Theory Unit 2 Exam Objectives Flashcards
Identify parts of a surgical instrument
Tips Jaws Box lock Shank Finger ring Ratchets
List types of endoscopes and a purpose for each.
Colonoscope Cystoscope Laparoscope Arthroscope Ureteroscope Angioscope
Identify types of powered instruments and a surgical application for each.
Reamer-driver
Application: Ream medullary canal or ream acetabulum
Images to follow
Reamers=slower; more torque; used to ream bone
Drills
Application: Drill holes in bone
Drills=fast; used to place pins or drill pilot hole for screws
K-wire driver
Application: Insert pins into bone
Dermatome (can be electric, battery or hand operated)
Application: Take skin graft
FYI: Very fast side-to-side action; disposable blade; very precise depth
Meniscutome (AKA: arthroscopic shaver)
Application: Used to trim damaged joint cartilage
Cranial perforator
Application: Drill burr holes in skull
Craniotome
Application: Connect holes drilled in the skull to remove a bone flap
List types of power sources for powered instruments.
Compressed air or nitrogen
Piped in (wall outlet)
Tank of compressed nitrogen
Electric (alternating current [AC]; plug cord to outlet)
Battery (direct current [DC] electric)State aspects of the care and handling of surgical powered instruments.
clean concurrently during surgery
don’t submerge in water with your instruments
don’t kink cords on air-powered tools
keep safety latch on when assembling parts
batteries must be flashed or Sterrad-processed because power drains out when stored
always consult manufacturer’s recommendations for assembling, cleaning, and sterilizing
Suture (noun)
Thread-like material used to close wounds and anatomic structures
Suture (verb)
The act of closing a wound or structure
Ligature/tie
Suture used to tie (ligate) vessels or other structures
Suture ligature/stick tie
Suture with needle used to tie (ligate) vessels or other structures
Ligature reel
Long strand of suture on a spool
Free tie
Single strand of suture used to tie (ligate) vessels or other structures
Instrument tie (on a pass)
Single strand of suture loaded on an instrument used to tie (ligate) vessels or other structures
Usually a Mixter clamp, sometimes a Schnidt or a hemostat
Absorbable
Characteristic of suture that is capable of being broken down (dissolved) by the body’s enzymes
Non-absorbable
Characteristic of suture that is able to resist being broken down (dissolved) by the body’s enzymes
Monofilament
Characteristic of suture that consists of a single strand; one thread
Multifilament (braided)
Characteristic of suture that consists of several strands braided into one thread
Ligate
To tie off a structure (blood vessel, duct, uterine ligament, etc.)
Controlled release
Needle comes off suture when pulled purposely
Primary suture line
The suture line that holds the wound together; e.g.; Fascia of abdominal wall
Secondary suture line
Supports primary line by easing tension; also used to obliterate dead space
Continuous suture
Series of stitches made with the same strand, tied only at the ends
Interrupted suture
Series of stitches made one stitch at a time and tied individually
Retention suture
Large, interrupted sutures placed lateral to primary line as wound reinforcement; usually used for patients with obesity or patients who smoke
Purse-string suture
Continuous suture placed around a lumen and closed like a drawstring
Just like your scrub pants!
Subcuticular suture
A method of closing a skin incision by placing continuous stitches just under the skin
Traction suture
Sutures placed to hold a structure out of the way temporarily, e.g., dural flap
State information contained on the primary packet of a suture.
Name of suture: brand and generic
Characteristics of suture
Mono/multi (braided); color; absorbable/not-absorbable
Size (e.g., 3/0, 7/0)
Type of needle; name and image
Length of strand, manufacturer, order #, expiration date
Explain the meaning of an expiration date on a suture package
Pertains to the quality of the suture material. This is the date beyond which the manufacturer will no longer guarantee the quality of the suture
NEVER use suture that has expired because depending on the type the suture degrade over time and lose tensile strength.
MATCH SIZES AND TYPES OF SUTURES WITH COMMON USES
1
Closure of orthopedic wounds/tissue layers Closure of abdominal fascia 0 Closure of orthopedic wounds/tissue layers Closure of abdominal fascia 2/0 Closure of superficial orthopedic wounds/tissue layers Closure of some general surgery wounds/tissue layers Proximal aortic anastomosis 3/0 Subcuticular skin closures GI anastomosis Peritoneum closure 4/0 Subcuticular skin closures GI anastomosis Peritoneum closure Dura closure 5/0 and 6/0 Vascular anastomosis (FYI: radial and ulnar, distal femoral, popliteal, and carotid arteries) 7/0 Vascular anastomosis (FYI: coronary and carotid arteries) 8/0 – 11/0 Microvascular anastomosisOphthalmic tissue Absorbable sutures are used for Tissues that do not need continued support or tissues that heal quickly (FYI: rapidly growing tissues such as mucosal layers, peritoneum, or that don’t need as much support such as subcutaneous fat, subcuticular skin closure) Non-absorbable sutures are used for Tissues that need continued strength or tissues that heal more slowly (FYI: heart, blood vessels, dura, fascia, skin)
Identify basic parts of a needle.
Point
body (or shaft)
eye
Identify needles by the eye, body, and point.
Needle eye
Closed eye; French eye; Eyeless (AKA: swaged)
Needle body
Straight; 3/8 circle; ½ circle; 5/8 circle
Needle point
Taper; blunt; cutting (various types of cutting FYI: conventional, reverse cutting, side cutting)
List purposes or uses for each of the following types of needle points: cutting, taper, and blunt
Cutting (conventional cutting only)
Skin
Taper
General closure, Intestine, Blood vessels
Blunt
Friable tissue; liver, kidney, spleen
FYI: sharps safety issues – companies are working on making all needles blunt to reduce injuries
State advantages of staples/stapling devices.
Less tissue reactionoFaster wound healing due to decrease tissue trauma
Faster than sewing; decrease OR and anesthesia time
Airtight, leak-proof anastomosis or closure
Also:
Can be applied endoscopically
Makes a smooth, hemostatic edge
Identify the two types of electric current.
Direct current (DC)
Such as batteries
Battery-powered saws/drills
Dermatome
Flows from negative to positive pole
Alternating current (AC)Trace the flow of current in a monopolar and bipolar electrosurgical unit (ESU).
The flow of current in a monopolar ESU goes from:
Generator to
Active electrode to
Patient tissue to
Inactive electrode
Back to generator
The current in a bipolar ESU flows from:
Generator to
Active electrode (one prong of forceps) to
Patient tissue to
Inactive electrode (other prong of forceps)•
Back to generatorState safeguards to use when placing an ESU dispersive grounding pad (inactive electrode) for monopolar units.
Apply pad after final positioning is completed
To prevent wrinkling, gapping, or movement of pad
Place on a large muscle mass
More tissue and better since it has good vascular supply and more dispersal area for current
The area must be clean and dry
So pad adheres to skin and current doesn’t “jump” to pad causing a burn
Not placed over bony prominence
Bone is dense; lots of resistance and can concentrate current
Do not place on buttocks of supine patient
Pad is not visible and could have uneven placement
Not placed over area of a metal prosthesis
Metal concentrates current and can cause heat/burn
Handle pad as little as possible
To maintain gel for adherence and conductivity
Pad must have full contact with patient’s skin
Prevent wrinkling or tunneling causing a burn
If gel is dried (such as package open too long) do not use
To maintain pad conductivity
Place near operative site if possible
Minimize amount of current traveling through body
But don’t sacrifice muscle mass for nearness to site
Do not remove pad and replace, start with new
To maintain pad adherence and conductivity
Area must be free of scars (such as skin graft)
Scars = increase tissue density = increase resistance to free flow of current to pad
Site is free of hair (clippers used PRN)
To ensure complete pad adhesion to skin
List the components (parts) of a laser system
Energy pump or excitation source
Lasers are named by the medium contained here;
e.g.; KTP
Laser head
Ancillary components (console, cooling system, vacuum)
Control panel
Delivery system
List types of laser systems
Argon CO2 Nd: YAG Krypton Excimer
List facts about the harmonic scalpel.
Uses ultrasonic energy rather than delivering electrical current
Cuts and coagulates tissue at point of contact
Vibrations denature proteins; seals vessels
No charring or damage to adjacent tissues
Precise; coagulates at lower temperature
Less thermal damage; less vaporized plume
No grounding pad necessary
Generator converts electrical energy into mechanical energy
Hand piece (may be disposable or reusable)
Single use blade (other tips also available; supplies)
Blade moves by ultrasonic motion
55,000 movements per second
The role of the surgical technologist in robotics
We are scrubbed in
Positioning of the side cart in relation to the patient and site
Connecting electrical cords and equipment
System testing
Loading and switching instruments in the manipulators
Trouble-shooting the system and instruments
List examples of specialty surgical equipment and purpose/s.
Electrosurgical unit
Microscope
Illuminates and provide magnification to a small area
Light source/Headlight
Provide additional illumination of surgical site
Video camera
Capture image of surgical site
Video monitor
Displays image of surgical site
Insufflator
Fill abdominal cavity with CO2 especially during laparoscopic procedure – important pressure is 12-15 mm Hg
High pressure irrigator (aka. pulse lavage irrigator)
Pulsed lavage of wounds; trauma and total joint irrigation
Low pressure irrigator
Joint distension for arthroscopy
Phacoemulsifier-I/A unit
Cataract extraction
“I&A” - irrigation and aspiration
Cryotherapy unit
To freeze an area of tissue
Especially during retinal detachment
CUSA
Cavitron Ultrasonic Aspirator
Remove brain tumors
Navigation systems
Used to provide imaging and tracking of instrument position in surgical site
Nerve stimulator
Identify nerve branches especially during total thyroidectomy or parotidectomy
Also used to assess neuromuscular blockade by anesthesia provider
Suction unit
Vacuum blood or fluid from an area
Pneumatic tourniquet
A machine that reduces blood flow to an extremity by applying pressure
SCD unit
Reduce chance of thrombosis
Cast cart
Contains all supplies and equipment needed to apply/remove a cast
Crash cart
For cardiac arrest; contains meds and defibrillator
Vascular cart
Contains items needed to perform vascular surgery including sutures, grafts, catheters, vessel loops, etc.
State safety precautions for use of pneumatic tourniquets.
Place on long bones only (humerus, femur) NEVER at joint because superficial neurovascular structures pass at joints
Place soft roll padding under cuff to prevent pinching of skin
Use correct length and width (2”-3” overlap) to avoid excessive pressure caused by too much double-wrapping of cuff
Don’t let prep solutions pool, keep cuff dry
Record tourniquet time
Elevate extremity before inflating or exsanguinating
Identify parts of a surgical instrument
Tips Jaws Box lock Shank Ratchets Finger Ring
Instruments classification
Cutting/dissecting Grasping/holding Clamping/occluding Retracting/viewing Accessory
Identify supplies and state purpose or use for each.
SPONGES
Laparotomy
Commonly used during abdominal and orthodox surgery to protect wound edges andsoak up blood
GYN to pack intestines out of the way
Raytecs
Soak up blood
Kitner dissecting
Used for “blunt dissection”
Tonsil sponges
Pack in tonsil and adenoid spaces to provide temporary hemostasis
DRESSINGS
Non-adherent dressings: Telfa
First layer, comfort, allows seepage
Op-site (or Tegaderm)
able to keep wound dry and allow visual inspection of incision
Steri-strips
Support wound edges when subcuticular closure is performed
4x4 gauze
soaks up minor wound drainage
ABD - or combine dressing
used when significant drainage expected
Surgical tape
Secure dressings in place
Coband
In orthopedics to secure stockinette or dressings around an extremit
Ace wrap
to secure dressings on an extremity
Kling wrap
to secure dressings on an extremity
Kerlix
Bulky pressure dressing, extremity
Cast Padding
Place under cast to protect skin
OB pad/peri-pad
For vaginal drainage post C-section or vaginal procedure
CATHETERS
Robinson catheter
to empty the bladder
Foley catheter
Indwelling catheter to provide continuous bladder drainage
Foley catheter 3-way
three-way for continuous drainage and to irrigate bladder post-TURP; also provides hemostasis post-TURP
DRAINS
Penrose drain
Passive open wound drain, rarely used; Retract spermatic cord during open inguinal herniorrhaphy
T-tube drain
Passive drain for common bile duct after an open common bile duct exploration
Pezzer
used to drain hollow organs like bladder
Malecot
used to drain hollow organs like bladder
Hemovac; Jackson-Pratt; Blake; J-vac
Used to drain joint spaces, the brain, abdome
Chest tube
to re-establish lung inflation (negative pressure in thoracic cavity) and drain fluid (with Pleur-evac) after thoracoscopy or thoracotomy
Pleur-evac
A closed drainage and negative pressure system for chest tubes
TUBES
Naso-gastric suction tub
evacuate contents of stomach with suction
Tracheostomy tube
provide temporary or permanent airway
Endotracheal tube
ventilate patient during surgery and if necessary postoperatively. Temporary only
Pharyngeal airway
keep patient’s tongue out of the way - to facilitate ventilation when using mask anesthesia delivery
Laryngeal Masked airway (LMA)
A device used to facilitate ventilation under general anesthesia; limited applications
Syringes and needles
Bulb syringe
provide irrigation and suction in small amounts
Bulb with barrel syringe
irrigate wounds and surgical site
Plain tip syringe
to administer medications and for subclavian venipuncture
Luer-loc syringe
administer medications
Finger control syringe
administer medications
TB syringe
used when amounts & measurements are small
Hypodermic needles
To inject medications
Spinal needle
To administer spinal or epidural anesthesia
Miscellaneous supplies
Suction tubing
evacuate blood from operative site
Electrosurgical hand piece
disposable active electrode used to deliver electric current to bleeding points
ESU tips
ESU tip cleaner
To clean debris from non-coated ESU tip
Sharps container
to keep track of needles and other sharps; sharps safety and disposal
Magnetic instrument pad
keeps instrument from sliding off patient in lateral position
Light handle covers
To allow adjustment of surgical lights without contamination
Esmarch bandage
T o exsanguinate limb prior to inflation of tourniquet
Ligaclips/Hemoclips
To occlude a blood vessel
Skin marking pen
To mark surgical site; to label medications on back table
Medicine cup
To hold medications on back table
Specimen cup
For small specimens, foreign bodies, or implants removed from patient
Y-connector
To connect 2 chest tubes to Pleur-evac
