Procedures & Skills III Review- Not Done

What is an Incarcerated hernia?

Cannot be reduced without surgery.

What is a Strangulated hernia?

Bowel not getting enough blood/oxygen.

What 3 cords are always required for Laparoscopic Procedures?

Camera Cord, Light Cord, and Insufflation tubing.

If a laparoscopic case emergently turns to open, what are the first 5 things you need?

10 blade, Yankauer, Suction tubing, Laps, Bovie.

Heparin (Use/Action)

Anticoagulant—Prevents clot formation. MEASURED IN UNITS. MIXED WITH INJECTABLE NaCI

Thrombin (Use/Action)

Promote clotting—human plasma.

PUT ON GEL-FOAM, NEURO PATTIES. NOT IN A SYRINGE

Protamine Sulfate (Use/Action)

Reverse effects of heparin.

Contrast (Use/Action)

Dye for imaging. used in C_Arm, X-ray, NEED to wear LEAD GOWN, THYRIOD SHEILD.

IOC (Intraoperative Cholangiogram) purpose and requirements?

Intraoperative Cholangiogram- Determine the presence of stones in the common bile duct.

Lugols (Use/Action)

Staining agent used in thyroid & LEEP—iodine. Applied w/sponge stick or a large cotton-tipped applicator (FoxSwabs). CAN’T USE LASER

Acetic Acid (Use/Action)

Vinegar staining agent used to kill fungus & bacteria. DISTINGUISHES ABNORMAL TISSUE, GYN, CAN USE LASER.

Monsel (Use/Action)

After the procedure—Chemical hemostatic. BURNS TISSUE. BLACK IN COLOR, CAN DAMAGE TISSUE.

Methylene Blue (Use/Action)

Dye patency in fallopian tubes & breast cancer in lymph nodes; detects bladder injury. DILUTE IN NaCI. INJECTED INTO A VEIN.

Bone Wax (Use/Action)

Non-absorbing hemostatic is used on bleeding bone; it creates a barrier.

LOADED ON A : Freer Elevator

Saline (Use/Action)

Isotonic, topical, rinsing wounds. CONDUCTIVE

Sterile Water (Use/Action)

Hypotonic, rinse instruments, dilute prep. OK TO USE ESU- CAN NOT GET IN PATIENT- ORGAN WOULD ERUPT.

Chemotherapy Disposal/Safety

Hazardous waste (Yellow), Double glove.

Marcaine (bupivacaine) characteristics?

Helps with bleeding; lasts 3-7 hours; does not need epi.

Lidocaine characteristics?

30-60 mins to wear off; with epi, 2-3 hours; choice to wake patient.

Exparel characteristics?

Extended 72 hours; do not mix with lidocaine; used for nerve blocks.

Epinephrine characteristics?

Vasoconstrictor, topical; Never injected. EXTEND LENGTH OF LIDOCAINE.

Absorbable vs Nonabsorbable Suture rules?

Absorbable never used on vessels/arteries. Non used for mesh, anastomosis, valves, tendon repair.

Name common Absorbable Sutures.

Plain gut, Polydioxanone/PDS, Monocryl.

Name Natural Sutures.

Gut, Silk, Steel

Multifilament vs Monofilament?

Multifilament: Strong, ties easy, coated; do not use with infection (braid harbors bacteria). Monofilament: Smooth, glides easy, hard to tie, lots of memory; used for infections.

Cutting vs Taper Needles?

Cutting: Less trauma, skin/tough tissue. Taper: More trauma, stretching not cutting.

Skin Stapler characteristics?

Faster than suturing; 28-36 sutures; not used on Plastics. CAN NOT USE WITH INFECTIONS

Dermabond characteristics?

5 mins to dry; no bandage; can shower; adds strength. PROTECTS MOST FROM MICRORGANISMS

What are Pop-Offs (CR8)?

8 in a pack; extra support. INTERUPPED

Name two types of Drain Suture.

Silk and Nylon.

Suture for Laparoscopic Cut-down?

0 Vicryl UR-6.

Size 1 suture use?

Big incision- FASCIA

Size 0 suture use?

Adult laparoscopic Fascia.

Size 3-0 suture use?

Aorta. SUBCUTANEOUS BOWEL

Size 4-0 suture use?

SKIN & Aorta.

Size 5-0 & 6-0 Prolene use?

Peripheral—vascular/cardiovascular & GROIN.

Size 6-0 to 10-0 suture use?

Hearts.

Size 10-0 suture use?

Eyes.

RB-1 and PS-2 needle use?

Renal Artery bypass. SKIN

PS-2 needle use?

Plastic Surgery. SKIN

CT-1 OR CT-2needle use?

Deeper tissues. UTERUS FASCIA

TP-1 or CTX needle use?

Fascia.

C-1 or BV-1 needle use?

Blood vessel.

SH needle use?

Taper; intestinal subcutaneous. BOWEL

UR-6 needle use?

Fascia. LAPRASCOPIC

Which gauge hypo is smaller: 22 1/2 or 18?

22 1/2 smaller. (the higher the number, the smaller the hypo)

Metz (Metzenbaum)

Bowel, cut vessels, subcutaneous tissue & Prolene suture.

Potts

Extend incision into vessel.

Jorgenson

Cutting, dissecting dense or tough tissue.

Iris Curved

Tendon or Muscle in very small areas like fingers.

Iris Straight

Small suture on finger—delicate tissue.

Tenotomy

Dissecting tissue in hand—delicate tissue.

Debakey

Grasp bowel, delicate tissue, vessel loops or umbilical tape.

Geralds

Grasp small vessels and vascular very small prolene.

Russian

Grasps slippery tissue in cervix.

Rat Tooth

Tough tissue, Fascia, thicker, uterus.

Adson Forcep

Skin.

Mosquito

Clamp small blood vessel.

Allis

Grasps slippery tissue.

S-Retractors

Retract fat.

Army-Navy

Retracts organs.

Tonsil

Grasp tonsil.

Curette

Scrapes tissue from bone.

Castroviejo Needle Holder

Holds very small suture—Prolene.

Deaver Retractor

Deep abdominal retraction, retract vaginal canal.

Foerster (Sponge Stick)

Apply medication.

Penfield

Separate dura from skull.

Loaded Needle Holder & Forcep -> ?

Straight Mayo Scissors.

Bone Wax -> ?

Freer Elevator.

Penrose Drain -> ?

Kelly.

Knife then tonsil -> ?

Drain without Trocar.

Surgeon wants to grab bowel -> ?

Babcock.

Endo Clip -> ?

Endoshears.

Right Angle Clamp -> ?

Tie, Umbiliczl tape, loop

Loop -> ?

Tag or Str Mayo Scissors.

11 Blade on #7 knife Handle -> ?

Potts Scissors.

About to tie small Prolene -> ?

Wet surgeons hands.

Just finished suturing skin -> ?

Wet & dry raytec.

Surgeon is isolating a vessel -> ?

Right-Angle

What are the 5 components of Emotional Intelligence (EI)?

Self-awareness, Self-management, Social Awareness, Relationship management, Motivation.

List the items in a "Closing Mayo."

1 wet Raytec, Dry Raytec, Forceps, Hemostat, local, Medicine Cup, Straight Mayo, Suture.

Package Count: Ties?

2.

Package Count: Raytecs?

10.

Package Count: Kittners?

5.

When do we count? (List all)

Before case starts, when count is wrong, when surgeon scrubs in, when closing skin, when closing uterus, shift change, bathroom breaks, lunch, whenever someone wants to, when missing raytec is found.

What 3 cords are always required for laparoscopic Procedures?

Camera Cord, Light Cord, Monopolar Cord

After scrubbing in and preparing your back table, you go to grab the instrument tray out of the pan. What do you look for before it is on your table?

Indicators turned, Tamper tag, Debris, Condensation, blood in tray

What steps do you take when taking a tray from a blue wrap?

Check if the indicator turned, ask the nurse to check the blue wrap for holes, and check the indicator in the tray.