Transcript Chapter 12 Surgical Case Management

Surgical
Technologist Responsibilities
• Preoperative
• Intraoperative
• Postoperative
1
© 2008 Delmar Cengage Learning.
Preoperative Case Management
•
•
•
•
•
•
•
Prepare the OR
Pull necessary supplies
Don PPE
Prepare and maintain the sterile field
Scrub, gown, and glove
Count
Drape
2
© 2008 Delmar Cengage Learning.
Intraoperative
Case Management
•
•
•
•
•
•
Maintain the sterile field
Anticipate
Pass instruments, supplies as needed
Prepare and handle medications
Specimen care
Dressings
3
© 2008 Delmar Cengage Learning.
Postoperative
Case Management
• Maintain sterile field
until patient is
transported
• Transport used
instruments and
equipment to
decontamination area
• Prepare OR for next
patient
• Dispose of sharps
4
© 2008 Delmar Cengage Learning.
Five Steps to Critical Thinking
• Identifying the goal or problem
• Gathering and evaluating information
– Use A POSitive CARE Approach
• Generating one or more responses
• Implementing the best response
• Assessing the results
5
© 2008 Delmar Cengage Learning.
A POSitive CARE Approach
• CARE
– Caring Attitude
– Application
– Role
– Environmental
concern
• A POSitive
– Anatomy
– Pathology
– Operative
procedure
– Specific variations
6
© 2008 Delmar Cengage Learning.
OR Attire
•
•
•
•
•
Semirestricted areas
Restricted areas
Scrub suit
Hair cover
Shoe covers may be
required
• Jewelry, cosmetics,
artificial nails may be
restricted
7
© 2008 Delmar Cengage Learning.
OR Attire
•
•
•
•
•
•
Apply hair cover prior to scrub suit
Don scrub suit
Apply ID badge and X-ray monitor device
Change into appropriate OR shoes
Apply shoe covers
Apply mask and protective eyewear
8
© 2008 Delmar Cengage Learning.
Protective Attire
• PPE (Personal Protective Equipment)
– Scrub suit
– Mask
– Hair cover
– Shoe cover
– Gloves
– Protective eyewear
– Radiation protection
9
© 2008 Delmar Cengage Learning.
Sterile Attire
• Worn by the sterile surgical team
• Donned after surgical scrub
• Sterile gown
– Disposable
– Reusable
– Lint-free woven or nonwoven
• Sterile gloves
10
© 2008 Delmar Cengage Learning.
Sterile Gowns
• Gowns are sterile from waist level to midchest level
• In front
• Sleeves circumferentially to two inches
above the elbows
• Cuffs of the gown are considered
nonsterile
11
© 2008 Delmar Cengage Learning.
Sterile Gloves
•
•
•
•
•
Worn by all sterile team members
Applied immediately after the sterile gown
Available in a variety of styles and sizes
Latex-free
Lead gloves
12
© 2008 Delmar Cengage Learning.
Preparing the OR
13
© 2008 Delmar Cengage Learning.
Preparing the OR
• Check schedule board for daily room
assignments
• Pull surgeon’s preference card
• Check case cart
– Pull case supplies
• Verify all necessary furniture and
equipment is present
• Damp dust all flat surfaces
14
© 2008 Delmar Cengage Learning.
OR Setup
• Position back table, Mayo stand and ring
stand furthest from the door.
• Position the OR table and lights
• Check that all equipment is working
properly
15
© 2008 Delmar Cengage Learning.
OR Setup
• Position instruments and supplies:
– Basic pack on the back table
– Basin set in the ring stand
– Instruments on flat surface close to the back
table
16
© 2008 Delmar Cengage Learning.
OR Setup
17
© 2008 Delmar Cengage Learning.
Establishing the Sterile Field
•
•
•
•
•
Apply mask
Medical handwash
OR doors must be closed
Verify exposure to sterilization process
Examine integrity of the package
18
© 2008 Delmar Cengage Learning.
Establishing the Sterile Field
• Open back table first followed by basin
and instruments
• Smaller items are opened
• ST’s gown and gloves should be opened
onto a separate surface
19
© 2008 Delmar Cengage Learning.
Opening Sterile Supplies
20
© 2008 Delmar Cengage Learning.
Beginning Technique
• Check packaging for integrity
• Unfold
– First flap away from you
– Second flap toward you
– Reposition and open third flap
– Move to opposite side to open fourth flap
21
© 2008 Delmar Cengage Learning.
Surgical Scrub
•
•
•
•
•
Personal protective equipment
Remove jewelry, watch, etc.
Inspect integrity of hands and arms
Handwash, clean nails
Begin counted brush stroke or timed
method
22
© 2008 Delmar Cengage Learning.
Surgical Scrub
• Disposable scrub brushes impregnated
with antiseptic
• Plain brush used with antiseptic solution
provided by the facility (foot pump)
• Waterless scrub:
– Dispenser
– Rubs in
– No drying
23
© 2008 Delmar Cengage Learning.
Surgical Scrub
• Counted method
– Requires a measured number of brush
strokes for each anatomical area scrubbed
– Dictated by the facility policy
24
© 2008 Delmar Cengage Learning.
Surgical Scrub
• Timed
– Hands and arms are scrubbed for a
prescribed length of time
– Most commonly the first scrub of the day is 10
minutes
– Subsequent scrubs are 5 minutes
25
© 2008 Delmar Cengage Learning.
Surgical Scrub
• Inspect hands and arms
• Inspect nails and cuticles
26
© 2008 Delmar Cengage Learning.
Surgical Scrub
• Open brush package
• Apply water
27
© 2008 Delmar Cengage Learning.