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OR - Exam 2 > MIS > Flashcards

MIS Flashcards

1
Q

What are the 6 components of MIS?

A 
Camera and camera control unit (ccu)
Telescope
Light source and fibre optic light cable
Video monitor
Any peripherals required for recording/documentation
Video cables
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2
Q

You need to get the camera ready for a procedure, what should you do?

A

Inspect camera head
Plug camera into ccu and turn unit on
Set parameters to manufacturer and surgeon preference
Check focus and white balance capabilities

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3
Q

What should the scrub nurse do to get the telescope and light cord ready?

A

Look through telescope and check for clarity

Hold one end of the light cable up to a rm light and look at the opposite end. Should have clear light shining through.

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4
Q

What do black spots when mean looking through the light cable held up to a light source?

A

Damage

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5
Q

What is important to remember about the light cord?

A

It gets hot at end but not if tip is on. If tip off then could burn drapes, etc. do not place on or near flammable sources

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6
Q

What is the co2 insufflator used for?

A

To inflate stomach

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7
Q

What is the normal adult pressure for the Insufflator?

A

15mm/hg

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8
Q

What is the Hassan technique?

A

Inserting port for laparoscopic surgery with open technique. Most commonly used

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9
Q

What is the verres technique?

A

Needle inserted into abdomen blindly that then inflates the abdomen wi co2. More dangerous

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10
Q

Inserting co2 into the abdomen is known as creating a what?

A

A pneumoperitoneum

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11
Q

How do trocars work?

A

They create an orifice to work through by inserting through a cannula through the abdomen and is then removed leaving the cannula behind to work through.

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12
Q

What is important to remember about the cauterization instruments in laparoscopic surgery?

A

You need to check the long black tube insulation for cracks as this could transmit at crack and cause damage to tissue

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13
Q

How does the supine position create complications during MIS?

A

Respiratory complications, increased intraabdominal pressure,
Hypoxia can result and co2 absorption from peritoneal cavity can aggravate situation.

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14
Q

How does the reverse trendelenburg position create MIS complications?

A

Rspiratory advantage for lungs
Cardiac disadvantage because the heart has to work harder to get blood flow back up vs supine where it is all at gravity level.

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15
Q

Why is co2 used to create a pneumoperitoneum?

A

It is absorbed better

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16
Q

What are some tissue/organ injuries that could happen during MIS?

A

Accidental perforation
Bowel burn
Inadvertent coagulation of tissue
Bowel injury

17
Q

A crack in the black tubing of the laparoscopic instrument that can burn surrounding tissue by accident is known as what?

A

Insulation failure

18
Q

What is direct coupling?

A

Electrical energy is flowing eg. Through bovie, and it touches an Un-insulated object. The current is then transferred through that object and any tissue surrounding it will also be affected unintentionally

19
Q

What is capacitive coupling?

A

When a well inspected insulated laparoscopic instrument is used within a narrow space, eg. In a metal cannula, it can transfer the energy through the insulation and onto the other metal of narrow space which can transfer the energy to any nearby tissues that it may be in contact with.

20
Q

What is the first zone of injury?

A

Area of intended tissue reaction visualized by surgeon

21
Q

What are 2 and 3 zones of injury?

A

Areas where accidental injury occurs as result of insulation failure, direct coupling, or capacitive coupling

22
Q

What is zone 4 of injury?

A

Area on endoscope where surgical team can sustain burn as a result of problems with electrosurgical instruments

23
Q

How can a trocar site hernia be prevented?

A

Ensuring tissue layers at trocar site are completely closed

24
Q

What can cause hypertension as a complication in an MIS pt?

A

Pts position from increased abdominal pressure. Increased co2 absorption

25
Q

What are some complications of hypothermia?

A 
Increase stress response
Increase wound infection rate
Longer hospital stay
Prolongs recovery
Delays drug metabolism
Causes hemodynamics instability
Cardiac ischemia
Depresses cognitive function
26
Q

What are some access complications of MIS?

A

Verres needle - misplaced insufflaton
Needle puncture
Trocar placement
Visceral injuries

27
Q

How do you help prevent N&V during an MIS case?

A 
Hydrate vigorously
Reduce narcotic use
Use local anesthetic
Prophylactic antiemetic
Insert NG tube and empty stomach before emergence
Use of propofol
28
Q

Signs of a co2 embolism?

A 
Sudden fall in BP
Dysrhythmias
Heart murmurs
Cyanosis
Pulmonary edema
Abrupt increase in end tidal co2

OR - Exam 2 (16 decks)

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