Theatre Practice COPY Flashcards
(358 cards)
1
Q
define sepsis
A
presence of pathogens of their toxic products in the blood/tissue of a the patient
2
Q
define asepsis
A
freedom from infection
3
Q
define antisepsis
A
prevention of sepsis by destruction/inhibition
4
Q
define disinfection
A
removal of microorganisms but not necessarily spores
5
Q
define disinfectant
A
agent that destroys microorganisms
6
Q
define sterilisation
A
complete removal of microorganisms
7
Q
define virulence
A
severity of disease
8
Q
what is a surgical site infection?
A
infection in a wound post invasive (surgical) intervention
9
Q
what are the 4 key factors which contribute to surgical site infection?
A
animal
personnel
theatre space and equipment
equipment, instruments and consumables
10
Q
what are the 2 key sources of contamination linked to an animal?
A
endogenous
exogenous
11
Q
where are endogenous sources of surgical contamination found on an animal?
A
within the body of the patient (naturally carried)
12
Q
where are exogenous sources of infection carried on an animal?
A
externally (e.g. on the skin/coat)
13
Q
what are 9 key considerations for the theatre space and environment?
A
layout surgery types performed and any procedures that are restricted materials on floor and walls lighting power points heating/air con presence of doors and windows minimal storage health and safety considerations
14
Q
what are the key factors to consider about the layout of a theatre?
A
should be a room on its own
easy to clean (4 walls and a floor!)
only one entry and exit to reduce footfall
15
Q
what is the ideal material for theatre walls/floors?
A
tiled or plastic as these are the easiest to clean
16
Q
what is the key consideration relating to lighting in theatre?
A
operating light which can be moved by the surgeon/scrub team aseptically
17
Q
what type of heating/ air con must never be used in theatres?
A
fans: risk blowing pathogens/ debris into surgical site
18
Q
why should there be minimal door and windows in theatre?
A
minimise environmental contaminants
19
Q
what is involved in the maintenance and cleaning of theatre?
A
SOP with daily, weekly and monthly tasks which will vary between practices
20
Q
what should be considered about theatre cleaning materials?
A
having separate items for theatre only that are properly washed after each use
21
Q
what may be involved in daily theatre cleaning SOP?
A
damp dusting prior to first op
clean of surfaces and equipment between patients
deep clean at end of day
22
Q
what are the 2 key ways items can be sterilised?
A
heat sterilisation
cold sterilisation
23
Q
what are the 2 methods of sterilisation in heat sterilisation?
A
autoclave
dry heat
24
Q
what type of heat is used in an autoclave?
A
steam
25
what are the 3 types of autoclave?
horizontal
vertical
vacuum-assisted
26
what is the most commonly used autoclave?
vacuum-assisted
27
why are vacuum-assisted autoclaves the most common seen in practice?
due to their drying cycle
28
what items may require cold sterilisation?
things that would melt in an autoclave (e.g. ET tubes, muzzles)
29
what are the 3 methods of cold sterilisation?
Ethylene oxide
Commercial solution (chemical/alcohol based)
gamma radiation
30
what are the 3 types of dry heat autoclaves?
hot air oven
high-vacuum oven
convection oven
31
what does the vacuum-assisted autoclave rely on to sterilise instruments?
steam penetration
32
as a rule what effect will increased pressure in the autoclave have?
reduced time of cycle
33
what are the 3 temperatures in a vacuum assisted autoclave?
121
126
134
(all centigrade)
34
in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 121?
PSI - 15
| 15 mins
35
in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 126?
PSI - 20
| 10 mins
36
in a vacuum assisted autoclave what is the pressure and time of cycle for a heat setting of 134?
PSI - 30
| 3.5 mins
37
what are the main considerations when using autoclaves to ensure they sterilise properly?
correct loading and packaging of instruments
maintenance of the autoclave itself with servicing and QA checks
monitoring efficacy of sterilisation
38
what are the 4 methods of monitoring autoclave efficacy?
chemical indicator strips
Bowie-dick indicator tape
Browne's tubes
Spore tests
39
what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?
TST strips
40
what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?
TST strips
41
what do TST strips show?
that the autoclave has reached correct temperature, time and pressure
42
where should TST strips be placed?
in the centre of the item to be autoclaved so that you can confirm that the middle is sterile
43
do you need different TST strips for different cycles?
yes
44
how do Browne's tubes show the efficacy of sterilisation within an autoclave?
change colour (orange/brown to green) when exposed to correct temperature and pressure for the correct length of time
45
what are the key issues with Browne's tubes?
glass - impractical
| correct tube must be chosen for the correct cyle
46
how does Bowie-dick indicator tape show efficacy of autoclave sterilisation?
stripes change do dark brown once 121 degrees is reached
47
is Bowie-dick indicator tape a reliable indicator of sterility?
no - only informs us that where the tape was the temperature reached 121 degrees
48
how do spore tests monitor the efficacy of autoclave sterilisation?
paper strips are impregnated with spores which should then be killed in the autoclave. The paper is incubated after autoclaving to ensure sterility
49
what are the benefits of spore tests for monitoring efficacy of autoclave sterilisation?
accurate
| good for quality assurance
50
what are the disadvantages of spore tests to show the efficacy of autoclave sterilisation?
there is a delay in results - not useful for instruments needed in surgery immediately
51
how does cold sterilisation using chemical solutions work?
items to be sterilised are immersed in the liquid for a set period of time
(follow individual instructions on bottle)
52
what must happen to instruments/equipment once it is sterilised using chemical solutions?
must be thoroughly washed as solution can cause chemical burns
53
what is gamma radiation often used to sterilise?
surgical gloves
54
what are the main considerations involved in packaging an instrument for sterilisation?
```
size of autoclave (will equipment fit!)
cost
time
effectiveness
labelling
sharp items (safety)
is TST strip needed
storage afterwards
```
55
when may a TST strip not be required?
single instrument
56
what should the sterilisation pouch be labelled with?
date of sterilisation
item enclosed
initials
(all permanent marker)
57
which way should items with handles be packaged?
handle towards the top of the bag so that when it is turned out the surgeon/scrub nurse is able to take the handle
58
why is double bagging ideal for all items?
protection of the sterilised item even if a tiny hole is made in the outer bag
59
why should theatre personnel be kept to a minimum?
increased personnel is an increased risk of infection
60
what are the main risks with moving around theatre?
accidental contamination of surgical site
61
what are the key recommendations for minimising risk of contaminating the surgical site when moving around theatre?
avoid excessive movement
unscrubbed personnel should never touch or lean over sterile field
unscrubbed personnel should ensure their clothing doesn't brush across trolleys/drapes
nobody should walk between scrubbed personnel and the surgical field
62
where should scrubbed personnel always be facing?
surgical field
63
what is the risk associated with scrubbed personnel turning their back to the sterile field?
may lead to contamination as your back is not sterile
64
how should scrubbed personnel pass each other?
back to back
65
what are the expected hygiene and appearance rules for theatre staff?
```
appropriate theatre clothing
good personal hygiene
fingernails short and clean with no nail varnish
minimal makeup
no jewellery
shower prior to entering theatre
```
66
what is included in general theatre attire?
scrubs (short sleeved)
comfortable, easy to clean theatre shoes or shoe covers
cap or hairnet
mask
67
what is the problem with wearing cover shoes in theatre?
can wear through
| still wearing outdoor 'dirty' shoes in theatre
68
define preoperative scrubbing up
systematic washing and scrubbing of the hands and arms
69
what are the 3 key purposes of a surgical hand scrub?
removal of debris and transient micro-organisms from the nails, hands and forearms
reduce the resident microbial count to a minimum
inhibit rapid rebound growth of microorganisms
70
why is it important that the antimicrobial used during a surgical scrub has good residual action?
inhibits regrowth of microorganisms for longer and so protects patient for longer
71
what are the 2 surgical scrub methods?
timed scrub or numbered stroke
72
where should you wash from and to during a surgical scrub?
clean to less clean (hand down to forearm)
73
why should the hands remain higher than the elbows at all times during a scrub?
allows water to flow from 'cleaner' hands to the less 'clean' area on the arms
74
in the numbered stroke method of preoperative surgical scrub what counts as one stroke?
one up and back motion is one stroke
75
describe the process of a numbered stroke scrub
remove all jewellery
wash hands and arms with antimicrobial soap
clean subungual areas with nail file
30 strokes over fingernails and nail tips
10 strokes each over all 4 'surfaces' of the fingers of the same hand - paying attention to webbed areas between fingers
10 strokes each over the 4 'surfaces' of the same hand
repeat above 3 stages on the other hand
10 strokes each over the 4 'surfaces' of each arm from wrists to 2" above elbows
rinse hands and arms by passing through water in one direction only fingertips to elbow
once in theatre hands and arms should be dried on a sterile towel following aseptic technique
76
during a scrub how should you view you fingers, hands and arms to ensure all areas are cleaned?
as a block of wood with 4 sides!
77
how should the stroke motion when scrubbing the 4 surfaces of the arm be made easier?
divide arm in half (wrist to mid arm, mid arm to 2" above elbow) and scrub 10 times each 'surface' in each half before moving on to the other half
78
during the scrub procedure what should be avoided?
excessive splashing onto surgical attire
79
how does a timed scrub differ from a numbered stroke scrub?
same principles - usually a 5-10 minute scrub but varies depending on scrub solution used
80
what are the 4 performance categories for surgical scrub agents?
antimicrobial action
persistent activity
safety
acceptance
81
describe the ideal scrub agent in terms of antimicrobial action?
broad spectrum
| rapid effect
82
describe the ideal scrub agent in terms of persistent activity
longer the residual/persistent activity lasts the lower the bacterial count will remain under the gloves
83
describe the ideal scrub agent from a safety perspective
non-irritating and non- sensitising
no appreciable occular or ototoxicity
safe for use
not damaging to skin or environment
84
describe the ideal scrub agent from the perspective of acceptance
well and properly used by vets/nurses
85
what are the 3 main forms that scrub agents come in?
liquid/foam soaps
impregnated scrub brushes/sponges
brush free scrub
86
what are the most common surgical scrub agents?
liquid or foam soaps
87
what are liquid/foam soaps used in conjunction with for a surgical scrub?
water and dry scrub brushes or sponges
88
what are the most common antimicrobial agents in liquid or foam soaps used for surgical scrubs?
chlorhexidine (CHG)
| iodophor
89
describe how to put on a surgical gown correctly
lift gown firmly and bring it away from the table
holding the gown at the shoulders allow it to unfold gently (do not shake)
place hands inside the arm holes and guide each arm through the sleeves by raising and spreading the arms
do not allow hands to slip outside the gown cuff
the circulator will assist by pulling the gown up over the shoulders and tying it
90
what is the best gloving technique to maintain asepsis?
closed gloving
91
where are hands kept during closed gloving?
inside the gown to minimise chance of contaminating the gloves
92
what may open gloving technique be used for?
bandaging/ changing wound dressing
93
what are the main parts of preoperative patient prep?
withholding food and water
bathing and grooming
clipping
94
when must water be removed from the kennel prior to surgery?
once premed is given
95
why is prolonged (over 12 hours) withholding of food prior to surgery unnecessary?
may increase risk of reflux
96
how long will most animals have food withheld before surgery?
6-12 hours
97
is bathing or grooming of the patient prior to surgery necessary?
worth considering - particularly a bath 1/2 days before to ensure animal is relatively clean
98
what should be checked before clipping begins?
blades are sharp and functioning well
clippers work!
the area to be clipped and the size
99
what must happen after clipping to the clipper blades?
must be disinfected
100
what must you be wary of with clipper blades particularly with a long clip?
they will get very hot - skin irritation/burn risk
101
why is it important that the clip is neat?
owner will see this and it gives an impression of the entire surgery
102
how should clippers be held during clipping?
pencil grip fashion to provide maximum control and menuverability
103
how should clippers be held against the skin to ensure the closest shave?
flat against the skin
104
when must extra care not to traumatise the skin be taken?
around bony prominences and thinned areas of skin (e.g. groin)
105
what is the best method for hair removal?
2 stroke method (unless hair is very short)
106
describe the 2 stroke method for hair removal with clippers
bulk of the hair is removed by clipping in the direction of the lie of the hair
closer clip is then achieved by clipping against the direction of the hair
107
what is the purpose of the 2 stoke method of clipping?
close surgical clip with minimal skin trauma
108
what must happen to the patient after clipping?
patient and area must be vacuumed to remove any loose hairs
109
where should clipping and vacuuming take place?
in prep - not theatre!
110
what else may be required pre-operatively?
```
enema
anaesthesia requirements (IV catheter)
eye lubrication
purse string sutures (e.g. anal surgery)
bandages (e.g. limbs)
throat pack placed (oral or nasal surgery)
any pre-op medication
```
111
what is the aim of aseptic skin preparation?
reduce skin contamination of microorganisms
112
where should skin prep be carried out?
in prep for 1st scrub and then theatre for second
113
describe the ideal surgical scrub solution
wide spectrum of antimicrobial activity
ability to decrease microbe count quickly, so allowing quick application
long residual effect
effective in the presence of organic matter
economical
safe for veterinary use and non toxic
extra considerations for occular use
114
name 3 commonly used scrubs
chlorhexidine (hibi)
povidone-iodine
triclosan
115
what are the key roles of a scrub-nurse?
counting or completion of checklist at start and end of procedure
passing instruments
suturing (skin closure)
holding/assisting with something in the surgical field
116
what is suture material used for?
suturing tissue/skin
| ligation (knot) around tissue
117
name 3 ideal properties of suture material
strong
non-irritant
knots well
118
define tensile strength
how much the suture material can be stretched before it snaps
119
define good knot security
knot will remain tight for as long as required
120
define tissue reaction to suture
how much the skin/vessel/organ responds negatively to the presence of suture - least possible
121
define capillarity
the ability of blood/fluid to move up the suture material - wicking effect
122
what level of capillarity is desirable in suture material used to close skin?
low so that blood doesn't leak from internally and lead to infection risk increase
123
define suture memory
whether suture holds it's shape when removed from packaging (not ideal)
124
define chatter
friction/grip of the suture against itself
125
define tissue drag
friction created as needle and suture pass through tissue
126
define stiffness and elongation of suture
rigidity of material and whether it stretches
127
define sterilisation characteristics relative to suture
should cope well wit sterilisation (high temp)
128
what are the 2 main types of suture?
absorbable
| non-absorbable
129
what are the 2 types of absorbable suture?
natural and synthetic
130
what are the 2 types of absorbable synthetic suture?
monofilament and multifilament
131
what is the only type of absorbable, natural suture?
multifilament
132
give an example of an absorbable, synthetic, monofilament suture
caprosyn
133
which suture types have less chatter and tissue drag?
monofilament
134
give an example of an absorbable, synthetic, multifilament suture
vicryl
135
what must happen to non-absorbable sutures?
must be manually removed
136
what are the 2 types of non-absorbable suture?
natural
| synthetic
137
what is the only type of non-absorbable natural suture?
multifilament
138
what are the 2 types of non-absorbable, synthetic suture?
monofilament
| multifilament
139
what are the 2 different ways of measuring suture size?
USP
| metric
140
what may be used to close wounds other than suture material?
staples
tissue glue
adhesive tapes (steri-strips)
141
what are the benefits of staples, tissue glue and adhesive tapes?
fast
easier
cheaper (some can be done with no GA)
142
what are the disadvantages of tissue glue?
stings a lot due to exothermic reaction it produces when working
risk of sticking to patient
143
what are the 3 basic components of a needle?
eye or swage
body
point
144
what is the difference between swaged and non-swaged needles?
swaged needles have suture material already attached so provide a smoother passage through the skin/tissue with less tissue trauma than non-swaged where the suture is seperate
145
label the 3 main parts of this needle and identify if it is swaged or non-swaged
A- point
B- body
C- eye
swaged
146
identify this needle shape
1/4 circle
147
identify this needle shape
3/8 circle
148
identify this needle shape
1/2 circle
149
identify this needle shape
5/8 circle
150
identify this needle shape
compound curve
151
identify this needle shape
straight
152
identify this needle shape
1/2 curve
153
what are the 5 main types of needle cross sectional shape?
```
conventional cutting
taper point
reverse cut
taper cut
special k
```
154
when are conventional cutting needles most often used?
tough areas e.g. skin
155
when are taper point needles most often used?
smaller viscera
156
what are the 7 different needle shapes?
```
1/4 circle
3/8 circle
1/2 circle
5/8 circle
straight
1/2 curved
compound curve
```
157
identify the needle cross section shape shown in the image
conventional cutting
158
identify the needle cross section shape shown in the image
taper point
159
identify the needle cross section shape shown in the image
reverse cut
160
identify the needle cross section shape shown in the image
taper cut
161
identify the needle cross section shape shown in the image
special k
162
what are the 4 most common materials instruments are made out of?
stainless steel
chromium plated carbon steel
tungsten carbide
titanium
163
what is the most common material used for surgical instruments?
stainless steel
164
what are the benefits of stainless steel surgical instruments?
great strength
highly resistant to corrosion
good appearence
165
where is tungsten carbide used in surgical instruments?
insert material in the tips of cutting/gripping instruments (e.g. scissors or needle holders)
166
what indicates that instruments have tungsten carbide in them?
gold handles
167
what is the advantage of tungsten carbide surgical instruments?
hard wearing
168
what is a disadvantage of tungsten carbide surgical instruments?
expensive
169
what are the disadvantages of chromium plated carbon steel instruments?
poorer quality so corrosion and pitting are likely to occur
| sharp instruments may blunt faster
170
what is the advantage of chromium plated carbon steel instruments?
lower in price
171
when may titanium instruments be used?
ophthalmic surgery due to their lightness and reduced glare under the microscope
172
what are the advantages of titanium instruments?
lightweight
173
hoe can titanium instruments be identified?
blue colouring
174
what is the disadvantage of titanium instruments?
very expensive
175
what are the 11 categories of common surgical instruments?
```
needle holders
scalpel holders
tissue forceps
haemostats/forceps
scalpel blades
scissor
towel clips
dissecting forceps
visceral clamps
retractors
suture removal
misc.
```
176
what are the main types of towel clamps?
cross action
| Backhus
177
what is the role of towel clamps?
holding drapes onto patients
178
what are the common types of scissors?
```
mayo
metzenbaum
iris
standard dressing scissors
castroviejo
```
179
what are the common types of suture removal scissor?
carless suture
spencer stitch
lister bandage/plaster
180
what are the key types of dissecting forceps?
```
plain tissue forceps
rat tooth/treves tissue forceps
adsons plain
adsons rat tooth
debakey
emmett
```
181
what are the common types of tissue forceps?
allis
babcock
duval
182
what are the common types of haemostats/artery forceps?
```
spencer wells - straight
spencer wells - curved
halstead mosquito
criles artery
rochester peans
kocher artery
dieffenback (bulldog) clamps
```
183
what are the main types of visceral clamps?
doyen may-robson
mayo robson
parker-kerr
184
what are the common types of needle holders?
```
gillies
olsen hegar
mayo hegar
mcphail
castroviejo
bruce clarke
```
185
what are the 2 groups of retractors?
self retaining
| handheld
186
what is the difference between self retaining and handheld retractors
self retaining have a mechanism which means they stay as they are left
hand held require an extra person to hold in the correct position (e.g. scrub nurse)
187
what are the common self retaining retractors?
```
gelpi
travers
west
cone
gosset
balfour
finnochietto (rib)
```
188
what are the common handheld retractors?
czerny
hohmann
volkmann (cairn) rake
langenbeck
189
what are some common speculums?
cusco vaginal speculum
williams eye
barraquer eye
190
what is some common diathermy equipment?
beare dissecting forceps
191
what is the main use for crocodile forceps?
removal of foreign bodies
192
what is the role of rampley sponge holders?
holding sterile swabs for patient prep
193
what is the role of cheatle forceps?
passing sterile instruments/items while unscrubbed
194
what else may be included with instruments within a kit?
swabs
195
when packing kits what should be placed on the outside of the autoclave bag?
kit label/name
196
identify this instrument and a key use
cross action towel clamp
197
identify this instrument and a key use (if necessary)
Backhaus towel clamp
198
identify this instrument and a key use
scalpel blade holder
199
identify this instrument and a key use (if necessary)
beaver scalpel and blades
200
how is a beaver scalpel best recognised?
hexagonal cross section of holder
201
identify this instrument and a key use (if necessary)
Mayo scissors - general purpose
202
what options are there for the blades of Mayo scissors?
straight or curved
203
how can Metzenbaum scissors be identified?
light, short blade and longer handle
204
identify this instrument and a key use (if necessary)
Metzenbaum scissors
205
identify this instrument and a key use (if necessary)
Iris scissors - ophthalmic surgery
206
identify this instrument and a key use (if necessary)
Standard dressing scissors
207
identify this instrument and a key use (if necessary)
Castroviejo scissors - ophthalmic surgery
208
identify this instrument and a key use (if necessary)
Carless suture scissor
209
identify this instrument and a key use (if necessary)
Spencer stitch scissor - has a notch in one of the blades to aid suture removal
210
identify this instrument and a key use (if necessary)
Lister bandage/plaster scissors - removal of large bandages and plaster
211
identify this instrument and a key use (if necessary)
rat tooth (Treves) tissue forceps - holding skin while suturing
212
identify this instrument and a key use (if necessary)
plain tissue forceps
213
identify this instrument and a key use (if necessary)
Adsons plain forceps
214
identify this instrument and a key use (if necessary)
Adsons rat tooth forceps
215
identify this instrument and a key use (if necessary)
Adsons rat tooth forceps
216
identify this instrument and a key use (if necessary)
Debakey forceps
217
how are Debakey forceps identified?
central groove on one side and a raised area on the other which fit together
218
identify this instrument and a key use (if necessary)
Emmett spay forceps - slim and long so used for spays
219
identify this instrument and a key use (if necessary)
Allis tissue forceps
220
how are Allis tissue forceps identified?
teeth on ends
221
identify this instrument and a key use (if necessary)
Babcock tissue forceps
222
how are Babcock tissue forceps identified?
rounded ends - no teeth
223
identify this instrument and a key use (if necessary)
Duval tissue forceps
224
how can Duval tissue forceps be identified?
triangular 'v' shaped ends
225
how are the serrations arranged on Spencer Wells artery forceps?
vertical (with instrument on it's side)
226
identify this instrument and a key use (if necessary)
Spencer Wells artery forceps
227
what forms do Spencer Wells artery forceps come in?
straight and curved
228
identify this instrument and a key use (if necessary)
Halstead mosquito - finer than Spencer Wells
229
what forms do Halstead mosquito artery forceps come in?
straight or curved
230
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Rochester Peans
231
how do Kocher artery and Spencer Wells differ?
Kocher artery has a rat toothed end, otherwise they are the same
232
identify this instrument and a key use (if necessary)
Dieffenbach (bulldog) clamps - soft tissue surgery
233
identify this instrument and a key use (if necessary)
Doyen May-Robson - GI surgery to occlude the intestine without damage
234
how do Doyen May-Robson clamps prevent damage to the bowel?
do not close flat along the full length of the blade
235
identify this instrument and a key use (if necessary)
Mayo Robson clamp
236
identify this instrument and a key use (if necessary)
Parker Kerr clamps
237
identify this instrument and a key use (if necessary)
Gillies needle holder
238
how can Gillies needle holder be easily identified?
angled thumb hole
239
identify this instrument and a key use (if necessary)
Olsen Hegar needle holder
240
what do Olsen Hagar needle holders have as well as needle holding area and rachet?
scissors
241
what are the most common needle holders?
Olsen Hegar
242
how do Olsen Hegar and Mayo Hegar needle holders differ?
Mayo Hegar do not have scissors
243
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Mayo Hegar
244
identify this instrument and a key use (if necessary)
McPhail needle holder
245
describe the grooves on the 'mouth' of a McPhail needle holder
not equal distance apart
246
identify this instrument and a key use (if necessary)
Castroviejo needle holder - ophthalmic surgery
247
what are the grooves within Castroviejo needle holders like?
not distinct
248
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Bruce Clarke needle holders
249
identify this instrument and a key use (if necessary)
Gelpi self retaining retractor - orthopedic surgery
250
identify this instrument and a key use (if necessary)
Travers self retaining retractor
251
how can you tell the difference between West and Travers self retaining retractors?
Travers - 4/5 prong combination
| West - 3/4 prong combination (3 is like a W)
252
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West self retaining retractors
253
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Cone self retaining retractor - stifle surgery due to hinged part which gives better visualisation
254
identify this instrument and a key use (if necessary)
Gosset self retaining retractor - abdominal wall retraction
255
identify this instrument and a key use (if necessary)
Balfour self retaining retractor - abdominal wall retraction with potential to retract organs at the same time (e.g. liver)
256
how do Gosset and Balfour self retaining retractors differ?
Balfour has an additional blade in the centre
257
identify this instrument and a key use (if necessary)
Finnochietto (rib) self retaining retractor - thoracic surgery
258
identify this instrument and a key use (if necessary)
Czerny handheld retractor
259
identify this instrument and a key use (if necessary)
Hohmann handheld retractor - orthopedic surgery
260
identify this instrument and a key use (if necessary)
Volkmann (Cairn) rake handheld retractor
261
identify this instrument and a key use (if necessary)
Langenbeck handheld retractor
262
identify this instrument and a key use (if necessary)
Cusco vaginal speculum
263
identify this instrument and a key use (if necessary)
Williams eye (retractor)
264
identify this instrument and a key use (if necessary)
Barraquer eye - ophthalmic surgery, holds eye open
265
identify this instrument and a key use (if necessary)
Beare dissecting forceps - diathermy (cauterisation)
266
identify this instrument and a key use (if necessary)
Crocodile forceps - removal of grass seeds/foreign bodies
267
identify this instrument and a key use (if necessary)
Rampley sponge holders - holding sterile swabs during patient prep
268
identify this instrument and a key use (if necessary)
Cheatle forceps - movement of sterile instruments/items by unscrubbed personnel
269
when was ASIF/AO established?
ASIF/AO was established in Switzerland in 1958.
270
What does ASIF/AO stand for?
Association for the Study of Internal Fixation / Association for Osteosynthesis
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what does ASIF/AO do?
Works in research, development, education and quality assurance in fracture treatment for the benefit of patients
272
What is the difference between a self-tapping and non self-tapping bone screw?
Self-tapping screw has cutting flutes of the tip with will enter the drill hole and cut a channel for the thread of the screw. Non-self tapping have smooth tips and require a tap to create a channel in the drilled hole for the threads to insert into
273
as a general rule what size should the screw be relative to the bone?
no more than 40% of the diameter of the bone
274
what is the main differnence between cortical and cancellous bone screws?
the type of bone that they drill into which informs their structure
275
what sort of screw is required when drilling into cancellous bone?
screw with a chunkier thread
276
why do screws used for cancellous bone need a chunkier thread?
as cancellous bone is spongy so a more chunky thread is needed in order to grip it
277
why can a screw with smaller thread be used in cortical bone?
cortical bone is much harder
278
of the 2 screws in this image which is the cortical and which is the cancellous bone screw?
cortical on the left
| cancellous on the right
279
what are the main 3 different types of bone plate?
dynamic compression plate
venables plate
sherman plate
280
describe the shape of the holes in the dynamic compression bone plate
oval holes
281
describe the shape of the edges (shoulder) of the dynamic compression bone plate (DCP)
sloping
282
what is the dynamic compression bone plate (DCP) used for?
causes compression so used with bone fragments
283
what screws hold dynamic compression bone plates (DCP) in place?
tapped screws (non-self tapping)
284
identify this bone plate
dynamic compression plate (DCP)
285
describe the screw holes of a Venables bone plate
round
286
how is a Venables plate held onto the bone?
by self-tapping screws
287
identify this bone plate
Venables plate
288
describe the outer edge of a Sherman plate
curved outer edge
289
by what type of screw are Sherman plates held in place on the bone?
self-tapping screws
290
identify this bone plate
Sherman plate
291
what is the role of a drill guide?
helps to prevent the drill bit slipping on the bone
292
identify this instrument and its main surgical area of use
drill guide - orthopedic surgery
293
what is the role of the depth gauge?
ensures that hole/tapped area is sufficiently long so that thread fully engages within the bone cortex
294
identify this instrument and its use
depth gauge - used to ensure that hole/tapped area is sufficiently long so that the thread fully engages into the bone cortex
295
identify this instrument and its use
depth gauge - used to ensure that hole/tapped area is sufficiently long so that the thread fully engages into the bone cortex
296
what happens once a hole has been drilled into bone and it's depth tested?
a thread will need to be cut into the bone using a bone tap or you can screw a self tapping screw straight into the hole
297
does each non-self tapping thread have it's own corresponding tap?
yes
298
identify this instrument and its use
Bone tap - taps drilled hole into bone to allow specific non-self tapping screw to be placed
299
what are the 2 types of head that screwdrivers need to have in order to fit screws?
hexagonal
| stardrive
300
what is the name of the head of this screw?
star head
301
what is the name of the head of this screw?
hexagonal head
302
describe the process of bone screw placement
1. a hole is drilled into the bone
2. the depth of the hole is measured using a depth gauge
3. a tap is used to create a thread in the bone or a self-tapping screw is used
4. a screwdriver is used to place the screw into the bone
303
identify this instrument and its role in surgery
Bone holding forceps - handle delicate bones (e.g. phalanges and metacarpals)
304
what is a key identifying feature of bone holding forceps?
has teeth to allow effective grip of bone without causing puncture damage
305
identify this instrument and its role
Liston bone cutters - used to cut through hard bone structures in order to to divide them or gain surgical field access
306
what is a key identifying feature of Liston bone cutters?
have a cutting edge
307
identify this instrument and its role
Bone rongeurs - used to make holes in bone, have a scoop shaped tip to facilitate this
308
what are the main handheld retractors used in orthopedic surgery?
Langenbeck, Senn and Hohmann
309
what are the main self-retaining retractors used in orthopedic surgery?
Gelpis, Travers and Wests
310
what is the name of these instruments and their role?
periosteal elevator - lifts and preserves periosteum
311
are all periosteal elevators the same?
no - have may different tips
312
what is the freer elevator used for?
spinal surgery
313
what is different about the Freer elevator than periosteal elevators?
Freer elevator is double ended
314
identify this instrument and it's role
Freer elevator - spinal surgery
315
what is the role of bone curettes?
They are sharped edge spoons used to cut and scope cancellous bone and remove cartilage
316
what is an example of a bone curette?
Volkmann scoop
317
identify this instrument and its role
Volkmann scoop - cut and scoop cancellous bone and remove cartilage
318
why may power tools be used during orthopedic surgery?
will reduce fatigue
319
what are 2 examples of power tools used in surgery?
drills and saws
320
identify this instrument
power tool handle (either saw or drill)
321
identify this instrument and its function
plate holder - holds bone plates
322
identify this instrument and its role
plate bender - bends bone plates
323
what are the 4 key types of orthopaedic wires?
arthrodesis wire
Kirschner wire
intermedullary (Steinmann) pins
cerclage wire
324
describe the end of Arthrodesis wire
both ends trocar
325
describe the ends of Kirschner wire
one end bayonet the other end flattened
326
describe the ends of intermedullary (Steinmann) pins
both ends sharp
327
identify this orthopaedic wire
Arthrodesis wire
328
identify this orthopaedic wire
Kirschner wire
329
identify this orthopaedic wire
intermedullary (Steinmann) pins
330
identify this orthopaedic wire
cerclage wire
331
identify this instrument
wire twisters
332
identify this instrument
graft/suture passers
333
identify this instrument
stifle distractor
334
define gossypiboma
Inflammatory response to a surgical sponge or a laparotomy pad left involuntarily in the body after a surgical procedure.
335
how is gossypiboma caused in veterinary surgery?
Failure to account for all surgical swabs used during a surgical procedure, it is iatrogenic – only caused by human negligence/error
336
What standard operating procedures could be put in place to minimise the risk of a gossypiboma?
Presence of a circulating or scrub nurse as standard
Use of radiopaque swabs so that presence can be easily identified with X-Ray
Ensure swabs are placed in properly counted bundles (e.g. of 5) before inclusion in kit and sterilisation
Count done before surgery of number of swabs in kit by scrub nurse
Swab count written on whiteboard in theatre clearly
Use of lap swabs due to increased size and tag which can be attached to
337
What is the role of the Veterinary Nurse in minimising the risk of a gossypiboma?
Counting of used swabs, trolley management and effective communication with theatre staff. Use of whiteboard and involvement in counting in and out all used swabs. Awareness of what is within a kit when packing it and ensuring correct amounts of swabs/other items are included every time so that a count is reliable.
338
What is a surgical safety checklist?
List of tasks followed before anaesthesia, before the procedure begins and after procedure has ended before anyone leaves theatre. Aims to minimise error or accident within the surgery that could be caused by human error. patient safety communication tool that is used by a team of operating room professionals
339
Why are surgical safety checklists used?
Removes element of human error and ensures that nothing is missed
340
when should clipper blades be cleaned?
between every patient use - with clipper disinfectant spray and brush
341
what is the source of most SSI?
endogenous flora of patients own skin
342
where does 80% of resident and transient skin flora reside?
in the first 5 levels of the epidermis
343
where does a surgical scrub need to reahc?
first 5 layers of the epidermis
344
how should scrub be applied to the patients skin?
sterile supplies (gloves, kidney dish, swabs) or no touch technique (e.g. Chloroprep)
345
why does pressure need to be applied to skin surface during scrub?
friction increases the antibacterial effects of an antiseptic
346
describe the correct surgical scrub technique
Block in centre over incision - left to right and up and down within this block until swab is clean
Then move out in lines on each side of the block until you reach the hairline
347
what is the correct dilution of 4% hibiscrub?
50:50
348
why should gloves be worn during initial skin prep?
provides a barrier between the patient and healthcare worker
| protection against CHG hypersensitivity
349
what type of antiseptic is best for skin prep?
2% CHG with 70% IPA
350
what antiseptic will be used for sensitive mm?
aqueous povidine iodine
351
does significant cleaning action occur from antiseptic spray?
no - lack of friction
352
why is friction prep more effective?
gets into more aspects of the skin
353
where should the skin prep be performed from and to?
from incision site to periphery
354
where should the further edge of the Chloraprep applicator be kept?
pointing towards edge of clipped site
355
identify this instrument and a key use (if necessary)
Kocher artery
356
identify this instrument and a key use (if necessary)
Adsons rat tooth forceps
357
identify this instrument and a key use (if necessary)
Adsons rat tooth forceps
358
what is the name of the most common chemical indicator strips used to monitor autoclave efficacy?
TST strips
