Safe use of equipment Flashcards
Personnel selecting ESU and accessories do what 2 things?
- make decisions based on safety features
- Minimize risks to patients
What is still the most common injury in the OR?
burn at dispersive electrode (grounding pad)
What is the path of electrocautery for monopolar
Energy comes from machine to pen. Straight line from pen to pad. Pad disperses the energy over wider surface area.
What is the path of electrocautery for bipolar?
btwn 2 tips
How are burns caused? 2 things
High current in small area of contact. OR the pad is under a warming blanket because of the heat.
Personnel using and supporting electrosurgery should what? through what?
demonstrate competency through orientation and continued competency
What should be readily available for ESU?
operating manual
What do you want to test before each use of ESU?
test safety features such as lights, alarms, volume loud enough to be heard
What do you want to keep the ESU away from? How does it want to be kept?
away from spills. Kept clean
What can you use to prevent ESU pedal getting wet?
footswitch cover
What are we checking when we do preventative maintenance?
checking preventative maintenance stickers because we are protecting patients from micro sock
what is micro sock?
leaking electrical current causing a current flow to the patient.
Why are swans at risk for micro shock?
because it measures temperature. The temperature probe sits outside the catheter. The catheter goes all the way to the right side of the heart, sitting up against the myocardium. If you have leaking electrical current, and it travels through the swan catheter it can cause heart stopping cardiac arrhythmias
We never use what?
damaged equipment
Confirm power settings for ESU how?
orally
What do you use to secure ESU to the drape?
use non-conductive material like plastic or flaps in the drape. NOT metal
Prevent what kind of coupling?
antenna coupling
what is antenna coupling
A bundle of cords can interfere with each other’s electromagnetic fields and amplify causing one of them to heat up.
DONT BUNDLE CORDS
What do we call pen on the exam?
active electrode
You don’t want a what kind of electrode on the field?
active electrode because it can cause fires and damages
Do not use ESU in the presence of what?
in the presence of flammable agents
What do you want to use to keep the ESU safe on the drapes?
A safety holster
Remove char from the ESU with a what?
a scratch pad
Use the ESU according to what?>
manufacturer’s recommendations
Keep dispersive electrode away from what 2 things?
- implanted metal prosthesis
- tattoos (metal based ink)
Be sure the dispersive electrode is what in its entirety?
adhered, so it has uniform body contact
We avoid putting the dispersive electrode on what?
boney, scarred or hairy surfaces
Where would be the best place to put a dispersive electrode?
- large muscle mass close to the surgery site
- clean dry area with no pooling liquid
What is the safest form of electrocautery?
bipolar
When do we ideally want to place the dispersive electode?
after patient positioned
What is the biggest muscle in the upper body for the dispersive electrode?
deltoid. DO not put it on ribs
When doing endoscopic surgery, the settings we want to use are going to be what?
very low (single digit)
Do not cauterize what in endoscopic surgery?
the port sites.
The trocar should be what in endoscopic considerations?
plastic only (not metal)
define direct coupling
when current is going through a metal instrument to cause a cautery or burn. active electrode touches another instrument
define capacitive coupling
electrical current passes through intact insulation to conductive material. (like through a glove, holding the instruments, they would get buzz through glove)
ICD and pacemakers need to be what?
out of the path between the active and dispersive electrode because it has metal and leads connecting to the myocardium
If we have ICD and pacemaker we should use what if possible?
bipolar
During surgery and if we are using ESU we need to turn what off?
turn ICD off
Does a pacemaker need to be turned off?
not always
ONLY use what with any nerve stimulator (cochlear implant - fries the auditory nerve, spinal stimulator)
bipolar
What is argon?
cautery for solid organ like the liver and spleen (wide swath of cautery to stop bleeding)
What are you pretty much doing with argon?
spray painting the organ with cautery, but you are never touching the organ!
What can you cause with argon because of the pressure?
gas emboli
Are settings high on argon?
yes
Hospital should provide what for employees with surgical smoke?
provide an environment free of surgical smoke because of health risk
Surgical smoke is not determined by what?
physician preference - they can’t say no to it
We need to evacuate all what?
surgical smoke
Staff must have what on surgical smoke safety?
have initial and ongoing education and competency verification on surgical smoke safety
Is surgical smoke a state law?
not a state law but it is regulatory requirement
What can surgical smoke cause?
emphysema and condylomas
What do we want to have to reduce surgical smoke?
presence of quality/performance improvement projects
What is the safe medical devices act of 1990?
In the case of an incident where there was involvement of equipment in patient injury send the equipment, supplies and packages to biomed before it is put back into circulation
How do we prepare for fire?
we need either a water mist or CO2 fire extinguishers
Water mist fire extinguishers are not good for what?
liquid fires
Co2 fire extinguishers are not good for what?
paper drapes
What kind of fire extinguishers can we not use in the OR? the type of what?
HALON fire extinguishers, which is a type of ABC fire extinguishers
What kind of fire extinguisher is water mist?
“A” fire extinguisher. A for ashes!!
What should you use A fire extinguishers on?
anything that will turn to ashes, paper drapes - garbage.
What should you use B fire extinguishers on?
flammable fluid
What should you use C fire extinguishers on?
electrical current
B and C fire extinguishers are also a type of what?
CO2 fire extinguisher
In regard to RACE and PASS what do you do first?
RACE
What does RACE stand for?
Rescue. Alarm. Contain. Extinguish
What does PASS stand for?
Pull. Aim. Squeeze. Sweep.
What is priority when there is a fire around the patient?
separate the fire from the patient FIRST then turn the gas off
What does NFPA stand for?
National Fire Protection Agency
Materials saturated in flammable fluids must be what?
thrown away at least six feet from the patient
If you are working in the head and neck, O2 must be off for how long before firing any ignition source?
1 minute
ALL personnel should be able to identify and shut off all what?
medical gasses
The patient should only be exposed to radiation only if:
medically indicated
Fire safety should be what?
reviewed annually with everyone
Patients should be shielded where when there is radiation?
pregnancy, gonads, thyroid
Consult who regarding shielding of patients?
the radiation safety officer
Shielding can sometimes have bad effects, which is what?
can trap scatter radiation and increase exposure
We want to what in patient record?
document measures
What do you have to have with x-ray?
dosimeter
Where should you wear dosimeters? 2ish places
- one worn at neck or left shoulder
- one worn under lead
- eyes too
You should not take a dosimeter where?
home
Dosimeter report results what?
annually
What are 3 considerations for pregnant staff with radiology?
- lead should protect front and back
- wear 2 badges - one for baby one for you
- wear on device at neck and other under the gown
Lead shield goes under who during fluoroscopy?
patient. Putting it on top of them increases their exposure
Body fluids and tissue from patients who have radionuclides may what?
emit radiation
If you have questions about radiation safety, you should call who?
radiation safety officer
Stand how far away from x-ray?
stand 6 feet away (2 meters) away and behind lead
What are 2 considerations for lead?
- appropriate fit
- clean and disinfect between use
What 3 things should you ideally wear to protect yourself during fluoroscopy?
- aprons
- radioprotective gloves
- thyroid collar
If you are within the 6 feet radius, what is at greatest risk?
head, neck and hands
Do not do what with aprons to store?
do not fold them. Lay them horizontally
What are 3 things that we test annually with lead aprons?
- label with last test date
- no cracks
- provides protection to the level reported
What can radiation do to the eyes?
cause cataracts
A multidisciplinary team for lasers is responsible for what 2 things?
- laser related policies and procedures and credentialing
- education and competency
If we own a laser you have to have what 3 things? (hint: if you have a company that comes in you don’t have to have that)
- laser program
- laser committee
- laser safety officer
What is a laser safety specialist?
assistant to the laser safety officer that fills in for the laser safety officer.
Is the laser safety specialist required?
no they are optional
Why would we have a laser safety specialist?
the role is recommended if multiple lasers might be operating at the same time
Who is the laser user?
physician or PA with the education, credentials and priveleges to operate a specific laser
Who is the laser operator?
they are required for every laser case. They do the shields, eye protection
Can the circulator be a laser operator?
NO
Laser operators go through what?
annual competency
Nominal hazard zone
area in which the laser beam is contained
When you are covering the windows, shutting the doors you are creating what?
the nominal hazard zone
Warning signs for laser should be what?
should be specific to the laser being used
Where should the warning signs for laser be?
entrances of the OR, NOT EXITS
What has to be available for laser?
eye protection
Eyewear is all about the what in regard to the laser?
wavelength and density of the laser
Can you label eyewear? Can you label a laser
You can label eyewear “use with CO2 laser.” You cannot label laser “use with red goggles.”
Education specific to the laser should be facilitated by who?
laser safety officer
What are 3 considerations for education specific to the laser?
- part of orientation
- continued competency
- on file for laser operator and user
When not in active use lasers should be what?
in standby mode
The footswitch is in what position for lasers?
proper position
Protect exposed tissue with what for lasers?
moistened materials like a woven towel
Pooled liquid can retain what?
laser heat and cause burns
don’t set what on high voltage equipemnt?
fluids
Use what for the laser?
a smoke evac for the laser
do we protect the patient’s eyes too with laser?
yes
If we are working around the eye - doing cosmetic stuff?
corneal eye shields
What is part of timeout?
fire risk assessment
If you are using laser in the airway, the ET tube needs to be what?
needs to be made of material made specifically for lasers (not clear plastic PVC ET tube)
What are 2 extra precautions we can take with ETT?
- ballon inflated with methylene blue tented saline
- keep wet raytecs damp packed down around the ET tube
Ventilate a patient with what if possible when using lasers?
with room air (21%) O2
If a patient will not tolerate room air with lasers?
we can use a laser with low concentration O2
What is low concentration O2?
30% or less
If a patient needs more O2 - greater than 30%, what happens with laser?
cannot use it
When we are intubating the patient, and they are bagged, the whole upper airway there is dead space in the cheeks, so 100% oxygen is just hanging in there, so what do they have to do before firing any laser or electrocautery?
suction residual O2
Use as what a cuff with pneumatic tourniquet?
as wide a cuff
The cuff needs to be greater than what?
half the diameter of the extremity
What kind of cuffs should be available for people that have like different shaped arms or babies with chunky thighs?
contoured cuffs
Ideal cuff should allow what?
bladder overlap, 3-6 inches on an adult
Apply what kind of padding below the pneumatic tourniquet?
wrinkle free padding
What can you do with adipose tissue distal to the cuff for obese patients?
gentle traction
Position the pneumatic tourniquet at the point of what?
maximum circumference
What is the most common injury from a pneumatic tourniquet?
nerve damage. The most common is the obturator nerve (located to the surface of the groin - burning pain in groin and inner thigh)
Tubing of pneumatic tourniquet needs to be what?
lateral aspect of extremity
The tubing should be what?
labeled identifying it as a pneumatic tourniquet.
If more than one tourniquet is used it should be what?
labeled according to the extremity
Use a what to exsanguinate the limb before inflation?
esmarch
Why would we use an esmarch?
pain reduction
Esmarch is contraindicated in patients with risk of what 4 things?
- thrombus
- infection
- dislocated fractures
- malignancy
If esmarch is contraindicated what do you need to do?
by elevation only in contraindicated cases
Tourniquet placement should be part of the what?
time out process
Prophylactic antibiotics infused before what of the pneumatic tourniquet?
inflation
Ideally infusion of antibiotics is complete how many minutes prior to inflation?
20 minutes
What causes nerve damage in pneumatic tourniquets?
- excessive pressure/uneven padding
- excessive inflation time
What can pneumatic tourniquet injury result in?
permanent motor/sensory deficits
Are there recommended time limits for the tourniquet?
no
Monitor patients for what 2 things with the pneumatic tourniquet?
- watch for increasing core temp - because the cooling system that is your extremities is cut off so the core is going to get warmer
- monitor pediatric patients for acidosis (especially if >75 min)
Inform surgeon of inflation time how often?
every 15 minutes after the first hour
If you are doing extended tourniquet time what can you do?
can deflate and allow reperfusion for a minimum of 10-15 minutes and then re-inflate for extended tourniquet time
Pressure settings are baed on what?
limb occlusion pressure
How do you measure LOP?
- use a doppler locate on artery distal to cuff
- slowly increase pressure until pulse stops
- let the pressure down and when you hear the pulse that is LOP
If LOP is less than 130 you want what mm/Hg for pressure?
40
If LOP is 131-190 you want what mm/Hg for pressure?
60
If LOP is greater than 190 you want what mm/Hg for pressure?
80
A pediatric pressure is set at what greater than LOP?
50 mm/Hg
So let’s say you have a LOP of 120, what is going to be your tourniquet pressure?
160
So let’s say you have a LOP of 150, what is going to be your tourniquet pressure?
210
So let’s say you have a LOP of 200, what is going to be your tourniquet pressure?
280
At minimum the pressure is based on what?
systolic pressure and limb circumference
What are 2 temperature concerns with pneumatic tourniquets?
hyperthermia after inflation and hypothermia after deflation
What can rapid deflation of tourniquet cause?
rush of metabolic waste and meds
What are signs and symptoms of a rush of metabolic waste and meds in the system?
ringing ears, numb tingling lips/fingers, loss of consciousness, seizures, arrhythmias
What can have within 1 minute of deflating a tourniquet?
emboli
What is the most important vital sign to get with tourniquet?
temperature. First temp in PACU is most important
What happens when you use isoflurane with a tourniquet?
increased ICP because there is cerebral vasodilation, so do not use it
Over pressurization of tourniquet can cause what?
- pain at tourniquet site
- nerve damage
Excessive tourniquet time can cause what 2 things?
- ischemic injury
- nerve damage
Underpressurization of tourniquet can cause what 2 things?
- bleeding
- venous congestion
What are 9 things you want to document with tourniquet?
- location of cuff
- skin protection measures
- cuff pressure
- limb occlusion pressure
- time of inflation and deflation
- skin integrity before and after use
- distal pulse before and after use
- ID number of tourniquet used
- person who applied cuff
