ST 128 Chapter 18 & 19 - Review Sheet

Overview

• Focus: Planning a case and the start of surgery.
• Topics Covered: Halstead principles, hemostasis, specimen management, sterile field management, and sutures.

Key Concepts

Instrument Use

• Tie on a Pass: Typically uses a right angle or curved clamp.

Halstead’s Principles of Surgery

1. Gentle handling of tissue.
2. Control bleeding.
3. Preserve blood supply.
4. Keep tissue moist.
5. Strict sterile technique.
6. Minimize tissue tension.
7. Eliminate dead space.

Hemostatic Agents

• Gel: Flo seal, Tisseel, Surgiflo.
• Dry Powder: Avitene surgical.
• Dry Sponge: Gelfoam.
• Fluid or Applicator: Silver nitrate.
• Solution or Dry: Topical thrombin.

Suture Information

• Packaging: Plain gut and chromic gut are in an alcohol and water solution to prevent breakage.
• Dry Sutures: Dip in saline if dried out.

Suture Handling

• Provide short curved and straight hemostats with sutures for stabilization.

Hemostatic Techniques

• Bone Wax: Used for hemostasis in bone.
• Suture Ligature: For large bleeding vessels.
• Free Tie: Pre-cut suture lengths for vessel ligation.
• Bolster/Retention Suture: Provides additional wound support.

Specimen Management

• Fresh, Frozen, Permanent: Different handling and medium requirements.
• Lymph Nodes & Tonsils: Specific methods for sending.
• Fluid Measurement Responsibility: Surgeon technologist.

Sponge Types

• Raytec Sponge: Used in body cavities, mounted to sponge stick.
• Laparotomy Sponge: For major surgery, padding, and absorption.
• Kitner, Cherry, and Peanut Sponge: Small, round, gauze-covered.
• Cottonoids: Used for hemostasis or as a filter.
• Tonsil Sponges: Used in throat surgery.

Wound Types

• Hematoma: Blood-filled space in tissue.
• Seroma: Fluid collection under the skin.

Biopsy Types

• Fine Needle Aspiration: Uses a fine needle.
• Incisional & Excisional Biopsy: Tissue removal methods.
• Core Needle Biopsy: Uses a large bore needle.

Tourniquet Use

• Arm: 1 hour max.
• Leg: 1.5 hours max.
• Risks: Tissue necrosis, vascular, and nerve damage.

Sterile Field Management

• Responsibilities: All OR members must announce breaks in sterility.

Wound Healing Phases

1. Inflammatory: 3-4 days, macrophage activity.
2. Proliferative: Collagen building, granulation tissue.
3. Remodeling: Strength gains, wound contraction.

Wound Classification

• Class 1 (Clean): No aseptic breaks.
• Class 2 (Clean Contaminated): Minor aseptic breaks.
• Class 3 (Contaminated): Major aseptic breaks.
• Class 4 (Dirty/Infected): Open traumatic wounds.

Grafts

• Allograft: From patient's body.
• Autologous Autograft: Relocated from patient's body.
• Porcine, Bovine, Xenograft: Animal-derived.

Drains & Incisions

• Passive & Active Drains: Hemovac, Jackson Pratt, T-tube.
• Incision Types: Subcostal, Paramedian, etc.

Suture Characteristics

• Memory: Shape retention.
• Pliability: Handling ease.
• Tensile Strength: Force to break.
• Capillary Action: Moisture absorption.
• Uniformity & Bioactivity: Uniform diameter and body response.

Additional Points

• Surgical Count Responsibility: Everyone in the room.
• Specimen Management: Secure biohazard labeling.
• RSI (Retained Surgical Item): Preventive measures and procedures for lost items.