ACEPTIC TECHNIQUE Flashcards
1
Q
What is ASEPSIS?
A
freedom from infectious material.
2
Q
What is Medical Asepsis?
A
reduction in the number of microorganisms. The single most important component is frequent hand washing. i.e. Hand washing, and chemical disinfectants.
3
Q
What is Surgical Aspesis?
A
Microorganisms have been completely removed or destroyed from the equipment and environment by means of a sterilization process.
4
Q
Which Asepsis technique is practiced and which is required?
A
Medical Asepsis is always practiced,
Surgical asepsis is required for invasive procedures
5
Q
What are some Various METHODS OF ASEPTIC TECHNIQUES?
A
Sterile Draping
Sterile Packs
Sterile Scrubbing
Sterile Gowning and Sterile Gloving
Sterile Procedures
6
Q
What is a Sterile field?
A
A Sterile Field means that the area is free of all microorganisms.
7
Q
How is the Sterile field established?
A
The field is established using Sterile drapes.
8
Q
What is STERILE DRAPPING?
A
A Sterile Drape is a sterile packaged drop cloth that isolates an area from contamination.
9
Q
What does STERILE DRAPE COVER?
A
A sterile drape covers a surface.
10
Q
What should we check for on a Sterile drape package?
A
Check expiration date on package, never use anything past the expiration date.
11
Q
Can we use an unseal sterile drape package?
A
Only use sealed packages.
12
Q
How do we open STERILE DRAP PACKAGES?
A
Open sterile packages adhering to sterile technique.
Packages are opened away from the person opening the package.
13
Q
How many inches away are STERILE PACKAGES GENTLY DROPPED ONTO THE STERILE FIELD?
A
6 INCHES ABOVE THE FIELD AT A SLIGHT ANGLE
Sterile items are gently dropped onto the sterile field from about 6 inches above the field at a slight angle.
14
Q
If a STERILE DRAPE BECOMES WET, IS IT CONSIDERED STERILE STILL OR UNSTERILE?
A
If a sterile drape becomes wet for any reason it is considered unsterile
15
Q
Can an unsterile package wrapping touch the sterile field?
A
Unsterile package wrappings should never touch the sterile field.
16
Q
What are STERILE PACKS?
A
Packages that are commercially prepared for a specific procedure that will contain the necessary sterile items.
17
Q
What will the STERILE packs contain?
A
Packages may include items that will be routinely used in a specific procedure: gauze, syringes, forceps, basins, etc.
18
Q
What are 3 types of STERILE PACKS?
A
OR sterile packs
Minor procedure packs
Special procedure packs
19
Q
HOW DO WE OPEN A STERILE PACK?
A
- To unwrap s sterile pack hold pack in the left hand. (Vice Versa)
- Unfold one corner of the wrap at a time, secure each corner in the palm of the left hand.
3.Hold the final corner with the right hand, hand should be completely covered by the warp.
4.When the pack is fully exposed and all corners secured, gently set the pack onto the sterile field, being careful not to allow your hand or arm to reach across the sterile field.
20
Q
What is SURGICAL SCRUBBING?
A
Surgical Scrubbing is the thorough cleaning of the hands and forearms before sterile gloves are put on
21
Q
WHAT ARE 2 TYPES OF SURGICAL SCRUBS?
A
-Numbered stroke method
- Timed Scrub
A minimum of 5 minutes
-All surgical scrubs are of a 5 minute duration with 2 ½ minutes of time spent on each hand and arm.
SURGICAL SCRUB- SCRUB FOR 5 MINUTES MINIMUM
22
Q
A surgical scrub anteseptic solution are?
A
*Currently, a surgical scrub with 2% chlorhexidine gluconate or
7.5% povidone-iodine is performed before each procedure
23
Q
For the surgical SCRUBBING TECHNIQUE, WHAT SHOULD WE LOOK FOR?
A
-Hands should be inspected for breaks in the skin
-No open wounds
-Mask and surgical cap must be put on before scrubbing
-All surgical scrubs are of a 5 minute duration with 2 ½ minutes of time spent on each hand and arm.
24
Q
Why should we inspect the hands?
A
-Hands should be inspected for breaks in the skin
- SHOULD BE NO OPEN WOUNDS
25
WHAT SHOULD BE PUTTED ON FIRST BEFORE SCRUBBING?
Mask and surgical cap must be put on before scrubbing
26
WE use liquid or foam soaps for surgical scrubbing such as?
1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges.
The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol).
These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.
27
What Types of brushes/sponge are used?
1. Impregnated scrub brushes/sponges.
(Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.)
2. Brush-free surgical scrub.
(These products use an antimicrobial agent and water but no scrub brush)
28
Non-Scrubbed personnel follow the aseptic techniques during surgical procedures:
Non-scrubbed personnel (runners):
Remove rings, watches and bracelets and other jewelry
Wear long sleeved clean scrub suit
Wear clean surgical cap or hood that covers hair
Wear clean closed shoes that will provide protection from fluids and dropped items
Wear masks covering mouth and nose, when open sterile items and equipment are present
Stay at the periphery of the OT, keeping a distance away from sterile areas
29
Unsterile Personnels should?
Stay at the periphery of the OT, keeping a distance away from sterile areas
30
What is the SURGICAL SCRUB PROCEDURE?
Make sure all cleaning supplies are available.
(scrub brush, antiseptic soap, nail cleaners)
Remove all jewelry, including watches.
Wash hands and arms with antiseptic soap.
Scrub the sides of each finger, between the fingers, and the back and front if the hand for 3 mins.
Scrub the arm with the hands higher than the elbows.
Each side of the arm is washed to 3 inches above the elbow for 1 minute.
Repeat the process for the other hand and arm.
The hands remain above the elbows at all times.
Dry the hands with sterile towels.
31
How do you wash/scrub YOUR ARM?
Scrub the arm with the hands higher than the elbows.
Each side of the arm is washed to 3 inches above the elbow for 1 minute.
32
Where should the hands be ?
The hands remain above the elbows at all times.
33
How should we perform the SURGICAL SCRUB?
-PALM TO PALM
- FINGERS INTERLOCKED
-ROTATIONAL RUBBING OF RIGHT TUMB CLASP ON OTHER
34
The purposes of the surgical hand scrub are?
(1) to remove debris and transient microorganisms from the hands, nails, and forearms
(2) to reduce the resident microbial count to a minimum; and
(3) to inhibit the rapid rebound growth of microorganisms.
35
When is Surgical Gowning and Gloving done?
Done after surgical scrubbing.
36
What are two methods of Gowning?
1. Self-Gowning
2. Gowning Another
37
What are 2 methods of Gloving?
1. Self-Gloving
2. Gloving Another
( 2 PERSON GLOVING)
38
What are 2 types of SELF GLOVING METHOD?
1. OPEN GLOVE METHOD
2. CLOSED GLOVE METHOD
39
What does STERILE GOWNING AND GLOVING FOCUS ON?
Sterile gowning and gloving focuses on surgical asepsis
40
How is Gowning and Gloving in SURGICAL ASEPSIS DIFFER FROM ISOLATION GOWNING AND GLOVING?
Sterile gowning and gloving focuses on Surgical asepsis
DIFFERS:
Isolation gowning and gloving which follows Medical asepsis techniques.
41
What are Sterile Procedures?
Radiographers must adhere to Principles of Basic Sterile Technique
42
Some Sterile Techniques are?
Only sterile items are used in sterile fields.
If in doubt about sterility of an object, consider it unsterile.
An unsterile object should be removed, covered or replaced.
As sterile field must be continually monitored to be considered sterile.
Create sterile fields as close to the time of use as possible.
Sterile persons should avoid unsterile areas.
43
What Parts that are sterile?
The front of the gown, the sleeves and anything above the waist up.
44
What parts are UNSTERILE?
The back of the gown and the area below the waist are considered unsterile.
below the level of the table or the level of the waist, the undersurface of the drape, is considered unsterile. Any item below this level is considered contaminated.
45
What parts of the glove should be considered unsterile when handing a sterile glove with an unsterile hand?
-UNSTERILE IS INSIDE OF THE CUFF
-Sterile gloves must be kept in sight and above waist level
46
A radiographer who is assisting with a sterile procedure but is not gloved and gowned:
May not have contact with the sterile field or anyone who is scrubbed in
47
When putting on gloves for a procedure, which of the following should occur first?
Wash hands
48
After a radiographer is gowned and gloved for a procedure, hands may not be placed:
Under the arms or on the sides or back of the
gown
49
WHERE SHOULD STERILE GLOVES BE KEPT?
Sterile gloves must be kept in sight and above waist level
50
STERILE ITEMS MUST BE KEPT DRY?
Sterile materials must be kept dry. Moisture permits contamination. Packages that become wet must be re-sterilized or discarded
51
HOW SHOULD PERSONS I STERILE GOWN AND GLOVE PASS EACH OTHER?
back to back
52
What can a STERILE PERSON TOUCH?
A sterile person may touch only what is sterile.
53
What must a UNSTERILE PERSON not do?
Unsterile persons cannot reach above or over a sterile field
54
What should we do if a solution soaks through a sterile field?
If a solution soaks through a sterile field to a non-sterile field, the wet area may be redraped.
55
What is the STERILE FIELD MADE UP OF?
Includes the patient, table, anything covered with a sterile drape and personnel wearing sterile attire.
Respect the “sterile corridor” which is the area in the OR between the patient drape and the instrument area.
Never pass anything over a sterile corridor, including the instrument table or pass through the sterile corridor.
56
What exactly is the STERILE FIELD?
The sterile field is any area prepared to receive sterile items or equipment.
57
What should we never do in a STERILE FIELD?
Never pass anything over a sterile field.
-NEVER LEAVE STERILE FIELD UNATTENDED
58
What is the STERILE CORRIDOR?
Respect the “sterile corridor” which is the area in the OR - between the patient drape and the instrument area.
Never pass anything over a sterile corridor, including the instrument table or pass through the sterile corridor.
59
Who makes up the Surgical Medical Imaging Team
- Chief Surgeon
* Assisting Surgeon
* Anesthesiologist or CRNA
* OR Nurse—Circulating NURSE OR
Scrub Nurse
* Support OR staff
60
Who is considered UNSTERILE IN THE OR?
Anesthesiologist ) (BEHIND THE DRAPE)
CIRCULATING NURSE- NON STERILE
61
Who are STERILE?
Chief Surgeon
Assisting Surgeon
SCRUB NURSE
62
How must the Radiographer be able to assist?
The radiographer must be able to assist the physician or nursing personnel with procedures in the Radiology Department that require sterile technique.
Depending on institutional policy the radiographer’s responsibilities will vary.
63
Some responsibilities may be?
i.e. Sterile Dressing Changes
Tracheotomies
Chest Tubes
Urinary Catheters
Intravenous and Intra-arterial Lines
Pacemakers
Operating Room Radiography
64
STERILE DRESSING CHANGES
All patient dressings such as wound coverings should be treated as if they are infected and the radiographers must use sterile technique when removing, applying and disposing of dressing materials such as pads, gauze and surgical tape.
All used material should be discarded according to institutional policy such as in biohazard plastic bags.
65
What is Purulent ?
Pertaining to pus. Containing or composed of pus. The term “purulent” is often used regarding drainage.
66
What is Tracheostomy?
A surgical incision into the trachea to provide an airway.
Sterile technique must be observed when the surgical opening is made and during the insertion and removal of the endotracheal tube.
67
What is SUCTION?
-PERFORMED BY NURSE
Suction of a Tracheostomy is necessary to remove secretions and is usually performed by the NURSE however, the radiographer should be able to respond in an emergency and assist medical personnel
68
What are CHEST TUBES KNOWN AS?
THORACOSTOMY TUBES
69
The first rule of caring for a tracheostomy patient is:
Establish communication
70
What are CHEST TUBES/THORACOSTOMY TUBES?
Tubes introduced into the pleural space under sterile conditions to remove air and/or fluid from the pleural space.
-DRAINES FLUID FROM PLEURAL SPACE
71
Chest tubes are known as thoracostomy tube and some are used for?
* Chest tubes are placed for: -
Draining the intrapleural space and mediastinum
Fluid or air
Creating negative pressure
Atelectasis
Pneumothorax
Hemothorax
Pleural effusion
Empyema
Open-heart surgery
72
What is ATELECTASIS?
1. Collapse of lung/ tissue
2. Harder to penetrate
73
WHAT IS Pneumothorax?
1. Air/gas in the pleural space that causes the lung to collapse
AIR LEAKS FROM THE LUNG INTO THE PLEURAL SPACE CAUSING TOTAL COLLAPSE
2. Easier to penetrate
74
WHAT IS Pleural effusion?
1. Accumulation of fluid in intrapleural spaces 2. Harder to penetrate
75
What is EMPYEMA?
1. Pus in the pleural space
2. Harder to penetrate
76
What is HEMOTHORAX?
BLOOD IN PLEURAL SPACE
77
OPEN HEART SURGURY
CHEST TUBES ARE USED TO DRAIN BLOOD
78
COMMON INSERTION SITES OF CHEST TUBES?
-Insertion sites for thoracostomy vary with the intrapleural substances to be removed.
-Usually inserted in the fifth to sixth intercostal space
-Lateral and midaxillary line
-Can be as high as the fourth intercostal space and as low as the eighth
79
What are the PARTS OF A CHEST DRAINAGE SYSTEM?
1. Collection chamber (collects fluids from the lungs)
2. Water seal chamber (contains water and prevents air from entering the cavity from the outside)
3. Suction control chamber (contains water to regulate the amount of suction that removes unwanted air and fluid)
4. Optional 4th chamber
5. Water seal (prevents the pressure buildup)
80
Where should the CHEST DRAINAGE SYSTEM BE KEPT?
below the level of the patient’s chest.
81
What should the RADIOGRAPHER BE CAREFUL WITH AND NEVER DO?
The RT must be careful not to disturb the chest tube or system while performing x-ray procedures.
-Never clamp or cause kinks or loops in the tubing.
-Never disconnect the tubing from the drainage bottle.
Be careful not to pull on the tube in any way causing it to become dislodged.
82
What is used to evaluate the PLACEMENT AND THE PROGRESS OF THE REMOVAL OF AIR AND FLUIDS?
Portable CXR’s (CHEST X RAYS)
ARE often taken before, during, and after the insertion of a chest drainage tube
To evaluate placement and the progress of the removal of air and fluids.
Patients may also travel to the radiology department for CXR with a chest tube in place with a drainage system.
83
Where must the Exterior assembly of the chest tube must always remain?
always remain lower than the patient’s chest.
--THIS IS VERY IMPORTANT IN PATIENT TRANSFER
84
What us Auscultation?
the process of listening to sounds produced within the body.
85
What is STOMA?
an opening into the body from the outside created by a surgeon.
86
What is a STETHOSCOPE?
an instrument used to transmit low-volume sounds such as the heartbeat (or intestinal, venous, or fetal sounds) to the ear of the listener.
87
What is Pneumonia?
is an infection that inflames the air sacs in one or both lungs.
88
How many lobes make up the left and right Lung?
RIGHT -Lobes: Three lobes (upper, middle, and lower)
LEFT: Lobes: Two lobes (upper and lower)
89
What is HEMOPENUMOTHORAX?
LUNG WITH AIR AND BLOOD
90
What are Catheters?
a tube for injecting or removing fluids.
91
What are the types of catheters?
1. Urinary Catheters
A. Indwelling
Indwelling is divided into 2 types
- Foley (retention baloon)
- Straight (intermittent) (NO BALOON)
92
Use the French system for sizing for foley and Straight Catheters
2.6 to 5.9 mm
8 Fr to 20 Fr
Use saline in the balloon
93
What are indwelling catheters?
catheter that remains in place
94
What is a Foley Catheter?
catheter that remains in the bladder by a balloon inflated with air or water.
(Use saline in the balloon)
95
What is a Straight Catheter?
a straight catheter does not contain a balloon for inflation.
96
What is Urinary Catheterization?
A flexible, hallow tube (catheter) is passed through the urethra into the bladder.
97
Urinary catheters are used for?
Catheters are used for urinary drainage, or to introduce fluids into the bladder.
98
What is the Indwelling catheter placement?
Tip of the catheter in the urinary bladder cavity
Catheter tubing taped to the inside of the leg
The end of tube attached to a calibrated drainage bag
99
How must the drainage bag be kept when using a Indwelling catheter?
The drainage bag must be always kept lower than the patient’s bladder to prevent retrograde flow into the bladder.- (reflux of urine back into the bladder)
100
Urinary system is primary site of?
nosocomial infections
101
What are the purposes of Foley Catheters?
-Empty the bladder
-Bypass obstruction
-Relieve the retention of urine
-Irrigate the bladder and introduce drugs
-Allow accurate measuring of urine output.
Relieve incontinence
102
Types of Incontinence IN URINARY SYSTEM
1. OVERFLOW- URINARY BLOCKAGE-UNABLE TO EMPTY PROPERLY
2. STRESS- RELAXED PELVIC FLOOR AND INCREASED ABDOMINAL PRESSURE
3. URGE- BLADDER OVERSENSITIVITY FROM INFECTION AND NEUROLOGIC DISORDER
103
When the Radiographer empties the urine collection bag, what must we do with the output?
If the radiographer empties the urine collection bag, then output must be measured and recorded, unless otherwise noted.
104
What are Voiding Cystourethrogram (vcug)?
It is a radiographic procedure used to visualize the bladder, and ureter before during, and after voiding.
(CONTRAST MEDIA ARE INTRODUCED BY A CATHETER)
105
A VCUG reveals?
A VCUG reveals an abnormality of the bladder that causes a reflux of urine back towards the kidneys.
106
INTRAVENOUS AND INTRA-ARTERIAL LINES (WHAT ARE THEY?)
A sterile procedure is required when any line is to be inserted into vessels.
These lines are called:
Central Venous Lines
Arterial Lines
107
What are Central venous Lines? (VENOUS ACCESS DEVICE)
CVs are open lines inserted into a large vein for the purpose of allowing easy access to the circulatory system on a continuing basis
108
When are CENTRAL VENOUS LINES USED?
1. Administration of chemotherapy drugs
2. Provide parenteral nutrition
3. Administer long term drugs
4. Manage fluid volume
5. Drawing of blood and blood transfusions
5.Monitor cardiac pressure
109
Central Venous Lines – are lines inserted into veins to introduce?
are lines inserted into veins to introduce fluids,
medications,
chemotherapy
and measure central venous pressure
110
How must the radiopgraher be careful with cv lines?
The radiographer must be careful that CV lines do not become displaced during radiographic procedures
111
Common types of Central Venous Lines (catheters)
Swan Ganz
Intracath
Hickman
Broviac
Arrow-Howes triple lumen
PIC (peripheral inserted)
112
Now what are Arterial Lines?
are typically used for removing or drawing blood and allowing a constant measurement of blood pressure
113
2 types of Arterial Lines are?
-Radial Arterial Line
-Femoral Arterial Line
114
What can we do to check the placement of iNTRAVENOUS AND ARTERIAL LINES?
the placement of Central Venous Lines and Arterial Lines.
CXR, portable CXR, and fluoroscopy may be taken to check
115
What position are patients placed in when lines are placed?
Patients are placed in the Trendelenburg position when lines are placed.
Trendelenburg Position – patient position in which the patient lies supine and the head is 30 to 40 degrees lower than the feet.
116
What are PACEMAKERS?
Are electromechanical devices inserted under the patient’s skin to regulate the heart rate.
117
What type of patient may most likely be a candidate for permanent pacemakers?
Patients with symptomatic bradycardia are most likely candidates for permanent pacemakers.
118
How can a PACEMAKER PREVENT BRADYCARDIA?
A pacemaker can prevent bradycardia by sensing the heartbeats of a patient and pacing the heart when it does not initiate a heartbeat on its own.
119
What size and weight are pacemakers unit?
Pacemaker units are approximate:
-1 inch wide in diameter and thickness,
-weighing just a little over 1 ounce.
120
What does the UNIT CONSIST OF?
The unit consists of a pulse generator and accompanying circuitry and is connected to a lead.
121
What does the TIP OF THE LEAD CONTAINS?
The tip of the lead contains a metal electrode that is put into contact with the heart.
122
What does the electrode sense?
The electrode senses heartbeats and can also produce an electrical impulse to make the heart contract
123
What are the ROLES OF. RADIOGRAPHER IN THE OPERATING ROOM (OR)?
When performing radiographic procedures in the OR the radiographer must observe strict adherence to always maintain sterile fields and practice sterile technique.
The radiographer must be familiar with and follow procedures of the institution that they are working in.
124
Who is a responsible member in a surgical team?
The radiographer is a responsible member of the surgical team.
125
When may they need a RADIOGRAPHER?
Radiographs may require at any time before, during or after surgery.
126
WHAT TYPE OF UNIT IS USED TO PERFORM SURGICAL RADIOGRAPHY?
Surgical radiography is performed with portable X-ray units and portable C-arm radiographic units
127
What are C -ARM RADIOGRAPHIC UNITS?
is a specific type of portable X-ray unit that can rotate 360 degrees around the patient.
C-arms are routinely used in the OR for hip pinning procedures and pacemaker insertions.
128
In Neonatal Radiography
A newborn infant up to a month old.
The neonatal period is defined and is important because it represents a short period of life where changes are very rapid and when many critical events can occur.
The radiographer must be careful when taking x-rays of neonates in the pediatric intensive care unit (PICU) to follow aseptic technique as appropriate.
Gonadal protection is very important!
Shadow shield
129
Which of the following is used to administer nutrition or long-term chemotherapy?
a. Urinary catheter
b. Chest tube
c. Ventilator
d. Venous catheter
d. Venous catheter
130
A venous catheter:
Is a combination unit with a needle inside a flexible plastic catheter; both the needle and the catheter are inserted into the vein, after which the needle is withdrawn
131
The radiographer must be proficient in the use of which of the following medical instruments?
a. Angiography catheter
132
Patients are placed in what position when lines such as central venous and arterial are placed?
Trendelenburg position when lines are placed.
(supine, head is 30-40 degrees lower than feet)
133
Hands should be washed:
Before and after contact with each patient and before touching equipment
134
When sterile fields are prepared, damp packages:
Are always considered contaminated
135
An item that must never be placed above the level of the bladder is a:
Urinary catheter
136
If you suspect an object is contaminated, assume:
a. That it is contaminated
137
When putting on gloves for a procedure, which of the
following should occur first?
a. Carefully open glove package, and avoid touching
outside of gloves
b. Wash hands
c. Place glove package in center of sterile field in
preparation for the procedure
d. Put on one glove immediately so that one hand is
b. Wash hands
138
A radiographer who is assisting with a sterile procedure but is not gloved and gowned:
May not have contact with the sterile field or anyone who is scrubbed in
139
Neonatal portable radiography requires the most care to maintain asepsis; which one of the following will best ensure asepsis of the infant?
1. careful attention is paid to everything that the radiographer comes in contact with and proper cleaning protocols are followed
2. hand washing after each patient
3. wiping down the machine before each patient
1 &3
140
Outside air is prevented from entering the pleural cavity through the chest tube by the:
Water seal chamber
141
sterile corridor?
Area between patient drape and instrument table
142
common neonatal chest disorder requiring portable radiography in the neonatal unit is transient tachypnea of the newborn (TTN). Radiographs are taken to visualize the chest for respiratory distress, and in doing so the imaging professional must:
1. employ the highest degree of aseptic techniques.
2. use lead protection when possible, and sterilize after each use.
3. wash hands only after the procedure is complete.
4. wrap all items that may have the potential of coming in contact with the newborn.
5. employ contact or shadow shielding for patient protection.
6. treat the procedure as a sterile procedure similar to surgery.
1,2,4,5
