Moving, Handling, and Positioning the Surgical Patient & Surgical Skin Preparation and Draping

Flashcards about moving, handling, positioning, skin preparation, and draping the surgical patient.

Abduction

Moving the arms away from the body.

Jackknife or Kraske position

A prone position where the patient lies on their abdomen with hips flexed into an inverted “V” position.

Shear injury

Tissue injury when two tissue planes are forcefully pulled in opposite directions.

Proper body mechanics

Reduces injuries for health care providers.

Assisting a falling patient

To assist a falling patient, ease the patient to the floor while protecting their head.

Drainage collecting units

must be lower than the patient’s body at all times.

Intravenous (IV) lines and fluid

Must be higher than the patient's body.

Transferring a patient

always make sure all wheels are locked.

Patient safety during transport

Keep hands and arms inside of stretcher rails.

Manually operated doors

Open the doors first and secure them open.

Elevator emergency

Activate the emergency alarm system.

Transferring an unconscious patient

The transfer board is the best option to use during transfer.

Pediatric patient

Caregivers may accompany a pediatric patient to the surgical suite and stay through anesthesia induction.

Communication with children

The developmental age of the child is critical for communication to be effective.

Teamwork

An important element for the safety of the patient during positioning is teamwork.

Arm board use

The arm board is used to extend the arms away from the body at an angle under 90 degrees.

Sequential compression devices

Sequential compression devices are used on patients having surgery to prevent blood pooling.

Lowering legs from stirrups

When lowering the patient’s legs from the stirrups postoperatively, they are lowered together slowly.

Footboard in reverse Trendelenburg

May prevent the patient from sliding downward, which can cause shearing injury.

Positioning the patient

The surgical team may begin positioning the patient only after the anesthesia care provider gives his or her permission.

Reverse Trendelenburg position

Is used when the surgeon requires unobstructed access to the upper abdominal cavity and lower esophagus.

Prone position

Lying with the abdomen downward.

Fowler’s position

A sitting position used for cranial, facial, and some reconstructive breast procedures.

Injuries reduced

Proper body mechanics can reduce injuries in health care workers.

Moving a patient

When moving a patient, keep feet well apart to provide a wide base support.

Safety strap placement

A safety strap should be placed on top of a blanket or sheet.

Patient transfer precautions

Whether the patient is conscious or unconscious, the same precautions are used when moving the patient from the operating table to the stretcher after surgery.

Patient risk

A weak, disoriented, or pediatric patient may attempt to climb out of the gurney or climb out of the crib and become entangled in side rails or climb over them and fall.

Patient safety

Remain alert and focused on patient safety.

Compartment syndrome

Severe swelling and tissue injury caused by constriction of the blood and lymph.

Ischemia

Loss of blood supply to a body part either by compression or as a result of a blockage in the blood vessels.

Range of motion

The normal anatomical movement of an extremity.

Fasciotomy

A surgical treatment for compartment syndrome in which the fascia is incised to release severe tissue swelling.

Necrosis

Tissue death.

Hypotension

Decreased blood pressure.

Compression injury

Tissue injury caused by continuous pressure over an area.

Embolism

A clot of blood, air, organic material, or a foreign body that moves freely in the vascular system.

Hyperflexion

Flexion of a joint beyond its normal anatomical range.

Safe Patient Transfer

Wheels on bed, wheelchair, or stretcher are locked.

Safe Patient Transport

Always warn patient of bumps or other unfamiliar movements.

Safe Patient Transport

Cover patient, apply safety strap, and raise rails.

Safe patient positioning

Knowing ahead of time what the surgical procedure will require.

Safe patient positioning

Requires the use of adequate padding, safety strap, and adequate help.

Safe Patient Transfer

Requires verifying the patient’s identity first.

Safe Patient Transfer

Always be prepared for falls.

Safe patient positioning

Is done only with the permission of the anesthesia care provider.

Safe patient positioning

Never move any part of the body against resistance.

Safe Patient Transport

Untangle and move lines, tubes, and equipment first, then the patient.

Head drape

Is used for procedures of the nose and throat. It protects the eyes during surgery and provides a sterile barrier over the head.

Securing drapes

The drapes are usually secured to the anesthesia screen.

Tube stockinette

Would be used on the hand or foot to isolate bacteria from the nails when an extremity is draped.

Towel clamps

Surgeons use nonpenetrating towel clamps to hold the towels in place when draping the patient.

Draping

When draping the patient for surgery, once a towel or drape has been placed on the patient, do not shift or move it.

Prepping the abdomen

When prepping the abdomen for surgery, clean the umbilicus with swabs, then begin at the incision site.

Radical mastectomy

Requires a preparation boundary that encompasses the neck, shoulder of the affected side, thorax to the operating table surface, and mid-pelvic region.

Cancerous tissue prep

Tissue that is suspected to be cancerous must be prepped gently, using as little friction and pressure as possible. This prevents tumor cells from migrating.

Alcohol, iodophor, or chlorhexidine prep solutions

Should never be used in or around the ears.

Highly colonized areas

Any area that is highly colonized with microorganisms, such as a colostomy area, is prepped with fresh sponges after the surrounding area is prepped.

Skin prep principles

The basic principles for the skin prep are based on the rules of aseptic technique and do not vary.

CABG patient prep

The leg and thorax are prepped separately, using a different setup for each site.

Purpose of draping

The purpose of draping is to provide a wide sterile area around the surgical site.

Chemical burns

Result when prep solutions are allowed to pool underneath the patient.

Triclosan

A safe prep solution for ophthalmic procedures.

Urinary catheterization contamination

Contaminants introduced by catheterization increase the risk of infection.

Patient hair

Hair removed from the patient in preparation for a craniotomy is considered the patient’s property and should be sent with the patient after surgery.

Surgeon's order

Hair clipping requires a verbal or written order by the surgeon.

Body's primary defense

Skin is the body’s primary defense against infection.

Surgical site infections (SSI)

A cause of SSI is the normal skin bacteria of the patient and the surgical team members being introduced into the incision.

Foley catheter

A Foley catheter is the most common catheter used during a surgical procedure for continuous drainage of the bladder.

Antiseptic solution use

Before surgery, the skin must be washed or painted with an antiseptic solution to reduce the number of transient and normal microorganisms to an absolute minimum.

Eyebrows

Eyebrows must never be shaved because of the failure to regrow or abnormal regrowth.

Prone position prep

If the patient is to be placed in the prone position for a surgical procedure, urinary catheterization must be performed before the patient is positioned.

Skin prep timing

The surgical skin prep is performed after the patient is anesthetized.

Approved solutions

Only antiseptics are approved for use on skin and may be used for the surgical skin prep.

Chemical burns

Although it normally is nonirritating to tissue, first degree and second-degree chemical burns can result from improper prep technique or if the patient is sensitive to iodine.

Laser surgery drapes

Aluminum-coated drapes are used whenever laser surgery is planned.

Leg prep

The limb must be elevated by an assistant or placed in a vertical legholder attached to the operating table.

Contaminated drape

The area may be covered with another impervious drape.

Uncontrolled systems

Uncontrolled or unmonitored systems create a risk of thermal burns because the exact temperature is not known.

Surgical prep agents

Surgical prep agents can cause skin irritation, rash, or other allergies.

Alcohol-based solutions

Alcohol and alcohol-based prep solutions are volatile and flammable. When alcohol solution or volatile fumes come in contact with heat sources, they can easily cause a fire on or inside the patient.

Prep solutions

Serious chemical burns can occur when prep solutions are allowed to pool under the patient during surgery.

Debridement

During the cleansing process, the surgeon removes all foreign material and trims away devitalized tissue.

Autograft

A tissue autograft is a graft that is removed from one site on the patient and grafted to another site.

Trauma

Trauma wounds are almost always contaminated because they are caused by external forces and often occur in environments that are mildly or grossly contaminated.

Cardiac and vascular surgery

Cardiac and vascular surgery require a large area of exposure.

Drapes

Drapes are folded in a specific way before sterilization so that they can be positioned over the operative site and unfolded in a way that prevents contamination.

Skin prep and draping

After the patient is under anesthesia and is intubated, the patient is then ready for the skin prep and draping.

Foley

Foley is a type of urinary catheter that remains in place. It is also called an indwelling catheter.

Catheter

Selection of the correct catheter is based on the patient’s age, size, and gender.

Catheterization of a female surgical patient

A female patient is positioned with the knees slightly flexed and the hips externally rotated.

Inserting a Foley catheter

The assisting hand does not contact sterile supplies, including the catheter itself.

Skin cannot be

Skin cannot be sterilized, but the number of bacteria can be reduced significantly with antiseptic cleansing or a coating of antiseptic on the skin.

During skin prep

Clean the umbilicus.

After skin prep

Place towels around surgical site.

Before skin prep

Clip hair.

Before skin prep

Administer anesthesia.

After skin prep

Place surgical drape on the patient.

Before skin prep

Position patient.

During skin prep

Blot dry with a sterile towel.