Surg Tech 1505 t1
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| 3 types of hospital | Non-Profit, Tax-supported, Proprietary
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| Non-Profit | tax exempt , all monies earned are reinvested into hospital
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| Tax-supported | receives some funding from govt
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| Proprietary | For profit w/shareholders, managers, individual owners
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| Funding Sources | Government, Community Agencies, Private Contributions, Grants
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| Ambulatory Care Facilities ◦5 different types: Center | Hospital based dedicated unit, Hospital based integrated unit, Hospital based affiliated satellite surgery center, Free standing ambulatory surgery center, Office based
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| Hospital based dedicated unit | Independent unit within or attached to the hospital, but is physically separated from the inpatient area. Main OR Radiology ICU Waiting Room Day Surgery
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| Hospital based integrated unit | patients share the same OR suite and other hospital facilities with inpatients. Separate preopholding areas usually provided.
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| Hospital based affiliated satellite surgery center | patients come to an ambulatory surgery center owned and operated by the hospital, but is physically separate from it.
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| Free standing ambulatory surgery center | Totally independent facility that is privately owned and operated, often by physicians.
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| Office based Center | Physicians office Plastics, Oral, Podiatry
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| JCAHO–Joint Commission on Accreditation of Healthcare Organizations. | Accrediting Body for Hospitals and Ambulatory Care Facilities
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| OSHA | U.S. Department of Occupational Safety & Health Administration
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| NBSTSA-National Board of Surgical Technologists and Surgical Assistants | The NBSTSA is the only organization that administers the surgical technology certification exam.
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| AST-Association of Surgical Technologists | Is the professional organization for the surgical technologist
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| CAAHEP-the Commission on Accreditation of Allied Health Education Programs | Is the accrediting body for the surgical technology program. Is an umbrella organization for the surgical technology committee on accreditation, provides programmatic accreditation. Is the only accrediting body recognized by the NBSTSA
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| ARC/STSA-The Accreditation Review Council on Education in Surgical Technology and Surgical Assisting | The committee on accreditation that works directly with each surgical technology program in the accreditation process. Performs on site evaluation to gather data on each program Meets twice a year to make recommendations, forwarded to CAAHEP
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| AORN-Association of PeriOperative Nurses | The professional organization of perioperative registered nurses whose mission is to promote quality patient care by providing its members with education, standards, services, and representation
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| Nursing Personnel | –Director of Surgical Services/OR Nurse Manager –Assistant Director/Assistant Nurse Manager –Head Nurse/Clinical Coordinator/Board Runner –In-service Education Coordinator/OR Nurse Educator –Registered Nurse (Staff Nurse) –RNFA –Nursing Assistants
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| Anesthesia | –Anesthesiologist –CRNA –Anesthesia Techs
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| Allied Health Personnel | –Surgical Technologists –Radiology Technologists –Surgical First Assistants
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| Ancillary Personnel | –Clerical –Housekeeping –Surgical Aides
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| Surgical Technologists report to? | Clinical nurse or clinical specialist
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| Non-sterile | –Circulator (RN) –Anesthesia Provider –Other Personnel
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| Sterile | –Surgical Technologist –Surgeon –Surgical Assistant
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| Team Member must remember | All members of the team, whether unsterile or sterile, are the patient’s advocate, especially once the patient is anesthetized and unable to communicate for themselves.
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| Registered Nurse | •Clinician over a specialty •Charge Nurse •Educator •OR Director
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| Circulator –(unsterile role) | Responds to the needs of the sterile field. Interviews patient, checks patient’s paperwork, labs, etc. Assists anesthesia with induction and emergence. Positions patient, preps patient and completes paperwork. Counts with sterile team member.
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| Scrub –(sterile role) | Sets-up and maintains sterile field, passes instruments, and assists as necessary.
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| First Assistant --(sterile role) | Assists surgeon throughout the procedure with visibility, through retraction and suctioning, and hemostasis.
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| Anesthesiologist | -MD specializing in anesthesia –MD Always available during induction and emergence –MD Always available in case of emergency
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| Certified Registered Nurse Anesthetist (CRNA) (Registered Nurse with 2 years anesthesia school) | –Continues care after induction until emergence. – Usually works under the supervision of an anesthesiologist.
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| Anesthesia Provider | Anesthesia providers induce anesthesia at different levels and maintain patient throughout using monitors and medications. Also responsible for overseeing patient positioning, movement of patient and codes.
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| Other Personnel (unsterile roles) | •Clinical Assistant –AKA: Patient Care Tech, Orderly, Attendant •Radiology Tech •Perfusionist •Anesthesia Tech
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| Surgical Assistant (sterile role) | Assists surgeon throughout the procedure with visibility, through retraction and suctioning, and hemostasis. Must have privileges to practice as first assistant at the facility
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| Surgical Assistants are: | –Another MD –PA –RN, Registered Nurse First Assistant (RNFA) –CST/Certified First Assistant (CFA)/Licensed First Assistant (LFA)/ Certified Surgical Assistant (CSA)/Licensed Surgical Assistant (LSA)
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| Surgical Technologist Scrub | (sterile role) Sets-up and maintains sterile field, passes instruments, and assists as necessary.
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| Surgical Technologist Assistant Circulator | unsterile role) Responds to the needs of the sterile field. Interviews patient, checks patient’s paperwork, labs, etc. Assists anesthesia with induction and emergence. Positions patient, preps patient and completes some paperwork.
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| Surgical Technologist Assistant Circulator (continued) | Counts with sterile team member. Gathers and tests equipment. Gathers supplies. Applies dressings. Helps transport the patient. Helps prepare OR for next case.
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| Surgical Technologist (ST) as per Association of Surgical Technologist (AST): 1 of 4 | The ST works under medical supervision to facilitate the safe and effective conduct of invasive surgical procedures. This individual works under the supervision of a surgeon to ensure that the operating room or environment is safe,
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| Surgical Technologist (ST) as per Association of Surgical Technologist (AST): 2 of 4 | the equipment functions, that the operative procedure is conducted under conditions that maximize patient safety.
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| Surgical Technologist (ST) as per Association of Surgical Technologist (AST): 3 of 4 | A ST possesses expertise in the theory and application of sterile and aseptic technique and combines the knowledge of human anatomy,
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| Surgical Technologist (ST) as per Association of Surgical Technologist (AST): 4 of 4 | surgical procedures, and implementation tools and techniques to facilitate a physician’s performance of invasive therapeutic and diagnostic procedures.
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| AST Standards of Practice 6 Standards | 1. Teamwork 2. Planning and Prep 3.Prep of environment 4. application of knowledge, 5.Patient Privacy, 6.every patient entitled to aseptic technique
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| Aeger Primo (1 of 4) | The Patient First. Becoming a truly proficient surgical technologist requires knowledge of anatomy and physiology, the pathophysiologies that require surgical intervention and a detailed knowledge of the steps in each procedure.
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| Aeger Primo (2 of 4) | It requires an ability to think about more than one thing at a time, manual dexterity, and the ability to anticipate the needs of the surgeon before they occur.
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| Aeger Primo (3 of 4) | That said, however, all these skills would be NOTHING without the primary skill of understanding aseptic principles and constantly reinforcing them. No matter what your speed and accuracy, inside a contaminated field, the patient is at risk.
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| Aeger Primo (4 of 4) | Never forget that all the other skills you will learn in this field are secondary to maintaining a sterile field for the safety and well-being of the patient.
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| The operating room should be designed so that it is close, or has easy access, to: | –PACU –ICU –ED –Pharmacy or Satellite Pharmacy –Central Supply and Processing –Labor and Delivery –Ambulatory Surgery (if applicable)
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| Other areas surgery interacts with: | –Control Desk –Laboratory / Pathology / Blood Bank –Radiology –Anesthesia
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| Transition zones | Holding area Induction room Dressing room / lounge
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| Most OR’s utilize multiple means of communication: | –Records / charts –Requisitions –Inservice programs –Computers –e-mail –Call lights –Closed circuit television –Verbal –Alarms
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| These areas are marked according to restriction | UNRESTRICTED – street clothes allowed. SEMI-RESTRICTED – proper O.R. attire required: scrub clothes, head covers, shoe covers. RESTRICTED – proper attire plus surgical masks are required.
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| Types of Designs | Racetrack design, Central corridor (hotel plan),Central core, Combination central core and peripheral corridor, Cluster combination with peripheral and central corridor
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| OR size | The O.R. should be a minimum of 400 sq. ft or 600 sq. ft for specialty rooms
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| OR Temp | Temperature: 65º–75ºF.
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| OR Humidity | Humidity: 30-60% (50-55% average)
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| Air Exchanges: | minimum of 15 filtered air exchanges with 3 fresh air per hour. Maximum is 20 filtered air exchanges with 4 fresh air
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| Air Pressure | positive
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| Surface materials should be: | –Non-porous –Smooth –Easy to clean –Waterproof and fire-resistant. –Walls should be non-glare and non-reflective –Electrical outlets should have ground fault interrupters and be explosion proof. Red outlets are on emergency generators.
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| Piped-in Systems | Oxygen X 2 Nitrous Oxide Vacuum (suction) X 2 Compressed Air (not required) Electricity Air handling system (Scavenger system) Nitrogen
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| Every O.R. should have: | –Emergency cut-off valves outside the room for gases –X-ray viewing boxes –Clocks with timers –Code and fire alarm activators –OR lights –Storage areas –Communication access (phones, intercom, etc.) –Computer
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| “Significant Others” | The O.R. should have Scrub Sinks, Warming Units and Sterilization methods in very close proximity to the surgical suites. Most O.R.’s have multiple areas that house these items.
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| Specialty Rooms - Rooms may house equipment or supplies that are specific to the type of procedures done: | –Endoscopy –Cystoscopy –Cesarean section
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| Whenever you go to a new O.R., be sure to find: | –Crash / Emergency carts –Fire Extinguishers and exit routes –Tracheostomy sets and tubes
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| Culture | Customary beliefs, social forms are material traits of a racial, religious or social group. Beliefs and behaviors that are learned and shared by members of a group
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| Diverse | Differing from one another. Differences in the customary beliefs, social forms, and material traits of a racial, religious or social group
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| Generalization | Statement presented as a general truth but based on limited or incomplete information. A beginning point. Identifies common trends but further info is needed to determine if an individual fits the generalization.
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| Stereotype | An oversimplification standardized image of a person or group. An ending point. No attempt is made to determine if an individual fits the statement. Can have negative results.
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| Asking right questions - the 4 Cs | What do you CALL your problem? What do you think CAUSED your problem? How do you COPE with your problem? What are your CONCERNS regarding your condition?
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| Maslow | Physiologic, Security, Social, Ego, Self Actualization.
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| What can we do as ST to provide an environment of care and concern? | Introduce self professionally -if appropriate Plan ahead Set up quietly and professionally Pay attention to language you use
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| The Patient Bill of Rights was established when? | in 1972
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| Why Patient Bill of Rights? | established the patient as the decision maker in his/her health care and put them in the position of consumers of health care.
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| Patients with special needs | Language barrier Hearing loss Visual impairment Physical problems Cognitive function problems Contact precaution patients Age related issues
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| Hearing | is the last sense to leave and the first to come back during a general anesthetic. Occasionally a patient might keep sense of hearing throughout the case. We must be quiet with instruments. Watch what you say at all times –even during the case
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| Hospitals must report by legal obligation | Diseases, Abuse, Misconduct, Criminal act, Statistics
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| Safe Medical Act of 1990 | Requires users of medical devices to report to mfg. or FDA any device that causes death, injury or illness to a patient.
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| Ethics | Identification of Values - what ought to be -ought to
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| Law | Expression of Values in Social rules -have to
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| Risk Management | Choices to reduce potential liability -choose to
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| Morality | A doctrine or system of moral conduct
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| Lawsuit | Any caregiver can be named in a lawsuit----All personal must work within their scope of practice
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| Four (4) D’s of Malpractice (1&2) | 1.DUTY TO DELIVER standard of care directly proportional to the degree of specialty training received. 2.DEVIATION of that duty by omission or commission.
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| Four (4) D’s of Malpractice (3&4) | 3.DAMAGE to a patient or personal property caused by the deviation from the standard of care.
4.DIRECT CAUSE of a personal injury or damage because of deviation of duty.
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| Areas of Legal Responsibility affecting the ST | Liability Accountability Invasion of Privacy Lack of proper supervision Incompetence Negligence
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| INJURY Incident report | if an injury occurs or other incidence during a surgical procedure such as equipment failure, or unintentional mishap the factual details must be documented. Details should be complete and accurate, and they should be written as statements of facts
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| Invasion of Privacy | Patients right to privacy exists as part of HIPAA
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| Abandonment (1 of 2) | "Abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital,
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| Abandonment (2 of 2) | clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients."
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| Liability Prevention for the Peri-operative Team (1 of 2) | 1.Become active within the professional organizations 2.Become certified and remain current with CE 3.Establish a positive rapport with patients. 4.Comply with the legal statues and standards
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| Liability Prevention for the Peri-operative Team (2 of 2) | 5.Prevent injuries 6.Control further insult or damage 7.Maintain good communication
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| Professional organizations set ? | Standards of Care
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| Bioethical situations | Abortion, HIV and other infections, Human Experimentation, Quality of Life, Euthanasia, Right to Die, Organ donation & Transplantation, Death & Dying
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| Assault | unlawful threat to harm someone physically
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| Battery | Carrying out bodily harm, from touching someone without consent to actually causing injury
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| Causation | action directly or indirectly causing injury
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| Damages | compensation awarded to make restitution for an injury or a wrong
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| Defendant | Person named as the object of a lawsuit
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| Deposition | Statement given under oath that is a documentation of fact used in a court of law
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| Liability | Legally responsible for personal actions
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| Malpractice | Substandard delivery of care that results in harm
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| Negligence | Careless performance of duty - negligence is a form of malpractice
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| Plaintiff | Person who initiates a lawsuit
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| Borrowed Servant Rule | Surgeon liable for acts of team members only when he/she has the right to control and supervise the way in which a task is completed. In most cases surgeon is not faulted if perioperative caregiver fails...
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| Doctrine of the Reasonable Man | Pt has right to expect all caregivers to bring skill, knowledge and judgement to the care they provide him/her with, and that they will meet the standards exercised by other "reasonably prudent persons involved in similar situations"
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| Doctrine of Res Ipsa Loquitor | The thing speaks for itself. Patient's injury stands as evidence of neglect and the burden of proof of innocence is on the caregiver.
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| Doctrine of Respondent Superior | Master will be responsible for the acts of a servant. Facility is responsible.
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| Doctrine of Corporate negligence | Facility is liable for its own negligence in failing to ensure that an acceptable level of care is provided. Must screen all staff, meet JCAHO standards.
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| Doctrine of Informed Consent | Surgeon's duty to inform the pt of the risks, benefits and the alternatives to any procedure and to obtain consent before any procedure is carried out.
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| Extension Doctrine | Informed consent allows the physician to perform procedures that are not explicitly listed in the informed consent if an unforeseen complication requires a procedure which was not anticipated
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| Patient (definition | The patient is a human being who is seeking help from a medical professional in order to diagnose, restore function, minimize loss, and / or cope with a disease condition or disability.
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| Perioperative Phases | Preoperative Intraoperative Postoperative
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| Preoperative | Time prior to the initiation of surgical procedure. Begins with the patient’s realization that something is wrong.
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| Physician Visit | H & P –Must include head to toe assessment covering all systems / Diagnostic studies –To rule out differential diagnoses / Diagnosis
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| Surgery scheduled | Patient instructions given –What time to show up / NPO / Tests may be done –If necessary
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| Night Before | Physician orders –enemas –douche –antiseptic shower
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| AM Admission | To Hospital –Sign hospital consent To room –Nursing H&P done –Baseline V.S. –Informed Consent signed –Anesthesia visit Just before going to the O.R. –Void –Remove glasses, contacts, jewelry, etc. In holding area
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| Pt. Arrival to O.R. | Transfer to OR bed / Monitors applied / Anesthesia Positioned / bovie pad / catheterization / shave / prep / Procedure started and completed
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| Postoperative Phase | Time from termination of procedure to recovery
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| Postoperative Phase continued | Emergence and Extubation / PACU / Monitors O2 / Warmth / Begin post-op orders / To room / Discharge from hospital / Post-op visit to physician’s office
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| Patient | The patient is a human being who is seeking help from a medical professional in order to diagnose, restore function, minimize loss, and / or cope with a disease condition or disability.
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| Perioperative Phases | Preoperative Intraoperative Postoperative
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| Preoperative | Time prior to the initiation of surgical procedure Begins with the patient’s realization that something is wrong.
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| Physician Visit | H & P –Must include head to toe assessment covering all systems Diagnostic studies –To rule out differential diagnoses
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| Surgery scheduled | Patient instructions given –What time to show up –NPO Tests may be done –If necessary
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| Night Before | Physician orders –enemas –douche –antiseptic shower
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| AM Admission | To Hospital –Sign hospital consent To room –Nursing H&P done –Baseline V.S. –Informed Consent signed –Anesthesia visit Just before going to the O.R. –Void –Remove glasses, contacts, jewelry, etc. In holding area
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| Pt. Arrival to O.R. | Transfer to OR bed Monitors applied Anesthesia Positioned, bovie pad, catheterization, shave, prep Procedure started and completed
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| Postoperative Phase | Time from termination of procedure to recovery
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| Postoperative Phase continued | Emergence and Extubation, PACU, Monitors, O2, Warmth, Begin post-op order, To room, Discharge from hospital, Post-op visit to physician’s office
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| Diagnostic Tests | Hematology (number/characteristics of RBCs) and UA (kidney and other systemic functions)
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| Hemoglobin | measures the hemoglobin content of the blood g/100ml blood.
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| Hematocrit | measures the volume of red cell mass in 100 ml of plasma volume. Expressed as a percentage.
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| WBC | protects the body from invasion by foreign agents. Measures the number of WBC in the blood.
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| Platlets | aid in coagulation. Measures the number of platlets in the blood.
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| Radiology | High energy electromagnetic wave capable of penetrating various thicknesses of solid substances and affecting photographic plates.
Most are done in a digital format.
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| Chest X-ray | Can reveal the location, size, shape of chest contents
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| Angiograms | –Use contrast liquid, or contrast media, to show structures
•Arterial angiograms
•Cholangiograms (usually done intraoperatively)
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| Fluoroscope and Image Intensifier | C-arm
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| EKG | Converts incoming electrical signals into a graphic display
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| CAT | Multiple X-ray beams pass through the body, detectors in the CT machine measure the amount of radiation not absorbed by the tissues. Forms a three-dimensional image on an ossilloscopic screen.
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| MRI | Similar to CAT. Patient is placed in a strong magnetic field and pulsed with a radio frequency, these are recorded and an image is developed.
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| Nuclear Medicine | Introduction of radionuclides that emit electromagnetic energy to trace the function and structure of organs.
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| Lymphoscintigraphy (Sentinal node sampling) | Technetium-99m or isosulfan blue dye is injected around tumor and the first node that absorbs the medicine is considered the sentinal node. If this node is negative, it can be assumed that the cancer has not spread to other nodes.
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| Endoscopy | Direct visualization within body cavities and structures.
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| Ultrasonography | Using vibrating high frequency sound waves to detect alterations in anatomic structures or hemodynamic properties within the body.
–Fetal ultrasound
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| Pathology | Use of laboratory methods to establish a clinical diagnosis of the nature of disease.
–Permanent section
–Frozen section - stat
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| Importance of Records | A legal account of the procedure. Provides valuable information to the post-op team.
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| The primary records that the surgical team are concerned with are: | –Informed consent
–Physician H & P
–Lab values
–Preop medications and orders (Dr’s order sheet
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| General Consent | Obtained upon admission to the hospital
Relied on for routine duties carried out in the hospital. May vary form hospital to hospital
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| Advance Directives | living will, DNR, DPA
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| Living will | allows pt to refuse treatment to prolong life
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| DNR | Do Not Resuscitate –determines what, if any, measures may be taken to prolong life
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| DPA (Durable Power of Attorney) | designates the person authorized to make decisions should the patient become incapacitated.
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| Informed Consent | Consent to a particular procedure which may be injurious to the patient. Doctrine of informed consent - premise … every human being of adult years and sound mind has a right to determine what shall be done with his own body…
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| "legally informed" patient is informed regarding: | –Diagnosis
–Nature of the proposed treatment including risks
–Medically recognized alternative measures
–Consequences of decision to decline or refuse treatment
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| Op permit | Informed Consent
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| Op permit required for: | Each operation performed including secondary procedures.
Any procedure in which general anesthesia is administered.
Procedures involving entrance into a body cavity.
Any high risk therapy such as chemotherapy.
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| Purpose of an informed consent | Protect the patient’s right to self-determination regarding surgical intervention.
Protect the patient form unratified and unwanted procedures.
Protect the surgeon and hospital from claims of unauthorized operation or other invasive procedure.
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| Validity of consent - must contain: | -the patient’s full name,
–the surgeon’s name,
–diagnosis
–the procedure
–potential risks
–patient’s and witnesses signatures
–date and time of signatures
The patient must be of legal age, mentally alert, and competent.
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| Special Cases: | A minor – parent or legal guardian must sign.
Emancipated minor may sign.
Illiterate – patient may sign with a “X” by which a witness confirms.
Mentally incompetent –legal guardian signs or court consents. (must have documentation on chart)
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| Witnessing a consent attests to: | Identification of patient or legal substitute.
Fact that the signing was voluntary and without coercion.
Mental status of signatory.
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| Consent in life-threatening emergencies | desired but not essential. Consent may be taken by telephone from a legal substitute, but requires witnessing by two nurses. Two physicians, not involved in the patient care, may deem surgery necessary and sign permit.
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| A rational patient may do what with regard to consent? | withdraw consent at any time prior to surgical intervention
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| decreased RBCs | may result from blood loss, severe anemia or fluid overload
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| increased RBCs | may indicate dehydration
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| increase WBC | may indicate pre or post-op infection
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| decreased WBC | may be due to bone marrow depression, may be lower in viral infection or a condition that may impair the patient's resistance to infection.
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| Hemoglobin | Used to identify anemia. Decrease may indicate severe or prolonged hemorrhage.
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| Hemocrit | decreased with massive blood loss, decreased with severe anemias, elevated level may indicate hemoconcentration suggesting dehydration. Given in %.
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