Chapter 9 Sterilization Procedures, Instrument Indentification and Surgical Supplies

Four (4) types of anesthetics

1- General Anesthetic: reversible loss of consciousness. used during major surgery 2- Local Anesthetic: administered into SC tissue, blocks sensory pain receptors at the point of injection and surround tissue. All suffix with "caine". May contain epinephrine which helps to prolong the effects of the anesthetic 3- Regional Anesthetic: used when a large area of tissue needs to be blocked. Adjacent nerves may be injected 4- Topical Anesthetic: applied to the skin. they may be either liquids, gels, or sprays

Sterilization Technique

chemical sterilants autoclaving dry heat sterilization gas sterilization shelf life of autoclave

suture needles are used to:

close wounds, atraumatic: swaged needle, eyeless, cause less tissue damage than traumatic needles traumatic: eyed needles, requires the user to thread the needle

Step 4 - Disinfecting Instruments

disinfection is the process to destroy or inhibit the growth of most microorganism. disinfection solutions are used to clean inanimate objects. there are 4 levels of disinfection: low level, intermediate level, high level, Sterling once solution has been prepared a label is placed on the outside must include name, strength, date prepared, date it will expire, initials of person that prepared it

autoclaving

most trusted and economical form of sterilization combines steam under pressure to reach a heat of 250-254*F sterilization means the complete destruction of all organisms including endospores

ligature

term used when referencing suture material used to tie off tubular structures - tying

Purpose of a suture

to hold the edges of a wound together until the natural healing process joins the tissue permanently promotes faster healing lessens scarring

Anesthetic

used to produce a lack of feeling during a surgical procedure. it can be given by injection, intravenous, topical, or inhalation

dry heat sterilization

usually require 1-2 hours ineffective against destroying spores common temperature used is 338*F

shelf life of autoclave

wrapped with paper or cloth = 30 days wrapped with sterility maintenance covers = 6 months sterilization pouches = 6months to a year after instruments have been sanitized, inspected, and lubricated they are ready for sterilization items need to be wrapped to maintain sterility

Common Solutions and Supplies

1- Nonfenestrated drapes: sterile drapes are used to cover the surgical tray and parts of the patient during the procedure 2- fenestrated drapes: to have one or more openings. a fenestrated drape has an opening that is placed over the surgical site once the skin has been prepped, provides a working area for the provider 3- gauze pads: used during or following surgical procedures the pads are used to absorb blood and cleanse and dress wounds 4- sterile gloves: to put on prior to the start of the procedure 5- surgical wicks: used to remove small foreign objects/bodies from the eye, ear, or wound. Used to instill a minute amount of solution to wounds, as well as to facilitate aspiration and drainage of fluids from the wounds that would become infected if such fluids were allowed to lie within the tissue 6- sterile packing material: packaged in long, sterile, cotton strips. 7- syringe/needles: used to anesthetize the surgical area as well as for irrigation purposes 8- specimen containers: filled with a tissue preservative and are used to transport tissue from a biopsy or lesion removal 9- betadine: used for preparing the skin for surgery, this is a skin cleanser that helps, reduce bacteria 10- isopropyl alcohol: used as a skin antiseptic, usually available in 70% solution, also known as rubbing alcohol 11- hibiclens: used as a skin antiseptic or skin cleanser during a surgical scrub, should be used sparingly may be harsh on tissue 12- Hydrogen peroxide: 13- tincture of benzoine:used to increase the adhesive capabilities of sterile adhesive skin closures 14- sterile saline: most common; used to flush and clean open wounds and to remove foreign particles from wounds 15- sterile iodine: most common

Two (2) types of sutures

1- absorbable: material is absorbed by the body's tissue so it does not need to be removed used when suturing deeper layers of the skin or suturing difficult to reach structures 2- Nonabsorbable: designed to suture external structures, most commonly used in medical office procedures. sizes are determined by the size of the suture 6-0 to 1-0 (1-0 is rarely used) 6 is the smallest needle, 1 is the largest needle

instruments to improve visualization

1- assist the provider in opening structures and moving other structures out of the way in order to provide an opportunity to view organs that cannot be seen externally 2- dilators: dilate structures that are constricted 3- probes: explore wounds, body cavities, hidden structures 4- retractors: used to pull aside tissue 5- scopes: illuminated instruments that is used to view an organ or body cavity 6- specula: increase the viewing area of a body cavity

Surgical Instruments are categorized into 4 Groups

1- instruments used for cutting 2- instruments used for grasping and clamping 3- instruments to improve visualization 4- instruments for probing

instruments used for grasping and clamping

1- used to hold onto tissue, clamping off tissue and blood vessels 2- may contain a locking mechanism 3- Forceps: grasp and hold tissue as well as other items in place 4- thumb or dressing forceps: look like a set of tweezers 5- tissue forceps: generally have ring handles and contain teeth 6- hemostats: used to stop bleeding. have ratchets to maintain a tight hold 7- needle holders: grab and firmly hold a needle during suturing 8- towel clamps: has 2 sharp edges used to hold sterile towels in place

instruments used for cutting and dissecting

1- usually have sharp edges or tips to cut through skin, tissue, and suture material 2- purpose of dissecting: explore for abnormal growths, remove abnormal tissue 3- Curettes are used to scrape or remove tissue from the skin or body cavities 4- Scalpes are used to make incisions 5- scissors are used to

Ultrasonic cleaner

A device that cleans instruments by transmitting sound waves through a cleaning fluid. creates a bubbling effect and loosens debris, eliminates the need for manual cleaning

Asepsis of Instrument-Step 1 Soaking Instruments

Immerse instruments in distilled water following a surgical procedure. Helps keep debris from drying on the instrument. Soaking containers should be sturdy plastic. Metal pans may also be used with a towel placed at the bottom of the container. Heavy or sharp instruments should be separated from delicate instruments.

Sterile Skin Closures

May be indicated by shallow wounds, come in a variety of widths and lengths, cut with sterile scissors for exact sizing Advantages: no local anesthetic needed, time efficient, cost efficient, less scarring, reduced risk of infection

Asepsis - Step 2 Sanitizing Instruments

all instruments in a surgical pack should be sanitized after a procedure. scrub items with a special soap. once scrubbed, items should be rinsed again in distilled water and thoroughly dried. all parts of each instrument should be cleansed with a nylon bristle brush and cleaned when in an open position

skin staples

applied to skin with a surgical stapler Advantages: quickly inserted, economical, cause fewer infections Disadvantages: scarring if applied improperly, imperfect aligning of wound edges

types of wraps

autoclave or sterilization paper sterilization cloth wraps sterilization pouches The proper method used to wrap instruments is referred to as the fan-fold or envelope method

gas sterilization

ethylene oxide is the most common gases used. effective against killing spores, used in larger facilities, like hospitals and Surgical centers, manufacturing plants that package sterile needles, sutures, catheters one of the most dependable forms of sterilization, combines steam under pressure. 15 pounds of pressure per square inch reaches a temperature of 250-254*F MA must include the name of the item, the date of expiration, and my initials on each pack

parts of surgical instruments

handle: part of the surgical instrument that is used to hold it ratchet: locking mechanism that tightens or locks the tip of an instrument shank: connects the handle with the working end of the instrument box lock: hinge found on a variety of ring handled instruments jaws: tip of certain instruments that are used to grasp or clamp items serrations: help to improve gripping power when working with slippery tissue teeth: used to puncture tissue may be referred to as mouse toothed circular blade: blunt on the outside sharp on the inside prongs and hooks: used to retract, lift and explore tissue

chemical sterilants

high-level disinfecting solutions that become sterilants under certain conditions must have the right dilution ratio and submersion length

maintaining the autoclave

internal and external inspection proper cleaning - daily cleaning with a damp cloth, run a commercially-approved cleanser through the autoclave weekly quality assurance through chemical and biological indicators- weekly spore check process indicators distinguish whether an item has been processed or autoclave autoclave tape is an example of a process indicator internal indicators and integrators: temperature, timing and saturation of sterilant are critical parameters used to determine that conditions are ideal for complete sterilization biological indicators check that all parameters were met for sterilization

Sterile Skin Closures/ Surgical Adhesives Surgical Adhesives

now used in place of sutures and staples commonly by providers in trauma, plastic surgery, and pediatrics sealant provides the incision site with instant strength usually within minutes Advantages: less pain, good cosmetic results, less chance of infection, no need for follow up

procedure for using Ultrasonic Cleaners

place like metals together use surgical soaps with a pH of 7 adjust water temperature avoid placing specially plated instruments into the cleaner

Step 3- Lubricating Instruments

process also known as milking the instruments. instruments are placed in a lubricating solution for 30-60 minutes, should not be rinsed following lubrication. Lubrication helps dissolve organic debris on the box locks, inhibits the instruments from becoming discolored, and provides a protective coating for the instruments

operating the Autoclave always follow manufactures instruction

properly load the Autoclave make sure water is at the desired level-use distilled water turn on the unit and follow instructions fill the chamber with water allow temp to climb to a minimum of 250*F allow load to run the entire length complete the ventilation cycle and have proper venting allow load to dry steam must be able to circulate through and between packs. packs should not be stacked on top or directly beside each other, packs should be vertical, and separated by 1-3 inches, jars should be placed on their sides avoid overloading the autoclave