MOD 2 - The OR

Sterile HCP

direct patient contact throughout surgery

• surgeon and their assistant

• residents

• students

Non-sterile HCP

not have direct contact with the patient

• Anesthesiologist

• circulating nurse

• medical radiation technologists

• students

• sales/service representatives

• technologists

Non-sterile members in the sterile field

they do not enter the sterile field but may operate equipment that is draped within the field

is the back considered sterile or non-steril

non-sterile, so we do not reach behind our backs

Pre-operative Care

• peri-anesthesia nurse confirms the type of surgery, diagnostics are completed, vital signs and answers patient’s questions

• surgeon will visit pt to review surgery procedure, get consent

Intra-operative Care

During the course of the surgical operation

Post-operative Care

pt moved to the post-anesthetic recovery unit to be monitored for several hours

who can terminate the surgery anytime

Anesthesiologist (and surgeon?)

Central Corridor - OR Layout

resembles a hotel

Central Core - OR Layout

a clean core with a peripheral corridor

Central and Peripheral Cores - OR Layout

a racetrack design

Grouping or Cluster Plans - OR Layout

with peripheral and central corridors

OR Zones

Zone 1: Unrestricted (& Transition)

Zone 2: Semi-restricted

Zone 3:Restricted

Zone 1: Unrestricted (& Transition)

• attire

• accessibility to whom

• where

• public

• street clothing

• pt bay

• locker/change rooms

• desk area

Zone 2: Semi-restricted - Zone 2

• attire

• accessibility to whom

• where

• authorized personnel

• Scrub suits and head/hair/beard coverings

• peripheral storage areas, corridors

Zone 3:Restricted

• attire/sterilization

• where

• OR scrub suits, head cover, shoe covers (or dedicated OR shoes) and a new mask

• hand wash prior to entry

• OR suites

Preoperative Medications Purpose

• Allay anxiety and fears.

• Minimize the danger of aspirating secretions.

• Produce some analgesia and amnesia.

• Dull awareness of the physical environment.

• Reduce the risk of nausea and vomiting.

• Raise the pain threshold.

Anesthesia Purpose

• Performing procedures/surgery without pain and discomfort.

• In the case of a general anesthetic, providing temporary memory loss of the surgery.

Anesthesia definition

“a loss of sensation resulting from pharmacological depression of nerve function”

3 main categories of anaesthetic agents

• General

• Regional

• Local

Local Anaesthesia causes

loss of sensation without the loss of consciousness (lidocaine [trade name Xylocaine])

pros

• Minimum equipment required

• Minimizes the recovery period

• Avoids the undesirable effects of general anaesthesia

• Reduced costs

cons

• Lack of patient acceptance because of awareness during the procedure

• Lack of feasibility of localizing some anatomical sites

• Pain at the injection site

• Individual variations in response to anaesthetic drugs

• Unanticipated rapid absorption into the bloodstream

Methods of Local Anaesthesia

• Topical (placed on the skin)

• Local infiltration (injection into tissues)

local anaesthesia side effects

• Light-headedness

• Dizziness

• Ringing in the ears

• Loss of consciousness

• Seizures

as techs we must recognize when there are problems related to anaesthesia, thus its important that

• Decrease patient anxiety, noise and conversations

• Assess patient for allergies and have antihistamines, epinephrine and corticosteroids available

• Have resuscitative equipment, drugs, oxygen and suction equipment available

• Monitor BP, pulse, breathing and appearance

• Assess for burning, itching, swelling and tissue irritation

• Remind patient who had a topical spray to the throat area not to eat or drink for at least one hour after the test — to prevent aspiration

Regional Anaesthesia

loss of sensation to a region of the body without loss of consciousness

Three common types of regional anaesthesia

• Spinal

• Epidural

• Nerve blocks

Our concerns and precautions for pts under Regional (Spinal) Anaesthesia

• some doc require pts to remain flat for at least 8 hours to decrease chance of headache SO know when the anaesthetic was administered

• patient may be prone to hypotension, so take precautions when moving the patient

General Anaesthesia

loss of sensation with a loss of consciousness and reflexes

Major Disadvantages to General Anaesthesia

• CNS depression

• Nausea and vomiting

• Aspiration

• Amnesia effects

• Hallucinogenic effects and flashbacks with certain agents

• Taking six months for the effects to be totally removed from the body

Four Stages of General Anaesthesia

Stage 1 - Altered consciousness

Stage 2 - Excitement

Stage 3 - Surgical Anaethesia

Stage 4 - Stage of Danger

Stage 1 - Altered consciousness

• pt is drowsy

• everyone in room should remain quiet

Stage 2 - Excitement

• pt is susceptible to external stimuli

• pt has irregular breathing and moves around

• remain quiet and be prepared to restrain pt

Stage 3 - Surgical Anaethesia

• surgery now can be performed

• pt has reg breathing and loss of sensation and consciousness

Stage 4 - Stage of Danger

• pt is not breathing, has little to no HR

• everyone should prepare for CPR

our role for pt under general anaesthesia

• prevent air way obstruction from the tongue; turn head to side

• be alert to hypotension

• be alert of anesthesia wearing off

• pts have low body temp so keep them warm

• for pts recovering, explain what you are doing as the hearing is the first sense to return

Conscious Sedation

alter a patient's perception during a procedure as well as manage pain

Administration of Conscious Sedation Medications

must always be equipped with:

• An oxygen source

• Airway management equipment

• Drugs to treat both anaphylaxis and other forms of hypotension

• Appropriate monitors

when is the MRT most involved

in the OR when patients are usually already under anesthesia

types of mobile fluoroscopy

• mini c-arm

• Conventional C-arm

• Biplanar C-arm

• Dedicated Fluoroscopy Units

• Angiography

mini c-arm

• used by surgeons for surgeries of the upper extremities and the ankles and feet

• techs are only required to set up and take it away and clean, ensure that req is properly filled

Conventional C-arm

• commonly used in the OR for a variety of cases from cardiac studies, orthopedics to abdominal surgery

• tech stays from start to finsih

Biplanar C-arm

• permits the surgeon to see the AP and Lateral projections at the same time to ensure accuracy and improve efficiency

• For cervical spine surgery

Dedicated Fluoroscopy Units

• some ORs include specialized tables which have fluoroscopy units built in

• dedicated urology and cardiac suites

Angiography

• Most c-arms are built with angiography capabilities

• when assessment and evaluation of blood flow is required

CT

known to be used for lung nodule excision, neuro and spine surgeries

MRI

No metallic objects can be in the vicinity of the MRI unit, therefore several safety precautions must be taken into consideration

Tech’s Resposibility

• ensuring all equipment is clean and ready to go for any situation

Appropriate Attires

• hospital attire: arms bare, no jewelry, faces cleanly shaven

• OR area attire: OR scrubs, bouffant, booties

• OR suite attire: mask, medical hand wash

ways to identify pt

• confirming with the circulating nurse

• confirm monitor is on right pt

• if possible, checking the patient’s wrist band

our responsibility before surgery begins

• ensure everyone is wearing lead (if a c-arm is being used)

• extra lead is available outside the room incase more pple come in

Doning Attire in each Zone

Zone 1: Bouffant, booties, OR scrubs

Zone 2: new mask

Zone 2/3: lead protection (depends where it is)

when is hand hygiene done

• start of donning

• prior to entering zone 3

• end of doffing

• after removing drape

• after cleaning C-arm

how to prepare equipment before imaging

• must ask the Scrub nurse to help you place the sterile C-Arm drape

• Do NOT touch the outside of the drape

• can only touch the inside of the drape and lower 3-4 inches to pull it down, and the third/lowest strap

tasks after imaging

• remove drape

• clean equipment

• fill out req

• send images to PACS

Doffing Attire in each Zone

Zone 3/2": lead protection

Zone 2/1: mask

Zone 1: Bouffant and booties