Procedures Flashcards
PDT Bluelight - Traditional
- Apply Levulan Kerastick
- Incubate (either in the office or leave but stay inside) for 90 minutes
- Bluelight for 16 minutes and 40 seconds
- SunBLOCK with zinc and titanium
- stay out of sun for 2 days
PDT Bluelight - Daylight
- apply levulan kerastick
- bluelight for 5 minutes
- sunSCREEN without zinc
- sit outside in the sun for 90 minutes
preparing for procedures
- ensure exam room is clean and contains all necessary tools on tray, etc.
- confirm the pt’s current medications and allergies prior to procedure. verify the pt is not pregnant or allergic to xylocaine with epinephrine. adk pt if they have taken any blood thinners (aspirin, fish oil, warfarin, NSAIDS) in the past two weeks. ask if pt has a pacemaker/defibrillator
- retrieve pt’s consent electronically on EMA (on paper for mohs)
- provide pt with gown/drapes if necessary
injecting local anesthetic
- make sure provider has clearly marked the area to be injected, take a picture in ema
- have guests leave the room unless pt is uncomfortable with needles
- wash hands and put on gloves
- wipe down the top of the xylocaine and sodium bicarbonate buffer solution with alcohol prep pads
- draw up 1 cc (biopsy) or 3 cc (surgical) needle and re-cap until ready for use, make sure to get rid of bubbles
- sterilize the area with alcohol pads / hibiclens making sure not to smear the marker lines
- notify pt that they will feel a little pinch and a burn
- inject the numbing slowly, then verify that the pt cannot feel anything a few minutes later by testing the area
ED & C
tray: provider gloves, cotton tips, drysol, gauze, curette
1. ensure cautery has a new sleeve and tip
2. turn on cautery and set it to LOW frequency
3. wash hands and glove up
4. numb area using lidocaine and epinephrine
5. assist provider by applying drysol to areas that are bleeding. once bleeding stops, bandage with aquaphor/mupiricin and band aids
6. instruct pt to keep dry for 24 hours. provide them with appropriate wound care sheet
7. place curette in sink /bin, replace cautery sleeve/tip, turn off machine
skin tag removal
tray: provider gloves, gradle, cotton tips, drysol, gauze, anesthetic/fridge derm
1. wash hands and glove up
2. assist provider by applying drysol to areas that are bleeding. once bleeding stops, bandage with aquaphor and bandaids
3. instruct pt to keep it dry for 24 hours, provide them with the appropriate wound care sheets
4. place gradle in wash bin
cyst I&D
tray: provider gloves, cotton tips, drysol, gauze/packing material, #11 blade, comedone extractor
1. wash hands and glove up
2. assist provider by applying drysol to areas that are bleeding. once bleeding stops, bandage with aquaphor and bandaids
3. instruct pt to keep it dry for 24 hours, provide them with the appropriate wound care sheets
4. place blade in sharps and tools in wash bin
biopsy shave / punch biopsy
tray: provider gloves, cotton tips, drysol, gauze, punch kit and corresponding sutures (punch), dermablade/punch, specimen bottle with pt’s name
1. wash hands and glove up
2. assist provider by applying drysol to areas that are bleeding. once bleeding stops, bandage with aquaphor and bandaids
3. instruct pt to keep it dry for 24 hours, provide them with the appropriate wound care sheets
4. immediately label specimen after confirming the correct dx and morphology with the provider. sign off the specimen in the log book and get an MA signature. place specimen in bin
5. place sharps into sharps and instruments in wash bin
suture removal
tray: S/R kit, cotton tips, drysol, aquaphor and bandaids
1. ensure pt is ready to get sutures out by reviewing prior visit note / ema sticky
2. check if pt has received results from path report / give results as needed
3. wash hands and glove up
4. remove bandage and check for any signs of infection (redness, pain, etc.), consult with provider if necessary
5. if no signs of infection, sterilize the area with hibiclens or an alcohol wip
6. for interrupted sutures: start at one end of the suture line and grab knot with tweezers. pull the knot over and cut along the side of the knot to remove each stitch
7. for running sutures: start at one end of suture line and grab knot with tweezers. pull knot over and cut along the side of the knot to remove top stitch. then continue to move down the line of sutures - pulling the suture thread through and cutting each loop as you go
8. after removing sutures, sterilize area again and take picture in ema
9. bandage with aquaphor and bandaid and give proper wound care sheet
surgical excision
- prepping the sterile field
- clean room
- place plastic drape on tray
- open excision kit
- remove the top sterile drape in kit, grab from the corner and shake open. use opposite hand to grab other corner and lay it on the plastic drape
- grab excision kit from both ends and drop onto one half of sterile drape without touching instruments
- open #15 blade and appropriate sutures and drop them on the tray
- cover by grabbing folded corner and pulling on top of instruments
- open sterile gloves and place them for provider on the counter - wash hands and glove up
- assist provider during procedure by blotting areas that are bleeding with cotton tips and gauze
- when provider knots the inner suture, cut directly above the knot using the straight edge scissors (don’t pick up until she picks up sutures). when provider knots the outer sutures, cut about half inch above the knot
- once procedure is complete, take closure picture in ema
- bandage wound and provide pt with appropriate wound care sheet
- immediately label specimen after confirming the correct dx and morphology with the provider. sign off the specimen in the log book and get an MA signature. place specimen in bin
- place sharps into sharps and instruments in wash bin
cosmetic visits
on tray: provider gloves, LMX cream, cold rollers, botox/filler and corresponding needles, gauze pads, face sheet with documented lot number, patient name, and expiration date
- get pt to sign consent and save in EMA
- take pictures of areas to be treated
- apply numbing cream to areas being treated as needed
- assist provider by lightly blotting any areas that are bleeding with gauze pads / holding cold rollers to pt’s face
- supply pt with appropriate post-care sheet
