Surgical Principles

Mayo scissors , What do?

Cut thick tissue, heavy fascia , and muscle .

Has a blunt tip

Difference between cleaning, sterilization, and disinfecting.

Cleaning: removes gross matter

Sterilization: destruction of all microorganisms

Disinfection: destruction of pathogenic microorganisms from surfaces

Bacteriostatic, virustatic, fungistatic

INHIBIT the growth of bacteria, viruses, and fungus

-static: to stop

Bactericidal, virucidal, fungicidal

KILL bacteria, viruses and fungi

-cidal: kill

What is a spore ?

Dormant form of bacteria, durable and can survive in less than ideal conditions

Sporistatic

Temporarily stops the spore’s ability to germinate without killing it

Sporicidal

Kills spores completely so they can’t germinate and grow

Antiseptic VS Antisepsis

Antiseptic: antimicrobial agent that kills / inhibits the growth of microorganisms

Antisepsis: prevention of infection by inhibiting the growth of infectious agents

Oxidation

Removal of electrons from an atom

Hydrolysis

Molecules of water breaks one or more chemical bonds

Reduction

Additional of electrons to an atom

Categories of infection: critical items

Objects in direct contact with internal fluids . High risk of infections

Categories of infection: semi-critical items

Inject in contact with MM or broken skin

Categories of infection: non-critical items

Objects in context with closed intact skin , but not MM

High -level disinfectants

Destroy ALL microorganisms except high numbers of bacterial spores

Low-level disinfectants

Kills MOST bacteria some viruses, and fungi. Won’t kill tubercle bacilli or bacterial spores

Chemical monitoring: External VS. Internal indicators

External: used OUTSIDE of the pack to verify the package has been sterilized

Internal: used INSIDE of the pack to verify the instruments has been sterilized

Three methods to monitor sterility

1. Mechanical monitoring

2. Chemical monitoring

3. Biological monitoring

For biological monitoring what spores are used inside of the specialized filter paper?

Geobacillus stearothermophilus: for steam/chemical sterilizers

Bacillus atrophaeus: for dry heat sterilizers

True or False: Glassine paper is permeable to sterilant but resistant to moisture and air at ambient temperature and pressure

True

The Autoclave should be at what temperature, pressure, and for how long ?

250 degrees Fahrenheit, pressure of 15-27 lb/in squared for 15 minutes

What is dry heat used for?

Useful for maintaining sharp edges of instruments and preventing corrosion

Temperature: 320-375 degrees Fahrenheit for 6-20 minutes (1-2 hours in oven)

When is ionizing used for cleaning materials?

Useful for heat-sensitive materials

Damages DNA and RNA

Ortho-phthalaldehyde (OPA)

Based on the powerful binding of aldehyde to the outer cell walls of contaminant organisms

• lowers inhalant exposure risk

• reduces disinfecting time

What is glutardehyde?

A high level disinfectant used to sterilize heat sensitive medical equipment

Laparotomies

Common major soft tissue surgery.

Indications: abdominal trauma / FB , internal hemorrhage, a biopsy of abdominal organs, gastrostomy , ovariohysterectomy, cesarean section

Ethylene oxide

Used to make antifreeze, is also used to sterilize medical equipment. Equipment should be aerated for several days after sterilization

Orchidectomy (OE)

When only one testicle is palpable and abdominal or inguinal surgery is needed to remove the undescended testicle

Paramedics incision

Offset from ventral midline (right or left)

Paranormal incision

Parallel to the last rib

Hematoma

Accumulation of BLOOD beneath the skin

Seroma

Accumulation of SERUM beneath the skin

Dehiscence

When the surgical wound closer is disturbed resulting in the splitting of incision revealing the inside of the wound or cavity

Evisceration

When internal organs are forced out through the incision making them visible to the owner . is a life threatening emergency

When do Non-absorbable sutures need to be removed?

After 10-15 days

Flank incision

Perpendicular to forum and caudal to thorax

What are signs of internal hemorrhage ?

Blood in the urine, bruising on skin, pale MM, oozing from incision, weakness, etc.

During scrubbing how many quadrants (sides) are on one finger?

4

Why is it important to see an indicator strip in a surgical pack ?

To make sure the pack was sterilized

What parts are considered the sterile field on a person who is stubs in?

Front of body, above the waist to the shoulders and across the width of the chest, and the arms and hands

True or False: Non-woven material such as paper has a longer shelf life than woven material like muslin.

True ,

If I pack is doubled wrapped will also increase shelf life

What order are surgical instruments cleaned?

1. Presoaking

2. Decontaminating

3. Ultrasonic cleaning

What kind of lubricants should be used on instruments?

Milk solutions, Lubricants must be water soluble to allow steam penetration during sterilization. Also helps prevent protein build up.

How long will a double wrap , two layer muslin pack last on the shelf?

7 weeks in a closed cabinet and 3 weeks in a open cabinet

How long will a double wrapped, non-woven barrier such as paper last on the shelf ?

6 months

What conditions should packs be kept? (Temperature and humidity)

75 degrees Fahrenheit, <70% humidity

Why do we want to avoid using a wire brush?

To avoid scratching the instruments and avoid bacterial growth

When cleaning instruments how do you prevent biological debri from splashing back?

Brush away from the body

True or False: surgical mask protect against airborne pathogens .

False, protects from splashes , for airborne pathogens must use a fitted respirator

Pros and cons of shoe covers.

Pros: minimize contaminants that can be spread from walking around

Cons: slipping hazard , no traction

Why are bubbles in an ultrasonic cleaner important ?

The bubbles expand and when they pop they create a tiny vacuum that helps loosen and dissolve any dibris or condensation

Aseptic VS Sterile

Aseptic : free of HARMFUL microorganisms

Sterile : free of ALL microorganisms

Before moving the patient to the surgical room they should be _____(aseptic or sterile)

Aseptic

What should be used as a surgical scrub?

Chlorhexidine or povidone iodine products

Who can do the draping of the patient?

The person who is scrubs in and wearing sterile PPE

True or False: the most common scalpel handle and blade combination is a #10 handle and a #3 blade

False,

Most common combination is a #3 handle and a #10 blade

Gelpi VS. Weitlaner retractors

Gelpi= has a single tip that extends outward to retract muscles

Weitlaner= has multiple prongs at the tip

• Both are used for orthopedic procedures and neurosurgery

Balfour VS. Finochietto retractors

Balfour= abdominal surgery

Finochietto= thoracic surgery

Malleable (ribbon) retractor

A retractor made of soft metals that can bend according to the area

Sennrake VS. Army-navy retractor

Senn = used for superficial muscle

Army-navy= used for large muscles

Poole tips (suction)

Removes abdominal fluids and can’t be plugged by omentum

Frazier-Ferguson tips (suction)

Removes blood and has different suction strengths

Yankauer tips (suction)

Removes fluids other than blood

What are metzenbaum scissors used for?

It is a fine tip instrument with long handles for cutting/dissecting delicate tissue.

Tip= blunt or pointy, straight or curved

What are Iris scissors used for ?

Small , sharp, delicate instrument commonly used for intraocular surgery

When passing non sterile people how should they pass each other ?

Back to back without touching

How do sterile people pass each other?

Front to front carefully without touching

Why should we count gauze before and after surgery ?

To make sure none were left inside the patient. Make sure to separate each guaze from each other to not count two of them as one gauze

True or False: To aid in hemostasis the suction should be placed NEAR tissue and not on tissue and we should DAB with gauze not wipe.

True , this way we are not adding trauma to the tissue and are allowing the blood to clot and stop bleeding

What should happen when a sterile object touches a non sterile object ?

It should be considered non-sterile and should be replaced

What are wire cutting scissors for?

A short tip with serrated edges used to cut wire and suture

Littauer and Spencer suture removal scissors, what do ?

Used to cut and remove sutures post-op,

One of the blade is curved into a small hook at the end as the other is straight

Rat tooth forceps what are they used for?

Grasp skin and place sutures

Arson-brown forceps what are they used for?

Is used with delicate tissue

What are dressing forceps used for ?

Used for dressing materials . It has serrations but no teeth

What are Russian forceps used for?

Used to hold hollow viscera

Backhaus towel clamp VS. Roeder forceps

Backhaus = secure drapes to skin

Roeder= similar to Backhaus but has metal beads on them to prevent puncturing the skin

What are Ferguson angiotribe forceps used for?

Assist in holding large bundles of tissue

What are sponge forceps used for?

Used to hold gauze sponges during surgery or preparation. The circular tip is covered in teeth/prongs

Lorna(Edna) non-penetrating towel clamps , what do?

Secure drapes to ground drapes

Define self-retaining forceps

Forceps that use a ratchet-locking devise to grasp and retract tissue.

What is the difference between Rochester carmalt / pean forceps ?

Carmalt = cross-hatched grooves at the tip and longitudinal grooves

Pean= longitudinal grooves only (grooves go in only one direction)

Kelly vs Crile forceps

Kelly= have distal transverse grooves only

Crile = have complete transverse grooves

What are three different shapes of needles?

Straight needles (Keith needles), Curved needles, Half curved needles

What needle shape requires the use of a needle holder ?

The curved needle

What needle is straight with a curved tip?

The half curved needle

Which needle type is commonly used for purse string sutures ?

The straight needle

True or false: the eye of the needle and the suture should be similar in size.

True

How long do absorbable sutures last?

Lose it’s strength within 60 days and starts to break down

How long do non-absorbable sutures last?

Strength will last for several months and even up to 2 years

How is a wired suture measured?

Measured in gauge, range from 18-40. (Lower number= thicker diameter)

How are natural or synthetic sutures measured?

Measured on a scale of 11-0 (smallest) to 7(largest)

11-0 means there are 11 zeros. 11-0 is a more convenient way to write it.

EX)

2-0= 00

4-0= 0000

What is the most common suture pattern used?

The interrupted suture

Advantage: each suture is placed individually and prevents all of them coming off of one is pulled off

Disadvantage: more knots means more sutures used, increasing the risk of infection and inflammation

Cyanoacrylates

A tissue adhesive ( superglue for the skin) . Use on a clean dry wound

What material can be used to repair hernias ?

Skin mesh

What is an example of natural or synthetic sutures?

Chronic gut(cat gut, surgical gut) , natural and absorbable