Unit 6: patient prep and draping Flashcards
When is most of the heat lost in surgery
First 20 minutes
When do you remove the hair of the animal
Clipping is performed in the induction area once the patient has been stabilized under anesthesia
Be sure you are comfortable with the patients level of anesthesia before you begin any manipulations
What should you wear when clipping a patient
An old green scrub gown or lab coat is usually worn when the patient is being clipped
How do you hold the clippers when shaving
Hold the clippers in a pencil grip
This grip permits the greatest amount of control and manoeuvrability
The clipper blade should lie flat on the patient’s skin for the closest clip
How do you shave a patient
The hand not holding the clipper can tense the skin to encourage as easy a movement as possible for the clipper
Ensure that the area of hair clipped is neat, tidy and symmetric
Clippers need to be cleaned and oiled as directed on product directions
It is a general rule to clip more rather than less hair
In long haired animals, clip the hair that may fall onto the surgical area
How much fur do you shave in surgery
The amount of hair to be removed depends on the surgery being performed
For general soft tissue surgery, a rule of thumb is to clip two clipper blade widths in every direction front eh proposed incision site
In orthopedic surgery, the patient is clipped more extensively ( the joint above to the joint below)
The limb needs to be clipped circumferentially to allow complete limb draping and manipulation
Where do you not use clippers
On the scrotum as it causes clipper burn
What should the shaved area include
Preoperative clipping and prepping need to include preparation for any ancillary procedures that may be done
Such as chest tubes or drains or placement of cautery pad
What should you do after the fur has been shaved off
Vacuum off the hair while you are clipping, and thoroughly once you have completed the clipping procedure
The hair should be vacuumed from the animal as well as from the area around the animal
When do you shave large animals for surgery
Determine the incision site
- Surgeons specifications
Standing bovine patients
- Clipped prior to entering surgery using a #40 blade
Equine
- Clipped once the animal has been anaesthetised in the induction area
When can you cause clipper burn
Clipper blades are dull
Technique is harsh
Excessive pressure is used
What should you look for on the clipper blades before use
Chipped or missing teeth
Rust
Anything else that may hinder their performance
What are the downfalls of irritation caused by the clipper blade
Inhibit surgical site healing if over the surgical site
Promote bacterial growth leading to possible infection of the surgical site
Promote excessive licking which also comprises the healing process
How and when do you clean clipper blades
Clipper blades should be cleaned and changed after each use
After using clippers spray with Clippercide
Remove all debris from clippers and blade with a brush
Remove the blade from the clipper
Place dirty blade and brush in to barbicide
Must be in barbicide for minimum of 10 minutes
When placing a new blade on clipper from the barbicide, wipe the blades dry with a cloth removing any excess liquid and spray with Clippercide
Why do you express the bladder before surgery
The urinary bladder should be manually expressed prior to performing the surgical skin prep
This will help to prevent iatrogenic trauma to the bladder when the abdomen is entered
Bladder expression is necessary to prevent the patient from urinating during the surgical procedure
If they urinate during the procedure, they will soak the table linens as well as their fur and skin
Lying in urine for may period exposes the patient to the risk of urine scald
There is an increased risk of contamination of the surgical wound if urination occurs post operatively
How do you express the bladder before surgery
The bladder can be expressed with the patient either in dorsal or lateral recumbency
Some type of receptacle, such as kidney bowl is used to collect the expressed urine
This is bode to avoid saturating the fur with urine or having the urine pool under the animal
Use gentle, constant pressure rather than a pulsating action when applying pressure to the urinary bladder
What is the reason for a surgical scrub
The purpose is to render the skin as clean as possible to minimize the risk of wound infection
There are multiple options of antiseptics, rinsing agents, and applications that can be used to prepare the skin for surgery
What are the antiseptic scrub products used for surgical site scrub
Providone iodine
Chlorhexidine gluconate
What are the positives of Providone iodine as a surgical prep scrub
Bacterial, viricidal, fungistatic and fungicidal – residual effect
Relatively low tissue toxicity
Generally diluted 50:50 with water when used as a patient scrub
What are the positives of chlorhexidine gluconate as a surgical prep scrub
Bactericidal action against 30 bacterial genera, viricidal and fungicidal – residual effect
Low tissue toxicity – except for mm
Generally used in a 60:40 dilution with water
What are the common rinsing agents for a surgical site prep
70% isopropyl alcohol
Sterile water or saline
What are the positives and negatives of isopropyl alcohol as a rinsing agent
Effective against most G- bacteria
Coagulates proteins, so contraindicated on open wounds and mm
Enhances residual properties of chlorhexidine
Rapid evaporating – can contribute to patient hypothermia
Do not use if electrocautery will be used intraoperatively
When do you use water as a rinsing agent
Removes detergent but has no antimicrobial properties
Used to prep open wounds, compound fractures, or mm where alcohol is contraindicated
What do you use to get the antiseptic onto the animal
Gauze sponge
- Most common
Cotton balls/cotton tipped applicators
- Particle only when prepping small areas
Spray bottles
- Appropriate only for application of final paint solution
- Can be messy
What do you do for a male dog going into a abdominal surgery
This step is required when the prepuce will be in the draped surgical field and is performed prior to beginning the surgical site prep
After the hair has been removed from the prepuce, the sheath must be flushed to remove potential contamination as follows
Combine 1mL of Povidone-iodine solution with 9mL of water
Insert syringe tip into the prepuce and inject 5mL of solution
Pinch the prepuce around the syringe tip before removing the syringe
Gently massage the solution in the prepuce
Place a towel over the end of the prepuce to absorb the solution
Release the pinch hold on the prepuce
Repeat the process with the remaining 5mL of solution
How and when do you use the target pattern for scrubbing
Most common pattern
Resembles a bullseye
Primarily used for abdominal, thoracic, and neurological procedures
How do you scrub the surgical site for orthopaedic surgery
Used for orthopedic procedures
Added step of covering foot with an exam glove
Caution to avoid creating a tourniquet with the tape holding the exam glove in place
How do you prep the surgical site for a perianal surgery
Pattern is 3 separate target patterns performed in a specific sequence
A purse string suture is placed in the anus before the preparation is began to prevent the evacuation of fecal material onto the surgical site during the procedure
Caution is needed to avoid puncturing the anal glands
As the surgical tech, you are responsible to ensure that the suture is removed after the procedure
What are common chemical related reactions seen
Reactions to prepping products generally manifest as plaques or wheals
Certain breads (labs or shar pei’s) tend to be more prone to these reaction
Povidone-iodine tends to cause more reaction than chlorhexidine
If a patient has a chemical related reaction, it should be recorded in their medical record
What is different between the final and initial surgical site prep
Performed in surgical room once the patient has been properly positioned and secured to the surgery table
Same procedure except that it is performed in a sterile manner
Wear gloves (open glove technique) and use a sterile prep set up
Solutions (“Paint”) are the final step in surgical site preparation
What is the final Paint step in the surgical site preperation
Differs from scrub in that it doesn’t contain a detergent
Efficacy improves if allowed to air dry prior to draping
If using a spray bottle as an applicator– the first squirt should be directed into the kick bucket to “clean” the nozzle of debris and bacteria
Providien-iodine
Tends to have a stronger concentration of iodine that the scrub
Chlorhexidine gluconate
0.2% concentration
What are the supplies needed when prepping a LA surgical site
Bucket of tap water
Scrub brush
Plastic container
Scrub soap
Spray solution (Povidone-iodine or chlorhexidine gluconate)
Alcohol
How do you scrub a LA patient
The operative site is scrubbed with the scrub soap and a brush then rinsed with water after each scrub until the site is clean using the target pattern
A small container is used to dip into the bucket of water
The brush is rinsed off after each scrub by pouring water over the brush from the small container
The brush should not be rinsed in the bucket as that water is to remain clean for further prepping
Three more preps are done using the scrub soap, rinsing with alcohol between each scrub
Make sure you are rinsing the brush with water between each scrub
Alcohol is poured onto the operative site beginning at the incision site and working towards the contaminated area
Sterile prep done in the surgical suite
Alcohol may be poured over the operative site rather than wiped using sterile gauze sponge
Finally, the paint solution is sprayed onto the operative site to complete the sterile prep
How do you know if a surgical scrub is good enough for a LA patient
Cleanliness of the patient’s skin is determined by drawing an alcohol-soaked gauze over the area
The gauze is then examined for debris or hair
If any is seen, the site is rescrubbed
This is continued until the alcohol soaked gauze appears clean
When is heat lost during surgery
Surgical site is shaved
Surgical site is cleaned using water then followed by alcohol - quickly cooling the skin
Anesthetic gas is carried by cold O2 due to compression of the O2 in the tank
Administration of the room temp fluids
Opened body cavity exposing internal organs to room temp air
Patient lying on a metal table/grate
What are the temps that are indications of hypothermia
Thermal hemostasis is achieved by modulating the flow of blood to organs, viscera and skin via vasoconstriction or vasodilation
Most patients lose body heat while they are anaesthetised
Mild hypothermia – body temp no lower than 36C– is expected and usually well tolerated by the patient
A body temp below 34C is worrisome and can affect the patients recovery adversely
Small patients are at the greatest risk due to their small body surface to mass ratio
Most what loss occurs within the first 20 min of general anaesthesia
Ways to maintain patients body temp
Circulating warm water pad
Warm air convector
Heating coils
Microwave heat pad
Plastic bottle of heated uncooked rice
Warm IV fluids
- Can warm bag or run the line through a bowl of warm water of fluid warmer before passing into patient
Plastic bubble wrap around extremities and head
Where are warming devices placed
Placed away from surgical site
May need to be in place before the patient is moved into surgery
Inflatable warming devices must remain turned off until the patient is draped
How are electrocautery plates placed
Need to be in direct contact with patient at all times
Poor contact affects function
Patient positioning factors
Surgical approach
Surgery to be performed
In orthopedics, affected leg often suspended form an overhead support of IV stand
Draping technique
Number of surgeries
How do you maintain patient position
Tape
Sandbags
Vacuum bags
Ties
When do you place a sterile drape
Sterile drape placement
Placed after site prep is completed
Provides and impervious barrier
What supplies are needed for draping
Quarter drapes
Towel clamps
Single large drape
What are drapes and gowns made of
Made of paper or cloth
Need to be folded in a consistent manner
There are specifically designed drapes for specific procedures
How do you quarter drape
Open away from table
The top of the drape is folded away from you
Corners are rolled outwards to warp around palms and minimize risk of contamination of gloves
Float the drape over patient - do not drag over the patient
The drape is placed close to the incision site
How do you secure a quarter drape
Penetrating towel clamps are used to secure the drapes to the patient and to each other
Once placed, towel clamps and drapes can not be moved
What are the final drapes used
Large final drape
- Covers patient and surgical table
Placing the drape is a sterile procedure
- 1-2 people
- Add fenestrations if needed after draping
What are some additional drapes sometimes used
Attached to the incision
- Sticky drapes
Placed near the incision
- Stockinettes
Sterile field contamination
- Add sterile drapes
- Replace garments
What is the hanging limb draping technique and how do you do it
Place a stockinette and secure to the patient with tape
Use tape to secure the distal end of the limb to the IV pole
Place quarter drapes sound the base of the limb
A sterile drape is applied to the distal limb to allow manipulation of the foot
Sterile outer layer of a self adherent wrap is placed over the distal limb
A fenestrated drape is placed over the quarter drapes
How do you prep equine skin for surgery
Sometimes difficult to clip before anaesthesia
Clipping done with electric razor in surgical suite
Hair cooled with portable vacuum
After initial skin prep, 3-5 surgical scrubs are performed
Spray with chlorhexidine solution
Prepuce sheath packed with gauze and sutured with a purse string suture
What is the purpose to drape a LA for abdominal surgery
To minimize contamination of the sterile surgical site
What drapes are need to an equine abdominal surgery
Aseptic prep
Aseptic gowns and gloves
Requires at least 2 people
How do you drape a horse for abdominal surgery
Step 1
- Begins after anesthetic prep
- Sterile stockinette or leg drapes over hindlimbs
- Hand towels placed on a four quarter fashion around the incision site
Step 2
- Large laparotomy drape
- Individuals are positioned on opposite sides of the patient, carefully unfolding the large drape over the horse
- Unfold with a backward step
- Then unfold longitudinally
Step 3
- Towel clamps to secure drape
- Cover exposed clamps with gauze sponge
- Adhesive, impervious drape over incision site
- Adhesive tape
What do you need for LA orthopedic surgery
Electrocautery plate
- Placed beneath patient
- Connect cords
Imperious plastic drapes
- Contain an adhesive
- Placed over the surgical site
- They reduce strike through contamination
How do you drape for LA orthopedic surgery
Step 1
- Limb prep (done in lateral recumbency)
- Suspend the limb from an IV pole
- Aseptic prep is performed
- The proximal area of the limb is draped
Step 2
- Remove limb form IV pole
- Grasp limb ( over the non prepped area)
- Place a sterile surgical glove or towel over hoof
- Placement of the fenestrated drape
- The limb is fed through the fenestration
- The drape is placed and secured with towel clamps
When do the common sterility breaks happen
During draping
surgical/instrument table setup
Remember: the back of the surgical gown is not sterile
Hands
Keep hands above waist and below shoulders
