Surgical Facilities & Basic Monitoring Equipment Flashcards
What are the major differences between small animal and large animal hospitals?
What kind of operating room in seen in this image?
The small animal surgical suit
New, modern
What kind of OR is seen in this image?
The large animal surgical suite
What are the different areas of the surgical facility?
Changing Area
- Anesthesia & Surgical Preparation Areas
- Anesthesia Supply Room
- Technician Workstation
- Sterile Instrument Room
- Equipment Room
- Housekeeping Supply Room
- Scrub Sink Area
- Gowning and Gloving Area
- Operating Room
- Post Operative Recovery Area
What is the difference between the clean area vs. mixed area vs. contaminated dirty area?
The goal of keeping areas as clean as possible is to minimize risk of infection.
Clean area = restricted to clean traffic = sterile supply, operating room, scrub sink; brand new pair of clean surgical scrubs on
Contaminated/dirty area = contaminated traffic –> anesthesia prep, lounges, offices
Mixed area : the more in between areas. Not sterile enough for surgery but still fairly clean.
What is the purpose of the changing area?
Used by personnel to change into scrubs
Should have: Cabinets or lockers for storage & Hamper
Where is the anesthesia and surgery prep area located?
Located adjacent to the surgical suite
What is common equipment used for an anesthetic event?
Machines and monitoring equipment
Drugs
Catheter supplies
“Block” supplies
Laryngoscopes
ET tubes
Clippers
Crash Cart
What are the prep materials used for anesthesia and surgery prep?
Vacuum
Clippers
Skin prep material
Sharps container
What are Supply rooms? What do you usually find in it?
every hospital will look different
sterile instruments
equipment
What is the way to clean ET tubes? What is important when using them in patients?
Sterilize + reuse, but usually throw them away
Let them dry- do not want them to be wet for the next patient
Where is the scrub sink area located?
Near the OR suites
What is important to remember for the scrub sink area?
Properly “stocked”
- Antiseptic soap [in correct dispenser]
- Scrub brushes [reusable vs. disposable]
- Botties, masks, scrub caps, etc.
What is important to remember about a scrub sink?
NEVER CLEAN surgical instruments in these sinks, or employee hands that are not scrubbing in.
Where is the Gloving and gowning area? What area results in least amount of cross contamination?
inside or outside OR
still no consensus as to which location results in the least amount of cross contamination
What is an operating room? What is positive pressure/ what is the benefit? What should you have in there in terms of lighting. What about surfaces?
Single Door
Keep door closed once the team is in the room
Scrub Sinks Outside the OR
Positive Pressure Air Flow = pressure higher in room than surrounding area so air can leave the room and not come back in (TPLO, total hip; to be as clean as possible b/c highest risk for post op implications)
Emergency Lighting
Minimize Horizontal Surface
Clean! Clean! Clean!
Surgical suite includes more than one operating room + recovery area, etc.
What is in the OR?
Anesthesia machine
Anesthesia crash cart
+/- sterile table
Mayo stand
Operating table
Heat source
+/- trough
Surgical lights
Medical receptable
Where can you usually find post op recovery?
Adjacent to the surgical area
Individual kennels [small animal] vs. Recovery stalls [large animal]
If the patient is critical patient is taken to the ICU
Careful monitoring
Warmer than OR
Emergency equipment
What are nonsocomial infections? What do we do to mitigate them?
Nonsocomial infections are infections that are aquirerd within the hospital. The purpose of all of these areas, scrub sink , changing scrubs, antiseptics ect, is to prevent a nonsocomial infection.
What is important about patient positioning?
Vital for effective surgical procedure
Positioning dependent on the procedure
Dorsal recumbency
Sternal recumbency
Lateral recumbency
Prep area
Heat source
+/- trough
What are the types of warming for patients? What is active warming? active core warming? Passive warming? What should you remember about the speed at which you warm a patient?
Minimizes heat loss during surgery
Passive Warming vs. Active Warming
Passive Warming
- Blanket or towels [act as an insulator]
Active Warming
- Heat source applied directly on the patient
Active Core Warming
- Heat applied centrally = giving warm IV fluids
Rewarm quickly, but carefully
How does anesthesia affect the patients body?
Anesthesia suppresses many of the body’s normal automatic functions
What vital parameters are affected by anesthesia?
Anesthesia does affect heart rate, respiratory, blood pressure, and other body functions
Why use monitoring equipment?
Monitoring equipment can provide valuable information, as well as act as an extension of the anesthetist’s own senses
What are the types of Monitoring equipment?
Monitor vital signs
Temperature
Rectal thermometer vs. Esophageal temperature probe
Heart Rate/Rhythm
ECG vs. Stethoscope vs.
Esophageal tube
Respiratory Rate
Capnography
Blood Pressure
Doppler vs. Oscillometeric
Monitoring Device
Oxygen Saturation
Pulse Oximeter
What are the parts of an anesthesia machine?
Delivers oxygen
Delivers anesthetic gas
Assists with ventilation
Removes exhaled carbon dioxide
What are important notes about temperature monitoring in anesthesized patients?
Monitoring prevents hypothermia and hyperthermia
Monitored every 5 – 10 minutes until:
Patient is in sternal recumbency
Body temperature between 99F to 102F
Rectal Thermometer vs. Esophageal Temperature Probe
Over heating
What is an ECG?
Continuously monitors electrical activity of the heart
Information about heartrate and rhythm
Electrical signal is picked up by electrodes, amplified and displayed on a screen
What is an Esophageal stethoscope?
Thin flexible tube attached to regular stethoscope
Allows lungs and heart auscultation of draped patient
Intubated patient
What are the 3 values of Arterial blood pressure ?
Systolic pressure
Diastolic pressure
Mean arterial pressure (MAP)
What is direct blood pressure monitoring? What is indirect blood pressure monitoring? What is the gold standard of blood pressure monitoring?
Direct: Arterial Blood pressure -> gold standard
- monitor heart rate and rhythm along with blood pressure
Indirect:
Doppler ultrasound and Oscillometeric. Doppler only gives you systolic blood pressure. Oscillometeric gives you systolic, diastolic, and map.
How do you take a doppler blood pressure reading?
Ultrasonic Doppler Method
Occlude arterial blood flow by inflating a cuff
Deflate the cuff until the blood flow goes back to normal
When pressure in the cuff is just below systolic blood pressure, the blood flow can pass the cuff and is detected by the doppler probe
Probe use ultrasonic waves to detect pulsatile blood flow or vessel wall motion and converts this to an audible signal = HEART RATE
How do you measure a blood pressure cuff?
Width of cuff is about 40% circumference of limb.
What does Oscillometeric Blood Pressure Monitoring Device measure?
Systolic arterial pressure
Diastolic arterial pressure
Mean arterial pressure [MAP] -> most accurate on these machines
Pulse rate
What are some reasons oscillometeric blood pressure is used over other forms of blood pressure reading? What is the downside?
Non-invasive detection of arterial blood flow
Commonly used
Less accurate than Doppler or invasive blood pressure monitoring
Various components lead to inaccuracies
How can you monitor patient respiration?
Movement of thorax
Movement of rebreathing bag
Auscultation [esophageal vs. stethoscope]
Condensation of ET tube
Monitors
Capnograph
What is a capnograph? What does it measure?
Measure exhaled carbon dioxide in patient’s breath over time
Can diagnose respiratory airway obstruction or leak in the ET tube cuff
ETCO2
Measure respiratory rate
What is a pulse ox? What does it measure? Where can it be attached? What is the drawback?
Non-invasive method of measuring the oxygen saturation of hemoglobin (SpO2) in arterial blood
Provides pulse rate of patient
Attached to the patient’s tongue, lip, ear (if not pigmented), paws, toes, and thin skin folds on extremities
Can be easily affected
What other things can affect pulse ox?
Pigmentation, poor bloodflow, motion, light or if the tongue dries out. If it does dry out you can add water to the tongue or use a tongue soaked gauze on the tongue.
What should you always remember when monitoring anesthesia?
NEVER TRUST THE VITAL SIGN MONTIOR’S VALUE ALONE
Always double check these values using traditional monitoring techniques
Example:
Check the monitor’s heart rate values versus what you actually hear using your stethoscope
What is the importance of fluids during surgery?
Intraoperative fluid therapy helps restore and maintain tissue fluid, as well as electrolyte homeostasis and central euvolemia
What are the fluid rates used for patients in surgery?
10 – 15 mL/kg/hour of crystalloid fluids Lower rate (5 mL/kg/hour) may be used for healthy patients undergoing less invasive elective procedures
What are typical causes of fluid loss in surgery?
Fluid losses
Large abdominal and thoracic incisions have much larger evaporative losses
What is a good idea in terms of fluid preparation for surgical patients?
Prewarm fluids
Where should a patient undergo surgical prep? What is involved in surgical prep?
Should take place in the preparation room
Anesthesia/surgical prep area
Surgery site is clipped with adequate margins for the procedure to be performed
Usually performed under anesthesia
Initial scrub
Patient moved to the OR and then 3 additional scrubs performed
What is the goal of skin preparation?
Reduce resident skin flora to prevent infection
Achieve residual antiseptic activity
It is NOT possible to completely sterilize the skin
Who are the members of the surgery team?
Surgeon
Assistant Surgeon [if needed]
Anesthetist
LVT
What are the surgeons responsibilities?
Pre-Operative Responsibilities
Operative Responsibilities
Post-Operative Responsibilities
What are the assistant surgeons responsibilities?
Pre-Operative Responsibilities
Operative Responsibilities
Post-Operative Responsibilities
What is the Anesthetist/anesthesiologist responsibilities?
Pre-Operative Responsibilities
Operative Responsibilities
Post-Operative Responsibilities
What is the Licensed veterinary technicans responsibilities?
Pre-Operative Responsibilities
Operative Responsibilities
Post-Operative Responsibilities
How should you prepare for surgeries?
Know the case
Review pathophysiology and basic of procedure
Review possible complications of procedure
Surgeon preparation
Patient preparation
TEAMWORK MAKES THE DREAM WORK!
What are some common surgical procedures?
Ovariohysterectomy [aka Spay]
Neuter
Mass Removals
Laceration Repairs
Cystotomy
Gastrotomy
What does the ending TOMY mean?
the surgeon cut something
What does the ending ECTOMY mean?
the surgeon cut something out
What does the ending OSTOMY mean?
The surgeon made an opening
What does the ending PLASTY mean?
the surgeon changed the shape of something
What does the ending PEXY mean?
the surgeon moved the organ to the right place
What does the ending RRAPHY mean?
the surgeon sewed something up
What does the ending DESIS mean?
the surgeon made two things stick together
