Chapter 13

Summary of Invasive Procedures and Surgical Asepsis

Chapter Objectives

  • Objective 1: Understand the rules of surgical asepsis for invasive procedures.
  • Objective 2: Comprehend the importance of maintaining a sterile field.
  • Objective 3: Be capable of correctly opening a sterile tray.
  • Objective 4: Be skilled at establishing a sterile field and correctly donning sterile personal equipment.
  • Objective 5: Appreciate the sonographer’s role as part of the team in the surgical suite.

Introduction

  • Invasive procedures necessitate proficiency in:
    • Establishing a sterile field.
    • Donning sterile gear.
    • Maintaining a sterile environment.

Surgical Asepsis

  • Definition: Surgical asepsis involves the complete removal of microorganisms and their spores from the surface of an object.
    • Areas considered sterile include the blood, brain, bone, heart, and vascular systems.
    • Application:
    • Required for all invasive and surgical procedures that necessitate a sterile field.
    • Necessary for minimal wound care by the sonographer.
    • Examination of areas adjacent to surgical, wound, or burn bandages should be done without disrupting the bandages unless facility guidelines are followed.
    • Care required with any wound drainage equipment.

The Rules of Surgical Asepsis

  • Reference: Page 392 includes 25 rules applicable whenever an invasive or sterile procedure is performed.
    • Govern knowledge and handling of sterile and non-sterile objects and personnel.

Preparing for an Invasive Procedure

  • Scheduling of procedures typically allows for preparation of both patient and sonographer.
  • Laboratory Tests:
    • Common tests include:
    • Complete Blood Count (CBC)
    • Prothrombin Time (PT)
    • International Normalized Ratio (INR)
    • Partial Thromboplastin Time (PTT)
    • Basic Metabolic Panel (BMP)
  • Importance of documentation in invasive procedures.
  • Sonographers may perform baseline health analyses and room preparation, including conducting scans prior to procedures.

Skin Preparation and Draping

  • Responsibility may include cleaning surgical sites, which involves:
    • Scrubbing the skin.
    • Shaving the surgical area to eliminate microorganisms.
  • If shaving is necessary, it may be performed by the physician or nurse.
  • Application of sterile drapes follows skin preparation, typically using single-use drapes.
  • Sterile gloves must be worn during the draping process, and step-by-step procedures must be followed.

Opening a Sterile Pack and Adding Items to a Sterile Field

  • Objective: Open sterile packs without contaminating the sterile field.
    • Note: Sterile packs are uniquely designed for specific procedures.
    • Most trays will contain the necessary equipment.
    • Instructions for use are clearly printed on the pack’s exterior.
    • Proper steps for adding items to a sterile field must be adhered to.

Sterile Gloving

  • Following proper handwashing, specific procedures must be followed to put on sterile gloves, which may be required during an invasive procedure.

Draping a Transducer with a Sterile Probe Cover and Needle Guide

  • Sterile probe covers are pre-packaged and can be easily introduced to a sterile field.
  • The draping process involves both a sterile person and a non-sterile person.
  • Proper procedural steps need to be followed for draping the transducer.

Syringe Assistance and Needle Disposal

  • Physicians may need support in administering local anesthesia or filling syringes with liquid.
  • A sterile syringe and needle are usually included in the sterile pack.
  • Always verify the vial label with the physician before assisting with syringe filling.
  • Maintain sterility during assistance tasks.
  • Post-procedure, it is essential to dispose of sharp objects properly:
    • Unused instruments and accessories must go into sharps containers.
    • All blood-soiled gauze and instruments should be discarded in biohazard containers.

Sonography in the Operating Room

  • The surgical area is divided into three designated zones:
    • Zone 1: Unrestricted zone with no special clothing requirements.
    • Zone 2: Requires scrub dress with covered hair and shoes.
    • Zone 3: Restricted zone requiring surgical clothing (employer-provided), shoe covers, and masks. Doors must remain closed, and personnel involved directly in the surgery must be in sterile gowns and gloves (referred to as “being scrubbed”).

The Surgical Scrub

  • While the sonographer is typically not the sterile person, they should know how to perform a surgical scrub:
    • Change into surgical scrubs, hair covering, shoe coverings, and masks before entering the surgical suite.
    • Special situations may necessitate extensive hand and arm scrubbing.
    • Clean your transducer and the cord between patients.
    • Follow established procedures during the surgical scrub process.

Sterile Gowning

  • After completing the surgical scrub, donning a sterile gown may be required:
    • The sterile gown should be opened and positioned into a sterile field before scrubbing.
    • Adhere to the proper instructions for wearing the gown.

The Surgical Team

  • The surgical team includes various healthcare professionals with distinct roles:
    • Surgeon
    • Surgical Assistant
    • Anesthesiologist
    • Nurse Anesthetist
    • Circulating Nurse
    • Scrub Nurse or Technician
  • The sonographer’s role can vary based on the type of surgery, but it is crucial to maintain cleanliness of ultrasound machines and transducers before entering the operating room.
  • While the surgeon may often perform the scan, it is essential for the sonographer to be ready to assist when necessary, avoiding all contact with the sterile field.