ST 128
CHAPTER 18 & 19-Review Sheet
Planning a case and start of surgery
Halstead, Hemostasis, Specimens, Management of Sterile field, And Suture
1. Instrument you use on the end of a tie to make it a tie on a pass
Right angle or curved clamp
2. Halstead
Halstead advocated for gentle handling of tissue and the use of very fine sutures placed close together with minimal tension on the tissue edges.
Halstead’s principles of surgery are as follows:
1. Handle tissue gently
2. Control bleeding
3. Preserve blood supply
4. Keep tissue moist
5. Observe.strict sterile technique
6. Minimize tissue tension
7. Eliminate dead space
3. hemostatic agents-flow seal, tisseel, surgiflo, avitene surgical, gelfoam ect.
Flo seal: Gel
Tisseel: Gel
Surgiflo: Gel
Avitene surgical: Dry powder
Gelfoam: Dry sponge
Dermabond: Liquid
Silver nitrate: Fluid or applicator
Topical thrombin: Solution or dry
4. What is plain gut and chromic gut packaged in? Why? What can you do if you take it out of the package and it dries out?
Packaged in alcohol and water solution
Prevents suture from breaking
If dries out, dip in saline
5. When giving the surgeon a suture what else do you need to give him to stabilize the tissue?
Short curved and straight hemostats
6. Bone wax
Hemostasis in bone
7. suture ligature
Used to ligate large bleeding vessel
8. free tie
Pre-cut lengths of suture used to ligate a bleeding vessel
9. Tie on a pass
Suture ties without a needle, suture grasped by tip of clamp
10. stick tie/swaged suture
Needles with suture pre-attached
11. Detach/control release suture
12. Bolster /retention suture
Bolster/ Retention: Interrupted technique used to provide additional support to wound edges in abdominal surgery
13. mechanical hemostasis/examples
Enhance normal coagulation
14. flowable hemostatic agents
Surgiflo
Crosseal
Floseal
15. How specimens are sent-fresh, frozen, permanent and medium sent in
Sent- fresh :
Frozen: Received in bowl/basin and kept moistened with saline
Permanent:
16. How do you send lymph nodes? Tonsils?
17. Who is responsible for measuring fluids?
Surgical technologist
18. Raytec sponges
The raytec sponge is also called a “four by four” is a large square of loosely woven gauze folded into a 4-inch square pad. When used in a body cavity or in a deep incision, the Raytec must always be mounted to a sponge stick.
19. laparotomy sponge
The laparotomy sponge or “lap sponge” is used in major surgery. Lap sponges are used to absorb blood and fluid and for padding the blades of large retractors.
20. kitner, cherry, and peanut sponge
Small round. Oval sponge covered with gauze and secured with x-ray detachable thread
21. cottonoids
The flat sponge is called a cottonoid or patty is a compressed square of synthetic or cotton material with an x-ray detectable string attached. The flat sponge is used to maintain homeostasis or as a filter over delicate tissue requiring fine-bore suction. Flat sponges are available in many different sizes for use during neurosurgical, ear and vascular procedures.
22. weck cells (spears)
23. tonsil sponges
A round sponge (tonsil sponge) is covered with gauze and has a string attached for retrieval. The sponge is commonly used in throat surgery and often is used to control bleeding, the string will hang out of the patient’s mouth.
24. What is a hematoma, seroma?
Hematoma- Abnormal blood-filled space in tissue that prevents wound healing and may result in infection.
Seroma- Collection of fluid (serum) builds up under the surface of your skin.
25. What is suture material used for?
Approximate tissue
26. What suture is largest, O, 1, 2-0
1
27. fine needle aspiration
Long, fine needle to aspirate (suction) small pieces of tissue with mas
28. Incisional biopsy
Cut is made through skin to remove a sample of abnormal tissue/ part of a lump or suspicious area
29. excisional biopsy
Cut is made through skin to remove an entire lump or suspicious area so it can be checked under microscope
30. core needle biopsy
Similar to FNA, large bore hollow grocer or needle used to collect tissue
31. bandage is used to exsanguinate the limb
Esmarch bandage
32. Tourniquet -tourniquet time for arm? Leg?, deflation time, risk if up to long
Arm: up to 1 hour
Leg: 1 ½- hours
Risk of tissue necrosis, vascular and nerve damage
33. When having saline on the field should it be warm?
Yes to prevent infection
34. continuous irrigation and when is it used
Fluid used as a medium through surgery
Used in joint capsule, genitourinary tract, and uterus
35. What does exsanguinate mean?
Hemorrhage with the potential the deplete the patient's total blood volume
36. When should the specimen be passed off the field?
After surgeon approves it
37. most common specimen preservative
Formalin
38. two types of cultures taken in the operating room
Aerobic
Anerobic
39. What documentation items must be on the specimen label.
Biohazard labeling
40. How should forensic evidence be handled?
Submitted in a dry container with a seal.
41. swaged on needle?
Needle with suture pre-attached
42. How does the diameter of the suture relate to its size?
Based on the size of a single strand
43. What does it mean on the suture pack when it says detach or control release?
Suture is released from needle pulling it straight back from sewage
44. methods of hemostasis?
Direct pressure
Clamp
Electrosurgical coagulation
Ultrasonic
Colafulation
Ligature
Hemostatic agent
45. Where should you never keep a specimen?
Never use surgical sponges or towels to wrap a specimen
46. documentation items should be on the container before sending to pathology. (at least 5 items)
Surgeons name and contact number
Date and time of collection
Tissue of origin
Patients DOB and gender
Patient's name and 2 indemnifies
47. Know the Suture name, color of packaging, absorbable, non-absorbable, You have a chart and a suture book. (5 questions)
48. Identify 10 items found on the suture package or box
1. expiration date
2. lot number
3. suture length
4. looped suture
5. reorder code
6. needle description
7. color
8. qty/pack (x) length
9. MFG date
10. D-TACH symbol
49. Suture color on package, absorbable/non-absorbable
Vicryl-purple-absorbable
Monocryl- peach- absorbable
PDS II- Grey/silver- absorbable
Chromic Gut- Tan- Nonabsorbable
Plain Gut-Yellow-absorbable
Proline- purple- Nonabsorbable
Silk-Robin egg blue- Nonabsorbable
Nylon- Green- Nonabsorbable
Ethibond-Orange- Nonabsorbable
Umbilical Tape- Pink- Nonabsorbable
Steel- Gold- Nonabsorbable
50. Who is responsible for counts?
Everyone in the room is responsible for the surgical count
51. Who is responsible for watching breaks in sterile technique?
Surgical tech (everybody)
52. Fluid on the field- why important to keep track and who keeps track
So that total blood loss can be calculated accurately
53. RSI-Retained surgical item.
surgical sponge, instrument, tool, or device unintentionally left in a patient after surgery or another invasive procedure, potentially causing significant harm
54. Counts- what do you count, when do you count(6 times you may count), why do you count, who’s responsible for counts, procedure of closing count, what is the order of counting when closing the patient-where do you start.
Any retained surgical items
1. Before any surgery begins
2. Any time additional sponges or other counted items are added to the sterile setup
3. Before closure of any body cavity or cavity within a cavity
4. At the start of wound closure
5. At the skin closure or when counted items are no longer used on the sterile field
6. Whenever permanent relief staff enters the case
To prevent any objects from being left behind in the patient
All team members are responsible for ensuring that no items are left in a patient. The surgical tech and the circulator typically perform counts together.
1. Items on the immediate sterile field
2. Items on the mayo stand
3. Items on the back table
4. Items that have been discarded or dropped from the field
5. 55. Why items are lost, procedure of lost item-what do you do when an item is lost
ST not keeping tack of where items are
Double count, look in trash, take XR of patient
56. Sterile field, what is sterile, who is responsible for the sterile field and watching breaks in sterility on field
Back table
Mayo Stand
Instruments
Basin
OR bed
Everyone in the OR is responsible for announcing when they see a break in sterility
57. Wound healing- inflammatory phase, proliferative phase, remodeling phase
Inflammatory/ Lag-
3-4 days
tissue continually removed by macrophages
Proliferative
4-5 days up to 2 weeks
collagen building, granulation tissue
Remodeling
22 days-1 year
Gains strength over time
Slight wound contraction
58. Wound classification- Clean, Contaminated, Clean Contaminated, Dirty/Infected
Class 1: clean
No breaks in aseptic technique (total hip replacement, breast biopsy)
Class 2: Clean contaminated
Minor break in aseptic technique (appendectomy, cystoscope, vaginal procedure)
Class 3:Contaminated
Major breaks in aseptic technique (colon resection with gross spillage of GI contents)
Class 4: Dirty/Infected
Open traumatic wound (4+ hours old)perforated visceral (I&D an abscess)
59. Adhesions
An abnormal band of tissue that binds abdominal structures together. Adhesions may form as a result of infection of surgery.
60. Dehiscence
Separating of the edges of a surgical wound during healing.
61. Evisceration
The displacement of tissue(s) outside their normal location in the body.
62. Allograft- Power point
Made from patient body (tissue)
63. Autologous autograft-power point
Obtained from patients body and planted to mother spot on the body
64. Surgical mesh-power point
65. Porcine graft-power point
Made from pig (used to temporarily cover full-thickness injury)
66. Bone-graft-power point
Made from bone
67. Bovine graft-power point
Made from cow
68. Xenograft-power point
Made from tissue made from 1 species and placed on another species
69. Drains- Passive drains, active drains - (hemovac, Jackson pratt), water seal, T-tube
70. Abdominal incisions-in power point
Subcostal
Paramedian
Mcburney
Pfannestiel’s
Oblique
Upper abdominal transverse
Upper midline
71. Hemostatic clips
Placed over blood vessel to occlude it
72. Characteristics of suture (memory, pliability, tensile strength, capillary action (wicking), bioactivity, uniformity
Memory: Tendency to retain original shape after removal from package
Pilability: Ease of handling or softness in hand
Tensile Strength: Amount of force needed to break suture
Capillary Action: Absorb moisture and hold body fluid
Unifromity: Uniform in diameter to maintain tensile strength
Biocavity: body’s response to suture