Surgical Instruments / Sterile Technique Donning / Surgical Gowns and Gloves Flashcards
Towel Clips ?
penetrating
non-penetrating
Sponge stick ?
mostly disposable now
Knife Handles ?
no blade loaded
use hemostat to pick up blade ( never use fingers) - take blade off and throw it out after procedure
long blade - for deep in a cavity
Knife Blades sizes ?
10 and 15 used most
top - abdominal incision
bottom - face incision
Holding the Scalpel ?
The scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel.
Long gentle cutting strokes are less traumatic to tissue than short chopping motions.
The scalpel should never be used in a “stabbing” motion.
**index finger on top **
Bovie purpose ?
To cauterize
To cut/dissect
**cauterize
different tips and it is heat and it seals off small bleeders **
Retractor examples ?
Army-Navy
Richardson
Goelet
Deaver abdominal
Senn
Volkman Rake
Balfour abdominal
Bookwalter
Williams
Kocher
Army-Navy ?
two flat ends and used in minor and major surgery to move tissue out of the way (fascia) - common
Richardson ?
handle to it or two ends
Goelet ?
more curve to it, come in pairs for each side of incision
Deaver, abdominal ?
deeper for down in the abdomen
Senn ?
rake on one end and flat on the other, plastic surgery, tiny ones for face
(Volkman) Rake ?
different teeth for better grip
Balfour abdominal ?
hold open abd. cavity ( three sides to it)
Bookwalter ?
biggest type of instrument , but not as common now cause laparoscopic surgery ( makes a nice circle around the edges)
Williams ?
self retaining
Forceps aka ?
Hemostats, “stat”
Clamps
Forcep examples ?
Kelly – straight
Kelly – curved
Crile – straight
Crile - curved
Carmalt
Halstead mosquito
Heaney hysterectomy
Allis
Lahey
Right angle
Babcock
Kelly forceps ?
common, straight or curved -
serrated on distal half of the jaws and smooth on the proximal, grabbing tissue
What is special about the Crile forces ?
it is all serrated throughout
Carmalt ?
ridges are in a different direction ( longitudinal ) -
help blood flow better?
Halstead mosquito ?
fine tipped, S or C,
Mosquitos are tiny and so are these
pinching off bleeders ( bigger ones you cant just Bovie)
Heaney hysterectomy ?
larger than M
Allis ?
curves at distal ends of the tip, forcibly grasp tissues and do some retraction,
space inbetween and they just pinch at the tip, some teeth as well
Lahey ?
same as car malt ( longitudinal)
Right angle ?
for deeper spaces
Babcock ?
intestinal
put around a blood vessel without pinching on the tissue , put vessel or nerve in the hollow spaces and it wont pinch it
Thumb Forceps aka ?
Pickups
Thumb Forceps use ?
The instrument should remain at the tips of the fingers for maximum control
hold in a pinching motion
Thumb Forceps are not called ?
Tweezers
- *not tweezers !!!
- *
Thumb Forceps are not held like a ?
knife
Thumb Forceps – “Pickups” examples ?
Adson (Brown) tissue forceps
Russian tissue forceps
Ferris-Smith tissue forceps
Bayonet
DeBakey
Bonney
Rat tooth
Adson (Brown) tissue forceps options ?
Without teeth
1x2 teeth
7x7 teeth
** A for suturing **
Russian tissue forceps ?
circle of teeth at the tip
Ferris-Smith tissue forceps ?
teeth at the tips , cross hatching = more secure when grasping
Bayonet ?
offset angle to them
DeBakey ?
w and w/o teeth
thin strip of teeth though the middle of the tong
Bonney ?
…
Rat tooth ?
teeth are longer than adsons
( A for suturing and this is for retracting)
Rat tooth has larger, interlocking teeth than Adson
Scissors examples ?
Metzenbaum
Mayo
Iris
Sharp-Blunt
Bandage
Metzenbaum ?
scissors
Curved or straight
Blunt or sharp tips
Mayo ?
scissors
Curved or straight
Blunt or sharp tips
heavier fascia or suture sissors,
What is the difference between the Metzenbaum and the Mayo scissors ?
length of the handle versus length of the cutting surface ( curves always held to face up)
Metzenbaum has a longer _______________ ratio
handle to blade
Iris options ?
Curved
Straight
Angled
Iris use ?
two sharp points and for very delicate surgery
Bandage scissors ?
slide it under a badge to not cause tissue damage
When holding scissors… the ____ and the ____ finger are inserted into the rings of the scissors while the ______ and ______ fingers are used to guide the instrument
thumb and ring finger
index and middle
The _______ finger does NOT go into the ring ?
middle
The curve of the scissor (if it is curved) should be pointed ?
Up!
not down
Needle Holders examples ?
Crile
Mayo Hegar
Laparpscopic Instruments ?
Needle nose (big bird) grasper
Tissue Dissector
Scissors
Trocar
** all attached to an external handle
all can become a bovie tip if they connect to cautery **
Needle nose (big bird) grasper ?
big bird - gripper
Tissue Dissector ?
TD - push through fascia to separate layers
Passing Instruments: Hand it to another in the position it will be ____ by the receiver
used
Sterile Technique: Method by which _______ is maintained throughout the duration of an invasive procedure thereby minimizing the introduction of microorganisms into a sterile field.
asepsis
Sterile Technique: Healthcare professionals are required to know, understand and follow the procedures for ______________ .
sterile technique.
Sterile Technique: ______-________ ________ can be dramatically reduced when careful sterile technique is followed.
Surgical site infections (SSIs)
medical errors are _____ lead cause of preventable death
third
Principles of Sterile Technique: All items used within a sterile field must be ______
sterile
Principles of Sterile Technique: A sterile barrier that has been permeated (wet or torn) must be considered_________ .
contaminated
Principles of Sterile Technique: The _____ of a sterile container are considered contaminated once the package is opened
edges
Principles of Sterile Technique: Tables are sterile at the ___________ only
table surface level
Principles of Sterile Technique: Sterile persons and items touch only ______ areas; unsterile persons and items touch only_______ areas
sterile
unsterile
Principles of Sterile Technique: Movement within or around a sterile field must not ________ the field
contaminate
**back to back passing **
Principles of Sterile Technique: All items and areas of _______ ______ are considered contaminated
doubtful sterility
Shoes and Scrubs ?
Dedicated OR scrubs
Dedicated OR shoes or shoe covers
Compression hose
**undershirt so the sleeve cannot cross the scrub sleeves **
Surgical Cap ?
Don before scrubbing
Tighter fit cap okay for short hair
More voluminous cap (bouffant) for longer hair
Surgical Mask ?
Put on after cap
Molded or two ties
Both have aluminum strip to bend over nose
Hand scrub should have the following effects ?
Immediate reduction in the resident bacteria
Sustained effect to maintain a reduced bacterial count under surgical gloves
Cumulative effect with each additional application of the antiseptic
Persistent effect providing progressive reduction of bacteria with additional applications
**have sustained affect so later case you can just put advair on and not necessarily resorb all over again **
Put on clean scrubs, hat, mask, shoe covers, +/- goggles_____
first
Remove what when surgical hand scrubbing ?
Remove rings, watches and bracelets
Use nail cleaner under running water to remove _____ ?
debris
Use either an _______ or __________ hand rub
antimicrobial soap or an alcohol-based
If using an alcohol-based rub, prewash hands and forearms with a ________________, dry. Then apply the product, allowing it to ___ completely before donning gloves
non-antimicrobial soap
dry
Scrub time is ____ minutes, depending on product
2-6
__ minute scrubs are NOT recommended – too abrasive
10
_____________ or ________________ ( mores skin reactions) solutions in sterile sponge
Chlorhexadine gluconate
povidone-iodine
Surgical hand scrub is Combined with a________ for cleansing action
detergent
Surgical hand scrub: _______________________ against gram-positive and gram-negative microorganisms
Rapid acting, broad spectrum antimicrobials
Surgical Hand Scrub 2 methods ?
Timed (5 minutes)
Counted stroke (30 for nails, 20 for each surface of fingers, hands, wrists and arms)
Both surgical hand rubs follow a prescribed anatomical pattern, which is ?
Nails
Four surfaces of each finger
Palmar and dorsal surfaces of hands and wrists in a circular motion
4 sides of forearms up to elbows
Rinse starting at fingertips, working toward ________ .
elbows
Keep hands above the _____ so contaminated water drips off the elbows
waist
Don’t get ______ wet
scrubs
Drying Hands technique ?
Grasp corner of towel
Do not shake out towel, but lean forward so that as it falls it does not touch scrubs
Dry each right finger, then right hand and arm with one half of towel
Repeat on left fingers, hand and arm, using other half of towel
Discard towel appropriately – dropping it into waste from waist height
Donning Sterile Surgical Gowns technique ?
Grasp gown on inner neck surface
Step back from table and allow it to unfold
Slide arms in, being careful of surroundings
Do not push hands through cuffs
Circulator (nonsterile) attaches Velcro at neckline and ties the back
Two Person Gowning: If scrub tech/nurse gowns you, he/she will ?
Help you put on the gown
Adjust your gown cuffs before gloving
Help you with gloves
Donning Sterile Surgical Gown cont.. ?
After donning gloves
Grasp paper card in one hand and short tie in other
Hand card to circulator or scrub nurse
Slowly spin around
Pull long tie from card, tie long end and short end
Closed-Glove Technique (Self-Gloving) ?
Keep hands inside cuffs
Open sterile paper of glove package
Grasp the folded cuff
Lay it on palm, fingers pointing up forearm
Pull the glove onto hand
Repeat on other side
Assisted Gloving ?
Scrub nurse adjusts your cuffs
Scrub nurse holds right glove open with two hands
Push your hand in, downward, in a fluid motion
Use your right hand to help open the left glove
Don left glove
Gloves should cover cuffs of gown
Removing Gown and Gloves ?
Untie side ties
Grasp gown at chest/shoulders
Pull away from you, releasing neck Velcro and back tie
Roll contaminated outer gown inward
Discard appropriately
Remove gloves – Glove to Glove, Hand to Hand
Gowns are considered sterile in front from ______ to _____ level, and the sleeves are considered sterile to _ inches above the elbow
shoulder to waist
2
Preparing Operative Site ?
Remove hair with clippers, if necessary (no razors)
Antiseptic soap applied to procedure site first, working outward in a circular fashion toward periphery
On reaching outer boundary, discard the first sponge and repeat with a new sponge
Apply sterile drapes
Preparing Operative Site: Apply sterile drapes ?
Lint free, antistatic, fluid resistant, abrasive-free, fit contours
Towels, sheets, split sheets, fenestrated sheets, stockinette (for extremities) and plastic incision drapes
Draping ?
Hold drapes high enough to avoid touching unsterile areas
Walk around the table to drape the opposite side (don’t reach over the patient)
Don’t shake out drapes, let them drop
Make a cuff of the drape over your gloved hand
Why make a cuff of the drape over your gloved hand ?
Protects your glove from touching an unsterile area
Folded edge towards incision
- Provides a uniform outline
- Prevents instruments and sponges from falling between layers
Draping cont ?
Any part of the drape below waist level or table level is considered unsterile
Towel clips fastened through drapes have contaminated points
If a hole is detected in a drape that has been placed, cover it with a new drape
Maintaining a Sterile Field: _________ passes sterile instruments and supplies into the sterile field without ____________ anything
Circulator
contaminating
Maintaining a Sterile Field: Unsterile personnel must stay at least ________ away
12 inches
Maintaining a Sterile Field: Passing ?
Front to front or back to back
Maintaining a Sterile Field: Contamination of personnel or supplies must be addressed ___________.
immediately
Surgeon typically stands on the_____ .
right
