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Theatre Practice COPY Flashcards

1
Q

define sepsis

A

presence of pathogens of their toxic products in the blood/tissue of a the patient

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2
Q

define asepsis

A

freedom from infection

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3
Q

define antisepsis

A

prevention of sepsis by destruction/inhibition

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4
Q

define disinfection

A

removal of microorganisms but not necessarily spores

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5
Q

define disinfectant

A

agent that destroys microorganisms

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6
Q

define sterilisation

A

complete removal of microorganisms

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7
Q

define virulence

A

severity of disease

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8
Q

what is a surgical site infection?

A

infection in a wound post invasive (surgical) intervention

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9
Q

what are the 4 key factors which contribute to surgical site infection?

A

animal
personnel
theatre space and equipment
equipment, instruments and consumables

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10
Q

what are the 2 key sources of contamination linked to an animal?

A

endogenous

exogenous

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11
Q

where are endogenous sources of surgical contamination found on an animal?

A

within the body of the patient (naturally carried)

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12
Q

where are exogenous sources of infection carried on an animal?

A

externally (e.g. on the skin/coat)

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13
Q

what are 9 key considerations for the theatre space and environment?

A 
layout
surgery types performed and any procedures that are restricted
materials on floor and walls
lighting
power points
heating/air con
presence of doors and windows
minimal storage
health and safety considerations
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14
Q

what are the key factors to consider about the layout of a theatre?

A

should be a room on its own
easy to clean (4 walls and a floor!)
only one entry and exit to reduce footfall

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15
Q

what is the ideal material for theatre walls/floors?

A

tiled or plastic as these are the easiest to clean

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16
Q

what is the key consideration relating to lighting in theatre?

A

operating light which can be moved by the surgeon/scrub team aseptically

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17
Q

what type of heating/ air con must never be used in theatres?

A

fans: risk blowing pathogens/ debris into surgical site

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18
Q

why should there be minimal door and windows in theatre?

A

minimise environmental contaminants

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19
Q

what is involved in the maintenance and cleaning of theatre?

A

SOP with daily, weekly and monthly tasks which will vary between practices

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20
Q

what should be considered about theatre cleaning materials?

A

having separate items for theatre only that are properly washed after each use

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21
Q

what may be involved in daily theatre cleaning SOP?

A

damp dusting prior to first op
clean of surfaces and equipment between patients
deep clean at end of day

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22
Q

what are the 2 key ways items can be sterilised?

A

heat sterilisation

cold sterilisation

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23
Q

what are the 2 methods of sterilisation in heat sterilisation?

A

autoclave

dry heat

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24
Q

what type of heat is used in an autoclave?

A

steam

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25
Q

what are the 3 types of autoclave?

A

horizontal
vertical
vacuum-assisted

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26
Q

what is the most commonly used autoclave?

A

vacuum-assisted

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27
Q

why are vacuum-assisted autoclaves the most common seen in practice?

A

due to their drying cycle

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28
Q

what items may require cold sterilisation?

A

things that would melt in an autoclave (e.g. ET tubes, muzzles)

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29
Q

what are the 3 methods of cold sterilisation?

A

Ethylene oxide
Commercial solution (chemical/alcohol based)
gamma radiation

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30
Q

what are the 3 types of dry heat autoclaves?

A

hot air oven
high-vacuum oven
convection oven

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31
Q

what does the vacuum-assisted autoclave rely on to sterilise instruments?

A

steam penetration

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32
Q

as a rule what effect will increased pressure in the autoclave have?

A

reduced time of cycle

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33
Q

what are the 3 temperatures in a vacuum assisted autoclave?

A

121
126
134
(all centigrade)

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34
Q

in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 121?

A

PSI - 15

15 mins

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35
Q

in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 126?

A

PSI - 20

10 mins

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36
Q

in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 134?

A

PSI - 30

3.5 mins

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37
Q

what are the main considerations when using autoclaves to ensure they sterilise properly?

A

correct loading and packaging of instruments
maintenance of the autoclave itself with servicing and QA checks
monitoring efficacy of sterilisation

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38
Q

what are the 4 methods of monitoring autoclave efficacy?

A

chemical indicator strips
Bowie-dick indicator tape
Browne’s tubes
Spore tests

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39
Q

what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?

A

TST strips

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40
Q

what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?

A

TST strips

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41
Q

what do TST strips show?

A

that the autoclave has reached correct temperature, time and pressure

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42
Q

where should TST strips be placed?

A

in the centre of the item to be autoclaved so that you can confirm that the middle is sterile

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43
Q

do you need different TST strips for different cycles?

A

yes

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44
Q

how do Browne’s tubes show the efficacy of sterilisation within an autoclave?

A

change colour (orange/brown to green) when exposed to correct temperature and pressure for the correct length of time

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45
Q

what are the key issues with Browne’s tubes?

A

glass - impractical

correct tube must be chosen for the correct cyle

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46
Q

how does Bowie-dick indicator tape show efficacy of autoclave sterilisation?

A

stripes change do dark brown once 121 degrees is reached

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47
Q

is Bowie-dick indicator tape a reliable indicator of sterility?

A

no - only informs us that where the tape was the temperature reached 121 degrees

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48
Q

how do spore tests monitor the efficacy of autoclave sterilisation?

A

paper strips are impregnated with spores which should then be killed in the autoclave. The paper is incubated after autoclaving to ensure sterility

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49
Q

what are the benefits of spore tests for monitoring efficacy of autoclave sterilisation?

A

accurate

good for quality assurance

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50
Q

what are the disadvantages of spore tests to show the efficacy of autoclave sterilisation?

A

there is a delay in results - not useful for instruments needed in surgery immediately

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51
Q

how does cold sterilisation using chemical solutions work?

A

items to be sterilised are immersed in the liquid for a set period of time
(follow individual instructions on bottle)

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52
Q

what must happen to instruments/equipment once it is sterilised using chemical solutions?

A

must be thoroughly washed as solution can cause chemical burns

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53
Q

what is gamma radiation often used to sterilise?

A

surgical gloves

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54
Q

what are the main considerations involved in packaging an instrument for sterilisation?

A 
size of autoclave (will equipment fit!)
cost
time
effectiveness
labelling
sharp items (safety)
is TST strip needed
storage afterwards
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55
Q

when may a TST strip not be required?

A

single instrument

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56
Q

what should the sterilisation pouch be labelled with?

A

date of sterilisation
item enclosed
initials
(all permanent marker)

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57
Q

which way should items with handles be packaged?

A

handle towards the top of the bag so that when it is turned out the surgeon/scrub nurse is able to take the handle

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58
Q

why is double bagging ideal for all items?

A

protection of the sterilised item even if a tiny hole is made in the outer bag

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59
Q

why should theatre personnel be kept to a minimum?

A

increased personnel is an increased risk of infection

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60
Q

what are the main risks with moving around theatre?

A

accidental contamination of surgical site

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61
Q

what are the key recommendations for minimising risk of contaminating the surgical site when moving around theatre?

A

avoid excessive movement
unscrubbed personnel should never touch or lean over sterile field
unscrubbed personnel should ensure their clothing doesn’t brush across trolleys/drapes
nobody should walk between scrubbed personnel and the surgical field

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62
Q

where should scrubbed personnel always be facing?

A

surgical field

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63
Q

what is the risk associated with scrubbed personnel turning their back to the sterile field?

A

may lead to contamination as your back is not sterile

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64
Q

how should scrubbed personnel pass each other?

A

back to back

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65
Q

what are the expected hygiene and appearance rules for theatre staff?

A 
appropriate theatre clothing
good personal hygiene
fingernails short and clean with no nail varnish
minimal makeup
no jewellery
shower prior to entering theatre
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66
Q

what is included in general theatre attire?

A

scrubs (short sleeved)
comfortable, easy to clean theatre shoes or shoe covers
cap or hairnet
mask

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67
Q

what is the problem with wearing cover shoes in theatre?

A

can wear through

still wearing outdoor ‘dirty’ shoes in theatre

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68
Q

define preoperative scrubbing up

A

systematic washing and scrubbing of the hands and arms

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69
Q

what are the 3 key purposes of a surgical hand scrub?

A

removal of debris and transient micro-organisms from the nails, hands and forearms
reduce the resident microbial count to a minimum
inhibit rapid rebound growth of microorganisms

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70
Q

why is it important that the antimicrobial used during a surgical scrub has good residual action?

A

inhibits regrowth of microorganisms for longer and so protects patient for longer

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71
Q

what are the 2 surgical scrub methods?

A

timed scrub or numbered stroke

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72
Q

where should you wash from and to during a surgical scrub?

A

clean to less clean (hand down to forearm)

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73
Q

why should the hands remain higher than the elbows at all times during a scrub?

A

allows water to flow from ‘cleaner’ hands to the less ‘clean’ area on the arms

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74
Q

in the numbered stroke method of preoperative surgical scrub what counts as one stroke?

A

one up and back motion is one stroke

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75
Q

describe the process of a numbered stroke scrub

A

remove all jewellery
wash hands and arms with antimicrobial soap
clean subungual areas with nail file
30 strokes over fingernails and nail tips
10 strokes each over all 4 ‘surfaces’ of the fingers of the same hand - paying attention to webbed areas between fingers
10 strokes each over the 4 ‘surfaces’ of the same hand
repeat above 3 stages on the other hand
10 strokes each over the 4 ‘surfaces’ of each arm from wrists to 2” above elbows
rinse hands and arms by passing through water in one direction only fingertips to elbow
once in theatre hands and arms should be dried on a sterile towel following aseptic technique

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76
Q

during a scrub how should you view you fingers, hands and arms to ensure all areas are cleaned?

A

as a block of wood with 4 sides!

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77
Q

how should the stroke motion when scrubbing the 4 surfaces of the arm be made easier?

A

divide arm in half (wrist to mid arm, mid arm to 2” above elbow) and scrub 10 times each ‘surface’ in each half before moving on to the other half

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78
Q

during the scrub procedure what should be avoided?

A

excessive splashing onto surgical attire

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79
Q

how does a timed scrub differ from a numbered stroke scrub?

A

same principles - usually a 5-10 minute scrub but varies depending on scrub solution used

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80
Q

what are the 4 performance categories for surgical scrub agents?

A

antimicrobial action
persistent activity
safety
acceptance

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81
Q

describe the ideal scrub agent in terms of antimicrobial action?

A

broad spectrum

rapid effect

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82
Q

describe the ideal scrub agent in terms of persistent activity

A

longer the residual/persistent activity lasts the lower the bacterial count will remain under the gloves

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83
Q

describe the ideal scrub agent from a safety perspective

A

non-irritating and non- sensitising
no appreciable occular or ototoxicity
safe for use
not damaging to skin or environment

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84
Q

describe the ideal scrub agent from the perspective of acceptance

A

well and properly used by vets/nurses

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85
Q

what are the 3 main forms that scrub agents come in?

A

liquid/foam soaps
impregnated scrub brushes/sponges
brush free scrub

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86
Q

what are the most common surgical scrub agents?

A

liquid or foam soaps

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87
Q

what are liquid/foam soaps used in conjunction with for a surgical scrub?

A

water and dry scrub brushes or sponges

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88
Q

what are the most common antimicrobial agents in liquid or foam soaps used for surgical scrubs?

A

chlorhexidine (CHG)

iodophor

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89
Q

describe how to put on a surgical gown correctly

A

lift gown firmly and bring it away from the table
holding the gown at the shoulders allow it to unfold gently (do not shake)
place hands inside the arm holes and guide each arm through the sleeves by raising and spreading the arms
do not allow hands to slip outside the gown cuff
the circulator will assist by pulling the gown up over the shoulders and tying it

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90
Q

what is the best gloving technique to maintain asepsis?

A

closed gloving

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91
Q

where are hands kept during closed gloving?

A

inside the gown to minimise chance of contaminating the gloves

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92
Q

what may open gloving technique be used for?

A

bandaging/ changing wound dressing

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93
Q

what are the main parts of preoperative patient prep?

A

withholding food and water
bathing and grooming
clipping

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94
Q

when must water be removed from the kennel prior to surgery?

A

once premed is given

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95
Q

why is prolonged (over 12 hours) withholding of food prior to surgery unnecessary?

A

may increase risk of reflux

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96
Q

how long will most animals have food withheld before surgery?

A

6-12 hours

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97
Q

is bathing or grooming of the patient prior to surgery necessary?

A

worth considering - particularly a bath 1/2 days before to ensure animal is relatively clean

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98
Q

what should be checked before clipping begins?

A

blades are sharp and functioning well
clippers work!
the area to be clipped and the size

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99
Q

what must happen after clipping to the clipper blades?

A

must be disinfected

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100
Q

what must you be wary of with clipper blades particularly with a long clip?

A

they will get very hot - skin irritation/burn risk

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101
Q

why is it important that the clip is neat?

A

owner will see this and it gives an impression of the entire surgery

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102
Q

how should clippers be held during clipping?

A

pencil grip fashion to provide maximum control and menuverability

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103
Q

how should clippers be held against the skin to ensure the closest shave?

A

flat against the skin

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104
Q

when must extra care not to traumatise the skin be taken?

A

around bony prominences and thinned areas of skin (e.g. groin)

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105
Q

what is the best method for hair removal?

A

2 stroke method (unless hair is very short)

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106
Q

describe the 2 stroke method for hair removal with clippers

A

bulk of the hair is removed by clipping in the direction of the lie of the hair
closer clip is then achieved by clipping against the direction of the hair

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107
Q

what is the purpose of the 2 stoke method of clipping?

A

close surgical clip with minimal skin trauma

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108
Q

what must happen to the patient after clipping?

A

patient and area must be vacuumed to remove any loose hairs

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109
Q

where should clipping and vacuuming take place?

A

in prep - not theatre!

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110
Q

what else may be required pre-operatively?

A 
enema
anaesthesia requirements (IV catheter)
eye lubrication
purse string sutures (e.g. anal surgery)
bandages (e.g. limbs)
throat pack placed (oral or nasal surgery)
any pre-op medication
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111
Q

what is the aim of aseptic skin preparation?

A

reduce skin contamination of microorganisms

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112
Q

where should skin prep be carried out?

A

in prep for 1st scrub and then theatre for second

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113
Q

describe the ideal surgical scrub solution

A

wide spectrum of antimicrobial activity
ability to decrease microbe count quickly, so allowing quick application
long residual effect
effective in the presence of organic matter
economical
safe for veterinary use and non toxic
extra considerations for occular use

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114
Q

name 3 commonly used scrubs

A

chlorhexidine (hibi)
povidone-iodine
triclosan

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115
Q

what are the key roles of a scrub-nurse?

A

counting or completion of checklist at start and end of procedure
passing instruments
suturing (skin closure)
holding/assisting with something in the surgical field

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116
Q

what is suture material used for?

A

suturing tissue/skin

ligation (knot) around tissue

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117
Q

name 3 ideal properties of suture material

A

strong
non-irritant
knots well

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118
Q

define tensile strength

A

how much the suture material can be stretched before it snaps

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119
Q

define good knot security

A

knot will remain tight for as long as required

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120
Q

define tissue reaction to suture

A

how much the skin/vessel/organ responds negatively to the presence of suture - least possible

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121
Q

define capillarity

A

the ability of blood/fluid to move up the suture material - wicking effect

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122
Q

what level of capillarity is desirable in suture material used to close skin?

A

low so that blood doesn’t leak from internally and lead to infection risk increase

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123
Q

define suture memory

A

whether suture holds it’s shape when removed from packaging (not ideal)

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124
Q

define chatter

A

friction/grip of the suture against itself

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125
Q

define tissue drag

A

friction created as needle and suture pass through tissue

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126
Q

define stiffness and elongation of suture

A

rigidity of material and whether it stretches

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127
Q

define sterilisation characteristics relative to suture

A

should cope well wit sterilisation (high temp)

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128
Q

what are the 2 main types of suture?

A

absorbable

non-absorbable

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129
Q

what are the 2 types of absorbable suture?

A

natural and synthetic

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130
Q

what are the 2 types of absorbable synthetic suture?

A

monofilament and multifilament

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131
Q

what is the only type of absorbable, natural suture?

A

multifilament

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132
Q

give an example of an absorbable, synthetic, monofilament suture

A

caprosyn

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133
Q

which suture types have less chatter and tissue drag?

A

monofilament

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134
Q

give an example of an absorbable, synthetic, multifilament suture

A

vicryl

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135
Q

what must happen to non-absorbable sutures?

A

must be manually removed

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136
Q

what are the 2 types of non-absorbable suture?

A

natural

synthetic

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137
Q

what is the only type of non-absorbable natural suture?

A

multifilament

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138
Q

what are the 2 types of non-absorbable, synthetic suture?

A

monofilament

multifilament

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139
Q

what are the 2 different ways of measuring suture size?

A

USP

metric

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140
Q

what may be used to close wounds other than suture material?

A

staples
tissue glue
adhesive tapes (steri-strips)

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141
Q

what are the benefits of staples, tissue glue and adhesive tapes?

A

fast
easier
cheaper (some can be done with no GA)

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142
Q

what are the disadvantages of tissue glue?

A

stings a lot due to exothermic reaction it produces when working
risk of sticking to patient

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143
Q

what are the 3 basic components of a needle?

A

eye or swage
body
point

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144
Q

what is the difference between swaged and non-swaged needles?

A

swaged needles have suture material already attached so provide a smoother passage through the skin/tissue with less tissue trauma than non-swaged where the suture is seperate

145
Q

label the 3 main parts of this needle and identify if it is swaged or non-swaged

A

A- point
B- body
C- eye

swaged

146
Q

identify this needle shape

A

1/4 circle

147
Q

identify this needle shape

A

3/8 circle

148
Q

identify this needle shape

A

1/2 circle

149
Q

identify this needle shape

A

5/8 circle

150
Q

identify this needle shape

A

compound curve

151
Q

identify this needle shape

152
Q

identify this needle shape

153
Q

what are the 5 main types of needle cross sectional shape?

A 
conventional cutting
taper point
reverse cut
taper cut
special k
154
Q

when are conventional cutting needles most often used?

A

tough areas e.g. skin

155
Q

when are taper point needles most often used?

A

smaller viscera

156
Q

what are the 7 different needle shapes?

A 
1/4 circle
3/8 circle
1/2 circle
5/8 circle
straight
1/2 curved
compound curve
157
Q

identify the needle cross section shape shown in the image

A

conventional cutting

158
Q

identify the needle cross section shape shown in the image

A

taper point

159
Q

identify the needle cross section shape shown in the image

A

reverse cut

160
Q

identify the needle cross section shape shown in the image

161
Q

identify the needle cross section shape shown in the image

162
Q

what are the 4 most common materials instruments are made out of?

A

stainless steel
chromium plated carbon steel
tungsten carbide
titanium

163
Q

what is the most common material used for surgical instruments?

A

stainless steel

164
Q

what are the benefits of stainless steel surgical instruments?

A

great strength
highly resistant to corrosion
good appearence

165
Q

where is tungsten carbide used in surgical instruments?

A

insert material in the tips of cutting/gripping instruments (e.g. scissors or needle holders)

166
Q

what indicates that instruments have tungsten carbide in them?

A

gold handles

167
Q

what is the advantage of tungsten carbide surgical instruments?

A

hard wearing

168
Q

what is a disadvantage of tungsten carbide surgical instruments?

169
Q

what are the disadvantages of chromium plated carbon steel instruments?

A

poorer quality so corrosion and pitting are likely to occur

sharp instruments may blunt faster

170
Q

what is the advantage of chromium plated carbon steel instruments?

A

lower in price

171
Q

when may titanium instruments be used?

A

ophthalmic surgery due to their lightness and reduced glare under the microscope

172
Q

what are the advantages of titanium instruments?

A

lightweight

173
Q

hoe can titanium instruments be identified?

A

blue colouring

174
Q

what is the disadvantage of titanium instruments?

A

very expensive

175
Q

what are the 11 categories of common surgical instruments?

A 
needle holders
scalpel holders
tissue forceps
haemostats/forceps
scalpel blades
scissor
towel clips
dissecting forceps
visceral clamps
retractors
suture removal
misc.
176
Q

what are the main types of towel clamps?

A

cross action

Backhus

177
Q

what is the role of towel clamps?

A

holding drapes onto patients

178
Q

what are the common types of scissors?

A 
mayo
metzenbaum
iris
standard dressing scissors
castroviejo
179
Q

what are the common types of suture removal scissor?

A

carless suture
spencer stitch
lister bandage/plaster

180
Q

what are the key types of dissecting forceps?

A 
plain tissue forceps
rat tooth/treves tissue forceps
adsons plain
adsons rat tooth
debakey
emmett
181
Q

what are the common types of tissue forceps?

A

allis
babcock
duval

182
Q

what are the common types of haemostats/artery forceps?

A 
spencer wells - straight
spencer wells - curved
halstead mosquito
criles artery
rochester peans
kocher artery
dieffenback (bulldog) clamps
183
Q

what are the main types of visceral clamps?

A

doyen may-robson
mayo robson
parker-kerr

184
Q

what are the common types of needle holders?

A 
gillies
olsen hegar
mayo hegar
mcphail
castroviejo
bruce clarke
185
Q

what are the 2 groups of retractors?

A

self retaining

handheld

186
Q

what is the difference between self retaining and handheld retractors

A

self retaining have a mechanism which means they stay as they are left
hand held require an extra person to hold in the correct position (e.g. scrub nurse)

187
Q

what are the common self retaining retractors?

A 
gelpi
travers
west
cone
gosset
balfour
finnochietto (rib)
188
Q

what are the common handheld retractors?

A

czerny
hohmann
volkmann (cairn) rake
langenbeck

189
Q

what are some common speculums?

A

cusco vaginal speculum
williams eye
barraquer eye

190
Q

what is some common diathermy equipment?

A

beare dissecting forceps

191
Q

what is the main use for crocodile forceps?

A

removal of foreign bodies

192
Q

what is the role of rampley sponge holders?

A

holding sterile swabs for patient prep

193
Q

what is the role of cheatle forceps?

A

passing sterile instruments/items while unscrubbed

194
Q

what else may be included with instruments within a kit?

195
Q

when packing kits what should be placed on the outside of the autoclave bag?

A

kit label/name

196
Q

identify this instrument and a key use

A

cross action towel clamp

197
Q

identify this instrument and a key use (if necessary)

A

Backhaus towel clamp

198
Q

identify this instrument and a key use

A

scalpel blade holder

199
Q

identify this instrument and a key use (if necessary)

A

beaver scalpel and blades

200
Q

how is a beaver scalpel best recognised?

A

hexagonal cross section of holder

201
Q

identify this instrument and a key use (if necessary)

A

Mayo scissors - general purpose

202
Q

what options are there for the blades of Mayo scissors?

A

straight or curved

203
Q

how can Metzenbaum scissors be identified?

A

light, short blade and longer handle

204
Q

identify this instrument and a key use (if necessary)

A

Metzenbaum scissors

205
Q

identify this instrument and a key use (if necessary)

A

Iris scissors - ophthalmic surgery

206
Q

identify this instrument and a key use (if necessary)

A

Standard dressing scissors

207
Q

identify this instrument and a key use (if necessary)

A

Castroviejo scissors - ophthalmic surgery

208
Q

identify this instrument and a key use (if necessary)

A

Carless suture scissor

209
Q

identify this instrument and a key use (if necessary)

A

Spencer stitch scissor - has a notch in one of the blades to aid suture removal

210
Q

identify this instrument and a key use (if necessary)

A

Lister bandage/plaster scissors - removal of large bandages and plaster

211
Q

identify this instrument and a key use (if necessary)

A

rat tooth (Treves) tissue forceps - holding skin while suturing

212
Q

identify this instrument and a key use (if necessary)

A

plain tissue forceps

213
Q

identify this instrument and a key use (if necessary)

A

Adsons plain forceps

214
Q

identify this instrument and a key use (if necessary)

A

Adsons rat tooth forceps

215
Q

identify this instrument and a key use (if necessary)

A

Adsons rat tooth forceps

216
Q

identify this instrument and a key use (if necessary)

A

Debakey forceps

217
Q

how are Debakey forceps identified?

A

central groove on one side and a raised area on the other which fit together

218
Q

identify this instrument and a key use (if necessary)

A

Emmett spay forceps - slim and long so used for spays

219
Q

identify this instrument and a key use (if necessary)

A

Allis tissue forceps

220
Q

how are Allis tissue forceps identified?

A

teeth on ends

221
Q

identify this instrument and a key use (if necessary)

A

Babcock tissue forceps

222
Q

how are Babcock tissue forceps identified?

A

rounded ends - no teeth

223
Q

identify this instrument and a key use (if necessary)

A

Duval tissue forceps

224
Q

how can Duval tissue forceps be identified?

A

triangular ‘v’ shaped ends

225
Q

how are the serrations arranged on Spencer Wells artery forceps?

A

vertical (with instrument on it’s side)

226
Q

identify this instrument and a key use (if necessary)

A

Spencer Wells artery forceps

227
Q

what forms do Spencer Wells artery forceps come in?

A

straight and curved

228
Q

identify this instrument and a key use (if necessary)

A

Halstead mosquito - finer than Spencer Wells

229
Q

what forms do Halstead mosquito artery forceps come in?

A

straight or curved

230
Q

identify this instrument and a key use (if necessary)

A

Rochester Peans

231
Q

how do Kocher artery and Spencer Wells differ?

A

Kocher artery has a rat toothed end, otherwise they are the same

232
Q

identify this instrument and a key use (if necessary)

A

Dieffenbach (bulldog) clamps - soft tissue surgery

233
Q

identify this instrument and a key use (if necessary)

A

Doyen May-Robson - GI surgery to occlude the intestine without damage

234
Q

how do Doyen May-Robson clamps prevent damage to the bowel?

A

do not close flat along the full length of the blade

235
Q

identify this instrument and a key use (if necessary)

A

Mayo Robson clamp

236
Q

identify this instrument and a key use (if necessary)

A

Parker Kerr clamps

237
Q

identify this instrument and a key use (if necessary)

A

Gillies needle holder

238
Q

how can Gillies needle holder be easily identified?

A

angled thumb hole

239
Q

identify this instrument and a key use (if necessary)

A

Olsen Hegar needle holder

240
Q

what do Olsen Hagar needle holders have as well as needle holding area and rachet?

241
Q

what are the most common needle holders?

A

Olsen Hegar

242
Q

how do Olsen Hegar and Mayo Hegar needle holders differ?

A

Mayo Hegar do not have scissors

243
Q

identify this instrument and a key use (if necessary)

A

Mayo Hegar

244
Q

identify this instrument and a key use (if necessary)

A

McPhail needle holder

245
Q

describe the grooves on the ‘mouth’ of a McPhail needle holder

A

not equal distance apart

246
Q

identify this instrument and a key use (if necessary)

A

Castroviejo needle holder - ophthalmic surgery

247
Q

what are the grooves within Castroviejo needle holders like?

A

not distinct

248
Q

identify this instrument and a key use (if necessary)

A

Bruce Clarke needle holders

249
Q

identify this instrument and a key use (if necessary)

A

Gelpi self retaining retractor - orthopedic surgery

250
Q

identify this instrument and a key use (if necessary)

A

Travers self retaining retractor

251
Q

how can you tell the difference between West and Travers self retaining retractors?

A

Travers - 4/5 prong combination

West - 3/4 prong combination (3 is like a W)

252
Q

identify this instrument and a key use (if necessary)

A

West self retaining retractors

253
Q

identify this instrument and a key use (if necessary)

A

Cone self retaining retractor - stifle surgery due to hinged part which gives better visualisation

254
Q

identify this instrument and a key use (if necessary)

A

Gosset self retaining retractor - abdominal wall retraction

255
Q

identify this instrument and a key use (if necessary)

A

Balfour self retaining retractor - abdominal wall retraction with potential to retract organs at the same time (e.g. liver)

256
Q

how do Gosset and Balfour self retaining retractors differ?

A

Balfour has an additional blade in the centre

257
Q

identify this instrument and a key use (if necessary)

A

Finnochietto (rib) self retaining retractor - thoracic surgery

258
Q

identify this instrument and a key use (if necessary)

A

Czerny handheld retractor

259
Q

identify this instrument and a key use (if necessary)

A

Hohmann handheld retractor - orthopedic surgery

260
Q

identify this instrument and a key use (if necessary)

A

Volkmann (Cairn) rake handheld retractor

261
Q

identify this instrument and a key use (if necessary)

A

Langenbeck handheld retractor

262
Q

identify this instrument and a key use (if necessary)

A

Cusco vaginal speculum

263
Q

identify this instrument and a key use (if necessary)

A

Williams eye (retractor)

264
Q

identify this instrument and a key use (if necessary)

A

Barraquer eye - ophthalmic surgery, holds eye open

265
Q

identify this instrument and a key use (if necessary)

A

Beare dissecting forceps - diathermy (cauterisation)

266
Q

identify this instrument and a key use (if necessary)

A

Crocodile forceps - removal of grass seeds/foreign bodies

267
Q

identify this instrument and a key use (if necessary)

A

Rampley sponge holders - holding sterile swabs during patient prep

268
Q

identify this instrument and a key use (if necessary)

A

Cheatle forceps - movement of sterile instruments/items by unscrubbed personnel

269
Q

when was ASIF/AO established?

A

ASIF/AO was established in Switzerland in 1958.

270
Q

What does ASIF/AO stand for?

A

Association for the Study of Internal Fixation / Association for Osteosynthesis

271
Q

what does ASIF/AO do?

A

Works in research, development, education and quality assurance in fracture treatment for the benefit of patients

272
Q

What is the difference between a self-tapping and non self-tapping bone screw?

A

Self-tapping screw has cutting flutes of the tip with will enter the drill hole and cut a channel for the thread of the screw. Non-self tapping have smooth tips and require a tap to create a channel in the drilled hole for the threads to insert into

273
Q

as a general rule what size should the screw be relative to the bone?

A

no more than 40% of the diameter of the bone

274
Q

what is the main differnence between cortical and cancellous bone screws?

A

the type of bone that they drill into which informs their structure

275
Q

what sort of screw is required when drilling into cancellous bone?

A

screw with a chunkier thread

276
Q

why do screws used for cancellous bone need a chunkier thread?

A

as cancellous bone is spongy so a more chunky thread is needed in order to grip it

277
Q

why can a screw with smaller thread be used in cortical bone?

A

cortical bone is much harder

278
Q

of the 2 screws in this image which is the cortical and which is the cancellous bone screw?

A

cortical on the left

cancellous on the right

279
Q

what are the main 3 different types of bone plate?

A

dynamic compression plate
venables plate
sherman plate

280
Q

describe the shape of the holes in the dynamic compression bone plate

A

oval holes

281
Q

describe the shape of the edges (shoulder) of the dynamic compression bone plate (DCP)

282
Q

what is the dynamic compression bone plate (DCP) used for?

A

causes compression so used with bone fragments

283
Q

what screws hold dynamic compression bone plates (DCP) in place?

A

tapped screws (non-self tapping)

284
Q

identify this bone plate

A

dynamic compression plate (DCP)

285
Q

describe the screw holes of a Venables bone plate

286
Q

how is a Venables plate held onto the bone?

A

by self-tapping screws

287
Q

identify this bone plate

A

Venables plate

288
Q

describe the outer edge of a Sherman plate

A

curved outer edge

289
Q

by what type of screw are Sherman plates held in place on the bone?

A

self-tapping screws

290
Q

identify this bone plate

A

Sherman plate

291
Q

what is the role of a drill guide?

A

helps to prevent the drill bit slipping on the bone

292
Q

identify this instrument and its main surgical area of use

A

drill guide - orthopedic surgery

293
Q

what is the role of the depth gauge?

A

ensures that hole/tapped area is sufficiently long so that thread fully engages within the bone cortex

294
Q

identify this instrument and its use

A

depth gauge - used to ensure that hole/tapped area is sufficiently long so that the thread fully engages into the bone cortex

295
Q

identify this instrument and its use

A

depth gauge - used to ensure that hole/tapped area is sufficiently long so that the thread fully engages into the bone cortex

296
Q

what happens once a hole has been drilled into bone and it’s depth tested?

A

a thread will need to be cut into the bone using a bone tap or you can screw a self tapping screw straight into the hole

297
Q

does each non-self tapping thread have it’s own corresponding tap?

298
Q

identify this instrument and its use

A

Bone tap - taps drilled hole into bone to allow specific non-self tapping screw to be placed

299
Q

what are the 2 types of head that screwdrivers need to have in order to fit screws?

A

hexagonal

stardrive

300
Q

what is the name of the head of this screw?

301
Q

what is the name of the head of this screw?

A

hexagonal head

302
Q

describe the process of bone screw placement

A
  1. a hole is drilled into the bone
  2. the depth of the hole is measured using a depth gauge
  3. a tap is used to create a thread in the bone or a self-tapping screw is used
  4. a screwdriver is used to place the screw into the bone
303
Q

identify this instrument and its role in surgery

A

Bone holding forceps - handle delicate bones (e.g. phalanges and metacarpals)

304
Q

what is a key identifying feature of bone holding forceps?

A

has teeth to allow effective grip of bone without causing puncture damage

305
Q

identify this instrument and its role

A

Liston bone cutters - used to cut through hard bone structures in order to to divide them or gain surgical field access

306
Q

what is a key identifying feature of Liston bone cutters?

A

have a cutting edge

307
Q

identify this instrument and its role

A

Bone rongeurs - used to make holes in bone, have a scoop shaped tip to facilitate this

308
Q

what are the main handheld retractors used in orthopedic surgery?

A

Langenbeck, Senn and Hohmann

309
Q

what are the main self-retaining retractors used in orthopedic surgery?

A

Gelpis, Travers and Wests

310
Q

what is the name of these instruments and their role?

A

periosteal elevator - lifts and preserves periosteum

311
Q

are all periosteal elevators the same?

A

no - have may different tips

312
Q

what is the freer elevator used for?

A

spinal surgery

313
Q

what is different about the Freer elevator than periosteal elevators?

A

Freer elevator is double ended

314
Q

identify this instrument and it’s role

A

Freer elevator - spinal surgery

315
Q

what is the role of bone curettes?

A

They are sharped edge spoons used to cut and scope cancellous bone and remove cartilage

316
Q

what is an example of a bone curette?

A

Volkmann scoop

317
Q

identify this instrument and its role

A

Volkmann scoop - cut and scoop cancellous bone and remove cartilage

318
Q

why may power tools be used during orthopedic surgery?

A

will reduce fatigue

319
Q

what are 2 examples of power tools used in surgery?

A

drills and saws

320
Q

identify this instrument

A

power tool handle (either saw or drill)

321
Q

identify this instrument and its function

A

plate holder - holds bone plates

322
Q

identify this instrument and its role

A

plate bender - bends bone plates

323
Q

what are the 4 key types of orthopaedic wires?

A

arthrodesis wire
Kirschner wire
intermedullary (Steinmann) pins
cerclage wire

324
Q

describe the end of Arthrodesis wire

A

both ends trocar

325
Q

describe the ends of Kirschner wire

A

one end bayonet the other end flattened

326
Q

describe the ends of intermedullary (Steinmann) pins

A

both ends sharp

327
Q

identify this orthopaedic wire

A

Arthrodesis wire

328
Q

identify this orthopaedic wire

A

Kirschner wire

329
Q

identify this orthopaedic wire

A

intermedullary (Steinmann) pins

330
Q

identify this orthopaedic wire

A

cerclage wire

331
Q

identify this instrument

A

wire twisters

332
Q

identify this instrument

A

graft/suture passers

333
Q

identify this instrument

A

stifle distractor

334
Q

define gossypiboma

A

Inflammatory response to a surgical sponge or a laparotomy pad left involuntarily in the body after a surgical procedure.

335
Q

how is gossypiboma caused in veterinary surgery?

A

Failure to account for all surgical swabs used during a surgical procedure, it is iatrogenic – only caused by human negligence/error

336
Q

What standard operating procedures could be put in place to minimise the risk of a gossypiboma?

A

Presence of a circulating or scrub nurse as standard
Use of radiopaque swabs so that presence can be easily identified with X-Ray
Ensure swabs are placed in properly counted bundles (e.g. of 5) before inclusion in kit and sterilisation
Count done before surgery of number of swabs in kit by scrub nurse
Swab count written on whiteboard in theatre clearly
Use of lap swabs due to increased size and tag which can be attached to

337
Q

What is the role of the Veterinary Nurse in minimising the risk of a gossypiboma?

A

Counting of used swabs, trolley management and effective communication with theatre staff. Use of whiteboard and involvement in counting in and out all used swabs. Awareness of what is within a kit when packing it and ensuring correct amounts of swabs/other items are included every time so that a count is reliable.

338
Q

What is a surgical safety checklist?

A

List of tasks followed before anaesthesia, before the procedure begins and after procedure has ended before anyone leaves theatre. Aims to minimise error or accident within the surgery that could be caused by human error. patient safety communication tool that is used by a team of operating room professionals

339
Q

Why are surgical safety checklists used?

A

Removes element of human error and ensures that nothing is missed

340
Q

when should clipper blades be cleaned?

A

between every patient use - with clipper disinfectant spray and brush

341
Q

what is the source of most SSI?

A

endogenous flora of patients own skin

342
Q

where does 80% of resident and transient skin flora reside?

A

in the first 5 levels of the epidermis

343
Q

where does a surgical scrub need to reahc?

A

first 5 layers of the epidermis

344
Q

how should scrub be applied to the patients skin?

A

sterile supplies (gloves, kidney dish, swabs) or no touch technique (e.g. Chloroprep)

345
Q

why does pressure need to be applied to skin surface during scrub?

A

friction increases the antibacterial effects of an antiseptic

346
Q

describe the correct surgical scrub technique

A

Block in centre over incision - left to right and up and down within this block until swab is clean
Then move out in lines on each side of the block until you reach the hairline

347
Q

what is the correct dilution of 4% hibiscrub?

348
Q

why should gloves be worn during initial skin prep?

A

provides a barrier between the patient and healthcare worker

protection against CHG hypersensitivity

349
Q

what type of antiseptic is best for skin prep?

A

2% CHG with 70% IPA

350
Q

what antiseptic will be used for sensitive mm?

A

aqueous povidine iodine

351
Q

does significant cleaning action occur from antiseptic spray?

A

no - lack of friction

352
Q

why is friction prep more effective?

A

gets into more aspects of the skin

353
Q

where should the skin prep be performed from and to?

A

from incision site to periphery

354
Q

where should the further edge of the Chloraprep applicator be kept?

A

pointing towards edge of clipped site

355
Q

identify this instrument and a key use (if necessary)

A

Kocher artery

356
Q

identify this instrument and a key use (if necessary)

A

Adsons rat tooth forceps

357
Q

identify this instrument and a key use (if necessary)

A

Adsons rat tooth forceps

358
Q

what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?

A

TST strips

JJ (33 decks)

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