General Surgery Etiquette and Procedures

Lecture 4

Which people are allowed to go between the instrument table and surgery site?

Only sterile people “scrubbed in”

A non-scrubbed person never extends their arm over what?

a sterile field, whether it is an instrument table or a draped patient

The instrument table is place toward the surgeon’s which hand, except in the case of neuters?

dominant

Where do we want anesthesia to be in the surgical area?

as far from the area as possible but where they can still monitor

Why are sterile backed gowns important in large animal surgery?

because the instrument table is directly behind the assistant surgeon and potentially lead surgeon rather than off to the side as in small animal

What are ways we are able to reduce contamination in surgery?

attire

positioning of instrument table

organization of surgical area

positioning of patient

What is ideal table height?

arms bent and even with surgical field

Before you set up your surgical field, what should you do?

check table height

double check patient position

turn on and position surgical light

What is the general order for the surgeon setting up the surgical field with minimal assistance?

open table drape

open outer layer of pack and drop inner layer wrapped pack onto table

open selected suture and scalpel blade onto pack

open gown

open gloves onto gown or to side of gown

go “scrub” then come back and gown and glove

open pack to get drapes

drape

organize instruments

cut

What is the general order for the surgeon setting up the surgical field with dedicated technical assistance?

open gown

open gloves onto gowns

go “scrub” then gown and glove

take table drape from non-sterile assistant

open table drape without contamination

take inner pack from non-sterile assistant

open and organize pack

non-sterile assistant opens selected suture and scalpel blade

drape

cut

What area is not considered sterile on a draped table?

below table

When towel clamping, if the clamp touched skin it is then considered contaminated. What does this mean if you need to reposition the clamp?

You cannot bring the clamp completely back through the drape and go back to surgery site, you have to unclamp them and reposition while the clamp is still through the drape

Where do you start when draping a patient?

start closest to you and work away

Before cutting, what should you do?

you MUST check with your anesthetist

What positions can you put your hands in once you are scrubbed/sterile?

clasp them together in front of you

prayer hands

half crossed arms

What should you not do with your hands once you are scrubbed/sterile?

hold them above your shoulders or below your waist or away from your body

What are jobs for the assistant surgeon?

organize table

count gauze sponges

count instruments

hand instruments

retract things

hold “things”

cut suture (the most important job)

run suture

Why do we count gauzes?

we use radiopague gauze

formation of gossypiboma

What should you do with gauze as you use them during surgery?

put them in a pile on the table, so you can catch a miscount before closing

How should you hand an instrument to a surgeon?

hand the surgeon the handles firmly like a good handshake

What should you do before cutting suture as an assistant surgeon?

check length with lead surgeon

Explain the method of running suture.

surgeon places bites

surgeon gathers suture and hands excess to assistant

assistant holds suture out of the way of surgeon taking bites

When suturing, what is possible in cases of large animal surgery that is not possible in small animal?

co-suturing

What are the general rules of writing a surgery report?

critical part of the medical record so gial is to accurately report what occured during the procedure

details are important including lengths, instruments, and suture

templates are your friend

should be step by step using proper medical terminology and generic terms and no filler words

What is the first part of a surgery report?

animal being anesthetized/restrained (brief) and how it was positioned (± which table or positioning aids were used)

What is the second part of a surgery report?

describe area prepared and how it was prepared

What is the third part of a surgery report?

described the approach: location, length (cm), and instruments used

What is the fourth part of the surpery report?

the body:

describe major findings including what was explored and findings (pathology report)

describe major procedures in order including general ligation and size of suture, transection and instrument used, blunt dissection, sharp dissection, and implants placed including exact numbers, size, etc

What is the fifth part of the surgery report?

incision closure including layers, patterns, suture, ± needle type

What is the sixth part of the surgery report?

describe any incisional dressings that were applied

What is the seventh and final part of the surgery report?

how the animal recovered from anesthesia