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parts of sterile technique
create a feild free of microbes
cleansing skin
sterile equipment and opened in sterile fashion
indications of sterile technique
surgery
bedside procedures
biopsies
central lines
dressing changes
lumbar puncture
Thoracentesis
Paracentesis
RELATIVE contraindications of sterile technique
documented allergies
allergic dermatitis
→ substitute with another agent/product
Patient prep
pre-op showering with minimal soap, ideally antibacterial
no shaving surgical site
If known nasal colonization of MSSA → mupirocin ointment to nairs and chlorhexidine body wash to reduce skin colonization
Pre-op IV abx to prevent surgical site infections (within 60 min of skin incision)
GI: bowel prep and PO abx
within how long should pre-op abx be given
within 60 minutes of incision
prefered surgical pre-wash
antiseptic soap that is alcohol based combination agents such as Chlorhexidine or povidone-iodine
one of the leading causes of healthcare acquired infections
surgical site infections (SSIs)
how to keep sterility during prewash
use sterile gloves
use gauze and sponges
hold things w long clams/forceps
Sterile towel to dry
what to do prior to surgical scrubbing
take off all jewelry
clean and trimmed nauls
NO artificial nails
prewash w regular (nonmedicated) soap
use disposable nail cleaner
what are the 2 scrubbing techniques and what is preferred
timed/anatomic
vs
counted/numbered → Strongly recommended for people new to scrubbing
how long does scrubbing take
3-5 minutes (should never take less than 2 minutes)
order of scrubing
fingernails
fingers
hand/wrist
forearm
end 2 inches above elbow
finish one whole arm before moving onto the next
when do you use abrasive side of sponge
ONLY for fingernails
how to count the scrub
30 strokes for fingernails
20 for 4 sides of fingers
20 for palmar and dorsal hand/wrist
20 for 4 sides of foream
20 for 4 sides of upperarm 2 inches above elbow
which way do you spin in the final step of tying the gown
counterclockwise
safety zone
nipple to navel
how far to stay away from non-sterile areas
12 inches
final wash
immediately before surgery use forceps to hold antiseptic impregnanted sponge and clean wider than expected incision outwards and repeat til all sponges are used (usually 3)
**le
purpose of blue drapes
helps reduce glare and prevent eye fatigue
how to drape the opposite side of a pt
walk around the table
NEVER reach over the patient
T or F: once drape is placed, adjust it to fit the sterile area
FALSE! never move or adjust
get new drape and cover it
how to hold drape
up and away to avoid touching nonsterile
above waste/table height
what should you do if hole in the drape
cover w another drape
what parts of gown are “contaminated”
in front below the waist
more than 2 inchest above the elbow
gowns fully in the back3
goal of surgery
safely bring the patient through the surgery procedure
whats in the sterile field
the OR table → where pt is on
Instrument/equipment tables (+/- mayo stand)
scalpel indication
Create surgical incision
Handle + blade
MC blades used for scalpel
10, 11, 15, 20
scissors indication
primarily cut
assist in dissection by spreading tissue
Mayo vs Mets scissors
mayo → heavier more aggressive use for harsher dissection and cutting thicker suture
metz → lighter/gentle use w delicate dissection and cuts delicate suture
needle driver indication
hold and drive the needle
how to hold scissors
thumb halfway thru one hole, ring or middle finger in other w pointer finger supporting from top
forceps indication
grasp tissue
smooth vs toothed
smooth or toothed forceps cause minimal tissue trauma
toothed
retractors indication
retract (pull back) tissue/organ to maintain exposure to surgical site
suction indication
removes fluid from surgical field
** be gentle and avoid blood vessels, spinal dura, anything that u can cause injury to
clamps indication
holding objects in place, maintain control of tissue, cutting off blood flow
clamps in order of smallest to biggest
mosquito
crile (hemostat)
kelly
kocher
bovie
electrocautery → Heat generation allows for coagulation (hemostasis)
Requires a grounding pad placed prior to surgery on an area outside the surgical field (large muscle mass, not adjacent to metal)
sponges indication
soaking up blood/fluids, providing compression/hemostasis, cleaning the field/tools
** must count before and throughout case → dont throw away, return to scrub tech of kick bucket
how can sponges be detected in patient
count before and after
radio-opaque marker can be seen on x-ray
drills and saws indication
drilling/cutting bone
parts of imaging system
laparoscope
camera
light source (generates heat!!)
video monitor
camera settings
white/color balance
focus and zoom
level of illumination (brightness)
how to drive the camera
buttons and light source face up → everything is opposite
left is right
up is down
trochars indication
aka ports
serve as conduits to allow entry of the laparoscopic instruments into the cavity
laparoscopes indication
Allows for the visualization of the operative field
graspers indication
grasp tissue during laparoscopic cases
what type of grasper for delicate tissue
smoother choice
what type of grasper for narrow area
pointed tip
what type of grasper for spreading pressure over larger area
broader choice