HOSA Surgical Tech

aeger primo

"The patient first" motto of the AST

-> basically means that every decision a surgical technologist makes must *prioritize patient safety* even if it slows things down

surgical conscience

the *inner drive* to:

- follow sterile technique perfectly

- admit mistakes immediately

ex) if you contaminate an instrument, you must say something, even if no one saw it

NBSTSA

National Board of Surgical Technology and Surgical Assisting

-> they are the *certifying body*

respondeat superior

legal principle stating the surgeon/ employer is responsible for everything that happens

"Let the master answer."

res ipsa loquitur

legal principle saying, "the thing speaks for itself."

ex) leaving a sponge inside a patient

primum non nocere

means "first, do no harm"

roles in the OR

CST = sterile

Circulator (RN) = non-sterile

Anesthesia provider = non-sterile

surgical scrub

purpose is to *remove microorganisms from hands and arms*

-> 3-5 minutes, usually timed method

stroke count

specific number of strokes when washing:

- fingertips (20)

- fingers

- hands

- arms

*hands and arms are surgically clean, NOT sterile*

closed-glove technique

used for initial gowning

*big sterile setup = closed glove*

open-glove technique

used for minor procedures or catheterization

*small task = open glove*

skin prep

the surgical tech must clean the skin * from the incision outward using a circular motion*

-> common prep solutions: *chlorhexidine (CHG), providine-iodine (betadine)*

supine

flat on back

*used for most surgeries*

trendelenburg

head lower than feet

*used for pelvic/lower abdominal operations*

lithotomy

legs in stirrups

*used for vaginal/ rectal operations*

prone

on stomach

*used for spinal surgeries*

surigcal counts

ensure nothing is left inside the patient

order of surgical counts

1. baseline (initial)

2. cavity closure

3. final (skin closure)

items counted for surgical counts

sponges, sharps, instruments

mechanical hemostats

- clamps

- ligatures

- bone wax

thermal hemostats

- ESU (Bovie)

- lasers

chemical hemostats

- gelfoam

- thrombin

- avitene

wound classification I

clean: no inflammation, no GI/ respiratory entry

wound classification II

*clean-contaminated*: controlled entry

wound classification III

*contaminated*: fresh wound, gross spillage

wound classification IV

*dirty/ infected*: old wound, infection present

monofilament

type of suture with a *single strand*

ex) *prolene, nylon*

*less infection risk*

multifilament

type of suture that is *braided*

ex) *silk, vicryl*

it *holds the knots better, but there IS a higher risk of infection*

postoperative procedures

*AFTER the patient leaves*

1. sharps disposal: *use a puncture-resistant container*

2. dressings

3. terminal cleaning: THOROUGH cleaning of OR, done at *end of day*

pressure dressing

a bulky dressing held in position with a tightly wrapped bandage, which applies pressure to help control bleeding

*prevents hematoma/edema*

stent/ bolster

holds skin graft in place

preference cards

surgeon-specific lists of:

- instruments

- supplies

*help prepare the OR correctly*

autoclave

equipment used to sterilize articles by way of steam under pressure and/or dry heat

-> gravity displacement: *250 F for 30 min*

-> pre-vacuum: *270 F for 4 min*

ethylene oxide (EtO)

gas used for heat-sensitive items

-> *requires longer steirlization time

biological indicator

uses *geobacillus stearothermophilus*

*confirms sterilization worked*

right upper quadrant (RUQ)

liver, gallbladder

left upper quadrant (LUQ)

stomach, spleen, pancreas

right lower quadrant

appendix

left lower quadrant

sigmoid colon

cranial nerve I

Olfactory (smell)

cranial nerve II

Optic - vision

cranial nerve X

vagus (longest; affects heart/ digestion)

layers of the abdominal wall

1. skin

2. subcutaneous fat

3. fascia

4. muscle

5. pertoneum

"Time Out"

AST

A professional organization that sets guidelines and standards

CAAHEP / ABHES

Accredited programs

ARC/STSA

Reviews education standards

AORN

OR nursing standards

sterile-field rules

Anything below the waist = contaminated

Anything out of sight = contaminated

Edges of packages = contaminated

Back of gown = non-sterile

OR environment

Temp: 68-75°F

Humidity: 30-60%

Positive air pressure

If count is wrong:

STOP

Recount

Notify surgeon

X-ray if unresolved

Sharps safety

Sharps never passed hand-to-hand

Use neutral zone

Dispose immediately

medication handling

CST must label meds with:

Name

Concentration

Expiration

laparoscopy

Abdomen inflated with CO₂

Opening instrument = Trocar

penrose drain

passive

JP/ hemovac drain

active

If equipment malfunctions

Remove from service

Label "broken"

Notify appropriate personnel

incident report

Filed when:

Error

Injury

Unusual event

Sterilization

kills ALL microorganisms

Disinfection

reduces pathogens

Decontamination

makes items safe to handle

dry-heat

sterilization for glass/metal

myocardium

heart muscle

"master gland"

pituitary gland

Islets of Langerhans

Pancreas

alveoli

Gas exchange

femur

Longest & strongest bone

supination

Palm up

surgical asepsis

Sterile technique prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery

medical asepsis

clean technique; involves procedures and practices that reduce the number and transfer of pathogens

silk

absorbable

bandage

cover/protect