Introduction to Surgery Self-directed Learning Flashcards
Adson Tissue Forceps appearance and use:
- Have a broad thumb grip and narrow rat tooth grasping end.
- Used for gentle tissue handling
Adson-Brown Tissue Forceps appearance and use:
- Have a broad thumb grip and narrow serrated grip
- Used for more delicate tissue (e.g. blood vessels etc.)
Lane’s Dissection Tissue Forceps (‘Rat-tooth’ Tissue Forceps)
- Used for grasping and manipulating tough tissues like fascia and cartilage.
- They are not suitable for delicate tissues
Gillies Forceps
Can be used to grasp the needle when suturing
Dressing Forceps
- Used to hold and manipulate dressings, gauze, and other materials during wound care and surgical procedures
Mayo-Hegar Needle Holder
Provides good control and stability of needle
Mayo Scissors appearance and use:
- Can be curved or straight
- Short and wide (fat) blades
- Optimal for heavy tissues (e.g. fascia)
Metzenbaum Scissors appearance and use:
- Can be curved or straight
- Long and slim (skinny) blades
- Useful for delicate, fine, thin tissue
Suture or Operating Scissors
- ‘Sharp-sharp’ scissors
- ‘Sharp-blunt’ scissors
- ‘Spencer-stitch’ scissors (Used to remove sutures)
Scalpel Handle
has different blades for different animals
Rochester-Carmalt Clamps
- Can be curved or straight
- Jaws are crosshatched at the tips, and the remaining length is longitudinally serrated.
- Used for clamping large pedicles and blood vessels
Kelly Tissue Forceps
- Straight jaws
- Transverse striations extend half the way along the length of the jaws.
- Used to clamp small to medium vessels
Crile Tissue Forceps
- Curved jaws
- Transverse striations extend all the way along the jaws
- Crile Tissue Forceps
- Rochester Pean Tissue Forceps
- Halsted-Mosquito Haemostatic Clamps
- These all share the same jaw pattern, but vary in size and use.
- The Rochester Pean’s are the largest, and the Mosquito forceps the smallest
Allis Tissue Forceps
- Used to grasp tissue.
- May cause some trauma
Carmalt Tissue forceps
Longitudinal serrations extend the entire length of the jaws
Backhaus Towel Clamp
Most commonly used to hold drapes in place
A common way to calssify suture material is into …. or ….
Absorbable or non absorbable.
Where is absorbable suture materials used?
- Internal suturing
- Buried into living tissue.
- As the wound heals, the suture material is absorbed
Where is non-absorbable suture materials used?
- The skin.
- Might be used in suturing tendons because tendons have a poor blood supply and take a long time to
heal.
What types of suture material is used in a vet?
- Needle
- Suture (comes in different weights - some are more heavy duty)
What are the different ways suture material is packaged?
- Continuous line in a cassette (cheaper)
- Individual packets with swaged suture
Simple interrupted suture
- Enter the needle on the far side of the incision
- Bring the needle back to the near side
- Tie the knot after each thread
Types of sutures
- Simple interrupted
- Simple continuous
- Cruciate suture
- Ford Interlocking suture
Simple continuous suture pattern
- A very common and versatile appositional pattern
- Enter the needle on the far side of the incision
- Bring the needle back to the near side
- Suturing continuously without cutting it each time
The near side is..
The side closest to the surgeon
The far side is….
The side opposite the surgeon
When using an autoclave, first check …
The distilled water level
When using an autoclave, DONT ___
Overpack
What cannot go in an autoclave?
Most plastics
Before using the autoclave, use an indicator strip to check that …..
- It is reaching correct temperature and pressure for the correct amount of time
What is autoclave tape used for?
- To indicate whether the pack has been in contact with the steam in the autoclave
- Be careful if running continuous cycles: the tape can turn black even if its in the autoclave but not run through a cycle.
What happens to autoclave tape when it comes in contact with the steam?
Black lines appear
Cruciate suture
- Interrupted appositional and tension relieving suture
- Looks like an X - suture ends go in opposite directions
Ford Interlocking suture:
- Continuous appositional pattern
- Looks kinda like fish netting
Simple continuous suture steps:
- Begin with a surgeon or
square knot - Stabilise the leading edge of
tissue with your thumb
forceps. Take an appropriate
bite on the far than near side. - Pull the suture through to
appose the tissue. - Repeat step 3-4 again to
continue the suture along the
incision - On the final loop of the
pattern, do not pull the
loop entirely through to
the other side. Leave at
least 3-4+cm loop of
suture for forming a knot - Place the needle holder
between the loop and
the long end of the
suture. Wrapping the
long end of the suture
around the needle
holder. Grasp the loop
with the needle holder
and pull through - Leave the jaws of the
needle holder open
when tightening the knot
to ensure even tension is
applied to each arm of
the loop
Ford Interlocking suture steps:
- Begin with a surgeons or
square knot - Lay the suture out in a loop
on the near side of the
incision - Take a simple bite,
ensuring needle emerges
within the loop of suture - Pull the suture through,
ensuring the suture is pulled
up through the loop. - Continue along your incision line
- Complete the suture pattern by
tying to the loop with square or
surgeons knot with 3-4
additional throws
How to autoclaves sterilise?
- Using moist heat, specifically saturated steam under pressure.
- This process denatures microbial proteins and kills microorganisms, including heat-resistant spores.
- Reaches and maintains specific temperatures, pressure, and time exposure to ensure effective sterilisation
What happens if a minor break in technique such as bumping the tap occurs during scrubbing?
Scrub that area for an additional minute.
Protocol for surgeon preparation: Prior to entry (4)
- Don clean scrubs, remove all jewellery
- Apply surgical head cover, mask and shoe covers or designated footwear.
- Hands should be visibly clean and dry. Fingernails trimmed less than 3mm in length.
- Fake nails or loose flaking nail polish should be removed
Protocol for surgeon preparation: surgical scrub with a medicated soap ()
- Wet hands and apply chlorhexidine or iodine soap from the dispenser to hands and forearms up to elbows
- Use nail pick to clean under fingernails
- start timing
- Using the sponge side, scrub each side of each finger, between the fingers, and the back and front of each hand for approximately 2 minutes and each
forearm for approximately 1 minute. - Rinse from hands to elbows keeping fingers above the elbows
- Dry hands and arms with a sterile towel working from the fingertips to the elbows
How long should an entire scrub last for?
5 minutes.
Surgical hand preparation with alcohol-based handrubs
- Hands should be wet from the alcohol-based rub during the whole procedure, which requires
approximately 15 ml depending on the size of the hands. - The time required is usually 3-minute exposure, although the application time may be longer or shorter for some formulations
Gowning and closed gloving step 1
- Grasp the gown securely by the inside top layer and lift it away from the table
Gowning and closed gloving step 2
- Hold the gown near the neck on the inside and allow it to unfold without becoming contaminated by touching your body or other objects
Gowning and closed gloving step 3
- Grasp the inside shoulder seams & open the gown
Gowning and closed gloving step 4
- Slide your arms partway into the sleeves, keeping your hands above shoulder level and away from your body
Gowning and closed gloving step 5
- Wait for an assistant to pull the gown over your shoulders and secure it
Gowning and closed gloving step 6
- Ensure that your hands do not protrude from the cuffs of the gown
Gowning and closed gloving step 7
- Keeping your hands inside the cuffs, open the glove packet positioned so that the fingers pictured point towards you
Gowning and closed gloving step 8
- Pick your first glove up by slipping your thumb under the folded cuff edge
Gowning and closed gloving step 9
- Rotate your hand so that the glove is sitting on top of your thumb
Gowning and closed gloving step 10
- Grasp the cuff with your other hand and stretch the glove over, manoeuvring your fingers into position
Gowning and closed gloving step 11
- Be sure to cover the entirety of your gown cuff with the glove
Gowning and closed gloving step 12
- You can grasp the glove and seam of the gown to pull the glove on more snuggly
Gowning and closed gloving step 13
- Pick up the next glove with your un-gloved and repeat the above steps (you will need to grasp the new glove with your already gloved hand)
Gowning and closed gloving step 14
- Adjust your fingers and ensure that there is no exposed skin, the sleeve cuffs are covered by the gloves, and no part of your skin has touched the outside of the gloves or gowns in the process
What to NEVER DO while wearing sterile gown and gloves (6)
- Drop your hands below the level of the sterile area at which you are working
- Touch your surgical gown above the level of the axilla or below the level of the sterile area where you are working
- Put your hands behind your back; keep them within your full view at all times
- Tuck your gloved hands under your armpits, as the axillary region of your gown is contaminated.
- Reach across an unsterile area for an item.
- Touch an unsterile object with gloved hands unless ordered to do so by the surgeon (e.g. cardiac arrest)
Patient skin preparation for male dogs step 1:
- For male dogs: clip preputial hair and flush prepuce at least four or five times using a 20mL syringe
filled with dilute chlorhexidine solution before preparation of abdominal skin.
Patient skin preparation for male dogs step 2
- Put on non-sterile gloves.
Patient skin preparation for male dogs step 3
- Lather the whole clipped area with 4x4 swabs soaked in Chlorhexidine surgical swabs.
Patient skin preparation for male dogs step 4
- Be careful to not abrade the skin.
Patient skin preparation for male dogs step 5
- Wipe away the dirty soap from the surgical area with 4x4 swabs that have been soaked with water.
Patient skin preparation for male dogs step 6
- Wipe from the center of the clipped area (where you will make your incision) to the periphery.
Patient skin preparation for male dogs step 7
- Discard swabs once you reach the periphery.
Patient skin preparation for male dogs step 8
- Wipe in a circular motion always keeping the dirtiest parts of the swab to the outside.
Patient skin preparation for male dogs step 9
- Wipe the hair surrounding the operative site with wet swabs also to remove unattached hair.
Patient skin preparation for male dogs step 10
- Spray alcohol liberally onto the clipped area.
Patient skin preparation for male dogs step 11
- Avoid spraying alcohol on mucous membranes and sensitive areas including anus, mouth, eyes.
Patient skin preparation for male dogs step 12
- With a dry swab, wipe from the centre to the periphery as before.
Patient skin preparation for male dogs step 13
- Do this at least three times. Always change swabs between applications of chlorhexidine swabs.
Patient skin preparation for male dogs step 14
- Spray alcoholic chlorhexidine solution onto the operative site and let it dry on the skin.
Aseptic Technique – Draping Male Dog step 1
- For male dogs: clamp prepuce to one side using a towel clamp before plain drapes are applied. Collect the tip of the prepuce with the towel clamps and then retract it laterally.
Aseptic Technique – Draping Male Dog step 2
- Grasp and unfold drape without being contaminated by touching the surgeon patient or other objects.
Aseptic Technique – Draping Male Dog step 3
- Fold approximately ¼ of the drape away from the surgeon.
Aseptic Technique – Draping Male Dog step 4
- Grasp the folded top edge of the drape at the top corners and hold the drape so that your hands are completely covered by the drape.
Aseptic Technique – Draping Male Dog step 5
- Hold the drape tight such that a tight neat edge is created.
Aseptic Technique – Draping Male Dog step 6
- Apply the first drape between the surgeon and the patient.
Aseptic Technique – Draping Male Dog step 7
- Apply the drapes so that there is substantial coverage of the prepared area (i.e. closer to the incision and not at the edge of the prepared area).
Aseptic Technique – Draping Male Dog step 8
- Adjust the drapes away from the incision and never draw the drape across the patient towards the incision.
Aseptic Technique – Draping Male Dog step 9
- Keep your hands within the sterile field when releasing your grip on the drape and adjusting the position of the drape.
Aseptic Technique – Draping Male Dog step 10
- Secure the drapes to patient’s skin with towel clamps ensuring the drape is between the towel clamp and the skin.
Aseptic Technique – Draping Male Dog step 11
- Apply the fenestrated drape by placing the fenestration directly over the planned incision and unfolding them from the inside out and avoiding contamination.
Cruciate suture steps:
- Begin by taking a simple
forehand bite. Pull
suture through leaving a
3-4 cm tag to form a
knot. - Take another forehand bite
adjacent the previous bite. - Tie off the suture with a
surgeons or square knot
with 2-3 additional throws.
