Rgical Equipment And Supplies Chapter 1

Front 1

Steam sterilization

Back 1

Most common and effective

Used for items not easily damaged by mositure and pressure

Pressure for certain amount of time before it can render an item sterile

Temperature must be 250-270 F

15pig (pound prr square inch guage)

Front 2

Types of Steam Sterilization

Back 2

Prevaccum and gravity displacement

Front 3

GRAVITY DISPLACEMENT

Back 3

Air pushed downward (by gravity) and out through a valve by pressurized steam/make sure loaded properly if not can trap air which will act as an insulator against the insulator against the steam/ any intems in this pocket wont be sterilized

Minium exposure time 250 F depends on item load and very 15 - 45 mins..complete sterilization two hours

Front 4

What is this

Back 4

Cold chemical Sterilization (Steris)

The most common form of cold chemical sterilization used in the old are is periactic acid steris system this method of sterilization provide chemical irrigation on the item for 20 30 minutes to sterilize . This method can be used only for items that can be fully immersed in fluid example some cameras scopes and chords when handling the scope in must be placed in the stratis machine before it is used remember the cup contains 35% of periatic acid which can cause severe burns and blind as it comes in contact with unprotected skin or eyes personal protective attire such as eye wear gloves and long sleeve collar jacket should be worn when removing the cup from the package and placing into the machine. The same attire should be worn when removing the used cup from the machine at the end of the cycle. Therefore the best way to test effectiveness is with a stick.

Front 5

GAS PLASMA STERILIZATION

Back 5

Gas plasma sterilization is a relatively new method of sterilization that employ the use of low temperature hydrogen peroxide gas plasma technology items are heat or moisture sensitive that can be safely sterilized using this method this method came on as an alternative to EO sterilization. The system does have some limitations linens liquids and cellular cannot be sterilized using this system with some of the stereo system there may be limits on the length and the diameter of the Lume and instruments that can be effectively sterilized.

Front 6

Cold chemical used to sterilize immersible items are?

Back 6

Glutaraldehyde (Cidex of Cidex OPA). Problem with using glutraldehyde as a sterizer and is that an order for some to be Deem sterile it must be soaked about 10 hours in a tub of solution to extend life cycle add to Cidex Surafactidant will last for 27 days. This longer soak makes it impractical to use in most cases in the o.r it is however used as a high-level disinfectant for endoscopes caution before placing any scope to soak in solution make sure it's clean and dry any debris or water left on an item can negatively affect the concentration of the solutions run can make it less effective it is about 2% effective must check with a stick.

Front 7

EO (ETHYLENE OXIDE) GAS STERILIZATION

Back 7

EO is a flammable toxic liquid that is combined with inert gas to produce sterilization this type of sterilization is used for delicate items that is those that cannot withstand heat pressure or moisture do penetrates wrappers and other materials that other sterilization methods may not as was all sterilization methods items must be thoroughly cleaned prior to sterilization the main disadvantage to EO is the toxicity any sterile processing center that uses EO must have devices through the area that monitors for leak or unsafe levels of you if a leak is detected the area must be evacuated and a hazardous Matt materials team must called in to deal with the problem exposure to EO has been associated with leukemia respiratory damage possible birth defects and neurological degrees this process is needed to take the debris out for 8 to16 hours for aeration so is that the toxic gases does not affect the patient.

Front 8

What is this?

Back 8

Another attire that the personnel are required to wear during certain procedures as a lab apron also referred to as a lead gown the apron should have an attached shield but lead apron and the thyroid shield Is pulled over the scrubs before scrubbing underneath the sterile gown of the scrubs personnel the lead apron is used whenever there is going to be exposure to radiation during the procedure there are several styles of lead Aprons one and two piece of with a skirt one that completely wrap around the body in one that covers around the persons front sides these aprons cannot be used with any other type of extra machines except for the c-arm if no lead gown patient must be 6 feet away from the x-ray machine

Front 9

Is this the proper way to hang the lead apron?

Back 9

No never do this led will break and won't protect your body from anything radiation before scrubbing always hang your lead apron up never fold it never crumble it they should not be folded or heat in piles let Avery should be checked to make sure they are not cracked or torn Cracked can compromise the integrity of the shield and decrease its effectiveness

Front 10

What are they wearing?

Back 10

Barrel space suits genesis of a regular sterile down and Esthero hood that's completely covers the head and face that's good has a convex clear full facial that resemble the hood use my ass wants the hood has a self-contained battery operated fan in the top of the hood that allows for ventilation the fan is place to a plastic headpieces that is placed on the scrub personnelles had power describing the battery pack is worn on the persons waist and hood is placed over the plastic frame on the person this type of attire is required to some precedures such as during total joint replacement cardiothoracic sore neurosurgery the theory behind this attire is that it cuts down on contamination from respiratory droplets and uncovered

Front 11

What is the function of each part of the OR tables?

Back 11

The body of the table usually consists of two parts with a break in between them the break allows for each piece to be flexed.

Front 12

What positon is the Or table positioned in during Kidney surgery?

Back 12

During kidney surgery elevate the table where it says kidney Rest which is set when the patient is in the Lateral Positon. When you raise the kidney rest you raise it so that the surgeon has more room to create the incision and to work on the side where the kidney is located when the surgeon is done the surgeon will lower it the kidney rest so that the skin can approximate properly. During this process is important to stabilize the patient while they are in the lateral position with beanbags underneath of the patient patient which are vacuum bags which are filled with air these bags are folded under the patient to keep the patient in lateral position.

Front 13

What is this used for?

Back 13

A Mayfield headrest is used for Neurosurgery specifically for some craniotomy procedures it generally is used to hold the head still when the patient is in prone or in fowler sitting position the headrest is attached to the patient's skull using sterile pins this headrest is attached to the patient by the surgeon and positioning is done with the surgeon present.

Front 14

What is this used for??

Back 14

Gardner tongs are used for brain head neck the slightest motion can damage so this is screwed into the temple for brain surgery to stabilize during neuro surgery procedures specifically craniotomies it is always having to be sterile and penetrate skull bones to immobilize the head.

Front 15

What are these used for

Back 15

Shoulder braces are used in the trendlenberg position to stop a patient from sliding down they are there to prevent the patient from sliding up word office of the bed as well. Caution should taken with these braces as improper positioning of the braces could cause undue pressure to the nerves and muscles of the shoulder resulting in injury to the patient shoulder braces should be applied only by personnel from familiar with this.

Front 16

What is this used for?

Back 16

Candy cane stirrups support the foot in the heel of the patient in a lithoatomy . These sirrups are used for GYN procedures care must be taken to make sure the side of the patients lower leg is not resting on the metal post of the candy canes stirrups do not place the sling directly over the Achilles area as damage can cause injury to the peroneal nerve. This is usually used in a lithoatomy procedures if not instead can damage to the peroneal nerve can cause foot drop

Front 17

What is this used for

Back 17

A beach chair also known as the captain's chair is attachment used to support the patient in the upright sitting position for shoulder surgery or for mammoplasty procedures the patient's head is strapped in the head and the nonoperative arm is strapped to the patient's waist specifically designed for disposable padding used with this positon. Patient positioning is in the Fowler positon or Semi Fowler position. The positioning of the pad has to be placed underneath the patient in order to not affect the sciatica nerve which ipasses through the Butox of the patient.

Front 18

What is this used for?

Back 18

Knee crutch stirrups support under the knee and area just above and below the knees they're generally use for short duration knee arthroscopy or side of cystoscopy procedures care must be taken to properly provide and position the stirrups to prevent popiteal nerve damage

Front 19

Frames for lumber surgery

Back 19

The Wilson frame is used to support a patient or so in a flex prone position this frame is used for surgeries of the lumber spine including laminectomy as well as diskectomy and microdiskectomy as well as an insertion of bladder control stimulas. The patient is sitting in a prone position face down in the hole in order to prevent respiratory compromise.

Front 20

Andrews Frame

Back 20

Andrew's frame is used to support the patients in the knee chest position for surgery on the lumber spine this frame is mounted on the bottom and end of the OR table or the foot piece has been removed the patient is Anesthesized in a supine position and carefully rolled prone and into the new position on the frame ventilation is a major concern with the use of this pain make sure the chest has room to expand once the patient is position.

Front 21

What is this used for

Back 21

Also known as a prep tables can be used for variety of things it is used for catherization or for skin prep when it is covered it can be use to hold the basin and other supplies for the skin pack or four separate sterile field used for a local anesthesia supply set up for stigmoidoscopy be unsterile to be used to hold paperwork specimen container. scales or other items

Front 22

What is this used for

Back 22

X-ray viewing boxes are mounted on the world is illuminated boxes allow patient films to be viewed during the procedures the boxes should be checked prior to the start of the case to ensure they are functioning properly

Front 23

What is this?

Back 23

OR sometimes have gas nitrogen oxygen and nitrous oxide functions and electrical outlets built in the column which vary in style and size that are mounted on the ceiling the different color wires are yellow for compressed air green for nitrogen black for nitrous oxide which is used for inhalation anesthesia gases black for nitrogen which is for the power tools and the yellow which is the compressed air which runs the whole machine

Front 24

What is this used for?

Back 24

X-ray cassette holders are mounted on wheels so they can be moved easily the height of the bars can be adjusted to accommodate several cassettes sizes these holders are used to hold the cassettes in place when lateral x-rays are needed interoperatively the holders and cassettes are not sterile therefore they must be draped by using a sterile have great if they are moves close to the surgical field . The circulator is the one that places the non sterile film in the steril cassette holder during the procedures in order for the film to remain sterile.

Front 25

Lead door

Back 25

Lead doors are used during precedures in the case that one forgets to don their lead aprons before the precedure

Front 26

ELectrosurgical Units

Back 26

The surgeons could now cut and coagulate active tissue with the push of a button or touch of the foot pedal instead of having to tie off each bleeding blood vessel individually some forms of electrosurgery is used in the most in most procedures common types of electrosurgery be mono poly and bipolar and Argon beams as well as parts of the electrosurgical unit active and inactive left choice and bipolar devices Argon beams.

Front 27

Back 27

This is the control panel for the electrosurgical generator there are three parts of it a grounding pad dispersive patient return electroid an active passive and negative most electrosurgical units are capable of producing two modes of current monopolar and bipolar

Front 28

Monopolar electrosurgery

Back 28

Monopolar is the most commonly used form of electrosurgical current form any surgeries in mono polar mode electrical current goals from the ESU generator to the hand piece called the pencil this is the active electrode wearing contacts the tissue once a tissue is contour cauterized the current travels through the patient's body until it goes to the grounding pad called the dispersive had this is the inactive electro the current exist through the grounding pad back to the generator and ground. When using the money polar current-mode it is essential that the patient have a properly plays grounding or dispersive patch in active or passive electroid on their skin most modern ESU generators will not work unless the grounding pad is plugged into the proper outlet if the patties, lose or is unfolded itself an alarm will sound however the staff person applying at dispersive had is responsible to make sure it is properly applied and then probably or misplace patties with the potential to cause burn to the patient's skin. This form of electrosurgical current both cuts and coagulates. The active electrode ( laposurgical pencil bovie) are interchangable count as sharps

Front 29

Bipolar Electrosurgery

Back 29

In bipolar elective surgery the current passes from one kind of the forceps to the other the current never passes through the patients the power is less than what can be achieved with the monopolar device and is used for cauterization during neurosurgery or on delicate issues the current does not passing the patient doesn't dispersive or grounding pad is not necessary if the patient is going to use both morning polar and bipolar crying during the procedure I didn't person electro pad must be placed on the patient this is only used for coagulation does not cut.

Front 30

Argon beam machine

Back 30

Argon coagulation use of the combination of argon gas and monopolar electrosurgery to coagulate tissue within the machine the gas is ionized making it electrically conductive this provides a more efficient pass for the current to travel along the tissues the tip of the instrument does not need to touch the tissue the beam of the ionized coagulation being within 2 to 10 millimeters of the tip Argan instrument produces less tissue damage less smoke plume and less charming that traditional electrosurgery methods do it still needs a grounding pad and it can be used by touching and instruments and having the electrical current go through through the instrument directly into the penetrated area.

Front 31

What are the different medical Gases

Back 31

Air-yellow

Cardon dioxide-gray

Cycloprone (anethestic gas)

Helium (brown)

Nitrogen (black)

Nitrous oxide (blue)

Oxtgen (green)

Front 32

What is this used for?

Back 32

The pneumatic tourniquet is used to create a bloodless surgical area by limiting circularization to a patient's operative limbs sometimes it can be used in the administration of regional anesthesia this device is used for procedures involving the knee lower leg ankle foot distal humerus elbow fore arm wrist and hand . It is hooked to an inflation machine to bang this room is the exsanguinated using an Esmarch bandage seen above once the limb has been exsanguinated the cuff can be inflated the surgeon is the one who decides at what point the cuff should be inflated and deflated the circulating nurse must know the time of inflation and deflation in his or her .documentation of when the tourniquet is inflated during a machine that allows compressed gas into the cup generally the surgeon will tell the circulator at what inflation pressure he or she wants tourniquet set based on the patients blood pressure the cuff can only be put on for 1 & 1 half hour at the max then it has to be deflated for 10 minutes then if the procedure is not done it can be inflated for another 15 and then again has to be deflated for another 10 and so on and so on until the procedure is over

Front 33

What is Autotransfusion?

Back 33

Autotransfusion is the reinfusion of the patient's own blood or blood products these products may be donated prior to surgery or blood may be collected interoperate or postoperatively and then reinfused.

Front 34

Why Reinfuse?

Back 34

Autotransfusion is sometimes preferable to a donor transfusion because it eliminates the danger of blood incompatibility and possible disease transmission patient to refuse a blood transfusion from an outside source may be willing to accept another transfusion there are times when you do not collect the patient's blood and refusing these times are when a patient has an ear infection if the patient's blood has been exposed to antibiotics or collagen hemostatic agent this can cause the blood to coagulate in the machine at the blood has been messed with amniotic fluid or gastric bowel contents

Front 35

What kind of device is this

Back 35

The cell saver or cell salvager allows the blood to be suctioned directly from the surgical field into the machine it can also suction bloody saline from a basin in which bloody sponges were immersed in Saline the machine filters and anticoagulate the blood and fluid ready for IV reinfusion back to the patient this process can cause little or no harm to the red blood cells it is capable of processing large quantities of blood and irrigation fluid and is used when a large blood loss is possible such as a ruptured spleen or large blood vessels major spinal surgery major orthopedic procedures are multiple trauma with suspected made your bleeding one major disadvantage to cell saver device is that it may require a dedicated operator to run it.

Front 36

Different types of Autotransfusion Drains

Back 36

A Hemovac or an active drain or closed collection systems that use a three speed evacuator or controlled wall suction to suction blood from the surgical wounds post-op early and collected for a possible reinfusion these devices contain filters within the collection chambers to filter out clots and debris is they have access port to allow for addition of anti coagulant medication the advantage to these drains or that they are easy to setup and use they are closed systems thus decreasing the chance of staff exposure to blood they are relatively inexpensive when compared with other reinfusion technology the transfusion of the fluid into the reinfusion bag is usually accomplished usually the push of a button or lever and you can only use one device per patient they can be used to collect and reinforce multiple times the disadvantages is that they can only be used for postoperatively not enter off early and they have a small collection capacity than other devices. Other examples of active drains are striker Jackson Pratt which is also like a grenade these operate with the vacuum like drainage system

Front 37

Passive Drains

Back 37

Used for common bile duct dont have a vaccum such as Penrose Ttube and a cigarette which is when the Penrose is filled with gauge hence the name Cigarette.

Front 38

What are these used for

Back 38

Chest rolls are used by lifting the chest off the stretcher during prone positioning to allow for chest expansion during respiration should be place so that extends from the top of the chest and the patient is on top of it the patients abdominal will not touch table protects respiration distress. Extenss from (acromion) top of the surface to top surface the hip bone ( iliac crust).

Front 39

What are these used for

Back 39

Holds fingers spread for surgery . can be adjusted to hold one or all fingers parted with foam to cushion the hand single patient use.

Front 40

What is this for

Back 40

Axillary rolls helps eleviate on the axillary nerves and blood vessels during lateral position it can be made from symbols readily available items to roll towels or blankets and inflated blood pressure cuff or full iv bag may also be used.

Front 41

What is this used for

Back 41

Beanbag positioner is used to stabilize the torso in a lateral position it is used when the air is taking out of the beanbag using suction to from the bag and hold the patient in place air is removed by suction only after the patient is positioned.

Front 42

What kind of sterilization is this used for

Back 42

An ultrasonic cleaner cleans debris from delicate instruments an example is instruments cleaning the debris from hard to reach places on instruments example box locks serated instruments such as crile or Kelly cavitation is used to remove the degrees in other words high frequency sound waves are converted to vibrations which create bubbles cause the bubbles to implode (collapse inward) implosion of the bubbles create a vacuum that pulls the breeze from the instruments instruments made of dissimilar metals should be not place an ultrasonic cleaner together gross the breeze must be removed from instruments before placing them in the ultrasonic cleaners.

Front 43

Back 43

Smoke evacuation systems are used to suction and filter Surgical plume system contains HEPA filters & absorbers to trap Surgical plume nozzle tip must be within two inches of the surgical site in order to be effective filter and tubing must be changed between patients filter are considered bio hazardous waste.

Front 44

What are these used for

Back 44

C Arm image is immediately available to view C ARM can be manipulated to give multiple views of the operative site in real time personal needs to wear lead apron or stand behind a Lead shield when C arm is in use. Used in fluroscopies which are closed reduction procedures meaning that the skin is not penetrated.

Front 45

What are these used for

Back 45

Sequential compression devices help to prevent venous status and decrease the chance of thrombus formation (blood clots) stockings massage the legs in the upper word motion to help prevent pooling of blood in the lower extremities.

Front 46

The maximum continous time of tourniquet should be left on a leg is

Back 46

90 mins

Front 47

Which of the following might be used to position a patient who has undergoing surgery on the lower back

Back 47

Jackson table wilson frame andrews frame and chest rolls

Front 48

A horseshoe Mayfield or Shea may be used to position the patients

Back 48

Head

Front 49

Hyperextension of the arm can cause damage to the

Back 49

Brachial plexus

Front 50

Which doesnt need a grounding bad

Back 50

Bipolar

Front 51

ABC in terms of electrosurgery stands for

Back 51

Argon Beam Coagulation

Front 52

Ultrasonic cleaning is used for

Back 52

Cavation to remove debris from instruments.

Front 53

Is a anesthetic gas

Back 53

Nitrous oxide

Front 54

An optigard is used for when the patien is prone to protect her or his

Back 54

Eyes

Front 55

A doppler is used to asses

Back 55

Blood flow