T4: Scrubbing In

Question 1

What area of the clinic should you clip a patient that you are preparing for surgery?

What size blade should you use?

Answer 1

• Not in the theatre, in tx room
• number 40 blade

Question 2

What are some things to remember when clipping a patient for surgery?

Answer 2

• clip the area of interest as short as possible w/ a large margin around where the incision will be
• vaccuum patient afterwards to remove hair

Question 3

_Preparing animals for surgery:
Orthopedic_

What does orthopedic surgery refer to?

What are some considerations when prepping an animal for ortho surgery?

Answer 3

• repair of fractures, reduction of dislocations and correction of growth/congenital skeletal
• vet may wish to repeat radiographs of the injury once the animal has been anaesthetised.
• fracture may have been temporarily stabilised using a Robert-Jones bandage or a type of splint
• For compound fractures gross contamination is likely. May need to covered w/ sterile saline swab

Question 4

_Preparing animals for surgery:
limb surgery_

Considerations?

Answer 4

• clip all the hair off the entire leg apart from the foot.
• foot is usually bandaged to prevent hair contamination. Once in surgery, vet will wrap the foot in a sterile drape or autoclaved cohesive bandage.
• During prep, the limb usually needs to be suspended away from the animal’s body, often by means of a stirrup attached to the foot.

Question 5

Describe how you would prep the skin for surgery

Answer 5

• wear gloves
• scrub skin first with a antiseptic that is detergent based to remove fats/oils
• Use gauze swabs in a circular motion
• scrub solution is then removed using a fresh swab w/ antiseptic applied
• done aseptically, systematically moving away from surgical site towards fur, then discard swab
• repeat with fresh swabs until scrub is removed
• Scrub surgical area twice with 70-80% ethyl alcohol, beginning in the centre of the clipped area and working peripherally
• final applications of antiseptic do not occur until animal is in theatre.
• Here, antiseptic is painted on using sterile sponges while wearing sterile gloves, or spraying the antiseptic

Question 6

How would you disinfect the eyes prior to surgery?

Answer 6

• Instil protective ointment into the eye or an antibiotic eye ointment to lubricate and protect the eye
• Cleanse the skin around the eye with weak povidone iodine solution; never use detergent solutions, chlorhexidine or alcohol in or around the eye.
  *

Question 7

How would you disinfect the mouth prior to surgery?

Answer 7

Wash thoroughly with Hibitane scrub, rinse with water or saline.

Question 8

How would you disinfect the bowel prior to surgery?

Answer 8

GIT can be emptied by 36-hour starvation, coupled with a mild laxative (coloxyl, paraffin) and enemas, twelve and three hours before surgery

Question 9

How would you disinfect an open wound prior to surgery?

Answer 9

• Flush gross contamination out of wound using saline
• Cover the open wound with KY gel, lignocaine gel or a saline soaked sponge
• Clip away from the wound, prep in usual fashion but avoid alcohol on open tissues.
• Higher concentrations of chlorhexidine (>0.02%) can also cause tissue toxicity

Question 10

Draping

-how?

types of drapes?

Answer 10

• 4 rectangular drapes are used to create a ‘window’ for surgical site
• secured using towel clamps
• fenestrated drapes have a ready-made purpose cut hole
• barrier drapes are clear and adhesive -used for high level of asepsis (placed over surgical site/window then cut through where incision will be made

Question 11

What are some personal grooming considerations when working in a theatre?

Answer 11

• fingernails should be short and no jewellery worn
• close fitting clothing w/ scrubs over top
• hair tied back
• talk as little as possible
• dedicated, no tread theatre shoes
• cap and mask

Question 12

Describe how you scrub your hands for surgery

Answer 12

1. wash hands and arms first with the scrub mixture to remove any gross contamination.
2. nails are clipped and cleaned next before the scrubbing procedure begins.
3. a sterile brush is used to scrub fingers first, then the hands and finally the arms
4. scrub over a period of five minutes.
   - Once the brush has been used on the arms, it should not return to the fingers.
   - Each finger should receive ten strokes on each surface
   - fingernails and both surfaces of the hands should receive twenty strokes

Question 13

How should you rinse and dry your hands after scrubbing in to surgery?

Answer 13

• Rinse in warm water, allowing the water to drip from fingers to elbows to prevent contamination of the hands with drips from upper arms.
• Dry by using sterile hand towel provided in gown pack
  Start in centre of towel, then one arm on one end - moving from the wrist to the elbow. Dry the other arm on the other end of the towel in the same manner.

Question 14

Name two solutions used to scrub with

Answer 14

• chlorhexidine
• povidone-iodine

Question 15

Describe the process for all staff getting ready for surgery

eg. in what order does everything happen?

when do you scrub and gown in?

who else is in the theatre?

Answer 15

• surgeon and any scrubbed assistants will first put on scrubs, caps, masks and theatre clogs
• they will then perform a surgical hand scrub.
• The non-scrubbed, circulating nurse will be required to open a sterile towel for each person
• the nurse will be required to open a gown pack in a sterile fashion and assist the surgeon by tying the neck ties and waist ties.

Question 16

Describe the process of surgical gowning

Answer 16

1. grasp gown at the neck and allow it to unroll, being careful not to allow it to touch the body or objects in the room.
2. then unfold gown, being careful not to touch the front of the gown.
3. grasp collar at the left tie string, with the right hand and inserts the left arm into the sleeve, extending the hand through the cuff. repeat with opposite arm/hand
4. both hands and arms are extended upwards
5. an attendant ties and adjusts the gown

Question 17

Describe the process of surgical gloving

Answer 17

1. attendant opens glove envelope.
2. surgeon picks up left glove with right hand, grasping it by the turned down cuff (the outside surface of the glove).
3. glove is then put on about two thirds of the way, with the aid of the right hand - care being taken not to unfold the cuff.
4. with the gloved left hand, the right hand glove is picked up under the cuff and, in one movement, is pulled onto the hand and over the cuff of the gown.
5. gloved fingers of the right hand are then placed under the cuff of the left glove at the palm, and the glove extended up over the cuff of the gown. The gloves are then adjusted on the hands and the surgeon is prepared.
6. to avoid any possible contamination, the hands are held up and in front of the body

Question 18

What kind of masks are suitable and unsuitable for surgery?

Answer 18

• SUITABLE:
  -double ply cotton
  -disposable paper
  => have metal nose piece that forms to shape of noise, can be used for up to 8hrs
  => moisture does not interfere
• NOT SUITABLE
  -Tissue paper masks with elastic loops for the ears

Question 19

What are some surgical WH&S considerations?

Answer 19

• animal handling and restraint
• lifting heavy animals
• mixing chemicals
• zoonoses and infective agents
• gas leakages and sharps
• biological waste

Question 20

What is a sterile field?

Answer 20

• created by placing sterile towels or surgical drapes around the surgical procedure site.
• should also be established on the stand that will hold sterile instruments
• Items below the level of the draped client are outside the field and are not sterile.

*

Question 21

How do we maintain a sterile field?

Answer 21

• Allow only sterile items and personnel within the sterile field
• Do not contaminate items when opening, dispensing, or transferring them.
• Consider any sterile item that has been penetrated (cut, wet, or torn) to be nonsterile
• Never set up a sterile field near a door or an open window.
• When in doubt about whether or not an item is still sterile, consider it to be contaminated

Question 22

Other tips on maintaining sterility?

Answer 22

• such thing as “almost sterile”
• only outside of wrappers should be touched by ungloved hands, and sterile packs should always be opened away from the body
• sterile articles are handled only by sterile gloves or a sterile instrument
• once a sterile article is removed from a pack, it is never returned to the container.
• any time a wrapper or sterile linens become moist, it should be considered unsterile
• before solutions are poured into a sterile container, a small amount should be poured into the kick bucket while the container is rotated to wash the neck.
• do not apply sterile drapes to a wet surgical field. If the antiseptic has not dried, use sterile sponge forceps and sponges to dry the skin
• once sterile drapes have been laid on the patient, they should not be moved. The only exception is that the edges of a fenestrated drape can be moved away from the incision site