positioning, skin prep, instrumentation

supine

most common

trendelenburg

-head tilted 15-30 degrees downward

-lower abdominal, colorectal, gyneocology, genitourinary procedures and central venous catheter placement

-support low blood pressure

-adverse effects: increased intracranial pressure, decreased lung expansion/lung volume

sims position

access to anus

prone

-spine and neck surgery, neurosurgery, colorectal, lower extremity tendon repair

reverse trendelenburg

supine with head up 30 degrees

-neck and head procedures and ocular

lateral position

-back, kident, colorrectal, hip surgery

-kidney position where a life is placed on the posterior abdmoinal wall to exaggerte retroperitoneal exposure

fowler position

-sitting

-shoulder and neurosurgery

jackknife

kneeling

-used for colorectal

lithotomy position

-urology, gyneocology, colorrectal, perineal

drop in core body temperature can lead to

myocardial events, infections, poor incision healing, postoperative pain, increased blood loss

benefits of warming patients

-decreased SSI

-decreased blood loss

-decreased hospital stays

-patient comfort

most common skin prep

-iodophers or chlorohexadine gluconate

-2 step scrub

povidone-iodine

-release of free iodine with in solution

-antiseptic destoryed microbial proteins and DNA

-safe on all skinn surface

-2 step application

cholorhexadine gluconate

-disrupting bacterial cell membrane

-more sustained antimicrobial activity and is more resistant to neutralization by blood products

-should not be used in genital region

hair removal

-dont remove unless at surgical site

-trauma to skin, increase of SSI

-use clippers

kocker clamp

traumatic toothed clamp

-hold tissue that will be removed

crile hemostat

-nontooth clamp

-gast tissue or vessels that will be tied off

kelly clamp

-larger size of crile hemostat

badcock

-jawed with smooth end

-delicate structures

allis

-toothed

-grasp firm tissue (fasica)

debakey

-non tooth

-grasp tissue such as bowel without damage

adson forceps

-tooths at the tip used for handling dense tissue in skin closure

bonney forceps

-heavy used for holding thick tissue (fascia)

russian forceps

atraumatic tissue grasping during dissection

right angle clamp

metzenbaum scissors

Fine tissue dissection

mayo scissors

-suture scissors

potts scissors

-incision in blood vessels

iris scissors

-fine dissection and cutting fine suture

10 blade

-large incisions

11 blade

-precise or sharply angles incisions

15 blade

-smaller vision of 10 blade for finer incisions

knife handle

-holds scaple in place

richardson

-hold back deep tissue structure

deaver

-abdominal wall

army-navy

-gain exposure of skin layers

malleable or ribbon retractor

-bent and customized

-protect intenstines

rake retractor

-sharp teeth to hold back surface structure

senn retractor

weitlaner

self retaining retractor

bookwalter system

Alias: universal ring retractor system

Use: deep retraction in the abdomen and pelvis

ring clamps

-hold a sponge

towel clip

-hold towels in place during draping

needle holder

-holding needles

yankauer suction

-surface suction

poole suction tube

-large amounts of fluid in surgical field

frazier suction tip

-ent and neurosurgery