Sterile technique and surgical instruments

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51 Terms

1
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parts of sterile technique

  1. create a feild free of microbes

  2. cleansing skin

  3. sterile equipment and opened in sterile fashion

2
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indications of sterile technique

  1. surgery

  2. bedside procedures

    1. biopsies

    2. central lines

    3. dressing changes

    4. lumbar puncture

    5. Thoracentesis

    6. Paracentesis

3
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RELATIVE contraindications of sterile technique

documented allergies

allergic dermatitis

→ substitute with another agent/product

4
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Patient prep

  1. pre-op showering with minimal soap, ideally antibacterial

  2. no shaving surgical site

  3. If known nasal colonization of MSSA → mupirocin ointment to nairs and chlorhexidine body wash to reduce skin colonization

  4. Pre-op IV abx to prevent surgical site infections (within 60 min of skin incision)

  5. GI: bowel prep and PO abx

5
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within how long should pre-op abx be given

within 60 minutes of incision

6
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prefered surgical pre-wash

antiseptic soap that is alcohol based combination agents such as Chlorhexidine or povidone-iodine

7
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one of the leading causes of healthcare acquired infections

surgical site infections (SSIs)

8
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how to keep sterility during prewash

  1. use sterile gloves

  2. use gauze and sponges

  3. hold things w long clams/forceps

  4. Sterile towel to dry

9
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what to do prior to surgical scrubbing

  1. take off all jewelry

  2. clean and trimmed nauls

  3. NO artificial nails

  4. prewash w regular (nonmedicated) soap

  5. use disposable nail cleaner

10
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what are the 2 scrubbing techniques and what is preferred

timed/anatomic

vs

counted/numbered → Strongly recommended for people new to scrubbing

11
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how long does scrubbing take

3-5 minutes (should never take less than 2 minutes)

12
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order of scrubing

  1. fingernails

  2. fingers

  3. hand/wrist

  4. forearm

  5. end 2 inches above elbow

finish one whole arm before moving onto the next

13
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when do you use abrasive side of sponge

ONLY for fingernails

14
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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

15
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which way do you spin in the final step of tying the gown

counterclockwise

16
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safety zone

nipple to navel

17
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how far to stay away from non-sterile areas

12 inches

18
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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

19
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purpose of blue drapes

helps reduce glare and prevent eye fatigue

20
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how to drape the opposite side of a pt

walk around the table

NEVER reach over the patient

21
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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

22
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how to hold drape

up and away to avoid touching nonsterile

above waste/table height

23
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what should you do if hole in the drape

cover w another drape

24
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what parts of gown are “contaminated”

  1. in front below the waist

  2. more than 2 inchest above the elbow

  3. gowns fully in the back3

25
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goal of surgery

safely bring the patient through the surgery procedure

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whats in the sterile field

  1. the OR table → where pt is on

  2. Instrument/equipment tables (+/- mayo stand)

27
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scalpel indication

Create surgical incision

Handle + blade

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MC blades used for scalpel

10, 11, 15, 20

29
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scissors indication

  • primarily cut

  • assist in dissection by spreading tissue

30
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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

31
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needle driver indication

hold and drive the needle

32
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how to hold scissors

thumb halfway thru one hole, ring or middle finger in other w pointer finger supporting from top

33
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forceps indication

grasp tissue

smooth vs toothed

34
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smooth or toothed forceps cause minimal tissue trauma

toothed

35
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retractors indication

retract (pull back) tissue/organ to maintain exposure to surgical site

36
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suction indication

removes fluid from surgical field

** be gentle and avoid blood vessels, spinal dura, anything that u can cause injury to

37
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clamps indication

holding objects in place, maintain control of tissue, cutting off blood flow

38
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clamps in order of smallest to biggest

  1. mosquito

  2. crile (hemostat)

  3. kelly

  4. kocher

39
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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)

40
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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

41
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how can sponges be detected in patient

  1. count before and after

  2. radio-opaque marker can be seen on x-ray

42
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drills and saws indication

drilling/cutting bone

43
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parts of imaging system

  1. laparoscope

  2. camera

  3. light source (generates heat!!)

  4. video monitor

44
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camera settings

  1. white/color balance

  2. focus and zoom

  3. level of illumination (brightness)

45
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how to drive the camera

buttons and light source face up → everything is opposite

left is right

up is down

46
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trochars indication

aka ports

serve as conduits to allow entry of the laparoscopic instruments into the cavity

47
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laparoscopes indication

Allows for the visualization of the operative field

48
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graspers indication

grasp tissue during laparoscopic cases

49
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what type of grasper for delicate tissue

smoother choice

50
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what type of grasper for narrow area

pointed tip

51
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what type of grasper for spreading pressure over larger area

broader choice