Safe Use Of Equipment Flashcards
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.
How far should evacuation device be from the source of smoke plume?
2 inches
Radiation exposure: primary radiation 
directly from source
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
What action decreases radiation exposure during fluoroscopy procedures?
Positioning the patient as close to the image intensifier as possible 
Magnetic resonance imaging (MRI)
Relies on radio frequency waves to reproduce cross-sectional images of the body without exposing the patient to ionizing radiation 
What movement of a powered instrument is used to drill holes were insert screws, wires, and pins?
Rotating
Reciprocating movements of a powered instrument are used for
Cutting or removing bone
Uses an in and out action 
Flammable antiseptic solutions
Below the flashpoint of 100°F
Combustible antiseptic solutions
Flashpoint above 100°F 
Oscillating movements of a powered instruments are used for
Cutting or removing bone
Uses a side to side cutting action
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
Compared to those warmed with a warm water circulating device, patients who are warmed with forced air show
A higher occurrence of adverse outcomes 
Radiation exposure: leakage radiation
from x-ray machine covering
Radiation exposure: scatter radiation
reflects off the patient, top of the table, protective shielding
Most common patient injury
Burn at dispersive electrode (grounding pad)
Best place for dispersive electrode
Large muscle mass close to the surgery site
Example: quadriceps (thigh muscle), deltoid (shoulder muscle)
Endoscopic considerations: direct coupling
Active electrode touches another instrument
Bovie to metal instrument
Endoscopic considerations: capacitive coupling
Electrical current passes through intact insulation to conductive material
Bovie to metal instrument but Surgeon feels buzz
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
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
