Lecture 4: General Surgery Etiquette & Procedures

How should the instrument table be placed in the OR?

• close to surgeon if no assistant, close to assistant if have assistant

• toward surgeon’s dominant hand, except for neuters

Only _______ people go between table and surgery site.

sterile (scrubbed in)

What should a non-scrubbed person NEVER do in the OR?

extend their arm over a sterile field (instrument table or draped patient)

What component of a surgical area should be placed as far as possible from surgery area?

anesthesia

What should be done before setting up surgical field?

• check table height (ideal height = arms bent and even with surgical field)

• double check patient position

• turn on and position surgical light

What is the general order of surgical site prep for the surgeon?

1. open table drape (or use outer pack drape as table drape)

2. open outer layer of pack and drop inner layer wrapped pack onto table (protect dirty arm)

3. open selected suture and scalpel blade onto pack

4. open gown

5. open gloves onto gowns

6. scrub

7. open pack to get drapes

8. drape

9. organize instruments

10. cut

What area is NOT considered sterile on a draped table?

below table

True or false: when draping, start furthest from you and work towards yourself.

false: start closest to you and work away

What must ALWAYS be done before cutting into patient?

check with anesthetist

How should scrubbed in hands be held to ensure sterility when moving or waiting?

in front of you within site

Why should gauze be counted during surgery?

• use of radiopaque gauze

• formation of gossypiboma

How should a surgical instrument be handed to a surgeon?

hand the surgeon the handles firmly, like a good hand shake

What scissors should NOT be used for suture and why?

mayo and metzenbaum; suture dulls scissors super fast

How may an assistant be important when a surgeon is performing a running suture?

the surgeon is placing bites and then gathers suture and hands excess to assistant to hold suture out of the way for said bites

What is the first thing noted in a surgery report?

Start with animal being anesthetized/restrained (brief) and how it was positioned (+/- which table or positioning aids were used)

Example: The dog was anesthetized and placed in dorsal recumbency in a V trough

After describing the anesthesia and positioning in a surgery report, what is explained?

the area prepared and how it was prepared

Example: The ventral abdomen from the xiphoid to the pubis was clipped and prepared for surgery using 4% chlorhexidine scrub and alcohol

What is included when describing the approach of the surgery in the report?

location, length (cm), and instruments used

Example: A 20 cm ventral midline celiotomy was created with a #10 scalpel blade. The peritoneal cavity was entered bluntly

What is included in the body of a surgery report?

• Describe major findings in order: what was explored, findings

• Describe major procedures in order: ligation (size of suture), transection (instrument used), blunt and sharp dissection, implants placed (exact numbers, sizes, etc)

What final parts of a surgery report should be included after the body?

• incision closure; layers, patterns, suture, ± needle types

• describe any incisional dressings that were applied

• end with how animal recovered from anesthesia