Transcript Document

Skill Assessments
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12-8 Laparotomy Draping
9-1 Sellick’s Maneuver
9-2 Syringe off field
9-3 Syringe into field
9-4 Accept meds to field
Draping
• Please refer to Draping lecture for this
content as well as textbook pages 357-363
Laparotomy Draping
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Prep
Towel out with four towels
Surgeon preference for securing towels
– Apply towel clips
– Apply skin staples
– Apply Incise sheet (Ioban)
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Laparotomy sheet
– Pass to surgeon on same side
– Move to other side of the OR table
– If on patient’s right side: Form cuff with right hand and push drape away from you
while holding onto the other part of the drape with your left hand, release when
patient’s lower body is covered (reverse hand position if on left side of patient)
– Take right end and form cuff, push drape away from you making sure arm is
covered by wing of sheet and hold if necessary for anesthesia to secure
– Retrieve mayo stand to begin case, getting light handle covers, bovie pencil
passed off and suction tubing passed off
Sellick’s Maneuver
• The application of cricoid pressure
• Applied to immobilize the trachea and create
occlusion of the esophagus between cricoid ring
and six cervical vertebrae
• Designed to prevent stomach contents from
ejecting during vomiting, hence reducing the risk
of aspiration into the respiratory tract
• Aspiration can result in drowning or aspiration
pneumonia
Sellick’s Maneuver
ET Tube
LMA
Sellick’s Maneuver
• Applied prior to and during general anesthesia
endotracheal intubation
• Applied when patient is suspected to have a full
stomach or during CPR
• Side benefit is that it also provides exposure of
the glottis which helps the anesthesia provider
place the endotracheal tube
• Hence may be utilized when visibility is obscured
Sellick’s Maneuver
• Procedure
– Stand on side of the table that will allow for
the person providing cricoid to be out of the
way
– Student must be able to identify thyroid
cartilage and locate cricoid cartilage inferiorly
– Form a “V” with the thumb and index finger
• May vary with patient size
– Wait form permission from the anesthesia
provider prior to releasing cricoid pressure
Medication Delivery
• Refer to Chapter 4 in your Pharmacology
book Pharmacology for the Surgical
Technologist
• You are responsible for all content
covered during lab
• Refer to your index of your Pharmacology
book to locate covered material
Antimicrobials
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Antibiotics
Antivirals
Antiprotazoals
Antifungals
Antiparasitics
Antibiotics
• Given for prophylaxis (for prevention) of postoperative
wound infection
• Administered IV (parenteral) per anesthesia
preoperatively, intraoperatively and postoperatively
• Also administered in the form of irrigant for the surgical
wound intraoperatively
• Will be mixed with normal saline on the field
• Typical concentration of antibiotic is 500ml NS to one
vial of antibiotic (500mg or 1g)
• Follow facility protocol and pharmacy recommendations
Antibiotics
• Major categories
– Aminoglycosides
– Cephalosporins
– Macrolids
– Penicillins
– Tetracyclines
Cephalosporins
• Ancef (cefazolin)
• Most commonly used for irrigation and IV
adminsitration
Aminoglycosides
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Gentamicin
Vancomycin
Typically used IV
May see as eye drops
Will NOT be administered as an irrigant as
it can cause tissue necrosis
Sulfonamides
• Silvadene
• Typically used with burn patients
Miscellaneous
• Bacitracin (Baci IM)
• Substitute for cephalosporins used for
surgical wound irrigants
• Comes in vial 50,000ut mix with 500ml of
NS
• Refrigerated in pharmacy
• Also seen as an ophthalmic agent
Miscellaneous
• Neosporin
• Topical ointment
• Neosporin/polymixin B Sulfate
• GU irrigant (bladder only)
• Mix in 3L or 3000ml irrigant bags
Anticoagulants
• Heparin
• Systemic administration by anesthesia during
surgical procedures where clotting is a
possibility that can lead to embolus formation
which can cause pulmonary embolism which
leads to death
• IV (parenteral) based on patient weight
• Also used as an irrigant when an artery or vein is
open to prevent clot formation at the surgical site
• Revert to regular irrigation after an artery is
closed
• Also used as an irrigant when an artery or
vein is open to prevent clot formation at
the surgical site
• Revert to regular irrigation after an artery
is closed
• Typical concentration on surgical field
when used as an irrigant: 1,000ut per
250ml NS
• Will see straight Heparin used to flush
ports on catheters such as Hickmans/ Vas
caths, Broviacs, and other central lines
• Concentration will be 5,000ut/ml
• Standard is 1ml of 5,000ut per port you
are flushing
• Utilized to maintain the patency of these
catheters
Antagonist or Reversal Agent for
Heparin
• The state of anticoagulation is reversed with the administration of
Protamine sulfate
• Given Iv by anesthesia provider dose based on patient weight
• This is used as we want a person to resume normal clotting after
vascular or cardiac surgery
• However, sometimes the patient may be maintained in a state of
anticoagulation postoperatively
• FYI: Protamine functions as a reversal agent ONLY when it is in the
PRESENCE of Heparin
– Alone, it actually causes anticoagulation, but is never used for this alone
– Created from salmon sperm
– Have seen reactions in males whop have had vasectomies and have
developed antibodies to sperm as a result of that surgery
Topical Hemostatics
• Used to enhance the clotting process at a
surgical site
• Most common:
• Surgicel or Nu-Knit
• Avitene
• Gelfoam
• Thrombin (typically used with gelfoam)
– Comes in powder that must be reconstituted
– 5ml, 10ml or 20ml
– 20ml vial or spray kit
Local Anesthetics
• Most common:
• Xylocaine (Lidocaine)
• Bupivicaine (Marcaine)
Xylocaine (Lidocaine)
• Injected (parenteral) by surgeon on
surgical field
• Strengths: 0.5%, 1%, 2%, 3%
• May come with or without epinephrine
(epi)
• Duration 30-60 minutes
• With epinephrine duration increases
• With epinephrine vasoconstriction occurs
at wound site minimizing sit bleeding
Xylocaine (Lidocaine)
• Also used IV by anesthesia provider in
situations of bradycardia, hypotension and
cardiac arrythmias such as fibrillation as
well as cardiac arrest
Bupivacaine (Marcaine)
• Injected (parenteral) by surgeon on
surgical field
• Strengths: 0.25, 0.50%, 0.75%
• May come with or without epinephrine
(epi)
• Longer duration than xylocaine
• 4 times more potent than xylocaine
Hormones
• Epinephrine (Adrenalin)
– Three functions:
• Cardiac stimulant (cardiac arrest)
• Bronchodilator (anaphylaxis or sever allergic
reactions)
• Combined with local anesthetics (vasoconstriction
at surgical wound site and prolonged anesthetic
duration)
Hormones
• Pitocin (oxytocin, syntocin)
• Causes uterine muscle contraction
• Use:
– Promote uterine contraction to facilitate
delivery of a fetus
– Promote uterine contraction (enhances
clotting) post delivery to facilitate clotting in
situations where hemorrhage post-delivery is
occurring
Hormones
• Pitressin (vasopressin)
• An antidiuertic hormone used to stabilize
fluid balance in diabetics
• DO NOT confuse it with Pitocin!
• I’ve seen this happen
Medications used for Injection
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Must be preservative free or safe for parenteral use
Irrigants are not for injection
Read your medication labels!
Label all meds on your field including irrigants and
syringes or aseptos used to administer them
• Prelabel for anticipated meds you have reviewed on the
surgeon preference card
• This facilitates surgery preventing unwanted delays
• Check meds prior to accepting them onto YOUR field!
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