Lecture 4: General Surgery Etiquette & Procedures (Exam 1) Flashcards
What is the primary difference btw/ small animal & large animal patient prep
When inducing anesthesia
T/F: There should be extra cleaning prior to inducing anesthesia
False; only if the animal is filthy
What is the bath controversy
- Does reduce baterial counts on skin
- Liberates deeper bacteria through open pores
- Dries out skin
- Hair must be dried prior to clipping
What is the prep for horses & food animals
- Groom & pick out feet before induction
- Cover feet before starting skin prep
- Can clip/rough prep while standing
What should be done for food animal/equine standing surgery
- Tie the tail
- clip & prep (in a room other than the OR)
- Block
Where is the final sterile prep performed
In the OR
Elaborate on clipping
- 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
What are the challenges of clippin
- Grease
- Dirt
- Blood
T/F: Small animals are susceptible to clipper burn so be gentle
Tru
What clipping techique should be used
- Smooth motions
- Angle the blade
- Go against the hair
What is the purpose of initial prep
- Remove grossly visible dirt, blood, etc
- Remove grease
- Clean the skin
- Use the same antiseptics as for “sterile” prep outside the OR
What are some special considerations for initial prep
- Limb hanging
- Foot prep preparation
- Opthalmic & dental procedures (no initial prep)
What type of scrub should be used in the final “sterile” prep in the OR
A dedicated surgical scrub that stays in the OR
What are the rules of a “sterile” skin prep
- The person performing the scrub should have a hat & mask, no lab coat, & sterile gloves (ideally washed hands)
What technique should be used during “sterile” skin prep
- circles starting @ the site of incision & working outwards
- One 4x4 square
- Scrub alternating w/ alcohol
What is some other preparation should be done for opthalmic surgery
- Dilute povidone-iodine solution
- Never use chlorhexidine or alcohol b/c it can melt the cornea
What is important in draping
- Effective bacterial barrier
- Lint free
- Tear resistant
- Sterile
- Effective fluid barrier
- Too breathable = not effective
- Not breathable = bacterial growth under the surface
Higher thread count = tighter weave = what
Better barrier
Describe cotton muslin as a draping material
Inadequate microbial barrier when wet or dry
Describe pima cotton as draping material
- 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 of using fabric as draping material
- Damage from puncture (like from towel clamps) disrupts the barrier
- Vulcanized patches resist autoclave steam penetration
Describe using disposable material for draping
- 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
When should double gloving be used
When contamination is likely
Why is are all visible surfaces of a patient is covered
Prevents aerosolization from unprepared areas
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
Why are self-adhering drapes helpful
For circumferential draping (legs) or when large areas are draped
List the steps of patient prep
- clip
- initial scrub
- move to OR
- sterile scrub
- drape
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
Who goes btw/ table & surgery site
Only sterile people
T/F: Non-scrubbed people can extend their arms over a sterile field
False; they should never
Where should anesthesia be
As far as possible from the surgery area
When should the instrument table is toward the surgeon’s dominant hand
During neuters
Describe the positioning of the patient in small animal
Maximize the location on the table for surgical procedures
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
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
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
What is the general order a surgeon should follow w/ minimal assistance
- Open the table drape (or use the outer pack drape as a table drape)
- Open the outlayer of the pack & drop the inner layer wrapped pack onto the table (“protect” the dirty arm)
- Open selected suture & scalpel blade onto pack
- Open gown
- Open gloves onto gown (or side of gown)
- Go scrub
- Drape
- Organize instruments
- Cut
delete this
Before cutting what must the surgeon do
Check w/ the anesthetist
T/F: Below the table is not considered sterile
True
What do assistants do
- Moral support
- Supervision
What is the most important job for the assistant
Cut suture
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
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
Why our gauze counted
- use of radiopaque gauze
- Counted on the table to catch a miscount before closing
How is an instrument handed to a surgeon
- Hand the surgeon the handles
- Firmly like a good hand shake
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
What should be put in the major findings of a surgery report
- What was explored
- Findings (like a pathology report)
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
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.)
