between small and large animal when prepping a patient?
when inducing anesthesia
small animal: no extra cleaning prior to inducing anesthesia (unless animal is filthy)
How can bathing be bad for surgery?
- liberates deeper bacteria through open pores
- dries out skin
- hair must be dried prior to clipping
What is the patient preparation for a horse before anesthesia?
- groom and pick out feet prior to induction
- cover feet before starting skin preparation
- can have horse standing
What about patient prep for food animal/equine standing surgery?
- tie the tail!
- clip and prep
- nerve block
Where should clipping and initial skin preparation be done?
room other than OR (OR should only have “sterile” prep)
What are the characteristics of clipping for patient preparation?
size 40 clipper blade at time of surgery
vacuum hair
What are the dimensions for clipping the surgical site?
at least 20 cm on either side of the surgical site
What is clipping technique for patient preparation?
smooth motions, angle of blade, against hair
small animals more susceptible to clipper burn
What is the purpose of initial preparation for patient prep?
- remove grossly visible dirt, blood, etc
- remove grease
- “clean” the skin
Which kinds of procedures do not need initial prep?
ophthalmic and dental procedures
What are the rules of a “sterile” skin prep?
do in OR and have solution that doesn’t leave OR
- hat and mask, NO lab coat, sterile gloves
What is the technique of the “sterile” skin prep?
outward from incision due to contact time!
one 4x4 per scrub, alternate with alcohol, circles
What should you never do for patient prep on ophthalmic cases?
NEVER use chlorhexidine or alcohol - melts cornea!
What are the benefits of draping?
- effective bacterial barrier
- lint free
- tear resistant
- sterile
What are the fabrics for draping?
cotton muslin
pima cotton
What are the characteristics of a cotton muslin drape?
inadequate microbial barrier when wet or dry
What are the characteristics of a pima cotton drape?
inadequate microbial barrier when wet
adequate barrier for skin shedding
can be treated to make it water resistant for 75 washes
What are the disadvantages for fabric draping?
- damage from punctures disrupts barrier
- vulcanized patches resist autoclave steam penetration
What are the characteristics of disposable drapes?
lint free, must be reinforced with polyethylene or plastic film to be water resistant
How should you drape?
- cover all visible surfaces of patient
- double gloving if contamination is likely
- drape out smallest area posible
- place adjacent to incision, then move away —> DO NOT go back towards incision
Which drape should you place first?
the drape closest to you!
When are self-adhering drapes helpful?
circumferential draping (legs) or when large areas are draped
What are the general steps of patient preparation?
- clip
- initial scrub
- move to OR
- sterile scrub
- drape
How should you position the instrument table - surgeon or if assistant is there?
just surgeon: close to them, next to dominant hand
assistant: close to assistant
T/F: Only sterile people can go between table and surgery site
TRUE
The instrument table is towards the surgeon’s dominant hand, except for ______
neuters
What is the organization of the surgical area - small animal?
What is the organization of the surgical area - large animal?
instrument table is behind assistant
in small animals, it was in the middle
How should you position the small animal in surgery?
maximize location on table for surgical procedure
How should you position a large animal patient?
- lots of padding - not really a lot of options
What should you do before you set up your surgical field?
- check table height
- double check patient position
- turn on and position surgical light
How should you prepare the instrument table as a surgeon with minimal assistance?
do what the assistant would have done - prepare the instrument table by draping it
What should the order be for the surgeon after your open your gown?
- open gown
- open gown onto gloves
- scrub
- put on gown and gloves
- open pack to get drapes
- organize instruments
- cut
T/F: Everything in the yellow and white outline is sterile
FALSE - below the table is not sterile
What should you always do before cutting?
check with your anesthetist!!
T/F: These techniques are proper sterile technique
TRUE
T/F: These techniques are proper sterile technique
left: yes
right: no
What are the jobs for the assistant surgeon?
Which one is correct?
left
What should you always do with gauze and instruments?
count them!
How should you hand the instrument to the surgeon?
handle them the handles firmly - like a good handshake
T/F: You can use mayo and metzenbaum scissors to cut suture
FALSE - use sharp-blunts
What are the general rules in writing a surgery report?
How should you start a surgery report?
start with animal being anesthetized/restrained and how it was positioned
What should be in a surgery report?
- start with animal being anesthetized/restrained and how it was positioned
- describe area prepared and how it was prepared
- describe the approach: location, length (cm), and instruments used
- describe major findings in order
- describe major procedures in order
- incision closure
- describe any incisional dressings were applied
end with how animal recovered from anesthesia
What is the body of a surgery report?
- describe major findings in order - what was explored, findings
- describe major procedures in order - ligation, transection, blunt dissection, sharp dissection, implants placed
