Inguinal Herina study

passing a skin suture loaded on a needle holder

pass an adson

when passing adson you then cut with

straight mayo

Passing a large fascia suture loaded on a mayo needle holder you pass with a

bonnie or a rat tooth — then cut with straight mayo scissors

passing a very small vascular needle on a castrovejio

pass a Gerald or a ruel

you cut small vascular suture with

Metz

passing a very small skin suture on a Webster

pass a adson and straight mayo

passing a suture to repair bowel— you pass a what type of forcep ?

debakey — then cut with straight mayo

begin of procedure after incision is made with a #10 what would follow ?

bovie or Metz

getting deeper Into the subcutaneous tissue

switch to debakey forceps

both surgeon and assistant hands are tied up what can be passed?

self-retracting weitlaner

what are you checking when we pour fluid into abdominal cavity

fluid/saline temperature

cold fluid can bring patients temp

below normothermia causing hypothermia and increases the risk of SSI

adsons

skin forceps

debakey

subcutaneous tisse

geralds, ruel forceps

small vessels

rat tooth, bonnie

tough tissues

forced for bowel

debakey

forceps used on uterus

bonnie, rat tooth

forceps used on larger vessels

debakey

scissors used on bowel, cutting vessels, cut subcutaneous, cut delicate tissue, cutting small prolene suture

Metz

curved mayo scisssors used on

tough tissue, cut uterus ,

straight mayo scissors used on

suture, cut bandages , drapes, cut umbilical cord,

potts scissors used on

extend incision into vessel

scissors used for cutting inner layers of cast, bandages . drapes, umbilical cord

lister

cut delicate tissue in very small area like finger

tenotomy scissors

straight iris scissors

cut suture in a very small area like finger

curved iris scissors

cut tendon or muscle in very small area like finger

What should you ALWAYS check before setting up for an inguinal hernia case?

The side of the hernia (so you know which side of the table to set up).

Before opening a Penrose drain, what two things must you confirm?

The patient is male and does not have a latex allergy

When should mesh be opened during surgery?

Only when the doctor specifically asks for it

What should you check before opening mesh?

Name,type, size, and expiration date.

What materials should you have ready for the surgeon when working with mesh?

Marker, scissors, and pop-offs

What must you do when mesh is being placed in an inguinal hernia repair?

Initiate a full (softs & instruments) closing count as the doctor begins sewing.

What do you do if the surgical count is wrong?

Recount, tell the surgeon, scrub tech searches the sterile field, circulator searches off the field, X-ray if still not found, document and tell charge RN, recount if found.

What are the two questions to ask when the surgeon requests a drain?

What kind of drain? 2-0 Silk or Nylon?

What is the process for handling a drain with a trocar?

Pass the trocar like a blade, use straight Mayo scissors to cut off trocar & excess drain, suture without forceps (unless Adson is needed), tag the drain.

What is a “tie-on-passer”?

A tie on a tonsil

How are Neuro patties passed?

On bayonets

What is a kittner placed on?

Kelly clamp

What is a penrose placed on?

Kelly clamp

What are booties placed on?

mosquito clamp

What must you always do before opening any supplies?

Double-check the patient’s allergies

When is a dressing applied at the end of a case?

Only after the final count is completed

Drain with a Trocar......

1. Pass the trocar safely (like a Blade)

2. Straight Mayo Scissors to cut off the trocar & excess drain

3. Drain Suture (usually without a forcep - if the surgeon wants a trocar - Adson because you are at  the skin)

4. Tag the drain to avoid the blood/exudate/fluid from leaking out during the remainder of the case ( Tag when the surgeon is waiting for something)

Drain without Trocar......

1. In place of the trocar - Skin Blade, then tonsil to the surgeon/assistant on the side of the incision

2. Hand the outside end of the drain into the tonsil for them to pull it out

3. Go to "Drain with a Trocar" and complete #2, #3, & #4

A protrusion of intrabdominal organs through a natural, abnormal hole going out of abdominal cavity or scrotum can be intestines, entire organ, abdominal tissue, fat, ovaries.

Inguinal Hernia

What is the most common hernia

Groin Hernia

____% of hernias are __________ and they are 10x more common in ____ 1 in 4 will develop one.

75%, inguinal, males

Usually congential- most common in children

Indirect inguinal hernia

Why is indirect inguineal hernia most common in children?

Inguinal ring fails to close during fetal development

Indirect inguinal hernia occurs in ___% of newborns & up to ___% of _________.

5% of newborns & 30% of priemies.

Acquired through weakened abdominal muscle

Direct Inguinal Hernia

What hernia is located in the Hesselbach triangle?

Direct inguinal hernia

What does the Hesselbach involves?

The inguinal ligament, the rectus abdominis muscle, and the Deep epigastric vessels

Panataloon Hernia ( aka: Dual/Saddel-bag hernia)- combination of _________ and _________ hernias.

Indirect and Direct Hernias

If bowel is dead from strangulation/lack of blood supply or injured during dissection it may result in

Bowel resection

Testicular Artery Injury may result in

Orcectomy, reaccurance, SSI

What postion is Inhuinal Hernia in?

Supine

Prep: Hair of surgical area removed ideally in?

Pre-op

Prep: Foley may be placed to decompress the?

Bladder

Prep: Groin & Scrotum- often prepped with _____________- scrub places towel underneath testicles.

Betadine

Abdomen is prepped with?

Chlora Prep

During time-out the team should look at the _______- this marks the correct side of the hernia is prepped and draped. Surgeon must mark the patient in _________ before the patient is medicated.

Intials; Pre-op

Supplies:

• Ties

• sutures (vicryl, PDS, Prolene, Ethibond)

• ____________

• Part of soft count (5 in a pack)

• Load on a _________

• Penrose (Part of ______ count)

• Check for __________ allergies

• For men to protect ____________ ________

• Load on a ___________

• Soak in ________

• Bovie

• Suction & Yankauer

Kittner, Kelly, Soft, Latex, Spermatic cord, Kelly, sailine

Once surgeon has requested for mesh, ask sureon if her wants it place in ________.

Saline

Avoid touching ________ as much as possible.

Mesh

A _______ _________ _________must be done as surgeon placing mesh.

First closing count

Counting

Before making an incision, softs & instruments- Before opening

When placing mesh full count-Softs & instruments

Closing Fasica- Full count soft & instruments

Closing Skin- Soft count only

What blades sizes would you used in inguinal hernia?

#10 and #15

#_____ blade used to make _________ inguinal incision

#10; oblique

______ or ________ used to dissect through subcutaneous tissues

Metz or Bovie

_____________— ________ ____________ usted to retract snd expose surgical field.

Armynavy, Richardson Kelly

_____________- self-retaining retractor used to free up surgical assist’s hand(s)

Weitlaner

#_____ is used to incise Fascia of External Oblique and _____ to continue opening muscle layer.

#15; Metz

______________ may be placed on edges of Fascia to _______.

Hemostats; retract

Muscle may need to be retracted with ____________ or ________ ________________ even with ____________ in wound.

ArmyNavy; Small Richardson; Weitlaner

Surgeon is looking for important nerves such as ______________ and _______ nerves to protect them

ilioinguinal; genital

Along the way, superficial veins are _______to minimize bleeding - _____/___

ligated; bovie/tie

Surgeon is looking for a ___________ around the ________ ______ in order to protect it.

dissecting; spermatic cord

____________ is place around spermatic cord and secured with _____ - this allows for soft retacted

Penrose; Kelly

Dissection continues until the ______ sac is exposed, free, and dissected away from adhesions and the ___________ ______ with ___, _______, ________

Hernia; Spermatic Cord; Metz, fingers, kittners

Hernia Sac can be carefully dissected and opened up with ______, _________, ______.

Metz, Hemostats, Bovie

If there is any tissue/organs trapped in the sace need to be _________

released

The hernia sac can be twisted and ligated with _________ or ____.

Suture or Tie

The hernia sac can be reintroduced back into the ________________ _______

abdominal cavity

The repair of the opening can be completed with ________ or _______— there are many techniques used according to the _______ of hernia, __________, ___________ ______________.

suture or mesh; type, patient, surgeon preference

If mesh needs to be cut - ___ should have ________ and ________ scissors available. Also be ready to hold one end of the mesh if surgeon cuts the mesh. ___________ would have been removed by this point.

ST, marker and suture (Mayo) scissors, Penrose

Surgeon checks to make sure testicles are in the _______- ____ _______ in place if necessary.

scrotum; pull back

_____- ___________ Sutures is used to hold the mesh in place- mesh may come with a hole to be placed around the _________ ______ or a _____ can be made for it

Non-Absorbable; Spermatic cord; split

Surgeon may want to inject local at this point while he/she can see _____/ ______ and other important structures

nerves/veins

__-__ Suture is used to close the Fascia

2-0

__-__ Vicryl is often used to close muscle layers and subcutaneous tissues

3-0

__-__ Monocry or _____ _______ is used to close skin

4-0, Skin Stapler

If closed with suture- _____________ may be used for dressing

Dermabond

If skin is closed with staples, what can not be used?

Dermabond

Occur above umbilicus

Epigastic Hernia

Occur below umbilicus

Hypogastric Hernia

Occurs where esophagus meets stomach (Gerd/ Heartburn)- Most common in women, obese, people over 50

Hiatal Hernia

2-4% of groin hernias occurs in femoral canal below inguinal canal- most common in women

Femoral Hernia