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surg tech 1505 t2

QuestionAnswer
Patient Checkin  Admitted  ID Wristband  Person issuing the ID band will verify  Name Birth date Spelling Place of admittance  Same-day surgery check-in  Various depts. (ER, specialty floor)In-patients Out-patients May come in ahead of time for lab work
Circulator Interview (pre-operative interview) Checks patient ID wristband Asks patient’s name Compares name (Including spelling) ID band All documentationDO NOT USE DIRECTIONAL QUESTIONS. USE OPEN ENDED QUESTIONS.
Required Questions (pre-operative interview) Patient Name Patient Allergies Name of surgeon Any jewelry, contact lenses, prosthesis, also check for piercings Procedure and side Bilateral ? NPO status
Recommended Questions (pre-operative interview) Were pre op orders followed? Did the patient recently void? Is family here and where?
Documentation (pre-operative interview) Documentation History and Physical Informed Consent and blood permit Doctor Orders Lab Values
Anesthesia Interview Anesthesia provider conducts their own interview
Surgeon Visit Surgeon sees the patient in the preoperative area before the patient is sedated. The surgeon will verify with the patient the procedure, answer any questions, and check the H & P.
All documents used are stamped... with the patient’s information and all stamps are verified for accuracy.
Transporter checks what? Correct Patient Correct Chart Patient Safety How patient arrives to holding area: Walking Wheelchair Stretcher Patient Room Bed
Patient transported to or by circulator and anesthesia provider On a Gurney (stretcher) On a Hospital Bed Infants Transported in Isolette Toddlers may arrive in a “crib”, wagon, walking, carried by staff, anything that makes it fun
Safety Patient always travels FEET FIRST Ensure patient’s dignity and comfort by providing sheets or blankets. Unless otherwise directed, patient’s head may be raised for comfort. Be aware of catheters, drains, Siderails up Never leave unattended
Transferring a Patient - Awake and alert may move themselves. Patient may need assistance. Use a draw sheet Most patients require a roller or transfer board Minimum of 4 people required: 1 on each side 1 at foot 1 at head ANESTHESIA PROVIDER CONTROLS THE HEAD/NECK AND DIRECTS THE TIMING.
Body Mechanics Use proper body mechanics Bend knees Legs shoulder width apart Keep back straight Lift with legs and arms, NOT BACK!!! Use assistive devices when available and necessary.
Circulator The circulator is the unsterile team member. Registered Nurse or a Surgical Technologist supervised by a Registered Nurse. Helps create and maintain the sterile field and provide a safe environment for the surgical patient
Circulating Guides and Duties 1 Know the preference card. Assemble necessary supplies / equipment for procedure. –Suction? –Electrocautery? –Positioning Aids? Make sure circulator and scrub are ready with set-up.
Circulating Guides and Duties 2 Assist anesthesia. Maintain quiet atmosphere during induction and emergence. Maintain patient safety, privacy and dignity. Know supplies, instruments and equipment. Watch for breaks in technique. ANTICIPATE needs of the team.
Circulating Guides and Duties 3 Be organized. Be ready to count and receive surgical specimens. Keep room stocked. Position, ground, shave, and prep patient. Catheterize if necessary. Highest Priority: hook sterile team up. Documentation Charges
Time Out A “time out” should occur prior to the incision being made on every case. Circulator verifies information with: surgeon, anesthesiologist and scrub Verify: identity of patient, procedure, and site. Position and implants should be verified also.
Correct Site Surgery Help improve the accuracy of patient identification, and eliminate wrong site, wrong procedure and wrong person surgery.
Correct Site Process Pre-op verification occurs Marking the operative site –Mark at or near the incision site only. Do not mark any non-operative sites. –The mark must be“yes” or initials. Use perm, non-toxic marker. •Must be visible after prep and draping. Marked by Dr.
Correct Site Process (con’t) Time Out –Verbal verification with team. Exception: Teeth, single organ cases and premature infants because the mark may cause a permanent tattoo.
Documentation 1 Legal account of what occurs in the OR. O.R. records should include: –Patient interview verification –Date –O.R. number –Names of all personnel in room •Surgeon •Assistant •Scrub(s) •Circulator(s) •Anesthesia •Others
Documentation 2 Diagnosis –pre and post-op Surgical Procedure Times Anesthesia information and ASA class Wound Class Position and aids Prep Shave
Documentation 3 Documentation Catheterization Electrosurgery Tournequit Blood, Medications, Irrigations Specimens, Cultures Dressings, Drains, Packing Counts Implants
Documentation 4 Transferred to… Nursing care plan Additional equipment Possibly a diagram to draw on. Additional forms may include –Charge sheet –Q.A. sheet
If it’s not documented, it was never done!
Purpose of Counts To protect the patient serious post-operative complications caused by sponges, sharps, or instruments inadvertently left in the patient during a procedure. Protect yourself and your employer from legal liability  To keep instrument sets complete
Sharp and Sponge Count: Scalpel blades, suture needles, hypodermic needles, needle bovie tips, raytec sponges, lap sponges, peanuts, etc.
Full count: Sharp and sponge count, plus instruments.
Type of Counts Sharps and sponge counts are done for every procedure Full counts are done whenever a cavity is opened.
When to do Counts Initial count –prior to the patient arriving in the OR. (Full count if cavity is entered) Closing counts –Cavity closure –full count –Skin closure –sharps and sponges
Number of Counts if cavity is not entered Two
Number of counts if cavity is entered Three
Number of counts for Cesarean Section Four
Who Counts? Circulator andScrub personnel. Counts must be done by two people. Many institutions require that one of the people be a registered nurse. Counts are done audibly and visibly. Both people should hear and see each item.
Who Initiates the Count Both the circulator and scrub are responsible for insuring the counts are done. – However, the scrub person has the advantage of knowing when the peritoneum is being closed and should inform the circulator.
Sequence of Counts Start at operative site -> mayo -> backtable -> kickbucket. Start with sponges -> sharps -> instruments
Counts are done by two people... each responsible for the accuracy of the count.
If any member of the team is concerned about the accuracy of the count... COUNT AGAIN –no questions asked, until the team is satisfied with the accuracy of the count
Omission of Counts The occurrence and reason for the occurrence is documented. An x-ray is taken at the end of the procedure. A count should always be performed, if at all possible, when the opportunity presents itself during the case.
Incorrect Count Count again. Notify surgeon. Scrub checks field, Circulator checks off the field, Surgeon checks wound. If item is not found, X-ray is taken and an incident report is filed.
Thermoregulatory Devices Maintain patient’s temperature Monitor temperature with: –Esophageal –Bladder –Rectal –Tympanic –Axillary –Forehead
Heat Loss Depends on: –Patient’s age –Patient’s physical status –Type of anesthesia planned –Ambient room temperature –Length and type of surgical procedure
Heat Loss occurs through: – Evaporation – Radiation – Convection – Conduction
What can we do to minimize heat loss? Cover patient with warm blankets Expose the smallest area feasible Decrease air movement Warm solutions Keep linens dry Warming / Cooling Blankets Warm Air Blowers (Bair Hugger) Heat Lamps Thermal Blankets, hats, leggings
Pediatrics and heat loss Infant lose heat quicker due to a larger surface area. Warm the room temperature ~ 70’s. Use K-thermia pad and possibly heat lamps or Ohio bed with built in lamps.
Sequential Compression Devices Used to prevent venous pooling in the legs. “massage” the legs sequentially
Role of the Scrub Know the preference card Check the case cart and pull any needed supplies or equipment Open case Scrub, gown and glove Set up the backtable and mayo Count Be aware of what is going on in the room
Role of the Scrub 2 Gown and glove other sterile team members Drape the patient Pass off suction, bovie, light handle cover, etc. Pass instruments correctly and efficiently as needed Retract, suction, sponge, etc. to assist in the progression of surgery
Role of the Scrub 3 Anticipate the needs of the surgical team and troubleshoot as necessary Assure correct specimen handling and specimen identification Count with circulator
Role of the Scrub 4 Apply dressings using sterile technique Keep table sterile until patient is out of room Assist with room turnover Knowing the anatomy and procedural steps will facilitate the surgery and decrease the anesthesia / surgical time.
cassettes for xray 4 platforms under the pads on OR bed
Kidney elevation bar to lift mid section while patient in lateral position
Perineal cutout Butt goes right up to cutout
HOB / FOB Head of Bed / Foot of Bed
breaks OR section separators
OR attachments Saftey Belts, armboards, metal footboard, stirrups, stirrup holders (clark socket), shoulder brace
Postioning aids sandbag, beanbag, lift sheet, foam pads, pillows, wedges, IV bags
Postioning considerations surgical procedure to be performed (approach and anteseptic technique), Age, Height and Weight, Physiologic Consideration (respiratory, circulatory, peripheral nerves, musculoskeletal, soft tissue)
Responsibility for Postioning - Position Selection Surgeon/consults with anesthesia,
Responsibility for Positioning - Positioning Patient Surgeon, Anesthesia, Circulator, First Assistant, Surg Tech (if unsterile) Anesthesia has the final word.
When is Patient Positioned? After administration of anesthesia
How do we know positioning required? review surgeons preference card, if unsure, ask surgeon.
Prep for positioning assemble all attachments and pads, check working parts and devices, check for cleanliness.
Goals of proper position Optimize surgical site exposure, Minimize risk of adverse physiologic effects, Facilitate physiologic monitoring by anesthesia, Promote safety and security for the patient.
Safety measures no body part should extend beyond edges of table, minimize body exposure, Do not obstruct or dislodge IV or monitors, Arms protected from hyperextension, legs uncrossed, protect from crush injury moving bed parts, protect from compression injury.
Equipment for positioning Safety belt or thigh strap, anesthesia screen/IV poles, armboard, stirrups, pads and pillows
Supine Pressure Points Nerves: Nerves: Radial, Medial, Ulnar, Common Peroneal, Tibial, Brachial Plexus
Supine Pressure Points Bony Prominences: Occiput, Spinous process, Scapula, Epicondyles of the humerous, Olecranon process, Sacral promontory, Calcaneus.
Occiput anatomical term for the posterior (back) portion of the head
Supine Positioning Materials Pillow/Headrest, Padding for bony prominence, Armboards, Safety Belts
Supine Common Procedures Appendectomy, Thyroid/Neck Surgery, Arm/Hand surgery, Total Knee Athroplasty, Abdominal Aortic Aneurism
Supine pressure points occiput, vertebrae, humerous, elbow, sacrum, thighs, heel, toes
Supine variations Trendelenburg -> total abdominal hysterectomy; Reverse Trendelenburg -> cholesystectomy
Modified Recumbant Coronary Artery Bypass with graft, bladder surgery (this is frog-like leg arrangement)
Prone Position Pressure Points Nerves: Radial, Medial, Ulner, Brachial Plexus
Prone Position Pressure Points Bony Prominences: Zygomatic Arch, Temporal Area, Acromion Process, Clavicle, lateral chest wall, Olecranon process, anterior superior iliac spine, patella, tibial tuberosity, dorsum of feet
Prone Positioning Materials Pillow/headrest, padding for bony prominences, Armboards, safety belt, wide adhesive tape
Prone Common Procedures Craniotomy, Spine surgery (modified prone)
Prone Pressure Points ear, rib cage, thigh, patella, toes
Kraske of Jackknife Rectal Procedures
Lithotomy Pressure Points Nerves: Radial medial, ulnar, common peroneal, tibial, sciatic, femoral, obturator, brachial plexus
Lithotomy Pressure Points Bony Prominences: Occiput, spinous process, scapula, olecranon process, lateral malleolus, femoral and tibial epicondyles, sacral promontary
Lithotomy Positioning Materials Pillow/headrest, padding for bony prominence, armboards, safety belt, protective coverings for leg stirrups, table attachments
High Lithotomy Common Procedures Most vaginal procedures, perineal prostatectomy, hemorrhoidectomy
Low Lithotomy Common Procedures Laparoscopic GYN Procedures
Lateral Positioning Pressure Points Nerves: Radial, Medial, Ulnar, Common Peroneal, Brachial Plexus
Lateral Positioning Pressure Points Bony Prominences: Zygomatic Arch, Temporal Area, Acromiun process, greater tubercle and lateral and medial epicondyles of humerous, olecranon process, lilac crest, greater trochanter of femur, medial and lateral malleolus
Lateral Positioning Materials: Pillow/headrest, padding for bony prominence, armboards, safety belt, kidney rest (optional), suction bean bag (optional), adhesive tape, axillary roll
Lateral Positioning Common Procedures Thoracotomy, Hip Arthroplasty
Lateral Positioning Pressure Points Ear, Humerous, greater trochanter, knees, lower leg, heel
Kedney Lateral Common Procedures Kidney Procedures
Sitting / Semi-Fowlers Pressure Points Nerves: Radial, Medial, Ulnar, Sciatic
Sitting / Semi-Fowlers Pressure Points Bony Prominences: Occiput, Spinous process of thoracic vertabra, scapula, olecranon process, sacral promontory, calcaneus
Sitting / Semi-Fowlers Positioning Materials Head Holder (mayfield, horseshoe, etc), Padding for bony prominence, Armboards (possibly), safety belt, padded foot board, Captain's chair (shoulder surgery)
Sitting / Semi-Fowlers Positioning Common Procedures Craniotomy, shoulder surgery, nasopharyngeal surgery, facial surgery
Created by: frovan on 2011-09-16



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