Theatre prep + etiquette Flashcards
1
Q
What’s the advantage of using a waterproof drape?
A
It prevents the patient from becoming cold + wet - thus maintaining thermoregulation
2
Q
When should you only wear scrubs?
A
In theatre
3
Q
Why should scrubs be coloured co-ordinated?
A
To differentiate between the levels of surgical personnel, within the theatre suite
4
Q
What should be considered when washing scrubs, after a surgical procedure?
A
They are washed seperately, in a seperate washing area
5
Q
What should be considered, in regards to footwear, when in theatre?
A
They are used only within theatre, no where-else - at any time
Consider foot covers also, as good practice
Foot-covers can be used in an emergency too
6
Q
In an emergency, what is the minimal amount of PPE that should be worn, when rushing into theatre?
A
Disposable + sterile:
1. Gowns
2. Sterile gloves
(Prep-scrubs under gown only)
1. Hair-nets
1. Foot-covers
Bare socks - if desperate, says Lucy!
7
Q
State the difference between prep-scrubs and theatre-only scrubs
A
Prep-scrubs = only to be worn in prep, when preparing patients for surgery
+
Theatre-only scrubs = Only worn in theatre - NOT within prep!
8
Q
If you need something in an emergency, and you are already in theatre, who can you ask?
A
The circulating surgical nurse!
9
Q
How can scrubs contribute towards contamination in theatre?
A
They can harbour micro-organisms, and therefore act as a fomite
10
Q
What is, arguably, the 2 most important sterile items to wear in the OR?
+
Who wears them?
A
Sterile:
1. Gloves
1. Gown
+
All sterile personnel
11
Q
Why should you (as gold standard) wear seperate, disposable gowns in the surgical prep area?
A
To prevent the transmission of fomites to vulnerable, sedated patients from risk of SSI etc
12
Q
What are the 2 main reasons why masks be worn in the OR?
A
- To prevent the spread of HAIs
+ - Act as eye protection
From patients that are infectious, harbour any HAIs or zoonotic disease
13
Q
What should you always be aware of, in regards to the sterile field?
A
Where you are, in relation to it
14
Q
Where does the Sterile Field begin and end?
A
Beings = At the surgical site
+
Ends = At the instrument trolley
15
Q
If you absloutely must move the drapes, during surgery, as directed by the vet - where can you touch it?
A
Underneath
16
Q
Define what is meant by the term ‘Sterile Field’
A
The Sterile Field = the area within the window (SS) , created by the drapes
+
The drapes themselves
SS = Surgical Site
17
Q
What are the 5 main aspects, that are included within the Sterile Field?
A
- Surgical site
- Drapes (All areas)
- Surgical tabletop
- Surgical instruments
- Instrument tray
18
Q
The exception to the rule..
What is the only non-sterile aspect within the surgical field?
A
The edges of the drapes!
19
Q
If anything falls off the surgical field, what should be done?
A
It must be disposed of
+
NOT re-used
20
Q
If you need to dispose of something, such as blood-soaked swabs, from the surgical area, where must it be disposed of?
(In theatre)
A
In the Kick bucket
21
Q
What must you do if you break sterility, and touch something that is not sterile, what 2 minimal steps must you take before re-entering the theatre?
A
You MUST - as a minimum:
2. Re-scrub
+
1. Re-glove
22
Q
Is the back or front of the gown considered sterile?
A
The Front
23
Q
Explain why the back of the surgical gown is not considered sterile?
A
Because when it is sterilised, the sterile part of the gown (the front) is folded inside when packed and sterilised
+
The back of the gown has to be touched by the surgical assistant, to tie it - breaking sterility
24
Q
What area of the sterile gown, is actually considered ‘sterile’?
A
The chest portion of the front of the gown, where the sterile gloved-hands are held and NO other area
25
Where should your hands be placed when you have been donned and gloved?
With your hands clasped, in-front of your chest
+
Must not move from this position, unless instructed otherwise
26
Why should your hands not touch any part of the gown or put your hands by your side when donned?
Because the portion outside of the chest area and gloves are not considered sterile
27
State the 3 things you must do when moving in the OR?
1. Move slowly
1. Walk back-to-back
1. Vocalise when you move, to inform everyone of your presence
28
What way should you face when you are moving around the SS?
## Footnote
SS = Surgical site
With your front facing the SS
29
What should you never block, for the VS, in the OR?
Their light source/the lamp
30
Where should you always stand, in relation to the VS, during a surgical procedure?
Opposite them, on the other side of the SS
31
What should Non-sterile assistants not touch?
Any sterile personnel or everything that is considered sterile!
| Sterile Personnel = Sterile assistant, VS etc
32
How should you act within the theatre?
## Footnote
(4 things)
1. Act calmly
1. Act slowly
1. Thinking before you act
1. Not leaning over the SS
33
How do you avoid unintentional contamination as non-sterile assistant?
By keeping your hands clasped
or
behind your back!
34
What should you do if you accidentally contaminate the surgical field?
Speak up!
It is better to address it immediately, than risk a patient's life or increase the risk of post-op surgical infections
35
Where should you stand, as a non-sterile assistant?
In the corner of the room
+
Away from all sterile personnel + equipment
36
Where should you stand when there is a teaching moment, in the OR?
Behind the VS
+
At the head of the surgical table with the anaesthetist
+
Remember to not lean forwards!
37
Why apart from the obvious, should you not sneeze and cough in theatre?
| 4 reasons..
## Footnote
Think about a particular pathogen that likes to live in the mms + nose!
To protect the patient from:
Cross-contamination
+
Surgical Site Infections
+
Prevent post-op infections
+
Limit spread of HAIs.. in particular MRSA!
| MRSA = Methicillin Resistant Staphylococcus Aureus
38
What 5 things should you be aware of when talking in theatre?
All discussions are kept professional
+
Subjects should be patient + case related
+
Keep talking to a minimum - to reduce the chance of mistakes, or disrupt the VS's concentration
+
Save any relative questions to the end
+
Don't interupt or disrupt the VS during emergencies
39
Should the VS touch the mayo trolley?
No, as it increases the risk of contamination
40
In some refferal practices, are scrub nurses able to pass sterile items to the VS?
Yes
41
How should you open seal and peel pouches?
In an aseptic manner:
Holding the edges of the openings and peel them up + away from each other, folding them outwards - without touching the sterile person
42
What should you check with the VS before breaking sterility, after seeming to have completed the surgical procedure?
Ask/confirm with the VS if they have finished + you are allowed to break sterility
43
What should you not do before confirming if it is okay to break sterility?
Do not remove equipment from the sterile field or move the patient unless asked to do so
44
What is considered the 6 main basic components of the surgical suite?
1.The surgical suite (itself)
2.Recovery kennels
3.Surgical changing rooms
4.Instrument washing + packing
5.Imaging suite
6.Preparation area
45
Name the 4 classifications of surgical procedures
1. Clean
1. Clean contaminated
1. Contaminated
1. Dirty
46
What is meant by a 'Clean' surgical procedure
+
Give an example of one
A surgical procedure which is not contaminated.
Example = Ovariohysterectomy or Orchidectomy
47
What is meant by a 'Clean contaminated' surgical procedure
+
Give an example of one
A surgery where a body cavity is entered under controlled conditions + with limited contamination.
Example = Median-sternotomy
## Footnote
Median-sternotomy, also known as a 'Sternal split' = allows the VS to access both halves of the chest cavity
48
What is meant by a 'Contaminated' surgical procedure
+
Give an example of one
A gross spillage or break into a body cavity, using a sterile technique.
Examples = oral surgery or abdominal surgery - with spillage
49
What is meant by a 'Dirty' surgical procedure
+
Give an example of one
A surgery including infected or necrotic tissues or bodily fluids.
Examples = Dentals + Abscesses
50
What is the ideal design of the theatre suite set to achieve?
Preventing cross-contamination by seperating areas
## Footnote
Dirty theatres, dental suites
51
Why should non-surgical personnel not go beyond prep area?
Preventing personnel from leaving + re-entering clean rooms
+
To limit unnecessary traffic + cross contamination
52
How should surgical personnel, rooms, equipment and instruments be coded?
Colour coded
53
What 5 procedures can you carry out in the prep room?
1. Induction of anaesthesia
2. Surgical prep (Clip + scrub)
3. Placing Intravenous catheters
4. Taking blood samples
5. Triage, minor or emergency care (general practice)
## Footnote
Some general practices may have a dental area in prep also
54
State some equipment that should be kept in the prep area
1. Endotracheal tubes
1. Pre-medication + induction pharmceuticals
1. Anaesthetic circuits + monitoring equipment
1. Crash box + cash area
1. Surgical prep equipment: Clippers, hoover, lint rollers
1. PPE
1. Sharps + clinical waste bins
1. Positioning aids: troughs + sand bags
1. Tables: fixed, on wheels or access to moveable trolleys
1. Fixed sinks for dirty procedures
1. Good lighting or moveable spotlight
55
Where should skin prep be found?
Just outside of theatre, NEVER inside the OR
56
How should theatre doors be designed?
They should be:
* Without handles
+
* They should be automatic or have a push mechanisms
57
Where should PPE, sterilised surgical instruments and consumebles be stored and why?
In Sterile stores
+
To avoid contamination + water droplets
58
How should equipment be stored within the Sterile storage area?
Should be near cleaan area/prep or corridor and has:
* Adequate shelving
* Easily accessible
* Logical order
* Glass doors
* Items can be clearly identified
* In-date (order)
* Well stocked
59
Where should the changing area be?
Near the clean area of theatre
60
What should be kept within the changing area?
Clean:
* Scrubs
* Shoes
* Masks
* Hats
* Seperate laundry bins - to limit cross contamination
## Footnote
Allows staff to change into surgical scrubs before entering the clean area
61
How should the changing area be cleaned?
In accordance to the surgical suite cleaning protocols
62
How should sinks be designed in the prep area?
They should be:
* No touch taps
* Operated by foot, knee, elbow or infrared (motion sensor)
+
* Mixer taps
63
What should be mounted to the wall, around the sink, in prep?
A skin cleansing solution
+
disposable paper towels
+
Preferably sterile single use, impregnated Hibiscrub or Iodine nail brushes/picks
Below the sink: rubber mats, to reduce trip hazard
## Footnote
Be aware that rubber mats increase the likelihood of miro-organisms
64
What should a sink be free from, in prep area?
+
What material should a sink be made out of?
Clutter
+
Stainless steel or any other form of antimicrobial surface
65
What type of flooring should be used in skin prep?
Non-slip flooring
66
Where should you donn and put gloves on?
In a clear area, just outside of theatre
67
Where should the recovery area, ideally be located?
Adjacent to theatre, but seperate from normal wards
+
Often found in prep areas, in the general practice
68
Ideally, where should critical patients be housed, to recover?
In High dependency units
or
Intensive care units
69
For how long should patients be monitored for, post-operatively?
Until the patient is:
* Fully recovered
* All parameters are within their normal limits
* They are conscious
* Apparent gag-reflex
70
What room temperature should the recovery area be, for patients?
22-24 degrees celcius
71
What important 'cart' should be avaliable and easily accessible in the recovery area?
Crash cart
72
Give an example of 2 types of equipment that should be kept in the recovery area
1. Head supports
2. Heating aids
73
What 'ratio' of RVN to patient, should there be?
## Footnote
According to the pp...
1:1
74
What large pieces of equipment can be portable in large hospitals and refferal centres?
Portable x-ray machines
75
Where should the 'Imaging' room be located?
* Close to theatre, with easy access
* Preferably = beside or in-between several theatres
76
Why is it important to have the imaging room so close to theatre?
For the VS to take pre-op + post-op imaging/x-rays of the patient
## Footnote
Especially in orthopeadics
77
What 3 potential types of facilities can an imaging room hold?
1. Radiography
2. Ultrasonography
3. Endoscopy
78
Why were/are wall-mounted x-ray viewers seen as an increased risk for infection?
Because of the dust + other particles that can harbour on the machine
79
What 2 things should be considered in regards to the layout of the operating room?
It is:
1. Spacious
1. Room to manoeuvre without compromising sterility
80
What should be considered in regards to the construction materials used in the operating room?
All surfaces are antimicrobial
81
What 3 things should be considered in regards to the equipment in the operating room?
1. Each piece of equipment is individual to that theatre - i.e; one per theatre
2. They are easy to clean
2. They are made of antimicrobal materials, where possible
82
What 4 things should be considered in regards to the environment of the operating room?
1. Air conditioning or use of a suitable air-flow system is in place
2. It is clean
3. It is dust-free
4. At the appropriate temperature
## Footnote
Remember - increased temperature = increased bacterial colonization
83
Why is it important to have an operating table which is electrically or manually able to adjust it's height?
1. To reduce back injuries of staff
2. Necessary for CPR
3. Adjust to patient size
3. Allow for more efficent treatment of care
## Footnote
CPR = CardioPulmonary Resuscitation
84
What is a Tilt table useful for?
Treating Diaphramatic hernias
+
For patients at risk of Aspiration - due to V+ or regurgitation
85
What 2 types of modifications can some operating tables have?
1. Self-heated
1. Drainage troughs = for dental + post mortem tables
86
What 2 types of surface materials should operating tables have?
Stainless steel or rubber
87
State 1 disadvantage of using a stainless steel top for an operating table
It requires another layer, such as rubber on top, to prevent hypothermia + increase patient comfort
| Patient comfort = less stress = decreased sedation pre-op time
## Footnote
Adding another layer = more expense
88
State 2 benefits of using a rubber top for an operating table
1. It's removable
2. Easy to disinfect + clean
89
Name the 4 types of positioning aids
1. Sandbags
2. Foam pads
3. Ties
4. Troughs
90
State 2 benefits (each) of using sandbags + foam pads for patient positioning aids
1. Usually have a plastic covering, which is easy to clean
2. They come in various shapes + sizes
91
Why are ties considered dangerous positioning aids?
Because they must **only** be tied on the table, when they are **anaesthetised**
They cannot be tied to the table as if they are sedated and they wake up, disoriented + scared, they will injure themselves
92
State 3 benefits of using Troughs for patient positioning aids
1. They are usually covered with plastic + easy to clean
2. They can be filled with foam, so they are comfortable for the patient
3. They can come in various shapes + sizes
93
True or False
Anaesthetised or recovering patients should be monitored at all times, when using patient transport systems.
True
94
What is the **vital** thing you **MUST** remember when using patient transport systems?
To maintain the patient's airway at **ALL** time
95
What are the 2 things you can do, to help maintain the patient's airway when using patient transport systems?
1. Pull the neck forward
+
1. Extend the tongue
96
Where should you place the patient's tongue, when extending the tongue, to maintain the airway?
Place the tongue under the lower jaw
97
What is the purpose of extending + placing the tongue under the lower jaw - specifically?
It helps prevent the tongue from falling back into the mouth + blocking the airwary
98
What can you use to help position patient's in sternal recumbency - especially brachycephalic breeds?
A foam wedge, to help maintain the airway
99
True or False
You shouldn't lift dogs that over 15kg by yourself
Truee
100
What posture should you maintain when you lift patients?
Bend your knees
+
Keep your back straight
101
State 8 materials/pieces of equipment can be used for transporting patients in the VP
1. Blankets
2. Towels
3. Stretchers
4. Hoists
5. Carriers
6. Cat trollies
7. Slings
8. Y-harnesses
102
State the 2 common types of stretchers
1. Nylon
2. Framed
103
Name an advantage and an disadvantage for using a blankets + towels for transporting patients
Advantages:
1. Removes some strain from staff
1. Keeps animal comfortable
2. Inexpensive
3. Easily accessible
4. Multi-use
Disadvantages:
1. Not secure
104
Name a benefit for using stretchers for transporting patients
Benefits:
1. Easy to clean
1. Machine washable
Nylon:
1. Have padded handles, for less strain for staff
Framed
1. Aids patient positioning
105
Name a benefit for using hoists for transporting patients
1. Great for moving recumbent patients
1. Provides rehabilitative support
106
What patient transport system should be used for cats, when they are conscious?
Carriers
107
Name an advantage + disadvantage for using a carriers for transporting patients
* Advantage: They are secure
* Disadvantage: Doesn't provide great visability to monitor the patient
108
Name a benefit for using a cat trollies for transporting patients
1. You're can attach it to cat baskets/carriers
2. Allows for easy transportation
109
Name a benefit for using a slings + y-harnesses for transporting patients
1. Easy to access
2. Great for supporting larger animals, such as large dogs
110
What is Diathermy equipment?
And what is it used for?
Equipment used for cutting + coagulating tissues
by the use of heat application
111
Briefly explain how diathermy equipment works
Tissues are cut using a high-frequency electrical current, which produces heat within the tissue - at the point of application.
As waveforms change, so will the corresponding tissue effects.
112
State the function of the continous waveforms
Cutting tissue
113
State the function of the interrupted waveforms
Coagulation
114
What is the most important thing that diathermy equipment can do?
It's rapid control for controlling blood haemorrhaging
115
What 2 things does diathermy equipment reduce?
It reduces:
1. Surgical time
1. Need for surgical materials
116
True or false.
Diathermy equipment can either Monopolar, Bipolar or Tripolar.
False.
There is only monopolar + bipolar.
117
When using monopolar diathermy equipment, does the patient need to be 'earthed'?
Yes
118
When using bipolar diathermy equipment, does the patient need to be 'earthed'?
No
119
How does monopolar diathermy equipment achieve coagulation?
By using a finger switch pencil
+
*The cutting action of monopolar is achieved by a continuous low voltage electric current waveform action which vaporises the tissues on contact*
120
Where does the earth wire sit in relation to the patient, when using Monopolar D-Eq?
The earthwire sits within the plate
+
Sits underneath the patient
+
connected to the diathermy unit
121
How does the earth-wire transfer the current?
Through a harmless plate, often through the floor of theatre
122
Why do you need good contact between the earthing plate and the patient?
To prevent the current from passing along the patient and to the VS
123
Where does the current pass through in Bipolar D-Eq?
Through the tips of the forceps + across the tissue
124
How is the current in bipolar D-Eq stimulated?
By the use of a foot pedal
125
How is coagulation achieved, when using bipolar D-Eq?
Applying the forceps directly to the site of haemorrhaging
126
What should be applied to the pads, when using D-Eq?
Contact gel
127
What is the benefit of using stainless steel pads, when using Bipolar D-Eq?
It's easy to clean
128
What do you not need if you have sticky pads, when using Bipolar D-Eq?
No contact gel
129
What 2 things should you **MUST NOT** do when cleaning any Diathermy equipment?
1. Do not use surgical spirit
2. Do not submerse the cables throughly
130
What is suction apparatus used for?
Suctioning fluids + bloods
131
Why are portable suction apparatuses great for dentals?
To help prevent aspiration during procedures
(If aspiration occurs, less bacteria will be in the mouth and aspirated contents reducing the chances of pneumonia)
132
Are suction tips classed as sterile or un-sterile?
+
Can they be reused?
They are sterile
+
They must **not** be reused
133
Can you get single and double bottled suction apparatuses?
Yes
134
Name a benefit of suction apparatuses
They're easy to clean
135
What is scavenging?
The collection + removal of anaesthetic gases in the OR
136
What is a key factor for any surgical suite?
## Footnote
Think air flow...
Good ventilation or scavenging set
137
Give an example of active air flow?
The use of a suction apparatus
137
What are the 2 types of airflow called, in the theatre?
1. Active
2. Passive
138
**Explain how to clip a patient in preparation for a surgical procedure**
Patient should be clipped in the prep room
Select appropriate clipper blades (Usually size 40)
Check for any damage, rust or visable soiling
Consider the possibility that the blades have been used before for previous patients - if in doubt = use clean ones or clean the current ones
Remove any loose hair
Use a smaller set of clippers, if necessary, to gain access to the smaller hairs, around the clipped area - using adhesive tape or an adhesive roller
Clean the clipper blades using a
## Footnote
Remember = never clip a patient in theatre!
139
Give an example of passive air flow?
'Feed down' tubes
(No suction)
140
What is the **minimal** number of air changes, there must take place in the theatre, over 12+ hours?
6 changes, every 12+ hours
141
When cleaning the OR, what type of dusting should you do every day?
Damp-dusting
142
When should you turn on the active ventiliation, for surgery?
Prior to **each** surgery
143
How often should anaesthetic circuits be cleaned?
Every day
144
How should you clean anaesthetic circuit?
Submerge it in disinfectant
## Footnote
* Sterilise regulary
* Includes the anaesthetic bag
145
What are the 3 biggest contamination factors in the surgical suite?
1. Foot traffic
2. Incorrect cleaning
3. Innapropriate lay out/storage
146
How often should spray bottles, filled with disinfectant solutions, be changed?
Spray bottles should be replenished weekly
147
How often should theatre specfic heads be changed?
Weekly
148
