Theory Unit 2 Exam Objectives

Question 1

Identify parts of a surgical instrument

Answer 1

Tips
Jaws
Box lock
Shank
Finger ring
Ratchets

Question 2

List types of endoscopes and a purpose for each.

Answer 2

Colonoscope
Cystoscope
Laparoscope
Arthroscope
Ureteroscope
Angioscope

Question 3

Identify types of powered instruments and a surgical application for each.

Answer 3

Reamer-driver
Application: Ream medullary canal or ream acetabulum
Images to follow
Reamers=slower; more torque; used to ream bone
Drills
Application: Drill holes in bone
Drills=fast; used to place pins or drill pilot hole for screws
K-wire driver
Application: Insert pins into bone
Dermatome (can be electric, battery or hand operated)
Application: Take skin graft
FYI: Very fast side-to-side action; disposable blade; very precise depth
Meniscutome (AKA: arthroscopic shaver)
Application: Used to trim damaged joint cartilage
Cranial perforator
Application: Drill burr holes in skull
Craniotome
Application: Connect holes drilled in the skull to remove a bone flap

Question 4

List types of power sources for powered instruments.

Answer 4

Compressed air or nitrogen
     Piped in (wall outlet)
     Tank of compressed nitrogen
Electric (alternating current [AC]; plug cord to outlet)
Battery (direct current [DC] electric)

Question 5

State aspects of the care and handling of surgical powered instruments.

Answer 5

clean concurrently during surgery
don’t submerge in water with your instruments
don’t kink cords on air-powered tools
keep safety latch on when assembling parts
batteries must be flashed or Sterrad-processed because power drains out when stored
always consult manufacturer’s recommendations for assembling, cleaning, and sterilizing

Question 6

Suture (noun)

Answer 6

Thread-like material used to close wounds and anatomic structures

Question 7

Suture (verb)

Answer 7

The act of closing a wound or structure

Question 8

Ligature/tie

Answer 8

Suture used to tie (ligate) vessels or other structures

Question 9

Suture ligature/stick tie

Answer 9

Suture with needle used to tie (ligate) vessels or other structures

Question 10

Ligature reel

Answer 10

Long strand of suture on a spool

Question 11

Free tie

Answer 11

Single strand of suture used to tie (ligate) vessels or other structures

Question 12

Instrument tie (on a pass)

Answer 12

Single strand of suture loaded on an instrument used to tie (ligate) vessels or other structures
Usually a Mixter clamp, sometimes a Schnidt or a hemostat

Question 13

Absorbable

Answer 13

Characteristic of suture that is capable of being broken down (dissolved) by the body’s enzymes

Question 14

Non-absorbable

Answer 14

Characteristic of suture that is able to resist being broken down (dissolved) by the body’s enzymes

Question 15

Monofilament

Answer 15

Characteristic of suture that consists of a single strand; one thread

Question 16

Multifilament (braided)

Answer 16

Characteristic of suture that consists of several strands braided into one thread

Question 17

Ligate

Answer 17

To tie off a structure (blood vessel, duct, uterine ligament, etc.)

Question 18

Controlled release

Answer 18

Needle comes off suture when pulled purposely

Question 19

Primary suture line

Answer 19

The suture line that holds the wound together; e.g.; Fascia of abdominal wall

Question 20

Secondary suture line

Answer 20

Supports primary line by easing tension; also used to obliterate dead space

Question 21

Continuous suture

Answer 21

Series of stitches made with the same strand, tied only at the ends

Question 22

Interrupted suture

Answer 22

Series of stitches made one stitch at a time and tied individually

Question 23

Retention suture

Answer 23

Large, interrupted sutures placed lateral to primary line as wound reinforcement; usually used for patients with obesity or patients who smoke

Question 24

Purse-string suture

Answer 24

Continuous suture placed around a lumen and closed like a drawstring
Just like your scrub pants!

Question 25

Subcuticular suture

Answer 25

A method of closing a skin incision by placing continuous stitches just under the skin

Question 26

Traction suture

Answer 26

Sutures placed to hold a structure out of the way temporarily, e.g., dural flap

Question 27

State information contained on the primary packet of a suture.

Answer 27

Name of suture: brand and generic Characteristics of suture Mono/multi (braided); color; absorbable/not-absorbable Size (e.g., 3/0, 7/0) Type of needle; name and image Length of strand, manufacturer, order #, expiration date

Question 28

Explain the meaning of an expiration date on a suture package

Answer 28

Pertains to the quality of the suture material. This is the date beyond which the manufacturer will no longer guarantee the quality of the suture NEVER use suture that has expired because depending on the type the suture degrade over time and lose tensile strength.

Question 29

MATCH SIZES AND TYPES OF SUTURES WITH COMMON USES

Answer 29

#1 Closure of orthopedic wounds/tissue layers Closure of abdominal fascia 0 Closure of orthopedic wounds/tissue layers Closure of abdominal fascia 2/0 Closure of superficial orthopedic wounds/tissue layers Closure of some general surgery wounds/tissue layers Proximal aortic anastomosis 3/0 Subcuticular skin closures GI anastomosis Peritoneum closure 4/0 Subcuticular skin closures GI anastomosis Peritoneum closure Dura closure 5/0 and 6/0 Vascular anastomosis (FYI: radial and ulnar, distal femoral, popliteal, and carotid arteries) 7/0 Vascular anastomosis (FYI: coronary and carotid arteries) 8/0 – 11/0 Microvascular anastomosisOphthalmic tissue Absorbable sutures are used for Tissues that do not need continued support or tissues that heal quickly (FYI: rapidly growing tissues such as mucosal layers, peritoneum, or that don’t need as much support such as subcutaneous fat, subcuticular skin closure) Non-absorbable sutures are used for Tissues that need continued strength or tissues that heal more slowly (FYI: heart, blood vessels, dura, fascia, skin)

Question 30

Identify basic parts of a needle.

Answer 30

Point body (or shaft) eye

Question 31

Identify needles by the eye, body, and point.

Answer 31

Needle eye Closed eye; French eye; Eyeless (AKA: swaged) Needle body Straight; 3/8 circle; ½ circle; 5/8 circle Needle point Taper; blunt; cutting (various types of cutting FYI: conventional, reverse cutting, side cutting)

Question 32

List purposes or uses for each of the following types of needle points: cutting, taper, and blunt

Answer 32

Cutting (conventional cutting only) Skin Taper General closure, Intestine, Blood vessels Blunt Friable tissue; liver, kidney, spleen FYI: sharps safety issues – companies are working on making all needles blunt to reduce injuries

Question 33

State advantages of staples/stapling devices.

Answer 33

Less tissue reactionoFaster wound healing due to decrease tissue trauma Faster than sewing; decrease OR and anesthesia time Airtight, leak-proof anastomosis or closure Also: Can be applied endoscopically Makes a smooth, hemostatic edge

Question 34

Identify the two types of electric current.

Answer 34

``` Direct current (DC) Such as batteries Battery-powered saws/drills Dermatome Flows from negative to positive pole Alternating current (AC) ```

Question 35

Trace the flow of current in a monopolar and bipolar electrosurgical unit (ESU).

Answer 35

``` The flow of current in a monopolar ESU goes from: Generator to Active electrode to Patient tissue to Inactive electrode Back to generator The current in a bipolar ESU flows from: Generator to Active electrode (one prong of forceps) to Patient tissue to Inactive electrode (other prong of forceps)• Back to generator ```

Question 36

State safeguards to use when placing an ESU dispersive grounding pad (inactive electrode) for monopolar units.

Answer 36

Apply pad after final positioning is completed To prevent wrinkling, gapping, or movement of pad Place on a large muscle mass More tissue and better since it has good vascular supply and more dispersal area for current The area must be clean and dry So pad adheres to skin and current doesn’t “jump” to pad causing a burn Not placed over bony prominence Bone is dense; lots of resistance and can concentrate current Do not place on buttocks of supine patient Pad is not visible and could have uneven placement Not placed over area of a metal prosthesis Metal concentrates current and can cause heat/burn Handle pad as little as possible To maintain gel for adherence and conductivity Pad must have full contact with patient’s skin Prevent wrinkling or tunneling causing a burn If gel is dried (such as package open too long) do not use To maintain pad conductivity Place near operative site if possible Minimize amount of current traveling through body But don’t sacrifice muscle mass for nearness to site Do not remove pad and replace, start with new To maintain pad adherence and conductivity Area must be free of scars (such as skin graft) Scars = increase tissue density = increase resistance to free flow of current to pad Site is free of hair (clippers used PRN) To ensure complete pad adhesion to skin

Question 37

List the components (parts) of a laser system

Answer 37

Energy pump or excitation source Lasers are named by the medium contained here; e.g.; KTP Laser head Ancillary components (console, cooling system, vacuum) Control panel Delivery system

Question 38

List types of laser systems

Answer 38

``` Argon CO2 Nd: YAG Krypton Excimer ```

Question 39

List facts about the harmonic scalpel.

Answer 39

Uses ultrasonic energy rather than delivering electrical current Cuts and coagulates tissue at point of contact Vibrations denature proteins; seals vessels No charring or damage to adjacent tissues Precise; coagulates at lower temperature Less thermal damage; less vaporized plume No grounding pad necessary Generator converts electrical energy into mechanical energy Hand piece (may be disposable or reusable) Single use blade (other tips also available; supplies) Blade moves by ultrasonic motion 55,000 movements per second

Question 40

The role of the surgical technologist in robotics

Answer 40

We are scrubbed in Positioning of the side cart in relation to the patient and site Connecting electrical cords and equipment System testing Loading and switching instruments in the manipulators Trouble-shooting the system and instruments

Question 41

List examples of specialty surgical equipment and purpose/s.

Answer 41

Electrosurgical unit Microscope Illuminates and provide magnification to a small area Light source/Headlight Provide additional illumination of surgical site Video camera Capture image of surgical site Video monitor Displays image of surgical site Insufflator Fill abdominal cavity with CO2 especially during laparoscopic procedure – important pressure is 12-15 mm Hg High pressure irrigator (aka. pulse lavage irrigator) Pulsed lavage of wounds; trauma and total joint irrigation Low pressure irrigator Joint distension for arthroscopy Phacoemulsifier-I/A unit Cataract extraction “I&A” - irrigation and aspiration Cryotherapy unit To freeze an area of tissue Especially during retinal detachment CUSA Cavitron Ultrasonic Aspirator Remove brain tumors Navigation systems Used to provide imaging and tracking of instrument position in surgical site Nerve stimulator Identify nerve branches especially during total thyroidectomy or parotidectomy Also used to assess neuromuscular blockade by anesthesia provider Suction unit Vacuum blood or fluid from an area Pneumatic tourniquet A machine that reduces blood flow to an extremity by applying pressure SCD unit Reduce chance of thrombosis Cast cart Contains all supplies and equipment needed to apply/remove a cast Crash cart For cardiac arrest; contains meds and defibrillator Vascular cart Contains items needed to perform vascular surgery including sutures, grafts, catheters, vessel loops, etc.

Question 42

State safety precautions for use of pneumatic tourniquets.

Answer 42

Place on long bones only (humerus, femur) NEVER at joint because superficial neurovascular structures pass at joints Place soft roll padding under cuff to prevent pinching of skin Use correct length and width (2"-3" overlap) to avoid excessive pressure caused by too much double-wrapping of cuff Don't let prep solutions pool, keep cuff dry Record tourniquet time Elevate extremity before inflating or exsanguinating

Question 43

Identify parts of a surgical instrument

Answer 43

``` Tips Jaws Box lock Shank Ratchets Finger Ring ```

Question 44

Instruments classification

Answer 44

``` Cutting/dissecting Grasping/holding Clamping/occluding Retracting/viewing Accessory ```

Question 45

Identify supplies and state purpose or use for each.

Answer 45

SPONGES Laparotomy Commonly used during abdominal and orthodox surgery to protect wound edges andsoak up blood GYN to pack intestines out of the way Raytecs Soak up blood Kitner dissecting Used for “blunt dissection” Tonsil sponges Pack in tonsil and adenoid spaces to provide temporary hemostasis DRESSINGS Non-adherent dressings: Telfa First layer, comfort, allows seepage Op-site (or Tegaderm) able to keep wound dry and allow visual inspection of incision Steri-strips Support wound edges when subcuticular closure is performed 4x4 gauze soaks up minor wound drainage ABD - or combine dressing used when significant drainage expected Surgical tape Secure dressings in place Coband In orthopedics to secure stockinette or dressings around an extremit Ace wrap to secure dressings on an extremity Kling wrap to secure dressings on an extremity Kerlix Bulky pressure dressing, extremity Cast Padding Place under cast to protect skin OB pad/peri-pad For vaginal drainage post C-section or vaginal procedure CATHETERS Robinson catheter to empty the bladder Foley catheter Indwelling catheter to provide continuous bladder drainage Foley catheter 3-way three-way for continuous drainage and to irrigate bladder post-TURP; also provides hemostasis post-TURP DRAINS Penrose drain Passive open wound drain, rarely used; Retract spermatic cord during open inguinal herniorrhaphy T-tube drain Passive drain for common bile duct after an open common bile duct exploration Pezzer used to drain hollow organs like bladder Malecot used to drain hollow organs like bladder Hemovac; Jackson-Pratt; Blake; J-vac Used to drain joint spaces, the brain, abdome Chest tube to re-establish lung inflation (negative pressure in thoracic cavity) and drain fluid (with Pleur-evac) after thoracoscopy or thoracotomy Pleur-evac A closed drainage and negative pressure system for chest tubes TUBES Naso-gastric suction tub evacuate contents of stomach with suction Tracheostomy tube provide temporary or permanent airway Endotracheal tube ventilate patient during surgery and if necessary postoperatively. Temporary only Pharyngeal airway keep patient's tongue out of the way - to facilitate ventilation when using mask anesthesia delivery Laryngeal Masked airway (LMA) A device used to facilitate ventilation under general anesthesia; limited applications Syringes and needles Bulb syringe provide irrigation and suction in small amounts Bulb with barrel syringe irrigate wounds and surgical site Plain tip syringe to administer medications and for subclavian venipuncture Luer-loc syringe administer medications Finger control syringe administer medications TB syringe used when amounts & measurements are small Hypodermic needles To inject medications Spinal needle To administer spinal or epidural anesthesia Miscellaneous supplies Suction tubing evacuate blood from operative site Electrosurgical hand piece disposable active electrode used to deliver electric current to bleeding points ESU tips ESU tip cleaner To clean debris from non-coated ESU tip Sharps container to keep track of needles and other sharps; sharps safety and disposal Magnetic instrument pad keeps instrument from sliding off patient in lateral position Light handle covers To allow adjustment of surgical lights without contamination Esmarch bandage T o exsanguinate limb prior to inflation of tourniquet Ligaclips/Hemoclips To occlude a blood vessel Skin marking pen To mark surgical site; to label medications on back table Medicine cup To hold medications on back table Specimen cup For small specimens, foreign bodies, or implants removed from patient Y-connector To connect 2 chest tubes to Pleur-evac