Safe Use Of Equipment Flashcards by Oyuki Gamboa

What risk of electrocautery should the perioperative nurse scrubbed into the laparoscopic procedure be aware?

Direct coupling

when the active electrode is activated near another metal device inserted into an adjacent trocar port. The current travels through the metal device and cauterizes tissue that comes in contact with it. The scrubbed team is careful that the electrocautery does not contact other metal devices.

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How far should evacuation device be from the source of smoke plume?

2 inches

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Radiation exposure: primary radiation

directly from source

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Methyl methacrylate

-bone cement
-Highly volatile
-Closed bowl for mixing with a scavenger system
-let anesthesia know when placing cement into the canal (may cause hypotension)
-Dry time for cement affected by room temp

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What action decreases radiation exposure during fluoroscopy procedures?

Positioning the patient as close to the image intensifier as possible

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Magnetic resonance imaging (MRI)

Relies on radio frequency waves to reproduce cross-sectional images of the body without exposing the patient to ionizing radiation

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What movement of a powered instrument is used to drill holes were insert screws, wires, and pins?

Rotating

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Reciprocating movements of a powered instrument are used for

Cutting or removing bone
Uses an in and out action

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Flammable antiseptic solutions

Below the flashpoint of 100°F

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Combustible antiseptic solutions

Flashpoint above 100°F

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Oscillating movements of a powered instruments are used for

Cutting or removing bone
Uses a side to side cutting action

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Contraindications to the use of a pneumatic tourniquet

-Venous thromboembolism
-Impaired circulation or peripheral vascular compromise
-Previous revascularization of the extremity
-Extremities with dialysis access
-Acidosis
-Sickle cell anemia
-Extremity infection

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Compared to those warmed with a warm water circulating device, patients who are warmed with forced air show

A higher occurrence of adverse outcomes

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Radiation exposure: leakage radiation

from x-ray machine covering

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Radiation exposure: scatter radiation

reflects off the patient, top of the table, protective shielding

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Most common patient injury

Burn at dispersive electrode (grounding pad)

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Best place for dispersive electrode

Large muscle mass close to the surgery site
Example: quadriceps (thigh muscle), deltoid (shoulder muscle)

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Endoscopic considerations: direct coupling

Active electrode touches another instrument
Bovie to metal instrument

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Endoscopic considerations: capacitive coupling

Electrical current passes through intact insulation to conductive material
Bovie to metal instrument but Surgeon feels buzz

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Electrosurgical safety with ICD and pacemakers

Used bipolar if possible
Keep the pacemaker out of the path of the device
Turn ICD off or use magnet

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What kind of energy should only be used with any nerve stimulator?

Bipolar energy
Example: cochlear implant

Argon electrosurgical unit

Prevent gas emboli, avoid direct contact with tissue

Safe medical devices act of 1990

In the case of an incident, send the equipment, supplies and packages to biomed

Water mist fire extinguisher

A extinguisher
For when ASHES will be left behind
Not good on liquid fires

CO2 fire extinguisher

BC extinguisher For when ashes won’t be left behind Not good for paper drapes

R. A. C. E.

Rescue Alarm Contain Extinguish

P. A. S. S

Pull Aim Squeeze Sweep

Fire safety

National fire protection agency (NFPA) -Materials saturated in flammable liquids must be thrown away at least 6 feet from the patient ex: Chloraprep -external O2 (NC) off for one minute prior to use in head and neck procedures -All personnel should be able to identify and shut off medical gases under direction

Greatest risk at 6 feet to occupational exposure to radiology are

Head Neck Hands

Laser safety specialist (optional)

-Assistant to the laser safety officer -Roll recommended if multiple laser might be operating at the same time

Laser user

Physician or PA with the education, credentials, and privileges to operate a specific laser

Laser operator

Required for every laser case Annual competency Cannot be the circulator

Laser nominal hazard zone

In room where operating Warning signs should be specific to the laser being used Appropriate eye protection

Laser resistant ETT

Balloon inflated with methylene blue tinted saline -ventilate with room air (21% O2) if possible or low concentration O2 (30% or less)

Pneumatic tourniquet cuff size requirements

Cuff greater than half of the diameter of the extremity Cuff should allow bladder overlap of 3 to 6 inches

Pneumatic tourniquet position

At the point of maximum circumference -Tubing on lateral aspect of extremity -Tubing should be labeled

Most common injury with pneumatic tourniquet?

Nerve damage of obturator nerve closest to surface of groin -from excessive pressure/uneven padding -or Excessive inflation time -Can result in permanent motor/sensory deficits

Esmarch exsanguination contraindicated in patients with

Risk of thrombus Infection Dislocated fractures Malignancy (tumor) -exsanguinated by elevation

How many minutes prior should Prophylactic anabiotic’s ideally be infused before inflation of pneumatic tourniquet?

20 minutes

Patient with pneumatic tourniquet should be monitored for

Increasing core temperature Pediatric patients for acidosis, especially if >75 minutes

When extended tourniquet time is needed

Can deflate and allow reperfusion for a minimum of 10 to 15 minutes and then re-inflate

Limb occlusion pressure

-Determines pressure settings of pneumatic tourniquet -Done in doctors office when scheduling surgery -Use a Doppler to locate an artery distal to cuff Slowly increase pressure until pulse stops

Tourniquet pressure=

LOP + (40, 60 or 80) 40 mm/Hg greater for LOP <130 *60 mm/Hg greater for LOP 131-190* 80 mm/Hg greater for LOP >190 Pediatric pressure set at 50 mm/Hg greater than LOP

At minimum the tourniquet pressure is based on

Systolic pressure and limb circumference

Pneumatic tourniquet complication with rapid deflation

Rush of metabolic waste and meds Lactic acid being produced by distal tissue to tourniquet S/s: ringing ears, numb tingling lip/fingers, loss of consciousness, seizures, arrhythmias

Pneumatic tourniquet temperature complications

Hyperthermia after inflation, hypothermia after deflation -Temperature increases when tourniquet is up -Temperature decreases when tourniquet is down

What anesthesia medication is contraindicated with pneumatic tourniquet use?

Isoflurane Increased ICP -It brings down blood brain barrier -Allowing organs to engorge

Other pneumatic tourniquet complications

-Emboli within one minute of deflation -Overpressurization – pain at tourniquets site, nerve damage -Excessive time - ischemic injury, nerve damage -Under pressurization – bleeding, venous congestion

Adequate eye protection for staff members and patients during laser procedures is determined by the

Optical density and laser wave length marked on the eyewear

Skin burns from the electrosurgical unit are most likely due to

High current on a small area of contact

Phacoemulsification

The process of cataract removal in which the cataract is broken up by ultrasonic vibration, and then aspirated