The Operating Room

cause of glove tears

-67% CAUSED BY NEEDLES -10% BY SCALPELS -23% BY INSTRUMENTS

what should you do during surgery if not sterile

-USE A STEP TO SEE OVER THE TABLE -STAND AT THE ANESTHESIA END OF THE TABLE AND OBSERVE OVER THE DRAPES

pt positioning

LOCK THE OR TABLE AND LOCK THE STRETCHER MAINTAIN PROPER ANATOMICAL ALIGNMENT OF PATIENT PLACE PILLOWS UNDER THE KNEES WHEN IN THE SUPINE POSITION AND BETWEEN THE LEGS WHEN IN THE LATERAL POSITION PAD BONY PROMINENCES THE THORAX OF A PRONE PATIENT SHOULD BE SUPPORTED WITH FOAM PILLOWS TO ALLOW FOR ADEQUATE VENTILATION NEVER CROSS THE PATIENT'S LEGS WHEN IN THE SUPINE POSITION WATCH HOW THE PATIENTS JOINTS ARE HANDLED DURING MOVING OF THE PATIENT PAD ALL FIXED INSTRUMENTATION STRAP THE PATIENT TO THE TABLE

•IN THEORY, WHEN PERFORMING A SURGERY FOR EXCISION OF A MALIGNANCY, _________________ SHOULD BE USED IF DOING MORE THAN 1 PROCEDURE

NEW STERILE INSTRUMENTS (and all scrubbed personnel should also change out

ways pt positioning can be bad

abn pressure on nerves

-Coordinates the anesthesia team. -Ensures patient safety during initiation of anesthesia. -Often help with post op pain management.

anesthesiologist (MD)

-Evolving career path that offers 2 career paths. -One is a 27 month training program and the other is a 5 semester training program for PA-C's. -Anesthesia Assistants can perform the same procedures as CRNA's. -They cannot perform regional anesthesia. -Central- epidural anesthesia -Peripheral- Brachial Plexus block

anesthesiology assistants and CRNAs

where are tables sterile

at tabletop

•IN AN ACADEMIC SETTING -THIS PERSON IS RESPONSIBLE FOR THE SURGICAL TEAM AND THEIR PATIENTS. -THEY TRAIN THE SURGICAL RESIDENTS -PERFORM SURGERIES • •IN THE PRIVATE SECTOR -THEY ARE THE LEADER OF THE TEAM. -DIRECTION IS GIVEN BY THEM -REMEMBER, IT IS THEIR RESPONSIBILITY THAT EVERYTHING GOES WELL FOR THE PATIENT

attending surgeon

more delicate and directed than bovie

bipolar cauterization

-BACTERICIDAL AND CONTINUES TO HAVE ANTI-MICROBIAL ACTIVITY AFTER APPLICATION. THIS IS A NON IRRITATING AGENT FOR MOST PEOPLE AND IS USED FOR HAND WASHING AND PREP OF THE OPERATIVE SITE.

chlorhexidine gluconate

•SUPERVISE THE ACTIVITY OF EACH MEMBER OF THE TEAM •PROVIDE ASSESSMENT AND CARE TO THE PATIENT IN THE SURGICAL SUITE •ASSIST WITH APPROPRIATE POSITIONING OF THE PATIENT ON THE OR TABLE (ENSURE THAT THE RIGHT TABLE IS IN THE RIGHT PLACE IN THE ROOM) •PREP THE PATIENT •ASSISTS WITH GATHERING AND OPENING SUPPLIES AND ENSURING EQUIPMENT IS AVAILABLE AND WORKING PRIOR TO AND DURING THE PROCEDURE •TROUBLE SHOOT EQUIPMENT •CALL FOR THE "TIME OUT" •RECORD INFORMATION ABOUT PROCEDURE DURING THE PROCEDURE

circulating nurse

temporarily occludes artery

clamping

permanently occludes artery

clipping

•USUALLY RN •LIKE AN AIR TRAFFIC CONTROLLER •RESPONSIBLE FOR WHERE EACH STAFF MEMBER GOES, WHEN THEY GO AND HOW ASSIGNMENTS ARE MADE AND CHANGED

control room supervisor

perks of double gloving

decrease in risk of contamination decrease in risk of finger contamination

risks of prone position

decrease of chest expansion and circulation brachial plexus injury

what can you develop from the talc in the gloves or from latex

dermatitis

•DESIGNED TO CREATE A STERILE AREA AROUND THE INCISION • •A STERILE SHEET WITH AN OPENING IS PLACED OVER THE FIELD ALLOWING ACCESS TO THE OPERATIVE SITE • •ALWAYS MAKE SURE THAT THE INCISION SITE IS DRAPED WITH A WIDE MARGIN •ONCE DRAPES ARE PLACED THEY SHOULD NOT BE REPOSITIONED

draping

•CIRCULATOR- MONITORS PROCEDURE • •HOLD DRAPE HIGH ENOUGH ABOVE THE TABLE TO PREVENT CONTAMINATION BUT NOT HIGH ENOUGH TO CONTMINATE • •NEVER REACH ACROSS THE TABLE • •IF YOU ARE HANDING THE STERILE DRAPE TO ANOTHER PERSON THAT IS NOT STERILE ( SUCH AS ANESTHESIA) USE THE DRAPE TO COVER YOUR HAND AS YOU PASS THE NON STERILE PORTION TO THE OTHER PERSON • •DO NOT TOUCH ANY PART OF THE DRAPE THAT FALLS INTO A NON STERILE AREA

draping the patient

if your mask doesn't fit properly what happens

expired air will leak out and mix with cold air resulting in fogged lenses

HAS COMPLETED A SURGICAL RESIDENCY AND IS CONTINUING TO TRAIN FOR A SURGICAL SPECIALTY. THE LENGTH OF THE FELLOWSHIP DEPENDS ON THE SPECIALTY.

fellow

•THIS IS THE LAST YEAR FOR MOST GENERAL SURGERY PROGRAMS. •SOME PROGRAMS EXTEND TO 7 YEARS. •PERFORM SURGERY •INSTRUCTS JUNIOR RESIDENTS AND OTHER STUDENTS •IS RESPONSIBLE FOR THE OVERALL MANAGEMENT OF PATIENTS. •THEY ARE WAITING TO BE MATCHED TO A PROGRAM OF THEIR CHOICE

fifth year resident

where do most glove tears occur

fingertips

USED FOR PATIENTS AND STAFF THAT ARE ALLERGIC TO BOTH IODINE SOLUTIONS AND CHLORHEXADINE GLUCONATE

hexachlorophene

•DESIGNED TO PROTECT THE PATIENT, YOUR CO-WORKER AND YOU •DO NOT LEAVE SHARP OBJECTS ON THE FIELD UNLESS ABSOLUTELY NECESSARY •IF YOU HAVE A TEAR IN YOUR GLOVE, REPORT IT __________AND CHANGE GLOVES •ALL INJURIES SHOULD BE REPORTED _________ •MODERATE OR MODERATELY SEVERE SKIN PROBLEMS SHOULD BE EVALUATED. YOU MAY NOT BE ABLE TO SCRUB IN WITH CERTAIN PROBLEMS

immediately

•CONTROL OF IATROGENIC CONTAMINATION •A SOURCE OF CONTAMINATION SHOULD NOT BE ALLOWED NEAR THE AREA WHERE SURGERY IS BEING PERFORMED •THE GOAL IS TO PERFORM SURGERY IN A FIELD WITHOUT LIVING MICROORGANISMS •ASEPSIS REQUIRES THE RECOGNITION, CONTROL AND ERADICATION OF CONDITIONS THAT PROMOTE THE GROWTH OF BACTERIA

infection control

•CLOSED DOORS- WELL MARKED. RESTRICTED TO PERSONNEL DRESSED IN HOSPITAL SCRUB CLOTHES. NO STREET CLOTHES.

intermediate zone

-EVERYDAY TASKS SUCH AS ADMITTING AND DISCHARING PATIENTS, WRITING ORDERS, DOING BASIC PROCEDURES, REVIEWING RESULTS OF TESTS, ETC... -THEY ARE HAPPY TO GIVE YOU WORK TO DO.

intern/first year resident

•RESPONSIBLE FOR MINUTE BY MINUTE CARE OF PATIENT. •HELP WITH TRAINING OF THE FIRST YEAR RESIDENT •SPENDS TIME IN OTHER AREAS BESIDES SURGERY INCLUDING THE ICU AND ER.

junior resident

complications of jack knife position

lack airway accessibility potential for facial skin breakdown decreased BP decreased chest movement femoral artery occlusion

RESPONSIBLE FOR BASIC PATIENT CARE. THIS IS THE PERSON THAT YOU WILL WORK THE MOST CLOSELY. YOU WILL BOTH BE LEARNING A LOT ABOUT BASICS SUCH AS BEGINNING IV'S, EMERGENCY PROCEDURES, DRESSING CHANGES, BASIC SURGICAL TECHNIQUES.

medical/PA student

if you arent sterile should you reach across sterile field

no

is the part of the drape that falls over the edge sterile

no

should you lean on the instrument table or the bed

no

should you leave the sterile field if not necessary

no

•OR SUPERVISOR •USUALLY A REGISTERED NURSE •RESPONSIBLE TO THE CHIEF OF SURGERY •RESPONSIBLE TO THE HOSPITAL'S DIRECTOR OF NURSING ( IN SOME FACILITIES) OR A HIGHER LEVEL ADMINISTRATOR •ADMINISTRATIVE DIRECTOR THAT MANAGES OVERALL STAFFING REQUIREMENTS, FISCAL REQUIREMENTS, PROBLEM SOLVING, INSTRUMENTATION PURCHASING, QUALITY CONTROL, ETC.. •THIS IS WHO THE SURGEONS GO TO WHEN THEY ARE REALLY MAD

operating room director

•PREP IS PERFORMED IN A CIRCULAR MOTION FROM THE INCISION SITE OUTWARD •CLEAN TO DIRTY HAIR REMOVAL SHOULD BE DONE where

outside OR

-SKIN PREPARATION AGENT USED WITH THOSE PATIENTS ALLERGIC TO IODINE CONTAINING AGENTS.

parachlorometaxylenol

•UNRESTRICTED. IS NOT STERILE. FAMILY MEMBERS ALLOWED WITH STAFF PERMISSION

periphery

•STAFFED WITH RN'S •THIS IS WHERE THE POST OP PATIENT GOES TO BE "RECOVERED" PRIOR TO BEING TRANSFERRED TO A ROOM OR DISCHARGED •THE PATIENT IS HEMODYNAMICALLY MONITORED, PAIN IS CONTROLLED, NAUSEA AND VOMITING CONTROLLED, COMFORT IS PROVIDIED •CRISIS INTERVENTION •ANESTHESIOLOGIST IS ALWAYS AVAILABLE •IT IS GOOD FOR THE PA TO GO WITH THE PATIENT TO THE PACU UNIT •THE NURSES WILL CALL YOU IF YOUR ORDERS ARE NOT COMPLETE

post anesthesia recovery unit

-OPERATIVE SITE- DETERGENT SCRUB IS APPLIED WITH SPONGES TO REMOVE GROSS DIRT AND OILS FROM SKIN. SKIN IS THEN BLOTTED WITH STERILE TOWEL. A NON-DETERGENT SOLUTION IS SPREAD OVER THE AREA

povidone iodine

risks of supine position

pressure points aspiration of gastric contents

•ASSISTS SURGEON BY PROVIDING INSTRUMENTS, SUTURES AND SUPPLIES AS NEEDED •ANTICIPATES THE NEEDS OF SURGEON AND FIRST ASSISTS BY UNDERSTANDING THE PROCEDURE AND MONTIORING THE PROGRESS OF THE PROCEDURE •CAN ASSIST WITH RETRACTING TISSUES, CUTTING SUTURES, SUCTIONING, ETC... •DOES THE COUNT ASSISTED BY THE CIRCULATING NURSE •ORGANIZES STERILE BACK TABLE AND PREPARES FOR EACH PROCEDURE DEPENDING ON THE REQUESTS OF THE SURGEON •THEY KNOW INSTRUMENTS

scrub nurse/surgical technologist

LARGE QUANTITIES OF FLUIDS, BODILY AND OTHERWISE, CAN ACCUMULATE ON THE FLOOR AND SATURATE THE SHOES so we wear a

shoe cover

•PRINCIPLE BARRIER TO DISEASE TRANSMISSION •HIGH RISK PROCEDURES SHOULD USE AN ADDITIONAL STERILE _________ OVER THE GOWN TO PREVENT STRIKE-THROUGH (PENETRATION OF MOISTURE THROUGH PROTECTION WITH MICROBIAL TRANSMISSION)

sleeve

•RN WHO KNOWS THE INS AND OUTS OF A PARTICULAR SPECIALTY SUCH AS ORTHOPEDICS, NEUROSURGERY, CARDIOTHORACIC SURGERY, ETC... •RESPONSIBLE FOR MAINTAINING EQUIPMENT AND INSTRUMENTS SPECIFIC TO THAT AREA •HELPS TRAIN NEW MEMBERS OF THE TEAM •MEETS WITH THE OR SUPERVISOR TO ENSURE THAT THEIR SPECIALTY AREA HAS EVERYTHING THE SURGEON NEEDS •THIS IS THE 1ST PERSON THE SURGEON GOES TO WHEN SOMETHING IS WRONG WITH EQUIPMENT, INSTRUMENTS, ETC...

specialty supervisor

what should you do during surgery if sterile

sterile field

•PROVIDE MAXIMUM SENSITIVITY WITH MAXIMUM PROTECTION

sterile gloves

•AREAS IMMEDIATELY ADJACENT TO OR SUITE AND THE OR SUITE. -SCRUBS, SHOE COVERS, MASKS AND HAT. -DO NOT CROSS THE RED LINE

sterile zone

risks of lithotomy position

strained lumbosacral muscles perineal nerve damage saphenous vessel nerve injury

• OCCURS WHENEVER MOISTURE BREAKS THROUGH THE PROTECTIVE BARRIER •IT CAN ALSO OCCUR WHEN BLOOD OR FLUIDS PENETRATE THE STERILE GOWN

strike through

if you arent sterile who should you walk behind

those who are

cons of double gloving

too tight numbness too baggy difficulty suturing or performing fine motor movements

second most common place for glove tears

wrist

should you change your mask between every procedure

yes

when draping the pt where should you stand

•A FOOT FROM THE OR TABLE TO PREVENT CONTAMINATING YOUR GOWN

surgical suite team

•Circulating Nurse (RN) •Surgical Technologist (CST or ST) •Anesthesiologist •Surgeon •Surgeon's Assistant (RN, PA, Med Student, or ST)

surgical attire inside and outside the ER

•SCRUBS SHOULD NOT BE WORN HOME OR LAUNDERED AT HOME. USE THE SCRUBS THAT ARE AVAILABLE IN THE LOCKER ROOM •SHOES WORN IN THE OR SHOULD NOT BE WORN OUTSIDE THE OR UNLESS COVERED WITH SHOE COVERS •SCRUBS WORN OUTSIDE OF THE HOSPITAL SHOULD BE COVERED BY A LAB COAT OR JACKET masks (must cover mouth and nose w/ string around back of head and lower behind neck) eye protection sterile gloves

how to maintain a sterile field

•THINK BEFORE TOUCHING ANYTHING. IS IT STERILE? • •IF THERE IS ANY SUSPICION THAT SOMETHING IS NOT STERILE, CONSIDER IT CONTAMINATED • •PAY ATTENTION TO EVERYTHING AROUND YOU • •THE OR IS A FLUID ENVIRONMENT AND THERE IS ALWAYS SOMETHING HAPPENING

in pt positioning, how should arms be

•NOT ABDUCTED MORE THAN 90 DEGREES OR BRACHIAL PLEXUS INJURY MAY OCCUR LEADING TO LOSS OF HAND FUNCTION

what should you do w/ pathology specimen

•PLACE IN APPROPRIATE CONTAINER WITH APPROPRIATE FIXATION MATERIAL •PATIENT'S NAME, ACCT. NUMBER, DOB, DATE, TIME, WHERE SPECIMEN WAS TAKEN