HOSA Surgery Principles

Define: Aseptic Technique

Describes the practices used to minimize risk of infection following surgical procedure

What do aseptic techniques include? (5)

Management of the surgical facility, patient, surgical site, surgeon and equipment

_____________ used to clean __________ in the _________ room, but they do not eliminate ______

Disinfectants, Facilities, Operating, Spores

True or False: Every surgical instrument is a potential source of contamination

True

As every surgical instrument is a potential source of contamination, hence the importance of _____________ where all ______________, including ______, are killed

Sterilization, Microorganisms, Spores

List means of sterilization (2)

Pressurized steam, Chemical

Define: Autoclave

Used to sterilize instruments using pressurized steam, and the instruments are packed in surgical wrap which the steam can penetrate

What are used to distinguish equipment that has been sterilized?

Heat sensitive markers

What are surgical packs often composed of? (6)

A needle holder, Forceps, Hemostats, Tissue scissors, Draping material, Absorptive gauze sponges

Good quality instruments are made of _________ _____, allowing for __________ and minimizing _________

Stainless steel, Durability, Corrosion

State the purpose of: Scalpel

Allowing for incision to the tissues

State the purpose of: Needle holder

Holds the needle for suturing

True or False: There are several different styles of scissors available

True

State the purpose of: Curved scissors

Used for more maneuverability

State the purpose of: Straight blade scissors

Used to cut through tougher tissues

Describe and state the purpose of: Tissue forceps

Have the appearance of tweezers, tip has a serrated end for delicate handling of tissue

State the purpose of: Hemostatic Forceps

Clamp blood vessels so vessel can be ligated to prevent bleeding

State the purpose of: Retractors

Hold tissues to expose surgical area

State the purpose of: Towel Forceps

Surgical drapes to cover animal except for surgical incision region

State the purpose of: Spay hook

To bring uterus through small incision

True or False: Stainless steel can withstand high temp of autoclave

True

True or False: All surgical instruments can be sterilized with autoclave

False; Stainless steel can withstand high temp of autoclave, but other surgical instruments may be damaged

How are other surgical instruments sterilized? What is used?

Sterilization via chemical means is used; Ethylene oxide is employed

Ethylene oxide is _____ and requires special ________ for ______________

Toxic, Chambers, Administration

True or False: Surgeons are not a source of contamination

False, surgeons ARE ALSO a source of contamination

Surgeons must be dressed with a ____ _____ and ____, _ __ ____ and ____

Head cover, Surgical mask, Sterile surgical gown, Gloves

Describe: The scrubbing procedure

Surgeons washing their hands and forearms with a surgical scrub

Why do surgeons have to be dressed with all the listed apparel and perform the scrubbing procedure?

Greatly decreases the number of bacteria present

_ ____ with the use of ___ is important

Contact time, Antiseptics

True or False: Antiseptics kill the bacteria immediately

False; Antiseptics DO NOT kill the bacteria immediately, so prolonged contact is necessary

How long does the scrub last? Why?

Usually lasts ~5 minutes so that the antiseptic can greatly reduce the number of bacteria present

State the position(s) during scrubbing and the reason for that position

Hands are held the highest (cleanest part is held the highest); As elbows have higher bacterial count, water does not run from elbows to contaminate the hands

What is used to dry the hands and arms in scrubbing?

A sterile towel, dry the hands then the arms

True or False: Surgical conditions greatly vary and impact the surgery

True

Describe and state an example of: Clean surgeries

Involve healthy skin and tissue being removed (E.g., Spay and Castration)

Surgeries involving the ____, ____ and ___ ______ are riskier

Mouth, Intestines, Contaminated wounds

What is the relationship between the risk of infection and the degree of contamination?

The risk of infection is DIRECTLY PROPORTIONAL to the degree of contamination

Surgery creates a _____ and the _

which occurs in

Wound Healing: What is the phase that begins right after the trauma or incision called?

Hemostasis phase

Wound Healing: In ____ phase, _____ is beneficial in the wound of ___

Hemostasis, Bleeding, Flushing, Contamination

Wound Healing: In _ phase, the _____ ___, slowing the ____ of _

Hemostasis, Blood vessels constrict, Flow, Blood

Wound Healing: In Hemostasis phase, what is signalled? What happens from this?

Coagulation factors are signalled; The blood begins to clot, protecting the animal from excess blood loss

Wound Healing: In _ phase, ______ ____ ____ the ______ and _____ it, as the ____ , a ____ is formed

Hemostasis, Fibrin clot fills, Wound, Seals, Clot dries, Scab

Wound Healing: In Hemostasis phase, what is the purpose of the scab? (2)

Protects the damaged area, Allows for healing to happen underneath

Wound Healing: Describe the Inflammation phase

Takes place when the blood vessels eventually dilate and release histamine and prostaglandins

Wound Healing: What does the dilation and release of histamine and prostaglandins in the Inflammation phase do?

Brings more white blood cells to help destroy the damaged tissue and bacteria

Wound Healing: In ____ phase, _ and ____ protect the ____ from __ and ______ ______

Inflammation, Neutrophils, Monocytes, Wound, Bacteria, Tissue debris

Wound Healing: What do the monocytes in the Inflammation phase become? When? For what?

Macrophages, A few days later, Clear the wound of debris and bacteria

Wound Healing: In ____ phase, the ___ _____ ____ produced to the area results in… (4)

Inflammation, Increased blood flow, Plasma leakage, adding to the swelling, causing pain and possible redness

Wound Healing: Describe the Repair/Proliferation phase

Describes fibroblasts entering the damaged area and forming fiber

Wound Healing: In / phase, there is an _ _ of ____ and ____

Repair/Proliferation, Increased deposition, Fibers, Matrix

Wound Healing: In / phase, ___ grow into newly forming ___ , providing ___ and _ to the new ____

Repair/Proliferation, Capillaries, Connective tissue, Oxygen, Nutrients, Tissue

Wound Healing: In Repair/Proliferation phase, what is the healing tissue known as? Why?

Granulation tissue, Due to its granular appearance

Wound Healing: In / phase, what cells move across the wound? What does this do? (3)

Repair/Proliferation, Epithelial cells, Minimize fluid loss, providing protection

Wound Healing: In Repair/Proliferation phase, _ ____ ___ allows the ____ _____ to _

Continued cell replication, Skin layer, Thicken

Wound Healing: In Repair/Proliferation phase, more ____ is deposited after the ____ looks completely ____, allowing for the ____ to _ in ____ over time

Collagen, Wound, Healed, Wound, Decrease, Size

Wound Healing: What brings the skin closer together in Repair/Proliferation phase? For what?

Contraction, So that less time is required for epithelial cells to reach across the entirety of the wound

In a ____ ____, _ are brought together with , the ____ edges are held close together to minimize the _

Surgical incision, Incisions, Sutures, Skin, Healing process

Define: First intention healing

Describes a wound with the edges closely apposed

Define: Golden period

Describes the first 6

What cannot be done past the "golden period"? Why?

Beyond this period, the wound cannot be sutured because bacterial contamination may be too high

Define: Second intention healing

Describes wound healing where granulation tissue is needed to fill the gap between the skin edges for epithelial cells to grow

What is Proud Flesh?

A condition affecting horses where an overgrowth of granulation tissue prevents epithelial tissue from growing across the wound

In Proud Flesh: It is ideal to ___ on ______ immediately for _

Suture lacerations, Horses, First intention healing

When suturing ____ ____, ____ ______ and ____ within wound, _ should be removed

Traumatic wounds, Dead tissue, Contaminants, Margins

Define: Debridement

Describes the process where damaged and contaminated tissue are removed

Define: Hematoma

Describes an accumulation of blood in the dead space

_____ has fluid similar to _ with a small number of ___ _____ _____

Seroma, Serum, Red blood cells

True or False: Fluid in a seroma may be white (with no red blood cells) or light red

False; Fluid in a seroma may be STRAW COLOURED (with no red blood cells) or light red

In Hematoma/Seroma: This collection of ____ increases the _ on the _, preventing the ____ from ____ to the ____ tissue underneath

Fluid, Tension, Incision, Skin, Adhering, Tissue

In Hematoma/Seroma: This fluid needs to be removed for ____ ____, if great amounts of ____ accumulate, a ____ must be used to remove the _

Complete healing, Fluid, Needle, Fluid

In Hematoma/Seroma: If not removed, the excess ____ can cause a ___ buildup and fluid may ____ from the area

Fluid, Pressure, Leak

Define: Dehiscence

The breaking of wound edges

Where may dehiscence occur? Why?

Can occur along the length of the suture line; This failure to heal may be due to excess tension or infection

How might dehiscence be caused in animals?

May be caused by the animal scratching or licking at their wounds

True or False: Suture material varies greatly

True

Suture material varies greatly and depends on… (2)

The strength and type of tissue being sutured

How many major classes of suture material are there? What are they?

2: Absorbable and Nonabsorbable

For absorbable suture material: It is used within the ____. The body eventually destroys the _ for it to be completely _

Body, Material, Eliminated

What is the primary requirement for absorbable suture material?

The material should maintain strength for a long enough time for complete healing to take place

_ suture material is not destroyed by the ____ and are later _

Nonabsorbable, Body, Removed

True or False: Suture needle type and pattern is the same regardless of surgery

False; Suture needle type and pattern DEPEND ON THE SURGERY

Define and Describe: Simple interrupted pattern

A suture pattern where the suture passes straight through the 2 sides of the incision, is tied, and the ends are cut

Define and Describe: Simple continuous pattern

A suture pattern starting with an initial simple interrupted suture which is tied, but the resulting end is not cut

True or False: Tying knots is a good skill for surgeons

False; Tying knots is an ESSENTIAL skill for surgeons

Multiple ____ are tied to secure the ______

Square knots, Suture

The knot ____ of materials varies, so some materials require a ____ number of ____

Security, Greater, Knots

What is the purpose of the suture? What is not the purpose?

To appose the edges, not overtighten the tissues

What are endoscopes?

A technological advancement that provides a light source and means to see inside a body cavity in surgery

On endoscopes: It is less ____ than ____ surgery and is __ for tracking through ____ structures such as the ___

Invasive, Conventional, Flexible, Intestine

True or False: Instruments can be placed at the end of the endoscope

True

What instruments can be placed at the end of the endoscope? (3)

Forceps, needle holders, scissors, and others

Define: Recumbent patients

Describe animals under anesthesia

What can't animals under anesthesia maintain?

Can't maintain their body temperature

Describe what is done to animals under anesthesia to maintain their body temperature

A heavy towel or blanket between the animal and table provides minimized heat transfer and supplemental heat

What is important to note for surgeries? (2)

There is not just one standardized method to performing surgeries; Many variations are possible given the approach or situation

What is a common abdominal surgery in pets?

Ovariohysterectomy, otherwise known as the Spay

In ovariohysterectomy: The animal is ____ and secured to the _ . _____ is _____ and ____ prior to surgery

Anesthetized, Surgery table, Abdomen, Clipped, Scrubbed

In ovariohysterectomy: A ____ ____ _____ is performed, where the ____ allows for __ ______ from both sides of the ___ ____ to meet

Ventral midline incision, Midlines, Connective tissue, Abdominal wall

In ovariohysterectomy: An _____ through the ____ and ____ ____ to expose the _ ____

Incision, Skin, Subcutaneous tissue, Linea alba