Surgical and OR prep

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  1. sterile
    free from bacteria or living microorganisms
  2. aseptic technique
    • used to maintain absense of disease-causing organisms in surgical environment
    • used to maximize asepsis.  
    • protect from infection
  3. scrubbed in
    person who has gone through process of scrubbing hands and forearms and gowning and gloving in preparation for surgery
  4. contamination
    disruption of sterility in a field prepared aseptically.
  5. strikethrough
    contamination of sterile field via liquid soaking through barrier drapes
  6. bair hugger
    warming measure in surgery, runs warm air around patient
  7. sterile field
    • a specified area that is considered free of microorganisms
    • Prepared aseptically
    • encompasses drapes upward, outer inch is considered nonsterile
    • contaminated by reaching across or getting wet
  8. how long do packs remain sterile?
    • single-wrapped are sterile for up to a year in a  closed cabinet
    • double-wrapped can be stored for 2 years in a closed cabinet.
  9. Surgery prep of patient
    • clip hair/fur at surgical site with generous borders.  
    • +/- dirty scrub
    • transfer to OR
    • set up P in OR
    • aseptic scrub
  10. scrubbing
    • dirty and aseptic
    • dirty removes gross debris after clipping
    • 2 solutions, Chlorhexadine or Betadine and Alcohol
  11. fur clipping for limb surgeries
    distal to proximal joint.  stifle surgery shaves from hip to tarsus
  12. clipping for abdominal surgery
    1-2 inches above xyphoid to pubis
  13. clipping for mass removal
    leave generous borders for closure
  14. dirty scrub
    • clear gross debris from surgical area
    • excess fur and hair removed
    • prepucial flush (for abdominal)
  15. strategies for limb suspension/tieback in surgery/prep
    • 1. glove on tip of limb, wrap glove in tape, tape strip up one side, down the other, stirrup, tape around the ends, hang with stirrup so you can prep all around, then surgeon can grab with drape
    • 2. suture through toe webbing, cut off needle and tie a loop, suspend.  Good for distal surgery
    • 3. babcock forceps, grab webbing and lock closed.  Tape one side of forcep handles so you can open them
  16. upper airway surgery placement
    • tie cling gauze to 2 IV poles, run behind canines.  Make sure there is a towel to support head/throat, don't pull neck back too far or P will hurt afterwards.  
    • This is a dirty surgery.  If scrub, careful of eyes
  17. placement for neck surgeries
    tie forlimbs downward, not up
  18. when tying down limbs you need
    2 points of contact to avoid swollen paw
  19. dorsal recumbancy
    positioned on back, belly-up
  20. lateral recumbancy
    can be right or left, positioned on side
  21. sternal/ventral recumbancy
    positioned on belly, back up
  22. scrub for eyes
    dilute betadine
  23. best scrub for body
    chlorhex followed by alcohol (synergistic)
  24. betadine and alcohol
    cancel each other out
  25. chlorhexadine and alcohol
  26. sterilium
    like chlorhex, replacing in OR because it doesn't dry hands and cause aseptic cracking.  Synergistic throughout the day.  Rubs are better than sponges
  27. cleaning instruments
    • soak
    • brush (gross debris removal)
    • ultrasonic cleaner
    • lay out to dry
    • instrument milk on hinges
    • wrap
    • sterilize
  28. what can't go in ultrasonic cleaner
    • staplers
    • hemoclips
    • anything that can't be submerged
  29. Flash sterilization procedure and temps
    • For emergencies, fast.  
    • nonporous: 131C/270F minimum 3 minutes (after gets to this temp) at 15psi.  crack door, dry 10 minutes
    • porous: 131C/270F for 10 minutes at 15 psi.  
    • NOT WRAPPED, very hot
  30. asepsis
    absense of pathogenic organisms in clinical setting
  31. disinfection
    • destruction of vegetative forms of bacteria but NOT SPORES
    • organisms remain in field, but no longer harmful to P.  Good for living tissue (can't be sterilized)
  32. sterilization
    destruction of all organisms and spores on an object
  33. disinfectant
    chemical agents that are applied to inanimate objects to destroy the vegetative form of bacteria, but not necessarily spore form
  34. disinfection time
    time required for particular agent to produce maximal effect
  35. antisepsis
    prevention of infection by inhibiting growth of infectious agents
  36. chlorhexadine
    • antiseptic, antimicrobial against bacteria, mold, yeast, virus
    • scrub and solution, Nolvasan
    • rapid onset, long residual activity (not compromised by blood, lavage solutions
    • synergistic with alcohol
    • non-irritating, not for use around eyes
  37. iodine
    • used in compounded forms, antimicrobial but limited against bacterial spores
    • povidine iodine, betadine
    • rapid onset, 4-6 hour residual activity
    • residual destroyed by alcohol, lavage soln and organic material
    • potential for skin irritation, okay in eyes if dilute
  38. alcohol
    • good against bacteria
    • isopropyl, ethyl
    • disinfectant and antiseptic, safe for living tissue
  39. quaternary ammonium
    • good against bacteria, some viruses
    • Benzalkonium
    • not for living tissue
    • disinfectant and antiseptic
  40. chloride
    • antimicrobial, kills bacteria and viruses
    • bleach
    • not for living tissue
    • disinfectant, not antiseptic
  41. aldehyde
    • antimicrobial, good for bacteria and viruses
    • formaldehyde, glutaraldehyde
    • not for living tissue
    • disinfectant, not antiseptic
  42. autoclave
    • steam sterilization, most common
    • 121C/250F for 15 minutes at 15psi (more for packs)
    • tape and indicator strips to check
    • biologic challenge test done periodically to check (strips containing pathogens)
  43. ethylene oxide sterilization
    • gas, for stuff that can't be autoclaved (cautery pens, light source wiring for endoscopes, nitrogen drill tubing)
    • colorless, flammable, explosive, toxic gas.
    • DESTROYS METABOLIC PATHWAYS in bacteria (alkylation), kills all microorganisms
    • 21C-60C (70-140F), 12-24 hours (aerate to remove gas)
    • biologic tests to check
  44. hydrogen peroxide gas plasma sterilization
    • safer than ethylene oxide
    • mycobacteria, bacterial spores, fungi and viruses
    • wrapped in nonwoven polypropylene or plastic pouches
    • vacuum in chamber, add vaporized H2O2, creates free radicals that kill.  
    • Takes 1 hour, no need for aeration after
    • indicator strips
  45. cold sterilization
    • soaking of instruments in disinfectant like chlorhexadine, benzalkonium or glutaraldehyde
    • ONLY for minor procedures like suture/staple removal, dental, etc.  STERILITY NOT GUARANTEED
    • soaked for 3 hours minimum then washed before use
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    • Halsted Mosquito Forceps
    • clamp small vessels that must be occluded, crushed or held in place
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    • Hartman Mosquito Forceps
    • used to clamp or occlude small capillaries or vessels that are cut or are about to be cut
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    • Crile forceps
    • Teeth go all the way (crocodile)
    • used to occlude vessels such as small uterine horns or small to medium sized blood vessels
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    • Kelly Forceps
    • Teeth stop halfway because Kelly is a prude and doesn't go all the way
    • used to occlude small to medium sized vessels
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    • Rochester-Carmalt Forceps
    • used to clamp large tissue bundles that contain blood vessels.  When instrument placed perpendicular to blood vessels, occludes vessel and prevents blood from flowing
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    • Allis Tissue Forceps
    • used to hold with maximum power.  Causes tissue trauma
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    • Babcock Intestinal Forceps
    • used to grasp delicate tissue such as intestines or uterus without crushing or traumatizing it.
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    • Brown-Adson Thumb Forceps
    • delicate tissues.  
    • There are 9 teeth on each tine.  There is a wide blade to allow for thumb and finger pressure.
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    • Adson Tissue Forceps
    • delicate tissues.  The very fine teeth cause minimal trauma and are arranged in either 1x2 or 2x3 pattern.  
    • There is a wide blade to allow for finger and thumb pressure
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    • rat toothed tissue forceps
    • skin and dense tissues (suture placement)
    • damage to delicate tissues
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    • Backhaus towel clamp
    • secure drapes to p's skin by means of small puncture
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    • Lorna Towel Clamp
    • secure drape to p or items to surgical field without puncture
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    • Olson-Hegar Needle Holder
    • drive suture through tissue and assist in tying and cutting sutures.  SCISSORS behind jaws
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    • mayo-hegar needle holder
    • drive sutures through tissue and tie.  NO SCISSORS
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    • Mayo scissors
    • Fat
    • perform blunt dissection and cut bulky connective tissue
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    • metzenbaum scissors
    • tiny
    • blunt-tissect or cut soft tissue
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    • Lister Bandage Scissors
    • remove bandages and dressings.
    • One blade ends in blunt triangle to push skin out of the way to prevent cutting.  Always cut down.
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    • spencer delicate-stitch scissors
    • remove sutures.  One tine ends in sharp curve to slip under suture tie.
    • Cut as close to skin as possible
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    • Operating scissors
    • cut suture material or other inanimate objects.  Many combinations (blunt vs sharp on each blade, curved or straight)
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    • Senn Rake Retractor
    • Hand-Held
    • used to hold open a wound or incision so surgeon can view underlying tissues
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    • Army-Navy Retractor/U.S. Army Retractor
    • Hand-held
    • used to hold open a wound or incision so surgeon can view underlying tissues
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    • Weitlaner Retractor
    • Self-retaining
    • used to maintain muscle retraction during orthopedic surgery
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    • Gelpi retractor
    • self-retaining
    • used to maintain wound exposure during orthopedic surgery and neurosurgery
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    • Balfour Retractor
    • self-retaining
    • used to hold the abdominal wall open for surgery
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    • Finochietto retractor
    • self-retaining
    • hold thoracic wall open for thoracotomies
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    • ruskin rongeur
    • remove or break up small chunks of bone, cartilage or fibrous tissue
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    • bone mallet and osteotome
    • mallet to set pins or strike osteotonmes or any other matter that requires pounding
    • Osteotome used to cut through or shape bone
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    • suction
    • wall mounted or portable. Allow for as much or as little suction as necessary
    • canisters must be emptied and cleaned but sterilization is not necessary (no p contact)
    • tubing must be sterile
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    • yankaur suction tip
    • suction fluids out of surgical fields
    • more rough suctioning, good for esophagus and large volumes
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    • frasier suction tip
    • suction fluids out of surgical field
    • orthopedic surgeries and delicate areas
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    • poole suction tip
    • suction fluids out of surgical field
    • abdominal surgeries
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    • bone curette
    • scrape out cancellous bone from medullary cavity to perform bone grafts or to scrape osteochondrosis dessicans (OCD) lesions.
    • bowl with sharp edges
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    • Snook's ovariohysterectomy hook
    • retrieve uterine horn from within a small animal.
    • allow surgeon to make a smaller incision, doesn't have to allow finger
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    • trephine
    • perform biopsies or drill small holes in skull or sinus
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    • cautery pen and plate
    • utilizes electrocautery (destroying tissue using head conduction from a metal probe heated by electric current) to stop bleeding from small vessels or cut through soft tissue.
    • NEEDS grounding plate with wet gauze in contact with P's skin to prevent burns.
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    • scalpel handles
    • used to incise and transect.
    • hold variety of sizes of surgical blade
    • #3 used primarily for small animals, 4 & 8 for large animals.
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    detail 11, 12, 15, 20, 23
    • scalpel blades
    • #10 - general blade used for most small animal surgeries.  Fits #3 handle
    • #11 - used to sever ligaments, Fits #3 handle
    • #12 - used to lance an absess, fits #3 handle
    • #15 - small, precise or curved incisions, fits #3 handle
    • #20 and #23 - general for large animals, fit #4 or #8 handle
Card Set
Surgical and OR prep
Surgical and OR prep and conduct in VETC 247
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