Wk 4 Flashcards
What are Grasping and holding forceps used for
Secure drapes and diathermy quivers
Hold needles for suturing
Hold sponges/gauze
Hold skin, muscle cartilage
What are cutting and dissecting instruments used for
Dissecting scissors Wire cutters Dissect Incise Seperate tissues
What are clamps used for
Artery forceps
Haemostatic forceps
Mosquito forceps
Occlude vessels, crush tissues, hold tissues
What are retractors used for
Hold back wound layers and anatomical structures to allow visualisation
What is suction used for
Aspirate fluids and debris from a surgical site or body orifice
What is haemostasis
Arrest or control of bleeding
Usually through blood clotting
Can use electrosurgery and tourniquet
Artificial methods of haemostasis
Internal or external pressure Tourniquet Surgical instruments Ligatures or ties Ligating clips Bone wax
Mechanical haemostasis - internal or external pressure
Direct to site
Indirect is area adjacent
Slows bleeding to allow clotting
Mechanical haemostasis - tourniquet
Construct blood flow Compresses blood vessel Used on extremities Temporary Bleeding needs to be controlled before tourniquet is released
Mechanical haemostasis - ligating clips
Pinching shut over a blood vessel Made of metal Serrated to prevent slippage Quick and easy to apply Large vessels Difficult to access areas
Mechanical haemostasis - bone wax
Sterile refined beeswax and softening agent
A mechanical barrier
Control of bone marrow oz zing from cut to bone surfaces
Rolled into small balls
Methods of thermal haemostasis
Electrosurgery
Laser
Ultrasonic surgery
thermal haemostasis - electrosurgery
Diathermy machine
Generates electrical current
Used to coagulate tissue
When electrical current meets resistance (passes through tissue) it generates heat (bursts tissue cells)
Because electrical current takes path of least resistance the placement of a diathermy plate (dispersive electrode) is important
Sticky gel plate, once only application, close to operative site, well vascularised/muscular area, no scars, prosthesis or hair, applied after positioning
What is a diathermy plate and how is it relevant
When electrical current meets resistance (passes through tissue) it generates heat (bursts tissue cells)
Because electrical current takes path of least resistance the placement of a diathermy plate (dispersive electrode) is important
Sticky gel plate, once only application, close to operative site, well vascularised/muscular area, no scars, prosthesis or hair, applied after positioning
Chemical methods of haemostasis
Gelatine sponge
Oxidised cellulose
Thrombin
Adrenaline
Chemical methods- gelatine sponge
Pliable and absorbable
Up to 45 times it own weight in blood
Foamy consistency
Chemical methods - oxidised cellulose
Absorbable
Knitted fabric
Swells in size when contact with blood
Forms gelatinous blood clot with mesh
Chemical methods - thrombin
Reacts with fibrinogen to form clots
Chemical methods - adrenaline
Causes vasoconstriction
Not recommended for extremities
Only fingers, toes, genitals, nose, ears
Instrumentation method of haemostasis
Haemostatic clamps: clamped onto end of bleeding vessel
Ties: strand of material tied around a vessel to occlude lumen
Sutures
Types of sutures
Absorbable and non absorbable
Synthetic and non synthetic
Tensile strength of sutures
Knot pull strength of suture
As tensile strength of suture increases so does the diameter of strand
Suture sizing
Diameter of strand
Largest and strongest is 5
Smallest and weakest is 10/0
Suture needles and the different types
Three basic components: point, body/shaft, eye
Tapered: no cutting edge, tissue with little resistance
Cutting: cutting edge, tough tissues
Spatula: flattened needle shaft, opthalmology
Trocar: highly sharpened point, tough tissue, small hole
Needle body /shaft
Part of needle grapes when in use
May be curved or flat
Needle eye
Swagged/eyeless needle: attached to suture material, diameter of needle matches size of suture
Closed eye: round, oblong or square eye similar to household needle
French eye: has slit from inside the eye to the end of the needle with ridges that catch and hold the suture in place, results in double strands going through skin
Suture classification
Monofilament: single strand that resists fluids soaking into it
Multifilament: multiple strands held together by a process of twisting, braiding or spinning (capacity to absorb body fluids) less sterile
Absorbable sutures
Digested by body enzymes or hydrolysis
Lose strength and gradually disappear
Prepared from collagen or synthetic polymer
Used on fast healing tissues
Natural absorbable sutures
Plain or chromic - results in closer absorption rate
Packaged in fluid to maintain pliability
Should only be handled when moist
Handled as little as possible
Synthetic absorbable sutures
Packaged and used dry Hydrolyse in body fluid Monofilament, braided, coated or uncoated Tensile strength is high Can be used in presence of infection
Non absorbable sutures
Encapsulated in fibrous tissue during healing process
Remain in body until surgically removed
Useful for slower healing areas
Natural non absorbable sutures
Thread from silkworm Braided or multifilament Treated to improve tensile strength Relatively strong Can't be used if signs of infection
Synthetic non absorbable suture
Polyester and polymides
Less irritation and higher tensile strength than natural fibres
Mono or multi
Smooth and inert
Used in delayed healing, infection, intended tissue support is required
Metallic non absorbable sutures
Mono Greatest tensile strength of all Inert, nonmagnetic, electro passive in tissue fluids In infection or slow healing areas Cutting requires wire scissors Avoid kinking
Most surgical instruments are made out of what
Stainless steel, titanium, vitallium, other
