D & D Ch. 24 & 25 Surgical Supplies and Instruments

-- pack wounds -- pack abscesses

-- Sterilized gauze squares or strips saturated with petroleum jelly or petrolatum -- used to _____________. -- Sterilized iodoform gauze strips, 1/4 inch to 2 inches wide and impregnanted with iodoform iodine. -- used to _____________ to act as a wick to draw out the infection; also used as a local antibacterial agent.

10 %. formalin

A _________ % ___________ solution typically is used to preserve excised tissue for specimens. Specimen bottles are purchased with preservatives included and should be part of the supplies prepared for a surgical procedure, if a biopsy is to be done.

perforated (penetrating wound)

A _____________ is a penetrating wound that passes through to a body organ or cavity, such as a gunshot wound.

1. Hemostatsis 2. inflammatory phase 3. profileration 4. Remodeling phase

All wounds go through a healing or repair process that has four phases. Name the four phases: 1. 2. 3. 4.

incised wound lacerated wound penetrating or puncture wound

An _____________ has a clean edge and is made with a cutting instrument. This type of wound may be the result of surgery, an accident, or a knife wound. A _____________ has torn or mangled tissues and is made by a dull or blunt instrument. A ______________ is caused by a sharp, slender object such as a needle or an ice pick, and passes through the skin into the underlying tissues.

endoscope

An _______________ is a medical device consisting of a miniature camera mounted on a flexible tube with an optical system and a light source that is used to examine the area inside an organ or a cavitiy.

1. Medical asepsis 2. Surgical asepsis

Asepsis = free of infection or infectious materials. 2 types = 1. 2.

autoclave spores

Autoclave = Sterilization can be achieved by moist heat, dry heat, ultraviolet or ionizing radiation, or gas, or with chemicals. Medical facilities typically use the ___________ method, which uses moist heat and pressure to achieve sterilization. Steam under pressure in this method -- is an excellent method of sterilization because it kills all pathogens and __________.

Plain roller gauze Wrinkled crepe-type roller bandages

Bandages that are too loose fall off, whereas those that are too tight may compromise circulation and further harm the patient. _____________ is seldom used. It is difficult to handle, has no elasticity, and tends to bind. It also tends to slip becuase it does not adhere to itself. _____________ are preferred because they easily conform to various shapes of the body and adhere to themselves. If the bandage is to cover a wound, it should always be applied over a sterile dressing.

laser beam

Because a _______________ is so small and precise, it can be used to safely treat specific tissue with minimal damage to surrounding tissues and limited scar formation.

transient chlorhexidine gluconate (Hibiclens) and povidone-iodine

Before surgery, the surgical site on the patient must be disinfected with an antiseptic skin cleansing preparation. This will reduce the number of pathogens. Although it is not possible to remove all microorganisms from the skin, using an antiseptic cleanser will remove most of the ____________ and pathogenic microorganisms. Resident flora will also be reduced. Research indicates that ______________ and _____________ are safe and effective antiseptics.

exactly bottle. preparation and expiration

Chemical Sterilization = In the medical office, chemical sterilization is used for instruments that cannot be exposed to the high temperatures of steam sterilization. The sterilizing chemical solution must be mixed ____________ according to the instructions on the ____________. The solution must be marked with the date of _____________ and ___________. Materials to be sterilized must be submerged in this chemical bath with a closed lid for 8 hours or longer. Items are removed with sterile forceps and must be rinsed with water to remove all traces of the chemical before the items are used on patient. You must avoid skin contact with the sterilizing solution because it is very caustic.

sterile

Chemical Sterilization = The use of chemicals for sterilization is not very practical in the ambulatory facility. The instruments or equipment cannot be wrapped during processing in the liquid chemical. Once they are removed from the liquid, they are no longer considered ____________. In addition, because of the caustic nature of the chemicals, instruments must be rinsed with water after removal from the chemical fluid. This water is typically not sterile. However, high-level chemical disinfectants do have a place in health care. They can be used on instruments that would be damaged by autoclaving.

5-0

Choose the smallest diameter of suture strand. 0 5-0 5 1-0

1. Cutting 2. Grasping 3. Retracting 4. Probing and dilating

Classifications of Surgical Instruments = Surgical instruments are generally classified according to their use, and most belong to one of four groups = 1. 2. 3. 4.

1. Do they cut? 2. Do they grasp? 3. Do they retract? 4. Do they probe? (probes into area). (dillator = dilates)

Classify instruments according to their use. 1. 2. 3. 4.

continuous running interrupted

Completing the Surgical Procedure : At the conclusion of the procedure, the provider begins wound closure. The techniques and methods of tissue closure vary; all of them cannot be described or illustrated here. The two basic methods of suturing are the ______________ suture and the ______________ suture, in which each knot is placed and tied one at a time, so that if one breaks, the others keep the wound closure intact. The interrupted technique is used for most skin closures in a medical office.

freezing temperatures

Cryosurgery involves =

4 F or (-20 C).

Cryosurgery involves the use of a very low temperature probe to destroy tissue by freezing it on contact. The probe's temperature is usually below _____________.

electrosurgical unit (ESU) The loop electrosurgical excision procedure (LEEP)

Electrosurgery is also known as electrocautery. And _____________ uses high-frequency current to cut through tissue and coagulate blood vessels. The _______________ uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment of abnormal or cancerous conditions of the uterine cervix.

anesthetics

Even minor surgical procedures require the use of ______________, which either are injected locally at the site of the procedure or may be applied topically to the skin. For patients who find injects of a local anesthetic painful or traumatic, the provider may first apply a topical anesthetic.

All of the above = Redness around the operative site Fever or swelling Increasing or severe pain

For which postoperative condition should the patient call the provider's office?

hemostats

Grasping and Clamping Instruments = Clamping instruments are used for many different tasks. Many have a sharp tooth or teeth and are used to retract, hold, and manipulate fascia. The most common clamping instruments are _____________, which originally were designed to stop bleeding or to clamp several blood vessels. Some clamping instruments are used to grasp other instruments or sterilized materials. Some hemostats and other clamping instruments are used interchangeably.

Place heavier instruments at the bottom of a collection basin

How should instruments be handled after surgery is complete.

healing

However, epinephrine is not used in areas where decreased circulation may cause problems with ____________, such as fingertips or toes.

condensation

In autoclave, __________ is necessary but can't have too much of it. Different ways to sterilize -- ultraviolet lights and gas. (use gas on airplanes), Ionization.

First phase

In which phase of wound healing is fibrin most involved?

discussion surgical treatment

Informed Consent = The legal requirement is not met simply by having the patient sign a consent form; a. _______________ must occur, during which the provider gives the patient or the patient's legal representative enough information to enable the person to decide whether to proceed with the proposed _____________.

light amplification by stimulated emission of radiation

Laser is an acronym for __________ ____________ by ____________ __________ of ____________.

Epinephrine Epinephrine

Local anesthetics = When highly vascular areas are involved, local anesthetics containing __________ may be used. ____________ causes vasoconstriction at the site, which keeps the anesthetic in the tissues longer, prolonging its effect. It also minimizes bleeding.

procedure room

Minor Surgery Room = When minor surgery is routinely performed, a minor surgery room that is separate from the other examining rooms may be used. Recovery rooms and family waiting areas may also be available and are common in the larger surgery centers. The minor surgery room in a provider's office, often called the ____________, should be near a workroom with a sink and an autoclave.

autoclave mayostand

Most places have a procedure room -- a little changing room. You should have a sink and an _____________ nearby. ______________ = what the tray is on.

Remodeling phase (final phase) collagen

Name the phase of healing = _______________ = remodeling phase, extends from 21 onward. Clean, shallow wounds may contract in the first two stages; large or mangled wounds require the time and cellular activity of this phase to build a bridge of new tissue to close the gap of the wound. The cells produce a fibrous protein substance called ______________ (i.e. connective tissue) that gives the wounded tissues strength and forms scar tissue.

The second, or inflammatory,

Name the phase of healing = _______________ = phase focuses on destroying bacteria and removing debris. Special white blood cells (WBCs), called macrophages, arrive to clear away bacteria and dead tissue. Within 1 to 4 days the fibrin threads contract and pull the edges of the wound together under the scab. During this phase, edema, erythema (redness), heat, and pain occur.

sharper

Needles --> Surgical needles are chosen. The ___________ the needle, the deeper it goes into the tissue.

pressure cooker, moist HEAT & pressure Sanitization

Not everything can go into ultrasound machine (autoclave). Alot of metal can go into an autoclave. It's a _________ with _________ and __________. _____________ = reducing # of bacteria to a safe level. Should be completed after instruments are used.

Standard Precautions

Postoperative Responsibilites = After caring for the patient, the MA clears the sterile field, following ____________. Wear gloves until all contaminated materials have been properly removed and handled. Place disposable equipment and supplies in biohazard waste containers and/or sharps containers. The room should be checked for any blood spills or other contamination and disinfected appropriately. After completing this process, remove the contaminated gloves and sanitize your hands.

consent forms (ready to sign) drive

Preoperative Instructions = When office surgery is planned, certain procedures are followed before the appointment. These include = -- Having the necessary _____________ ready -- Giving the patient the necessary preoperative instructions, such as medications to be used and special skin-cleansing instructions. -- Telling the patient to bring a relative or friend to __________ him or her home after the surgery.

jewelry Calling

Preoperative Instructions: -- Instructing the patient to leave _____________ and other valuables at home. -- ____________ the patient the day before the scheduled surgery to confirm any special instructions.

topical silver nitrate

Procedure room -- ___________ = put on wound to stop bleeding.

A). Color B) Sensation C). Movement D) Temperature

Remember: CSMT When Bandaging When applying bandages, you should assess the following: A) __________ = should be the same as the opposite extremity; report any bluish or white fingers or toes B) ____________ = Should be able to feel fingers/ toes; report any numbness C) _____________= Should be able to move fingers/ toes D) _____________= Should be the same as the opposite extremity; report any cool/ cold fingers/ toes

topical silver nitrate (AgNO3) solution

Sometimes the provider may want to use ______________ or coated applicator sticks to stop localized bleeding, such as with epistaxis (nosebleed) or capillary bleeding at the site of a wound. The applicators must be kept in lightproof containers. The applicator sticks are convenient for use in the mouth or nose.

sanitized disinfected sterilized

Sterilization = Before an instrument or piece of equipment can be used in a surgical procedure, it must first be ____________, then ____________, and finally ___________ to remove all forms of microorganisms. It is essential that you understand the concepts of sanitization and disinfection before learning sterilization methods. Written sanitization, disinfection, and sterilization procedures should be in place for each workplace.

Asepsis Medical asepsis

Surgical Asepsis and Preparation of Surgical Instruments: _____________ = is the condition of being free of infection or infectious material. ______________ = is the reduction of microorganisms and the prevention of the transfer or microorganisms. This creates an environment that is clean but not sterile (free of microorganisms).

mandatory

Surgical asepsis is the complete destruction of microorganisms. This technique is _____________ for any procedure that invades the body's skin or tissues, such as surgery. In surgical asepsis, everything that comes in contact with the surgical site must be sterile, including surgical gowns, drapes, instruments, and the gloved hands of the surgeon and surgical assistants. Any time the skin or a mucous membrane is punctured or pierced, as in venipunctures or injections, surgical aseptic techniques must be practiced. Urinary catheterization biopses, and dressing changes on open wounds are performed using this sterile technique.

frequently

Suture Sizing and Packaging Suture material is available in a variety of diameters and lengths. The diameter of the suture strand determines its size; the smaller gauges are numbered below 0 (pronounced aught), and the larger gauges are identified with numbers 0. For instance, 2-0 suture is thinner than size 0, which is thinner than size 2. ** The sizes from 6-0 to 2-0 are used most ______________ in the medical office. The length of the suture material may vary, with strands precut in 18-, 24-, 54-, and 60 inch lenghts.

Ought Os smaller

Suture sizing O = ____________ If you have 2 - O it means you have 2 __________. The more Os you have, the __________ it is. A regular 1 is larger in diameter than 0.

Absorbable Nonabsorbable staples

Sutures -- ____________ = dissolved in the body. -- ____________ = used until the sound healing is complete. The strongest nonabsorbable sutures = ____________

sterilized edges

Sutures -- every doc has different preference of the suture. -- Should be able to be ____________. -- Sutures are used to hold the __________ of a wound together. -- Tubes tied example -- sealing that off

ligature

Sutures = The word suture is used as both a noun and a verb. As a noun, it refers to a surgical stitch or to the material used to close a wound. As a verb, it refers to the act of stitching. The primary purpose of a suture is to hold the edges of a wound together until natural healing occurs. A suture may also be used as a ___________. This is a strand of suture material used to tie off a blood vessel or to strangulate tissue. If this type of suture is used to tie off an internal tubular structure, it may last permanently or long enough for the structure itself to disintegrate.

bottom ultrasonic machine

Taking care of instruments = Thick thick gloves used. Similar to washing dishes but more delicate. Instruments should be carefully examined. Placed in basin of disinfectant solution. Heaviest instruments should be at the ___________. If we have sharp instruments --> best to have cleaned in an _____________.

electrosurgery

The LEEP excisional procedure is considered =

third phase, profileration

The ____________ phase encompasses wound healing and new growth; this lasts 5 to 20 days. During the phase, the tissues repair themselves. New cells form, and the wound continues to contract and seal. If the wound is a clean surgical incision, complete contraction usually takes place and a cicatrix forms.

Needleholder

The jaws of which instrument are shorter and stronger than hemostat jaws?

isolated

The principles of medical asepsis are implemented to prevent reinfection of a patient and cross-infection of another patient or medical personnel. To prevent cross-contamination, potential microorganisms and pathogens must be ____________ by following standard blood and body fluid precautions and by sanitizing, disinfecting, and/or sterilizing objects as soon as possible after they become contaminated.

1. Be effective against bacterial spores 2. Work to reduce transient bacteria 3. Show evidence of persistent activity on the skin 4. Work despite the presence of organic matter, such as blood or wound drainage.

The provider's hands and those of the MA should be scrubbed to reduce the chances of wound contamination, even though the hands will be covered by sterile gloves. Surgical scrub preparations should: 1. 2. 3. 4.

250 F to 255 F

The recommended temperature for sterilization in an autoclave in ___________ to ___________.

121 C

The recommended temperature for sterilization in an autoclave is: __________ C

towel forceps (towel clamps)

These instruments have very sharp hooks =

splinter forceps

This instrument has a fine tip for retrieval of foreign objects =

10 formalin

Use _________% of it to preserve our specimens.

sanitization

What is the cleansing process that removes organic material and reduces the # of microorganisms to a safe level?

Sterilization

What is the complete destruction of pathogens and spores?

Wrinkled crepe type roller bandage

What type of bandage is preferred over plain roller gauze?

Seamless tubular gauze bandage

Which bandage material is superior for covering round, narrow surfaces such as fingers or toes?

Laparoscope

Which endoscope is rigid?

Endoscope used in an endoscopy

Which instrument would be damaged by the high temperature and steam under pressure of autoclaves and must be disinfected after each procedure?

Reaching over a sterile field

Which is a violation of sterile technique?

Dacron

Which is one of the strongest nonabsorbable sutures?

Dacron and Prolene

Which of the following are the strongest nonabsorbable sutures?

Disinfection (not sanitization)

Which of the following aseptic procedures is performed on blood pressure cuffs and stethoscopes after each use?

all of the above answer --->. Krause nasal snare, Hartmann "alligator" ear forceps, "Buck" ear curette.

Which ophthalmologic and otolaryngologic instrument is used to remove foreign bodies or polyps?

Penetrating wound

Which wound passes through to a body organ or cavity?

phase 1

Wound healing Name what phase of healing = ________________ = Blood vessels contract to control hemorrhage, and blood platelets form a network that acts as a glue to plug the wound. After a cascade of chemical reactions, fibrin is released into the wound and clotting begins. Fibrin continues collect red blood cells (RBCs), and the clot dries into a scab.

debridement

Wounds are susceptible to infection because the normal skin barrier is broken. If debris is present in a wound as a result of the breakdown of various cellular components, this dead (i.e. necrotic) tissue acts as a culture medium for bacterial growth. Suppuration (i.e. pus) contains necrotic tissue, bacteria, dead WBCs, and other products of tissue breakdown. Necrotic tissue must be removed; the removal of debris is called _____________, which may occur naturally or may be performed surgically.

needleholders and clamps

__________ and __________ = are for grasping and clamping out of the way.

curet curet

___________ = used to remove tissues, remove a polyp. Just need to remember a __________ is used for biopsy. (obgyn instrument)

Needle holder

____________ = 4 to 7 inches long, Jaws are shorter and stronger than hemostat jaws, Jaws may be serrated or may have a groove in the center, Used to grasp a suture needle firmly

Probes

____________ = Lengths range from 4 to 12 inches; available with or without bulbous tip, May be smooth or may have a grooved director, Used to find foreign bodies embedded in dermal tissue or muscle or to trace a wound tract

curet specula

____________ = takes a tissue sample _____________ = hold things open

Surgical sponges Syringes and needles Sterile dressing and bandaging materials

____________ = used to absorb blood and protect tissues during surgery. ____________ = used to inject local anesthetics and irrigate wounds. ___________ and __________ materials

Senn Retractor

____________ = used to hold things away from a surgical wound.

scizzors scalpels foracepts

____________ are for cutting ____________ are for cutting _____________ are for grasping

Sterile water

____________ is kept for two forms. Multiple-dose or single-use vials are used as a diluent for medications. Larger containers of it are used for irrigating wounds and rinsing instruments that have been in a chemical disinfectant solution.

Suture scissors

_____________ = Blade has beak or hook to slide under sutures. Used to remove sutures.

Splinter forceps Allis tissue forceps

_____________ = Design and construction vary, Fine tip for foreign object retrieval. _____________ = Available in different lengths and jaw widths, Used to grasp tissue, muscle, or skin surrounding a wound.

Specula

_____________ = Most common dilator used, Valves are spread apart, dilating the opening, Used to open or distend a body orifice or cavity, The most common of these is the vaginal speculum used during gynecologic exams.

Elastic bandages Seamless tubular gauze bandage tubular gauze bandage

_____________ = are excellent for bandaging the hand and wrist and the foot and ankle. ____________, with or without elastic, is a superior material for covering round, narrow surfaces such as fingers or toes. It can be used as a dressing if the gauze material is sterile; it can also be used as a bandage. A _____________ is applied with a cage-like applicator. Work with the open circle of the applicator toward the patient.

Disinfection

_____________ = the process of killing pathogenic organisms or rendering them inactive. Many types of disinfecting agents are available, an they have varying degrees of effectiveness. It is important to follow the manufacturer's guidelines on how to use each product properly .

Roller bandages

_____________ = usually are applied from the distal to the proximal part of the area, because they are more even and snug if they are wrapped from a smaller to a larger circumstance. Elevate the limb while you are bandaging and work with the roller facing upward, close to the patient's skin.

Surgical asepsis

_____________ is the complete destruction of microorganisms and spores. This technique is mandatory for any procedure that invades the body's skin or tissues, such as surgery.

Senn Retractor

______________ = -- Flat end is a blunt retractor --Three-prong end may be sharp or dull. -- Used to retract small incisions or to secure a skin edge for suturing.

Hartmann "alligator" ear forceps Laryngeal mirror

______________ = 3 and 1/2 inch shaft; made in a variety of styles, Action of the jaw similar to that of an alligator's jaws, Used to remove foreign bodies, polyps. ______________ = Made in various sizes, May have a nonfogging surface, Used for examination of the larynx and postnasal area.

Placenta forceps Sims uterine curette

______________ = Used to remove tissue from the uterus. ____________ = Available in several sizes, Hollow and spoon shaped; used for scraping, Use to remove polyps, secretions, and bits of placental tissue.

Tenaculum forceps

______________ = Very sharp, pointed tips, Used to hold tissue (e.g. the cervix) while a tissue specimen is obtained or to lift the cervix so that the fornix can be seen.

Microsurgery

______________ involves the use of an operating microscope to perform delicate surgical procedures. One of its major uses is in ophthalmologic surgery.

Sanitization Sanitization

______________ is the cleansing process that removes organic material and reduces the number of microorganisms to a safe level. This cleansing process removes debris, such as blood or other body fluids, from instruments or equipment. ________________ should be completed immediately after instruments are used. This should occur in a separate workroom or area or on the "dirty" side of the utility room to prevent cross-contamination of clean instrument and equipment.

Sterile normal saline solution

_______________ is also stocked in two sizes. The small vial is used for injection. A larger plastic container of it is used for cleaning, rinsing, and irrigating wounds. These commericially prepared products are ordered from a medical supply company.

Plain elastic cloth bandages or elastic roller cloth bandages

_______________ with adhesive backing (e.g. Ace) make flexible, secure covers. When an elastic roller bandage is applied as a pressure bandage, especially to the lower limbs, it is essential to keep the bandage consistent in spacing and tension to ensure even pressure. Even, gentle pressure stimulates circulation and healing. Uneven pressure causes constriction points that can create pressure sores, ulcers, or edema.