nappier - surgical principles Flashcards
ID Halsted’s Principles (7)
- Strict aseptic technique
- Meticulous hemostasis
- Preservation of blood supply
- Gentle tissue handling
- Minimal tissue tension
- Accurate tissue apposition
- Obliteration of dead space
Describe conditions (4) necessary to maintain strict aseptic technique
1. Sterile instruments (via sterilization method
2. Patient preparation (dirty & sterile preps)
3. Surgeon preparation (attire, scrub)
4. Creation of sterile surgical field (quarter/field drapes; towel clamps; table drape)
Describe methods of sterilization (4)
- Physical sterilization (steam/heat = autoclave - used for instruments)
- Ionizing radiation (used for disposables like suture)
- Chemical sterilization (ethylene oxide gas - used for instruments that can’t withstand steam like endoscope)
- Disinfectants (cold tray = alcohol, 10min for bacteriacidal acitivity; cidex - inanimate objects)
Describe preparation of the patient for surgery and use of antiseptics
- Hair removal (limit exposure to pt’s microbial flora)
- “Dirty prep” done in prep room w/ clean supplies- remove gross debris/transient bacteria
- “Sterile prep” done in OR w/ sterile supplies; “clean hand/diry hand” technique
clipping and scrubbing cause micro-traumas! avoid clip burns/abrasions/over-scrubbing
Describe dirty prep
- scrub
- alcohol
- scrub
- alcohol
- scrub
- alcohol
- chlorohex or povidone iodine solution & LEAVE on
- Enter OR
Describe sterile prep
- wipe off chlorohex or povidone iodine solution
- solution
- alcohol
- solution
- alchohol
- solution
- alcohol
- chlorohex solution or povidone iodine & leave on
What are antiseptics and their uses in sx
- Antibacterial for use on living tissue
- Uses = reduce bacterial flora//prep of pt and surgeon
Povidone Iodine; Chlorohexidine Gluconate
Cons to Povidone Iodine (2) versus Chlorohexidine Gluconate (3) solutions
Povidone Iodine
- decreased activity in organic material (dirt, pus, etc.)
- skin irritation
Chlorohexidine Gluconate
- significant corneal irritation
- ototoxicity
- delays wound healing (potential inhibition of contraction & epithelization)
Describe appropriate surgical attire/scrubs (5)
- change after arriving to hospital
- top tucked into pants, keep covered w/ buttoned lab coat when not in OR
- head cover/cotton scrub cap underneath
- surgical mask (dark side out)
- short-trimmed nails; no polish; no jewelry
Describe the steps of the surgical scrub
- nail pick
- rinse from fingertips to elbow, keeping hands higher than albows
- 10 strokes per anatomic area
fingertips & 4 sides of fingers; 4 sides of hands; forearms to elbows
3 causes of surgical hemorrhage
- Iatrogenic/technique
- Genetic
- Acquired: trauma, hemodilution, academia (teaching moments = longer-than-normal duration = higher risk for complications), hypothermia
Methods to prevent hemostasis (3)
- good surgical planning + knowledge of related anatomy
- ligation or coag. of vessels prior to transescting
- accurate dissection & knowledge of local vessels
Delayed Hemorrhage
- when does it occur
- why does it occur
- occurs post-op, up to ≥24h
- poor ligation technique, intra-op hypotension, dysphoric recovery
- primarily occurs b/c of icnomplete tx of 1º hemorrhage
Steps to controlling hemorrhage
- Calmly acknowledge
- Apply direct pressure
- Use tools to execute permanent hemostasis: hemostat + ligation; electrocautery; hemostatic material (gelfoam)
How long to apply direct pressure
30s for PLT aggregation; 2-3min for fibrin clot
How to use hemostats for hemostasis
- use smallest possible (larger ones are bulkier in your surgical field)
- for small, SF vessels: tip toward vessel, concave surface down, grasp with tip
- for large, vascular pedicles or vessels: perpendicular to vessel, concave surface toward line of transection, “tips up”, grasp w/ jaw for increased security
What size suture of ligature?
Smallest suture of adequate strength
- 0 to 4-0, commonly used is 2-0 to 3-0
What is “flashing” of small vessels
gently loosening the hemostat as the first throw is applied to gauge accurate width of vessel before tightening down with second throw
Describe 3 Clamp Technique
- transect b/w A and B, then remove A
- ligature just below C
- Flash C
- IF good, remove C hemostat, continue rest of throws, then remove B
Fully saturated 4x4 = __?__ mLs of blood
5mL
Entire surface of a lap sponge covered = __?__ mLs of blood
75mLs
Lap sponge is soaked & dripping = __?__ mLs of blood
100mLs
