Unit 3 Flashcards
List aspects of perioperative monitoring of the sterile field.
Observe for breaks in sterile technique
Correct breaks
Protect sterile field
Maintain sterile technique awareness.
List principles of back table organization
Orient back table to right or left side of room
And to procedure and/or surgeon preference
Minimize movement for efficiency and speed
Use principle of “body-in-a-box”
Move shoulders and arms, not entire body
Work in sections of table (3 sections)
Handle items once
Set an efficient pattern with a logical sequence
Repeat it case after case
Remain aware of total environment
Such as where the door is and which side of the room you’ll be on and who is in the room
State the 3-step basic sequence of back table organization.
Drapes
Stack in reverse order of use
Basin items (supplies)
Empty big basin and place small basins/pitcher near edge for transfer of solutions
Organize sharps
Organize countable items
Organize items for medication administration
Labels, pen, med cups, syringes, hypos – all together
Instruments
List principles of Mayo stand organization and set up.
First, orient tray to patient
May use rolled towel on Mayo (don’t hang rings over edge)
Place only items likely to be needed
Inspect each instrument
Placed in pairs or groups of alike instruments
For example: all scissors or all tissue forceps
Clamps closed on first ratchet
List items that must be included in surgical counts.
Sponges (all kinds)
Needles, blades, and other sharps
Instruments
When major cavity (abdominal/pelvic and thoracic) opened
Vessel loops, safety pins, ESU tip, ESU tip cleaner
State the times when surgical counts are performed.
Initial count (First count)
Before Mayo set up
And as items added intraoperatively
Before closure of body cavity (First closing count)
May do 2 counts if cavity within a cavit
E.g., at closure of uterus and closure of peritoneum (first and second closing counts)
At subcutaneous layer or skin (Final closing count)
Identify best practices for safe surgical counts.
Scrub & circulator count together, aloud
Scrub touch each item as it is counted
Circulator record immediately
Don’t interrupt counts
Keep not-yet-counted items away from counted items until completely counted
Relief persons verify complete count
Circulator’s duty to report counts correct to surgeon
Surgeon must acknowledge it verbally
Documenting varies/ may use RF tagged sponges
If pack is short or long, discard it and remove it from the room – do not try to work with it
If patient is in room, label and keep these in room separately
Don’t open dressings until final count is complete
State the appropriate surgical counting sequence.
Field (surgical site)
Tables: Mayo, back table and finish at
Floor (circulator)
List the sequence of steps taken when a closing count is incorrect.
Inform surgeon immediately Recount If still incorrect, inform surgeon again Check cavity Document all actions and findings May take x-ray to demonstrate presence or absence of item in body cavity
Identify (1 type each of) fenestrated, non-fenestrated, and accessory drapes.
Fenestrated:
Laparotomy drape
Laparoscopy, general
E.g.; laparoscopic cholecystectomy drape
Laparoscopy, gynecology
2 fenestrations; with leggings
Pediatric lap drape
Transverse laparotomy drape
Kidney, thorax, and also used for low abdomen
Thyroid sheet
Craniotomy drape
Perineal drape (aka. lithotomy drape)
C-section drape
Side pockets to catch fluid
Extremity drape
Carpal tunnel, ORIF ankle
Arthroscopy drape
Knee arthroscopy
Shoulder arthroscopy
Non-fenestrated drapes include:
½ and ¾ sheets (general coverage)
Table covers
When used as under drape for orthopedics
Lithotomy pack
(different from lithotomy drape); under-buttocks sheet; 2 leggings and top sheet
Split sheets; U-sheets
Accessory drapes:
Stockinette
FYI: Plain and barrier, various sizes; need Ace or Coban to secure it; used to drape extremities “free”; large for adult legs, regular for adult arms and kids
Microscope drapes
Laser arm drapes
C-arm drapes
Camera drapes
Used to cover video camera when camera is not sterile
X-ray cassette coversState principles and applications of draping
Organize drapes in order of use
Towels with 2” cuffed edge
Drapes are NOT passed over unsterile areas
Move to opposite side of OR bed to hand them PRN
4 towels and clips (PRN) in 1 trip
Handed one towel at a time
1 toward (nearest to sterile person), 1 superior, 1 inferior, 1 away
Drapes passed in folded position
Keep safe distance from unsterile area until drapedRemove protective covering of adhesive sections prior to handing
Placed on patient’s surgical site to unfold
Or held above patient and unfolded (such as first drape inferiorly)
Use sterile technique!
Sterile to sterile = sterile
Sterile gloves touch unsterile area = UNSTERILE!
Do NOT reposition drapes once placed
Cover with another drape PRN
Protect gloved hands with drape cuff
Contaminated drape removed by circulator
(unsterile to unsterile)
A drape dropped below table level is not sterile
Don’t drop (or raise) hands, either!
Non-perforating towel clips for cords
Summarize basic steps to drape the abdomen
Place sheet over lower body (“sheet below”)
4 towels and clips (clips optional) or sticky towels
Adhesive incise drape PRN
Place laparotomy drape
Summarize basic steps to drape the perineum
Place an under-buttocks drape
2-3 towels around perineum and clips
Different fold than for squaring off
Place leggings
Add lithotomy (fenestrated) sheet or top sheet
Summarize basic steps to drape the extremity
Sheet superiorly PRN; sheet under limb
May be a plastic table cover down
Place 2 U-sheets or split sheets; down & up
Place stockinette and coban or ace
Extremity sheet
Cut stockinette PRN, place adhesive incise drape PRN
Identify nerves most at risk for injury during positioning
Ulnar, radial, peroneal, facial, brachial plexus.
State patient safety concerns regarding surgical patient skin preparation.
Allergy; burn from warm prep solution; chemical burn; flammability; pooling of solution; incision marking visible.
State options for safely passing the scalpel.
Hand knife directly to surgeon and receive it back when used
Hand directly to surgeon and have him/her place it on the Mayo where you retrieve and place it back in location
No-hand technique with neutral zone
You place, surgeon picks up, replaces, you retrieve
No-hand technique with basin (caution)
List means that contribute to efficiency and order of the sterile field.
Position items for efficiency (one smooth move)
ESU tip cleaned after use and hand piece returned to holster
Bring clean sponges up first; then take dirty ones off
So you can do it all in one trip up and back!•Maintain order throughout for efficiency!!!
As surgeon sets used instruments on drapes
You retrieve them, clean them, replace them on your Mayo in the proper location•Sharps always placed in designated spot!
Suture
Is placed on Mayo when using
Placed on back table when not in use
Cut off strand only when fully used
Outline the process of patient transfer from OR bed to transport vehicle.
Gurney brought into room, placed beside OR bed and locked
Roller/slider placed on gurney
Patient’s IV moved, check Foley, etc.
Minimum 4 people to move, anesthesia leads
Place roller/slider under patient (log roll patient)
Move patient’s body in unison to gurney
Remove slider (again, log roll patient)
Put gurney side rails up, unlock gurneyTransfer patient to PACU
Identify the steps used to break down the sterile field postoperatively.
Put unsterile gloves on Complete specimen care Proper disposal of SHARPS! Used instruments in enzyme cleaner and place in case cart Un-used instruments placed in set; then in cart Linen in hamper Trash in bags Suction canisters handled per policy Furniture re-positioned, cart out PPE off – wash hands!
List types of dressings
Biological (skin graft)
One layer (adhesive spray; bioclusive; Dermabond; Foams; Gels; hydrocolloids; Steri-strips; Op-site/Tegaderm; Benzoin/Mastisol)
Three-layer consisting of an:
Inner (Xeroform, Vaseline gauze, povidone-iodine gauze, Adaptic, Telfa)
Intermediate (gauze 4x4 sponges, Kerlix gauze and fluffs, ABD pad)
Outer layer (various tapes, Ace wrap, Coban, Kling roller gauze, tube gauze, Montgomery straps)
Bulky dressing
Pressure dressing
Cast/splints
Specialty dressings (Bolster/stent; eye pad/shield; ostomy bag; thyroid collar; tracheostomy; wet-to-dry; wet-to-wet; wound-vac; nasal packing; vaginal packing).
State tissue specimen care principles
Observe where specimen came from
Various types and locations; right or left side is KEY!
Verify specimen with intelligent question that surgeon can answer with “yes” or “no”
Right breast biopsy – correct?
Repeat specimen name to circulator
So that it gets labeled correctly – very important!!!
Ask surgeon before handing off
Never on a raytec; tiny specimens can go on Telfa
Don’t let specimen dry out
Do NOT lose the specimen!!!!
Pay close attention to orientation markings, usually is a suture placed at 12 o’clock
Helps pathologist accurately identify locations of tumor margins
State foreign body specimen care principles
Send to lab dry for identification/documentation
State forensic foreign body specimen care principles
Do NOT handle with metal instruments or put in metal pan, can destroy markings for forensics
Make rubber shods for clamps with Robinson catheters to use to remove the bullet without harming the markings
Keep the chain of evidence short
Ideal is police officer witnesses bullet removed and takes the bullet to evidence room at police station
More often, the circulator takes it to the officer who is waiting outside surgery doors – get a signed receipt
State Smear and brus specimen care principles
Wipe specimen on slide; circulator will spray with fixative
State aspiration (aka. centesis and fluid analysis) specimen care principles
Send to lab in syringe Dr. drew fluid up in; place in biohazard bag
Otherwise put fluid in container with tight lid
State Incisional biopsy: frozen section specimen care principles
Send to pathology immediately and WITHOUT formalin
State Incisional biopsy: permanent section specimen care principles
Place in container and cover with formalin (volume of specimen plus about 10%)
Most OR’s don’t keep formalin anymore; send to lab ASAP
State Calculi specimen care principles
Do NOT put formalin on these! Send dry
But gallbladder with stones usually goes in formalin
Circulator may put gallstones in separate container without formalin
State Amputated limbs specimen care principles
Fingers and toes usually fit in a regular specimen container
Legs need to be double red-bagged and labeled and then placed in a box and labeled and then taken to the lab immediately!!! Send DRY no formalin!!!
State Bullets specimen care principles
Do NOT handle with metal instruments or put in metal pan, can destroy markings for forensics
Make rubber shods for clamps with Robinson catheters to use to remove the bullet without harming the markings
Keep the chain of evidence short
Get a signed receipt
State Orthopedic implants specimen care principles
To lab DRY
State Gram stain specimen care principles
Collected in sterile transport tube and taken to lab immediately
State C&S specimen care principles
Cotton-tip swabs used to collect specimen sample and sent to lab immediately in sterile transport tube
For anaerobic cultures place swab into the media in anaerobic tube immediately and transport to lab
List equipment needed and special considerations for Lithotomy
Equipment:
Stirrups and holders (sockets)
Types of stirrups:
“Candy cane”
Knee-crutch (pad carefully)
Allen (safest, what we have in lab, “yellow fin”)
Arm boards
Special considerations
Move head part of bed to foot of bed
Make bed in parts so foot of bed can drop
Check ROM preoperatively
Buttocks at edge (not over edge; not in hole)
Arms out on arm boards to keep fingers safe
Raise/lower both legs at same time
grasp ankle and calf to support knee (do NOT hyperextend joint)
Pad to protect peroneal nerve
Remember to cover patient for dignity
List equipment needed and special considerations for Lateral
Equipment:
Vac-pack and kidney brace or hip holder
3” adhesive tape
Arm board (down side) & arm extension (up side)
Pillows and pads; axillary roll
Special considerations:
Start supine on OR bed; anesthesia administered
Move only when anesthesia provider is ready!
Need minimum of 4 persons to turn patient
Turn patient while maintaining body alignment
Secure positioning devices
Vac-pack; kidney braces; arm board; axillary roll
Top leg straight; bottom leg bent
Pillows at prominences (ankle, knee)
3” adhesive tape over hip to help prevent tilting
Not for total hip; the hip positioner takes care of tilt
List equipment needed and special considerations for prone
Equipment:
Chest rolls or frame
Andrews, Wilson, etc.
Pillows
Arm boards special considerations for each of the following surgical positions. Prone
Special consideration:
Anesthesia begins on transport stretcher; airway secured
Log roll patient onto receiving staff arms
Lift simultaneously onto frame
Remove transport stretcher
Position arms; do NOT hyperextend shoulder
Check breasts for alignment; male genitals for pressure
Pillow under ankles to prevent hyperextension
Identify Supine positions and a use for it
Cholecystectomy Inguinal herniorrhaphy Mastectomy Gastric bypass Breast bipsy Total abdominal hysterectomy (TAH) Tuboplasty Laparotomy Gastrostomy or total gastrostomy Colon resection
Identify Trendelenburg positions and a use for it
Abdominal hysterectomy (during the procedure PRN)
Retropubic prostatectomy
Cystectomy
Laparoscopic Cholecystectomy
Identify Reverse Trendelenburg positions and a use for it
Thyroidectomy
Carotid endarterectomy
Dacryocystorhinostomy (DCR)
Open Cholecystectomy with Cholangiogram
Identify Fowler’s/Sitting positions and a use for it
Nasal polypectomy
Shoulder arthroscopy procedures (“beach chair”)
Breast reconstruction (temporary, for comparison)
Posterior craniotomy
Identify Semi-Fowler’s (beach chair) positions and a use for it
Acromioplasty, open
Total shoulder arthroplasty
Shoulder arthroscopy
Transsphenoidal Hypophysectomy
Identify Lithotomy positions and a use for it
Vaginal hysterectomy
D&C
Diagnostic laparoscopy GYN
Low anterior colon resection
Rectal access/EEA
Perineal prostatectomy
Cystoscopy (and TURP, TURBT, ureteroscopy, DVIU)
Transurethral resection of the prostate (TURP)
Endometrial ablation
HysterectomyIdentify Prone positions and a use for it
Posterior cervical fusion
Debridement of decubitus sacral ulcer; rotational flap to cover
Lumbar Laminectomy for discectomy with spinal fixation
Identify Kraske (Jack-Knife) positions and a use for it
Hemorrhoidectomy
Anal fistulectomy
Identify Lateral positions and a use for it
Thoracotomy
Total Hip arthroplasty
Shoulder arthroscopy
Pyelotithotomy
Identify lateral kidney positions and a use for it
Nephrectomy
Liver resection
Identify Sim’s positions and a use for it
Colonoscopy
Rectal examinations and enemas
