Patient Safety, OT Zones, Surgical Positions

Question 1

Colour coding of IV cannulas

Answer 1

26G: Violet
24G: Yellow
22G: Blue
20G: Pink
18G: Green
17G: White
16G: Gray
14G: Orange

Question 2

M/C complication of cannula insertion

Answer 2

Superficial thrombophlebitis

Question 3

Superficial thrombophlebitis presents as

Answer 3

Cord like tender swelling at the site and takes few weeks to resolve

Question 4

Management of Superficial thrombophlebitis

Answer 4

Topical heparinoids (Thrombophobe)

Question 5

Checklist for sign in for OT

Answer 5

Before induction of anesthesia (Ward -> OT)
1. Confirm: Patient identity, site, procedure
2. Written consent to be taken
3. Surgical site marking
4. Inquire about allergies
5. Confirm pulse oximeter functioning
6. Evaluate risk of blood loss

Question 6

Checklist for Time out for surgery

Answer 6

Before skin incision
1. Verbal confirmation of: Patient, site and procedure name
2. Surgeon confirms:
> Operative duration
> Anticipated blood loss
3. Anaesthetist: Antibiotic prophylaxis (To be given within 60 mins of procedure)

Question 7

Checklist for Sign out from surgery

Answer 7

Before patient leaves OR (At skin closure)
Confirmation:
1. Nurse: Gauze + Instrument count
2. Surgeon: Specimen labelling
3. Anesthetist: Actual blood loss

Question 8

OT zones

Answer 8

1. Protective zone
2. Clean zone (Connects protective zone to aseptic zone)
3. Aseptic zone
4. Disposal zone

Question 9

Places in Protective zone

Answer 9

1. Change rooms
2. Transfer bay
3. Pre and post op rooms
4. ICU/PACU

Question 10

Places in Clean zone

Answer 10

1. Equipment store room
2. Maintenance workshop

Question 11

Place in Aseptic zone

Answer 11

OT

Question 12

What happens in Disposal zone?

Answer 12

Waste disposal

Question 13

Types of OT positions

Answer 13

1. Supine (M/C used)
2. Trendelenburg
3. Reverse Trendelenburg
4. Lithotomy
5. Lateral/kidney position
6. Prone
7. Sitting/Fowler’s position
8. Jack-knife

Question 14

Uses of Supine position in surgery

Answer 14

Abdominal and breast surgeries

Question 15

Uses of Trendelenburg position in surgery

Answer 15

Pelvic surgeries

Question 16

Uses of Reverse Trendelenburg position in surgery

Answer 16

Upper abdominal surgeries
E.g: Laparoscopic cholecystectomy

Question 17

Uses of Lithotomy position in surgery

Answer 17

1. Obstetric, gynaecological, urological procedures
   Common peroneal nerve injury: If legs not properly supported

Question 18

Uses of Lateral/kidney position in surgery

Answer 18

1. Thoracotomy, kidney surgeries (E.g. Nephrectomy)
   Brachial plexus injury d/t hyperextension of arms

Question 19

Uses of Prone position in surgery

Answer 19

Spinal surgeries and pilonidal sinus surgeries

Question 20

Uses of Sitting/Fowler’s position in surgery

Answer 20

Posterior cranial fossa procedures
Advantages:
1. Better exposure
2. Bloodless field
Disadvantage: Inc risk of air embolism

Question 21

Uses of Jack-knife position in surgery

Answer 21

Not preferred
D/t positional asphyxia

Question 22

What is Air embolism?

Answer 22

50-100 cc of air getting sucked into the vein

Question 23

Clinical scenarios of Air embolism

Answer 23

1. During thyroid/head and neck surgery -> Vein nicked
2. While operating in sitting position

Question 24

Management of Air embolism

Answer 24

Durant’s position/Left lateral (Right side up) + legs up

Question 25

Significance of Air embolism

Answer 25

Air remains in right side of heart -> Easy aspiration (Image guided)

Question 26

Uses of No.11 surgical blade

Answer 26

Pointed/stab blade 1. Incision and drainage 2. Arteriotomy

Question 27

Uses of No. 12 surgical blade

Answer 27

Curved blade Suture removal

Question 28

Use of other surgical blades

Answer 28

Blades with a belly Making incisions

Question 29

What are Langer’s lines?

Answer 29

AKA relaxed tension lines Lines are perpendicular to action of underlying muscle Incision are made parallel to the lines (Give good scars)

Question 30

Types of Energy sources

Answer 30

1. Monopolar cautery 2. Bipolar cautery

Question 31

Flow of current in Monopolar cautery

Answer 31

Tip -> Body -> Cautery pad -> Machine

Question 32

Flow of current in Bipolar cautery

Answer 32

Locally completed Prong 1 -> Body -> Prong 2

Question 33

Advantages of Bipolar cautery

Answer 33

1. Safe to use with pacemakers 2. Can be used near vital structures, end arteries

Question 34

Disadvantages of Monopolar cautery

Answer 34

1. Thermal damage to nearby nerves and vital structures 2. Interference with cardiac conduction

Question 35

Cautery pad in Monopolar cautery Just study

Answer 35

1. Placed over well vascularised area 2. Wide area of contact required 3. If small -> Burns at attachment site

Question 36

Surgeries where Bipolar cautery is used

Answer 36

Thyroid, parotid, penile, CNS Sx, ear lobule

Question 37

Functions of each cautery

Answer 37

Monopolar: Can cut and coagulate Bipolar: Only coagulate

Question 38

Mode of current for cutting

Answer 38

Low voltage, continuous

Question 39

Mode of current for coagulation

Answer 39

High voltage, alternating

Question 40

Working principle of Harmonic scalpel

Answer 40

1. Ultrasonic, coagulation without heat production 2. Oscillatory blade (20000-50000 Hz oscillation)

Question 41

Advantage of Harmonic scalpel

Answer 41

1. Precise cut 2. Can cut through scar tissue 3. Can be used close to vital structures