T6: Assisting During Surgery Flashcards Preview

ASC183 Surgical Nursing > T6: Assisting During Surgery > Flashcards

Flashcards in T6: Assisting During Surgery Deck (23):
1

What is a sterile field comprised of?

How may this be compromised?

  • Incorporates the aseptically prepared skin covered by sterile drapes and extends to the sterile gloves and gown and the sterile instruments used by the surgeon.
  • Linen drapes becoming wet or the surgeon touching a non-sterile object are examples of how asepsis can break down and increase the risk of contamination.

2

To facilitate the setting up and maintenance of a sterile field, all of the following need to be carried out faultlessly:

  • cleaning surgical facilities.
  • Specifically allocated cleaning utensils (used in theatre only)
  • Blood and other debris must be removed asap at completion of surgery and before next procedure.
  • theatre should contain only the essential furniture
  • sterile preparation of equipment
  • aseptic preparation of the surgical site
  • wearing of sterile gloves and gown by the surgeon
  • Cap, mask gown, glove and thoroughly scrub his or her hands with an antiseptic scrub
  • all theatre staff recognising the boundaries of the sterile field.   

3

To provide sterile assistance, a nurse must first:

  • put on a surgical cap and mask
  • carry out a surgical hand scrub
  • put on a surgical gown
  • put on surgical gloves

4

  The scrubbed assistant may be required to assist with:

  • preparation of sterile instruments
  • passing instruments
  • retraction
  • haemostasis
  • lavage and suction
  • passing suture materials
  • cutting ends of ligatures

5

Providing sterile assistance:

Preparation of the instruments

surgical assistant can open the inner wrap of the instrument pack and arrange the instruments in order on the instrument trolley, as required.

6

Providing sterile assistance:

draping

  • placement of surgical drapes around the incision site forms a vital part of the sterile field.
  • Ideally, the whole animal is draped leaving only the surgical site exposed.
  • For some procedures, additional drapes such as skin towels or plastic adhesive drapes are used so that the draping extends up to the edge of the incision

7

Providing sterile assistance:

passing instruments

  • Always pass instruments with the handles towards the surgeon and the ratchets open.
  • Scalpel blades will need to be attached to the handle

8

Providing sterile assistance:

retraction

To improve visualisation of the surgical area, you may be required to assist with:

  • packing off organs with moistened laparotomy sponges
  • holding tissues with hand-held retractors or tissue forceps
  • holding tissues with stay sutures to retract them (e.g. the stomach wall so that the surgeon can make an incision)
  • holding tissues with moistened swabs
  • counting swabs
  • applying traction to a limb during an orthopaedic procedure (e.g. to better visualise a joint)

9

 Providing sterile assistance:

Cutting ends of ligatures and sutures 

  • Ligatures and internal sutures usually have the ends cut to approximately 2mm in length.
  • Skin sutures are left with ends of approximately 1cm.
  • Suture scissors should be used as the suture material can blunt the blades of tissue scissors. The tips of the scissors are used.

10

Non-sterile assistance:

List some things you may be required to do as a non-scrubbed (non-setrile) assistant nurse

  • set up theatre
  • select the appropriate surgical packs an place them in the theatre
  • transport and position the patient in the theatre
  • complete surgical skin prep (on patient
  • assist with tying the surgeon’s gown
  • select and open surgical gloves
  • select the appropriate suture material and scalpel blades and any other sterilised equipment which is not included in the general surgical pack
  • open the outer linen wrap of the surgical pack

11

What is an 'atraumatic' needle?

Pre-packed needle and suture materials

(atrumatic means without trauma)

12

Describe the properties of an atraumatic needle

  • they have no eye (suture material is inserted into shaft)
  • no need for double strand of suture material
  • less trauma caused to tissues
  • some have ribbed shaft to prevent rotation in the needle holders.

13

What is a suture?

a strand, cord, thread or band of pliable material used to appose living tissue mechanically.

14

What is a ligature?

a thread or strand used to tie a vessel or strangulate a portion of tissue.

15

What are the two basic types of sutures?

  • absorbable
    -usually buried w/in the body
  • non-absorbable
    -usually on body surface
  • Non-absorbable sutures eg, silk, mono-filament nylon, are also sometimes used in buried sites. Whenever a suture is used in a buried site, it must be absolutely sterile.

16

List the properties of an ideal suture material:

  • easily sterilised
  • easy to handle (less "memory")
  • adequate tensile strength
  • lack of foreign body reaction
  • good tying properties
  • non-capillary

17

How long does it take for an absorbable suture material loses its tensile strength?

How does it lose its strength?

  • 60 days
  • is broken down by hydrolysis or the body’s natural inflammatory processes

18

Suture materials maybe ....filament or ....filament (braided)

mono or multi filament

-multi causes more tissue trauma

19

Name some common absorbable suture materials

  • Maxon
  • PDS
  • Dexon
  • Vicryl
  • Chromic catgut

20

Name some common non-absorbable suture materials

  • Vetafil
  • Supramid
  • Silk
  • Prolene
  • Nylon

21

Suture materials come packaged as:

(3 types)

  • commercially pre-sterilised single-use materials with an inner foil and outer peel down wrapping. Many of these come with a suture needle already attached (swaged on)
  • multi-use cassettes which usually contain propyl alcohol
  • autoclavable reels. These are non-absorbable material (e.g. vetafil, stainless steel)

22

How many of each type of needle should you include in a surgical pack?

2 of each

23

Name the two kinds of needle shafts and what they are used for

  • smooth (round-bodied)
    -placing suture material in soft tissues
  • cutting tip (e.g. triangular)
    -generally used for the skin only.