VNSA10 Flashcards

Question

How long can a tourniquet be used to limit blood loss in surgery?

Answer 1

15-20 mins

Answer 2

Frazier - used for fine delicate suction which may be controlled by covering the hole at the base of tip Yankauer - has a bulb at the end which reduces trauma and allows maximum visibility. Open tip allows rapid aspiration. Poole - specially designed to remove pooled blood, fluids and debris. Allows for pinpoint suctioning - useful in abdominal surgery.

Answer 3

Liquid nitrogen used to destroy living tissue by controlled application of extreme cold. Aim is to kill cells in a diseased target whilst producing minimal damage to normal surrounding tissue. Used in - cancer, skin growths, removal of tumours or lesions, lumps/masses

Answer 4

Liquid nitrogen = harmful substance - subject to COSHH regulations and SOPs Only can be transported in an insulated supplied supplier metal container Insulated gloves and full PPE when handling Use a metal funnel when filling Patient prep = skin clipped and basic prep and insulate surrounding skin Skin will be erythematous and oedematous when finished Wash and disinfect then autoclave if possible probe when thawed.

Answer 5

Portable appliance testing

Answer 6

Stainless steel A ferrous alloy with a minimum of 10.5% chromium content. Doesn’t stain, corrode or rust as easily as normal steel. Nickel and chromium added to make it stainless.

Answer 7

High resistance to corrosion Great strength Attractive surface finish Chromium improves steel quality The more chromium in the alloy the more resistant it is to corrosion

Answer 8

Martensitic May be a touch magnetic Most commonly used in instruments Greater hardness through heat treatment Corrosion resistant Provides strength and durability Eg - biomedical cutting instruments, scissors, bone cutters and chisels

Answer 9

Austenitic Immune system reaction to nickel is a potential complication Hardened by being worked High resistance to corrosion Not as hard as martensitic Eg - implants and equipment thats put under pressure, bone fixation screws and plates, body piercings, trolleys

Answer 10

One of the hardest materials known (aka ‘man-made diamond’) Hardness makes it resistant to corrosion and wear It’s sintered at 1458°c to 3200°c These inserts are added to instruments to enhance their performance and longevity Inserts are micro bonded to the working end of the device Expensive Avoid them coming into contact with benzyl ammonium chloride

Answer 11

Popular as low price Rust, pit and blister due to plated surface being susceptible to low pH solutions Blunt quickly Easy to maintain Highly polished surface

Answer 12

Light, strong and lustrous white metal Alloyed with 6% aluminium and 4% vanadium Corrosion resistant inc oxidising and chloride environments Can be heated to 440°c Resistant to fatigue Often selected for metal plates or femoral stem implants Ophthalmic instruments as less glare - inc visability Expensive

Answer 13

More resistant to corrosion than stainless steel Expensive to manufacture Screws made of this bond securely to bone - care if removing to not break head off Mostly used in dentistry

Answer 14

NO Stainless steel plates shouldn’t be held with vitallium screws due to electrolytic and chemical reactions Corrosion of metal implants resulting in local tissue reaction leading to wound breakdown or non-union of the fracture. Care with instruments used also

Answer 15

Mirror - highly polished, doesn’t discolour easily Satin - dull matt (low glare) has been sandblasted. Easier to stain. Ebony - black, used for laser surgery

Answer 16

Separate area Dust free, dry and well ventilated Ideally in closed cupboards Handled as little as possible to minimise damage Packed loosely on shelves Sharp points covered Unused packs to be repacked/re-sterilised after 12 weeks, 6mths if double bagged or up to expiration

Answer 17

Lubricants recommended by manufacturer Avoid mineral oils and grease as they leave a film on the surface Antimicrobial water-soluble lubricants (instrument milk) No need to rinse

Answer 18

-suitable for use in any situation -readily available and inexpensive -readily sterilised by steam or ethylene oxide -show high initial tensile strength combined with small diameter material -have a good knot security -produce minimal tissue reaction - inert, non-allergenic, non-carcinogenic and non-electrolytic -show good handling characteristics- easy to handle when wet or dry and pass through material without friction or cutting -not create an environment for bacterial growth -be absorbed after its function has been served

Answer 19

The breaking strength per unit area of tissue

Answer 20

Related to the surface frictional characteristics of the material - every suture is weakest where it’s tied. Often the strongest sutures have the poorest knot security.

Answer 21

The less force required to stretch a suture, the more it will elongate before it ruptures

Answer 22

The response of the tissue to the suture material involved

Answer 23

The tendency of the material to return to its original shape. A material with a high memory tends to unlink during knot tying Knot security = poor with materials possessing high memory.

Answer 24

The lack of smoothness as a throw of a knot is tightened down

Answer 25

The degree of frictional force developed as the material is pulled through the tissue

Answer 26

The extent of which tissue fluid is attracted along the suture material. Materials with a high capillarity act as a wick and encourage fluids to move along them. Such materials should not be used in the presence of sepsis.

Answer 27

-ideally will absorb as soon as the tissue is able to support itself, this will vary to tissue type -suture will be absorbed in 2 stages: loss of strength and loss of mass -Most concerned with loss of strength -no foreign material should be left in the patient which could cause a tissue reaction later -natural absorbables are broken down by phagocytosis (some degree of tissue reaction) -synthetic absorbables are broken down by hydrolysis (minimal tissue reaction) -lose tensile strength by 60 days.

Answer 28

-suture material remains in the body for an indefinite length of time. It can migrate through the body tissues over time or cause a foreign body reaction. -often used in the skin -support tissue longer than an absorbable suture (longer than 60 days) -material is neither hydrolysed or phagocytosed (instead becomes encapsulated within fibrous tissue) -used when prolonged mechanical support is required.

Answer 29

Man-made material Very predictable Stronger than natural Causes minimal tissue reaction later

Answer 30

Tend to cause more severe tissue reactions than synthetic and huge tissue reactions when placed internally Knot well Easy to handle Variable in strength Less predictable than man-made materials

Answer 31

Less likely to cause infection but they’re usually stiff making them difficult to work with and reduces knot security. Single strand material Smooth to the touch and to pass through tissues Knot tying can be difficult as material can slip (Eg catgut)

Answer 32

Made up of multiple strands braided together - makes them less stiff and improves knot security on the downside rigid surfaces encourage capillarity - Often coated with wax, Teflon or silicon for this reason. This doesn’t weaken knot security Easy to handle Knot well Secure May cut through tissues Rigid enough capillarity When placed in infected tissue the infection may become persistent.

Answer 33

Skin = monofilament nylon or polypropylene, metal staples. Avoid materials with capillarity action. Subcutis = fine synthetic absorbable material with minimal tissue reaction (polydioxanone, polyglot in, polyglycolic acid) Muscle = synthetic absorbable, non-absorbable (nylon) Fascia = synthetic non-absorbable if prolonged suture strength is required. Hollow viscous = synthetic absorbable or polypropylene. In bladder use monofilament synthetic Tendon = nylon, polypropylene, stainless steel Blood vessels = polypropylene: least thrombogenic is silk Eyes = synthetic absorbable (eg - polyglactin, polydioxanone) Nerves = nylon or polypropylene as minimal tissue reaction

Answer 34

Allow rapid wound closure, reduce op times, good wound healing results, minimal scarring, cost effective and they bind wound hedges together so natural healing occurs Eg: stapes, tissue glue, adhesive tape, staplers, suture and skin staple removal kits, tissue adhesive

Answer 35

Corrosion-resistant stainless steel. Sharp and designed to penetrate tissue with minimal resistance Rigid but allow for some flexibility

Answer 36

Already have suture material attached. A: needle in perfect condition, tissue trauma minimised D: cost, fresh needle used for every procedure Uses: bladder, uterus, intestine, stomach, vessels of any sort and solid organs

Answer 37

Require threading A: economic use of suture material, specialised needles D: tissue trauma due to eye size, loss of needle tip sharpness, bending and corrosion due to repeated use.

Answer 38

Shape, size, shape of body, type of cutting point, thickness of needle. Shape of length: straight, 1/2 curved, 3/8 circle, 1/2 circle, 5/8 circle

Answer 39

Taper-point Designed to slide through body tissues, dilates rather than cutting them. As the needle passes through the tissue a leak proof suture line is maintained. Used where tissues will easily split: viscera, subcuticular tissues and friable tissue

Answer 40

The body is triangular with the apex of the triangle to the inside of the needle. Very sharp, cuts rather than dilate; creates weakness allowing suture tear out. Used for cutting through skin and tough tissue

Answer 41

Cutting tip and round body Increasing tissue penetration without increased tissue trauma Ideal for tough or calcified tissues: cardiac and vascular procedures

Answer 42

The body is triangular with the apex of the triangle to the outside of the needle. Very sharp, cuts rather than dilates, ideal for skin. Have their cutting surfaces on the convex surface and are ideal for tough tissue like skin, tendon sheath, oral mucosa and useful in subcuticular skin closures. Have more strength then conventional cutting needles and there is reduced risk of cutting through tissue. Commonly used in ophthalmic and cosmetic surgery where minimal trauma is paramount.

Answer 43

Body is flattened on the inside and outside to enable the needle to penetrate between 2 layers. Used in intra ocular surgery.

Answer 44

Very fine needles with a sharp cutting edge Used in ophthalmic surgery and microsurgery

Answer 45

Sutures bring the tissues in direct apposition

Answer 46

Sutures turn wound edges outwards

Answer 47

Sutures turn tissue inwards

Answer 48

Maintains strength and apposition Takes time and much suture material attached

Answer 49

Ease of placement and less suture material used. Knot slippage results in suture failure