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MRSA theory > Surgical Technology > Flashcards

Surgical Technology Flashcards

1
Q

Give some absorbable suture materials?

A

Catgut
Chromic catgut
Vicryl
Dexon
PDS

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2
Q

Give some permanent (non absorbable) suture?

A

Silk (although not well preserved)
Prolene
Ethibond

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3
Q

Biological sutures?

A

Silk
Catgut
Chromic catgut

(all braided)

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4
Q

Synthetic sutures?

A

PDS
Vicryl
Dexon
Prolene
Ethibond

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5
Q

Synthetic monofilament sutures?

A

PDS
Prolene

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6
Q

Synthetic braided sutures?

A

Vicryl
Dexon
Ethibond

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7
Q

How are suture size numbers determined?

A

The higher the index number the smaller the suture i.e. : 6/0 prolene is finer than 1/0 prolene.

When the /0 is removed they become thicker with ascending numerical value

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8
Q

which sutures should be used in vascular surgery?

A

always monofilament

braided potentially thrombogenic

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9
Q

Features of a redivac drain?

A

Suction type of drain
Closed drainage system
High pressure vacuum system

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10
Q

Features of low pressure drainage systems?

A

-Consist of small systems such as the lantern style drain that may be used for short term drainage of small wounds and cavities
-Larger systems are sometimes used following abdominal surgery, they have a lower pressure than the redivac system, which decreases the risks of fistulation
-May be emptied and re-pressurised

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11
Q

Features of latex tube drains?

A

-May be shaped (e.g. T Tube) or straight
-Usually used in non pressurised systems and act as sump drains
-Most often used when it is desirable to generate fibrosis along the drain track (e.g. following exploration of the CBD)

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12
Q

Features of corrugated drain?

A

Thin, wide sheet of plastic, usually soft
Contains corrugations, along which fluids can track

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13
Q

Features of chest drains?

A

May be large or small diameter (depending on the indication)
Connected to underwater seal system to ensure one way flow of air

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14
Q

what is level V evidence?

A

Panel or expert opinion

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15
Q

What is level IV evidence?

A

Evidence derived from case series or case reports

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16
Q

What is level III evidence?

A

Evidence derived from well designed pseudo-randomised controlled trials (e.g. alternate allocation) or historical controls

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17
Q

What is level II evidence?

A

Evidence derived from at least one properly designed randomised controlled trial

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18
Q

What is level I evidence?

A

Evidence obtained from systematic review of all relevant randomised controlled trials

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19
Q

what are stapled anastomoses associated with?

A

staple line bleeding

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20
Q

For an anastomosis to heal which criteria must be fulfilled?

A

Adequate blood supply
Mucosal apposition
Minimal tension

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21
Q

Key technique for vascular anastomosis?

A

1.Always use non absorbable monofilament suture (e.g. Polypropylene).
2.Round bodied needle.
3.Correct size for anastamosis ( i.e. 6/0 prolene for bottom end of a femoro-distal bypass).
4.Suture should be continuous and from inside to outside of artery to avoid raising an intimal flap.

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22
Q

when are laparoscopic hernia repairs indicated?

A

where there are bilateral hernias or recurrence of a previous open repair.

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23
Q

What is annual probability of hernia strangulation?

A

3%

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24
Q

What are the types of grafting technique?

A

Split thickness
Full thickness
Skin Substitute
Composite

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25
Q

Types of local flap?

A

Transposition
Pivot
Alphabetplasty (e.g. Z-Y)

26
Q

Types of regional flap?

A

Myocutaneous
Fasciocutaneous
Neurocutaneous

27
Q

Types of distant flap?

A

Free tissue transfer

28
Q

what are prelamination techniques?

A

Allows creation of specialised flaps e.g. buccal mucosa

29
Q

When are full thickness grafts used?

A

Most commonly used for facial reconstruction
Include dermal appendages
Provide superior cosmetic result

30
Q

Intraoperative strategies for infection mitigation?

A

-Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
-Cover surgical site with dressing

31
Q

what may increase surgical site infection?

A

having the wound using a razor (disposable clipper preferred)
Using a non iodine impregnated incise drape if one is deemed to be necessary
Tissue hypoxia
Delayed administration of prophylactic antibiotics in tourniquet surgery

32
Q

When to give preoperative antibiotic prophylaxis?

A

Antibiotic prophylaxis if:
- placement of prosthesis or valve
- clean-contaminated surgery
- contaminated surgery

Use local formulary
Aim to give single dose IV antibiotic on anaesthesia
If a tourniquet is to be used, give prophylactic antibiotics earlier

33
Q

What is the difference between cleaning, disinfection and sterilisation?

A

Cleaning refers to removal of physical debris.
Disinfection refers to reduction in numbers of viable organisms.
Sterilisation is removal of all organisms and spores.

34
Q

Method of sterilisation?

A

1.autoclaving
2. glutaraldehyde solution (2%)
3. ethylene oxide
4. gamma irradiation

35
Q

What is the action of topical silver nitrate?

A

cauterise the exuberant granulation tissue and promote healing.

36
Q

Management of sudden full dehiscence?

A
  • Analgesia
  • Intravenous fluids
  • Intravenous broad spectrum antibiotics
  • Coverage of the wound with saline impregnated gauze (on the ward)
  • Arrangements made for a return to theatre
37
Q

what is a mucous fistula?

A

conduit between the skin and a redundant segment of bowel
by definition they are usually seen in patients who have an end stoma

38
Q

When are mucous fistulas commonly seen?

A

following a sub total colectomy where the distal sigmoid colon is deemed too friable to close

39
Q

Common site of gastrostomy?

A

epigastrium

40
Q

Use of loop jejunostomy?

A

Seldom used as very high output
May be used following emergency laparotomy with planned early closure

41
Q

Use of percutaneous jejunostomy?

A

Usually performed for feeding purposes and site in the proximal bowel

42
Q

Common site of percutaneous jejunostomy?

A

Usually left upper quadrant

43
Q

Use of loop ileostomy?

A

Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)

44
Q

Common site of loop ileostomy?

A

Usually right iliac fossa

45
Q

Use of end ileostomy?

A

Usually following complete excision of colon or where ileo-colic anastomosis is not planned
May be used to defunction colon, but reversal is more difficult

46
Q

Common site of end ileostomy?

A

Usually right iliac fossa

47
Q

Use of end colostomy?

A

Where a colon is diverted or resected and anastomosis is not primarily achievable or desirable

48
Q

Common site of end colostomy?

A

Either left or right iliac fossa

49
Q

Use of loop colostomy?

A

To defunction a distal segment of colon
Since both lumens are present the distal lumen acts as a vent

50
Q

Common site of loop colostomy?

A

May be located in any region of the abdomen, depending upon colonic segment used

51
Q

Use of caecostomy?

A

Stoma of last resort where loop colostomy is not possible

52
Q

Common site of caecostomy?

A

Right iliac fossa

53
Q

Use of mucous fistula?

A

To decompress a distal segment of bowel following colonic division or resection
Where closure of a distal resection margin is not safe or achievable

any region of abdomen for clinical need

54
Q

In which electrosurgical modality does a sinusoidal, non modulated waveform result in vaporization of the tissues?

A

cutting current

55
Q

Features of coagulation current?

A

-Modulated current with intermittent dampened sine waves of high peak voltage
-Evaporation, rather than vaporisation of intracellular fluid occurs
-Results in formation of coagulum

56
Q

What is desiccation current?

A

-Active electrode in direct contact with tissue
-Low current and high voltage system
-Results in loss of cellular water but no protein damage

57
Q

What is fulguration current?

A

-Electrode probe is held away from tissue
-Produces spray effect with local, superficial tissue destruction
-Low amplitude and high voltage system

58
Q

What is blend current?

A

Alternating cutting and coagulation modes
Total average power is less than with cutting

59
Q

Most common gas for pneumoperitoneum in laparoscopic surgery?

A

CO2
gas delivered is adjusted to maintain a constant intra-abdominal pressure of between 12 and 15 mmHg
(more than this may lead to reduced venous return and hypotension)

60
Q

Which drain is standard following breast surgery?

A

Redivac type system that is made of polypropylene.

61
Q

What is an early sign of abdominal wound dehiscence?

A

seepage of pink serosanguineous fluid through a closed abdominal wound is an early sign of abdominal wound dehiscence

MRSA theory (20 decks)

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