Lecture 4: General Surgery Etiquette & Procedures (Exam 1) Flashcards
1
Q
What is the primary difference btw/ small animal & large animal patient prep
A
When inducing anesthesia
2
Q
T/F: There should be extra cleaning prior to inducing anesthesia
A
False; only if the animal is filthy
3
Q
What is the bath controversy
A
- Does reduce baterial counts on skin
- Liberates deeper bacteria through open pores
- Dries out skin
- Hair must be dried prior to clipping
4
Q
What is the prep for horses & food animals
A
- Groom & pick out feet before induction
- Cover feet before starting skin prep
- Can clip/rough prep while standing
5
Q
What should be done for food animal/equine standing surgery
A
- Tie the tail
- clip & prep (in a room other than the OR)
- Block
6
Q
Where is the final sterile prep performed
A
In the OR
7
Q
Elaborate on clipping
A
- Sterilization/cleaning of clipper blades
- Size 40 clipper blade (start w/ a 10 if they are to hairy)
- Clip only @ the time of surgery
- @ least 20 cm on either side of the surgical site
- Vacuum the hair
8
Q
What are the challenges of clippin
A
- Grease
- Dirt
- Blood
9
Q
T/F: Small animals are susceptible to clipper burn so be gentle
A
Tru
10
Q
What clipping techique should be used
A
- Smooth motions
- Angle the blade
- Go against the hair
11
Q
What is the purpose of initial prep
A
- Remove grossly visible dirt, blood, etc
- Remove grease
- Clean the skin
- Use the same antiseptics as for “sterile” prep outside the OR
12
Q
What are some special considerations for initial prep
A
- Limb hanging
- Foot prep preparation
- Opthalmic & dental procedures (no initial prep)
13
Q
What type of scrub should be used in the final “sterile” prep in the OR
A
A dedicated surgical scrub that stays in the OR
14
Q
What are the rules of a “sterile” skin prep
A
- The person performing the scrub should have a hat & mask, no lab coat, & sterile gloves (ideally washed hands)
15
Q
What technique should be used during “sterile” skin prep
A
- circles starting @ the site of incision & working outwards
- One 4x4 square
- Scrub alternating w/ alcohol
16
Q
What is some other preparation should be done for opthalmic surgery
A
- Dilute povidone-iodine solution
- Never use chlorhexidine or alcohol b/c it can melt the cornea
17
Q
What is important in draping
A
- Effective bacterial barrier
- Lint free
- Tear resistant
- Sterile
- Effective fluid barrier
- Too breathable = not effective
- Not breathable = bacterial growth under the surface
18
Q
Higher thread count = tighter weave = what
A
Better barrier
19
Q
Describe cotton muslin as a draping material
A
Inadequate microbial barrier when wet or dry
20
Q
Describe pima cotton as draping material
A
- inadequate microbial barrier when wet
- Adequate barrier for skin shedding
- Can be treated to make it water resistant for 75 washes
21
Q
What are the disadvantages of using fabric as draping material
A
- Damage from puncture (like from towel clamps) disrupts the barrier
- Vulcanized patches resist autoclave steam penetration
22
Q
Describe using disposable material for draping
A
- Can be celullose, wood pulp, polyesters, or synthetic polymer fibers bonding into sheets
- Lint free = lower particle count in the air
- Must be reinforced w/ polyethylene or plastic film to be water resistant
23
Q
When should double gloving be used
A
When contamination is likely
24
Q
Why is are all visible surfaces of a patient is covered
A
Prevents aerosolization from unprepared areas
25
Describe draping technique
* Drape "out" the smallest area possible (but have enough room for the incision)
* Place adjecnt to the incision then move away (Dont go back toward the incision)
* Quadrant drap first
Multi layers to build a waterproof barrier (Quadrant then larger sheet on top) & towel clamps should not penetrate below subsequent layers
26
Why are self-adhering drapes helpful
For circumferential draping (legs) or when large areas are draped
27
List the steps of patient prep
1. clip
2. initial scrub
3. move to OR
4. sterile scrub
5. drape
28
How should the instument table be positioned
* Close to the surgeon if no assistant (next to the surgeon's dominant hand)
* Close to the assistant if have an assistant
29
Who goes btw/ table & surgery site
Only sterile people
30
T/F: Non-scrubbed people can extend their arms over a sterile field
False; they should never
31
Where should anesthesia be
As far as possible from the surgery area
32
When should the instrument table is toward the surgeon's dominant hand
During neuters
33
Describe the positioning of the patient in small animal
Maximize the location on the table for surgical procedures
34
Describe the position of the patient for large animals
* Not really alot of options
* They take up the entire table
* Some adjustments for surger of upper respiratory tract
* LOTS of padding
35
What should be known while preping for surgery
* Assistance vs. no assistance
* Location of equipment in the OR
* Traffic flow in the OR
* Know how the pack is opened
* Min time that pack are open - esp during patient set up
36
What should the surgeon do before setting up the surgical field
* Check the table heigh (Ideal = arms bent & even w/ surgical field)
* Double check patient position
* Turn on & position the surgical light
37
What is the general order a surgeon should follow w/ minimal assistance
1. Open the table drape (or use the outer pack drape as a table drape)
2. Open the outlayer of the pack & drop the inner layer wrapped pack onto the table ("protect" the dirty arm)
3. Open selected suture & scalpel blade onto pack
4. Open gown
5. Open gloves onto gown (or side of gown)
6. Go scrub
7. Drape
8. Organize instruments
9. Cut
38
delete this
39
Before cutting what must the surgeon do
Check w/ the anesthetist
39
T/F: Below the table is not considered sterile
True
39
What do assistants do
* Moral support
* Supervision
39
What is the most important job for the assistant
Cut suture
39
What is the method of running suture
* Surgeon places bites
* Surgeon gathers suture & hands excess to assistant
* Assistant holds the suture out of the way of the surgeon taking bites
39
What are the jobs for the assistant surgeon
* Organize table
* Count gauze sponges
* Count instruments
* Hand instruments
* Retract things
* Hold "things"
* Cut suture
* Run suture
39
Why our gauze counted
* use of radiopaque gauze
* Counted on the table to catch a miscount before closing
39
How is an instrument handed to a surgeon
* Hand the surgeon the handles
* Firmly like a good hand shake
39
What are the general rules of writing a surgery report
* Critical part of the medical record (Goals is to accurately report what occurred during the procedure)
* Details are important (like length, instruments, & suture)
* Templates but tailor the template to the patient
* Step by step
* Proper medical terminology (give generic terms & avoid brand names)
* Use procedural writing
* Dont use filler words
39
What should be put in the major findings of a surgery report
* What was explored
* Findings (like a pathology report)
39
What are the parts of a surgery report
* Start w/ the animal being anesthetid/restraind & how it was position (+/- which table or positioning aids were used)
* Describe the area prepared & how it was prepared
* Describe the approach: location, length (cm), & instruments used
* Describe major finding in order (the body the report)
* Describe major procedures in order
* Incision closure (layers, patterns, suture, +/- needle type)
* Describe any incisional dressings that were applied
* End w/ how the animal recovered from anesthesia
* Provide good details for major surgical & anesthetic complications
39
What should be in the major procedures part of a surgery report
* Ligation (size of suture; not every single vessel)
* Transection (instruments used)
* Blunt dissection
* Sharp dissection
* Implants placed (exact numbers, size, etc.)
