MSN PAIN & SURGERY PDF

NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. OUTLINE SURGERY RELATED TERMINOLOGIES 1 Surgery...

NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. OUTLINE SURGERY RELATED TERMINOLOGIES 1 Surgery Operating Room/ Operating Theatre- room in health care 2 Perioperative Care facility in which patients are prepared for surgery, undergo 3 Operating Room Attire, Surgical Hand Scrubbing, Gowning, surgical procedures, and recover from the anesthetic Closed Gloving, and Instrumentation procedures required for surgery 4 Pre, Intra, Post Operative Care Perioperative- term used to describe entire span of surgery including before and after the actual operation 5 Pain and Pain Management Perioperative nursing- includes activities performed by the RN that encompasses pre-operative, intraoperative, and MODULE 1 - SURGERY post-operative phases of patient’s care Definition OR nurse- duly licensed nurse legally responsible for the Surgery, as a discipline, combines physiologic management nature and quality of the nursing care patients with an interventional aspect of treatment Surgical Conscience- awareness which develops a Total care of illness with an extra modality of treatment, the knowledge based on the importance of strict adherence to surgical procedure principles of aseptic and sterile techniques Branch of medicine that comprises pre-operative, Breach in sterility: stop and tell what happened (surgical intraoperative, and post operative team) Surgery as a Science What will happen: Infection, poor wound healing, financial burden Surgery as an Art Be a patient-advocate EVOLUTION OF SURGERY Asepsis- free from infection or absence microorganism Historical Background Aseptic Technique- methods by which contamination of Code of Hammurabi (1955-1913BC) - if patient died after microorganism is prevented surgical procedure, surgeons will be retribution in the form of amputation of his right hand Disinfection- process of destroying all pathogenic microorganisms except spore bearing ones Persians rule on surgery- successful procedure on 3 infidels before being pronounced as competent to practice surgery Sterilization- killing all microorganisms including spores; by Galen of Pergamum (130-200AD) heat using autoclave; by chemical using EO gas, plasma Caludius Galen - a Greek physician who performed animal sterilization dissections and fallen into disrepute; stressed the Surgical Intervention- therapeutic process rendered to importance of human dissections; restore or maintain health (i.e. the ability to function) Studied the muscles, spinal cord, heart, urinary system, and Surgical Procedure- invasive incision into the body tissues proved that the arteries are full of blood. or a minimally invasive entrance into a body cavity for Believed that blood originated in the liver, and sloshed back either therapeutic or diagnostic purpose during which and forth through the body, passing through the heart, protective reflexes or self-care abilities are potentially where it was mixed with air, by pores in the septum compromised Also introduced the spirit system consisting of natural spirit Antiseptic- substances which combat sepsis and cause or “pneuma” (air he thought was found in the veins), vital bacteriostasis spirit (blood mixed with air he believed to found in the Anesthesia- insensibility to pain and trauma with or animals) without loss of consciousness Informed consent- the patient’s autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved Lord Berkeley George Moynihan (1865 – 1936)- formal education Abdomin (o)- abdomen First professor of clinical surgery within the University Aden (o)- gland of Leeds Angi (o)- vessel Book: Abdominal Operations earned him an international Arthr (o)- joint operation Broncho- bronchus *Surgery has been made safe for the patient; we must now Card, Cardi (o)- heart make the patient safe for surgery. * Cephal (o)- head Improvement in Perioperative Patient Care Technology is attributed Chole, Chol (o)- bile to the following: Chondr (o)- cartilage Surgical specialization of surgeon and team Colo- colon Sophisticated diagnostic and intraoperative imaging Cost (o)- rib techniques Crani (o)- skull Minimally invasive equipment and technology Cele- tumor, hernia Centhesis - puncture On-going research and technological advancements GUMAPAC, E. & SOLIS, N. 1  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Ectomy- surgical excision/ removal To prevent infection and promote healing Itis- inflammation To obtain comfort Litho - stone/ calculus Ensure the ability to earn a living Ostomy- creation of new opening To restore or reconstruct a part of the body that is Rhapy- repair congenitally malformed or damaged by trauma or disease Oscopy- examination w/a lighted instrument Plasty- surgical repair or reshaping To alter cosmetic appearance Pexy- suture in place Conditions treated by Surgery Congenital- inborn deformity SURGERY Acquired- resulting from trauma or injury Surgery is performed for the purpose of structurally altering the Three (3) Categories of Surgical Procedure human body by incision or destruction of tissues and is part of the Invasive surgery- major surgeries; open practice of medicine. Minimally Invasive surgery- surgical procedures that use Objectives of Surgery specialized instruments inserted into the body either Repair of injuries through natural orifices or through small incision Alter form or structure less risky; laparoscopic surgeries Correction of deformities and defects Non-Invasive surgery- unrisky Relief of suffering Classifications of Surgical Procedure Diagnosis and cure of disease process According to Purpose: Prolongation of life Diagnostic surgery- to establish the presence of a disease Common Indications of Surgery condition; enables the surgeon to verify a suspected diagnosis; e.g. breast biopsy, biopsy of skin lesion Incision- open tissue of structure by sharp dissection; using scalpel Exploratory surgery- to determine the extent of the disease condition and at times to make or confirm a Excision- removal of tissue or structure by sharp diagnosis; e.g. exploration of abdomen for unexplained dissection pain, exploratory laparotomy Diagnostics- biopsy tissue sample; common example: lumps (benign or malignant) Curative Repair- e.g. closing of hernia Ablative- removal of deceased organ (suffix used is “ectomy”); e.g Removal- FBE cholecystectomy/ appendectomy Reconstruction- creation of new breast Constructive- repair of congenitally Termination- abortion of pregnancy defective organs (suffixes used are “plasty,” Palliation- relief on an obstruction “orrhaphy,” “pexy,”); e.g. total hip Aesthetics- facelift replacement, orchiopexy (surgery for Harvest- skin grafting undescended testes) Procurement- donor organ Reconstructive- involves repair of Transplant- placement of a donor organ damaged organ; e.g. plastic surgery after Bypass/ shunt- vascular rerouting burns Drainage/ evacuation- incision of abscess Palliative surgery- to relieve distressing signs and symptoms, not necessarily to cure the disease; e.g. Stabilization- repair of fracture resection of tumor to relieve pressure and pain Staging- checking of cancer progression Cosmetic surgery- correction of defects, improvement of Parturition- C-section appearance or change to a physical feature; e.g. Extraction- removal of tooth rhinoplasty, cleft lip repair, mammoplasty Exploration- invasive examination Diversion- creation of stoma According to Urgency: Four Major Pathologic Conditions Requiring Surgical Intervention Emergency- Immediate; life-threatening conditions Obstruction- impairment to the flow of vital fluids e.g. requiring surgery; e.g gunshot wound, severe bleeding, blood, urine, CSF, bile small bowel obstruction; patient may deteriorate Perforation- rupture of an organ immediately Erosion- wearing off a surface or membrane Urgent or Imperative- within 24-30 hours- client requires Tumor- abnormal new growth prompt attention; kidney stones, acute gallbladder Reasons for Surgical Intervention infection, fractured hip To preserve life Planned or required: planned for a few weeks or months after decision; client requires surgery at some point To Maintain dynamic body equilibrium To undergo diagnostic procedures GUMAPAC, E. & SOLIS, N. 2  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Elective- client will not be harmed if surgery is not Body image may be disturbed performed but will benefit if it is performed; revision of Lifestyle may be changed scars, vaginal repairs Legal Liability, Accountability & Ethical Issues Optional- personal preference usually aesthetic purposes; Safeguard the patient in the OR against hazards. Protect the nurse, cosmetic surgery technologist, surgeons, anesthesiologist, and the hospital. Prevention Risks: focuses on the quality assurance Preoperative: body disturbance Intraoperative: infection, safety Quality improvement as an ongoing process Understanding regulations, standards, policies, and procedures Post-operative: pain Accountability for one’s own actions According to Location Legal rights of the patients External- outside the body; e.g. hysterectomy Individualized patient care Internal- inside the body; e.g. hysterectomy Technical competency According to Extent or Risk Involved (Magnitude) Your surgical and ethical conscience. Major- life-threatening - High risk, extensive prolong, large amount of blood loss, To be liable is to be legally bounded, responsible, and answerable. major or vital vital organs are involved, great risk of PERIOPERATIVE NURSING complications Definition - Heart surgery, colorectal Perioperative Nursing Practice- includes activities performed by the Minor- non-life threatening, less serious professional registered nurse during the preoperative (before), generally not prolong, few serious complications; e.g. intraoperative (during), and postoperative (after) phases of the biopsy, excision patient’s surgical experience. Surgical Risks Patients Key Elements of Perioperative Nursing Practice Obesity- increased incidence of morbidity and mortality; Caring degree of morbidity varies with the severity of the obese Conscience condition Discipline Fluid, electrolyte, and nutritional problems: will cause delay Technique and poor wound healing Concept of Surgical Conscience Difficult to close up; larger structures, more difficult “Do unto the patient as you would have others do unto you.” Comorbidities, complications due to existing problems Philosophy of Operating Room Nursing (HPN, DM) To give service that aims to provide comprehensive support Undernourished- slow poor healing and recovery due physically, morally, psychologically, spiritually, and socially to a Extremely young- underdeveloped structures and patient undergoing surgery. immunity Goals of Operating Room Nursing Extremely old- physical changes; comorbidities To provide a safe, supportive, and comprehensive care to patient Person with disability To assist the surgeon by functioning effectively as a Presence of Disease/ Illness- has comorbidity; DM patients member of the surgical team have poor wound healing To create and maintain an aseptic/ sterile environment at Concurrent or prior pharmacotherapy- ask what meds are all times taken by the patient; some meds may alter physiologic Objectives of Operating Room Nursing functions that may affect the surgery (anticoagulants- bleeding) To help the patient return as rapidly as possible to the best physical and mental health attainable Other factors In case the patient did not return to his heath, pain and Nature and location of condition discomfort should b eased and s/he should be allowed to Magnitude and urgency of the surgical die with dignity procedure PERIOPERATIVE NURSE Mental attitude of the person toward Definition surgery- e.g. anxiety Perioperative Nurse is a nurse who provides patient care, manages, Caliber of the professional staff and teaches, and studies the care of patients undergoing invasive or non- health care facilities invasive procedures. S/he possesses a depth and breadth of Potential Effects of surgery to the Patient knowledge that allows for the coordination of care of the surgical Stress response is elicited patient. Vascular system is disrupted Responsibilities of a Perioperative Nurse Defense against infection is lowered Prioritizes interventions based on a comprehensive body of Organ functions are disturbed scientific knowledge and variation in patient’s responses GUMAPAC, E. & SOLIS, N. 3  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Uses critical thinking skills in applying the nursing process, acting as a patient advocate, and exercising judgment in a professionally accountable manner Operating Room Team Provides specialized nursing care to patients before, during, Each member of the operating room team is an integral and after their surgical and invasive procedure entity in unison and harmony with his/her colleagues for Works closely with all members of the surgical team the successful accomplishment of the expected outcomes. Helps plan, implement, and evaluate treatment of the OR Team is subdivided according to the functions of its patient members: sterile and unsterile team Designs, coordinates, and delivers care to meet the Sterile team (Surgeon, Assistant Surgeon, and Scrub Nurse) identified physiological, psychological, and spiritual; needs Surgeon- Must have the knowledge, skill, and judgement required of the patients to successfully perform the intended surgical procedure. Who can be the head surgeon: Expected Attributes of a Perioperative Nurse Considerate Licensed MD Informative and sincere DO (osteopath) Versatile DDS (Doctor of Dental Surgery) or Oral surgeon Analytical DMD (Doctor of Dental Medicine) Creative resourceful DPM (Doctor of Podiatric Medicine) Attributes of a surgeon Humanistic and Ethical Personal Attributes of a Perioperative Nurse Compassionate interpersonal behavior With sense of humor Accountability Objective Humanistic concern Enduring Appropriate clinical skills in data gathering Impartial, nonjudgmental, open-minded Good decision making & problem-solving skills Manual and intellectual Critical thinking ability Major responsibilities of a surgeon Curious to lean Preoperative diagnosis and care Empathic, conscientious, efficient Selection and performance of the surgical procedure Well-organized Post-operative management MODULE 2 – PERIOPERATIVE CARE Assistants to Surgeon (First Assistant/ Second Three Phases of Perioperative Care Assistant)- qualified surgeon or a resident in an accredited Preoperative Phase surgical education program. Begins with the decision to perform surgery and continues - The resident is maybe an associate with whom surgical until the client reaches the operating area practice is shared and to whom part of the patient’s care During this phase, the perioperative nurse performs the maybe delegated. assessment and planning components of the nursing - In hospital with accredited postgrad surgical residency process. training programs, the surgical resident in the third or later Questions to ask: year usually acts as 1st assistant. The resident is given Allergies increasing responsibilities under supervision at the Medications/ Diet (NPO) operating table to acquire skill and judgement. Practices (smoking, alcohol/ drug intake) NURSE is free to refuse to perform as first assist out of concern for the well-being of the patient and for his/her Location (left, right, bilateral) professional accountability. Intraoperative Phase Major Responsibilities of Assistants to Surgeon Begins with placement of patient on the operating table, Help maintain visibility of the surgical site, control bleeding, including the entire surgical procedure and extends until close wounds, apply dressings, handle tissues, and uses transfer of the client to the recovery room. The instruments implementation component of the nursing process is performed here Postoperative Phase Begins with admission to the RR recovery room/ PACU (Post Scrub nurse - Instrument and Suture Nurse - Nursing staff Anesthesia Care Unit) and continues until the client receives member of the sterile team a follow up evaluation at home or is discharged to a - RN, LPN (licensed practical nurse) or LVN (licensed rehabilitation unit evaluation component of the nursing vocational nurse), ST (surgical technologist) process is completed in this phase. Major Responsibilities of a Scrub Nurse Discharge plan, complications, wound care Responsible for maintaining the integrity, safety, and PERIOPERATIVE PATIENT CARE TEAM (OR TEAM) efficiency of the sterile field throughout the procedure. GUMAPAC, E. & SOLIS, N. 4  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Responsible for preparing and arranging the sterile Location- located accessible to the critical care surgical patient areas instruments and supplies for the surgical procedure. and the supporting service department-CSR, radiology, pathology, Anticipates, plan for, and respond to the needs of the etc. surgeon by constantly watching the sterile field. Many OR suites are UNDERGROUND or have solid walls Should have knowledge, skills, and experience with aseptic without windows. and sterile techniques. Ventilation - Must ensure a controlled supply of filtered air. Air Should have manual dexterity, physical stamina, stable conditioning is ideal and valuable; it controls humidity temperament, able to work under pressure, with keen Door - Ideally, sliding doors should be used. sense of responsibility and concern for accuracy in Floor - Must be suitably hard, suitable for heavy equipment specially performing all duties. during transport from one room to another and easy to clean. Nonsterile Team Lighting- General illumination is furnished by ceiling lights in white Anesthesiologist - is an MD or DO, certified by the Philippine Board fluorescence bulbs which are evenly distributed throughout the of Anesthesiology, specializes in administering anesthetics to room. produce various states of anesthesia. Should be shadowless o Be freely adjustable to any position Major Responsibilities of an Anesthesiologist or angle by vertical or horizontal range of motion Choice and application of appropriate anesthetic agents Produce minimum heat to prevent injuring exposed tissues and suitable techniques of administration and monitoring o Be easily cleaned of physiologic functions. Two Principles in designing an Operating Room Maintenance of fluid and electrolyte balance and blood a. Exclusion of contamination from outside the suite replacement during the surgical procedure. b. Separation of clean areas from contaminated areas Minimize the hazards of shock, electrocution, and fire. Types of OR Designs Responsible for overseeing the positioning and movement Central Corridor of patients. Central Core Able to use and correctly interpret a wide variety of Peripheral corridor monitoring devices. Combination central core & peripheral corridor Oversee the PACU to provide resuscitative provide care Three corridor layouts until each patient has regained control vital functions. Grouping or cluster plan Participate in the hospital’s program of CPR as teachers and team members. As well as consultants and managers for The OR suite should be large enough to allow for correct problems of acute and chronic respiratory insufficiency technique yet small enough to minimize the movement of requiring inhalation therapy and other fluid, electrolyte and patients, personnel and supplies. Provision must be made for metabolic disturbances requiring IV therapy. traffic control. The type of design will predetermine traffic They are integral staff member of Pain Therapy clinics. patterns. Signage should be posted properly. Circulating nurse - A RN or ST (surgical technologist) who functions under the supervision of an RN. Three Areas/Division of Operating Room Suite Major Responsibilities of a Circulating nurse Unrestricted / Unsterile Area Nursing judgement and decision-making skill are requisites This area is isolated by doors from the main hospital to assessing, planning, implementing, and evaluating the corridor or elevators and from other areas of the OR suite. plan of care before, during, and after surgical operation. Serves as an OUTSIDE-to-INSIDE access area Creation and maintenance of a safe and comfortable Street clothes are permitted environment for the patient through implementing the Vestibular / Exchange Areas (Transition Zone) - inside the entrance principles of asepsis, demonstrate a strong sense of surgical to the OR suite, separates the OR corridors from the rest of the conscience. facility Constant flexibility in identifying environmental danger Preoperative check-in unit - this is an unrestricted area of stressful, situations, and meet the unexpected act in an the OR for patient to change from street clothes to gown. efficient, rational manner at all times. Dressing rooms and lounges - clothes hanging areas must Maintenance of the communication link between events be provided for both males and females. Shoe rack is and team members at the sterile field and advisable for the OR scrub suit. Provision of assistance to any member of the OR team and Post-operative holding area - A designated room for any manner in which the circulator is qualified. patients to wait in the OR suite that shields them from Direction of the activities of all learners. The CN must have distressing sights and sounds. the supervisory capability and teaching skills needed to PACU - may be outside the OR or adjacent to the OR suite. ensure maintenance of a safe and therapeutic environment o Part of unrestricted area with access from both semi for the patient. restricted areas. Nurse anesthetist- refers to a qualified RN, anesthesiologist assistant Semi-restricted / Semi sterile Area (AA), dentist, our physician who administers anesthetics. Personnel should be wearing OR scrub suit with cap. PERIOPERATIVE ENVIRONMENT Physical Facilities GUMAPAC, E. & SOLIS, N. 5  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. This area includes peripheral support areas and access 16. Wall Clock with second hand corridors to the OR like PACU, SICU, offices for anesthesia 17. White board for recording department and administrative OR nursing personnel, etc. 18. Blood warmer machine attached to IV pole Work area or packing area 19. monitoring machines Steam sterilizing room Cabinets / carts Washer-sterilizer area MODULE 3 - OR Attire, Surgical Hand Scrubbing, Storage room for supplies o Record room Restricted / Sterile Area Gowning, Closed Gloving, and Instrumentation Operating Room Attire Personnel should be wearing complete OR scrub suit Description: including mask. Consists of body covers, such as a two-piece pantsuit, head This area performs sterile procedures o Includes OR suite cover or cap/turban, mask. shoe cover, or booties, googles, room, scrub sink areas, sub sterile rooms where unwrapped and apron supplies are sterilized. Protects us from blood and body substance of patient Desirable if all have the same size, so they can be used interchangeably to accommodate elective and emergency Purpose: cases. To provide effective barriers that prevent the dissemination Must accommodate equipment like laser, microscope, of microorganisms to the px video equipment, c-arm, portable light, etc. Protects personnel from infected patients and against Adequate size is at least 20x20x10 feet (400 sq ft or 37 m2) exposure to communicable disease of floor space or maximum of 20x30x10 feet (600 sq ft or 60 Has been shown to reduce particle count from the body m2). from over 10,000 particles per min to 3000 per min, or from Sub sterile Room 50, 000 microorganisms per cubic foot to 500 Work Area microorganisms per cubic foot. Steam Sterilizing Room Historical Background: Washer OR nurse take a bathe before a surgical procedure, to take Storage Room for Supplies a carbolic bath (anti-microbial soap) before laparotomy and to wear long sleeves and clean apron for the surgical Record Room procedure Peripheral Support Areas Central Administrative control Gustav Neuber (1883)- He insisted on wearing of caps by OR Sterile supply room personnel Work and storage areas Hunter Robb - A gynecologist at Johns Hopkins hosp Baltimore, General work room insisted on OR cleanliness and on the wearing of caps and sterile Utility room gowns Housekeeping Storage area Dr. William Halsted (1897) - He designed a semicircular instrument table to separate himself, in sterile gown and gloves, from observers Anesthesia work & storage areas in street clothes who watched him operate. Furnitures and other Equipment Inside the Operating Room Johann von Mikuliez (1896) - A pioneering german surgeon, 1. OR Table - divided into head, body, and leg sections. advocated the wearing of cotton gloves in 1896 but these were soon Attachment includes knee strap, arm strap, arm board, found to lack the qualities of impermeable rubber gloves for infection anesthesia screen, metal foot board, etc control. He also advocated the use of gauze masks in 1897. 2. Instrument table or Back table Joseph Lister- Fist use of caps and sterile gowns occurred in Germany 3. Mayo table - placed above and across the patient and while the value of joseph lister’s principle of antiseptic surgery to contains instruments which are in constant use during exclude putrefactive bacteria from wounds was still operation. From 1908 to 1930, various styles of turbans and shower 4. Small table for patient’s preparation equipment (skin prep table) cap-style head covering were worn. Charles Mayo (1913) 5. Ring stand for basin (s). 6. Anesthesia table and machine the team and mayo were photographed operating in surgical 7. Sitting stools and footstools/standing platforms gowns, caps, and masks 8. IV stands and hangers for IV solutions 1930- 1940 - Scrub dresses began to replace nurses’ regular 9. Suction machine, bottles, and tubing uniforms heretofore worn under the sterile gown, 10. Cautery machine observers in the OR were gowned, capped, and masked. 11. Kick buckets in wheeled bases 1958 - Disposable latex gloves were introduced 12. Basin in wheeled bases for soiled sponges and gloves Most efficient masks are disposable ones containing a high 13. Communication system / Intercom efficiency filter 14. Defibrillator 15. Negatoscope- obsolete device for displaying Xray films GUMAPAC, E. & SOLIS, N. 6  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. 1960 - Full skirts were replaced by close fitting scrub - Fingernails should be kept short. Nail polish is not allowed. dresses and pantsuits that reduces the hazard of brushing - Pierced-ear studs must be confined within headcover against a sterile table when near or passing by it - Jewelry (rings and watches) should be removed before 1950 - OR personnel were required to change shoes when entering the semi-restricted and restricted areas. entering the OR suite and to wear only those shoes when - Necklaces and chains can grate on the skin, increasing within the suite. Currently, disposable shoe covers are desquamating commonly worn. - Facial makeup should be minimal CRITERIA FOR OR ROOM ATTIRE - Eyeglasses should wiped with a cleaning solution before OR attire should be: each surgical procedure and properly secured An effective barrier to microorganisms. Both reusable - Hands must be washed frequently and woven and disposable nonwoven materials are used. thoroughly. Hand cream may be used after to prevent Design and composition should minimize microbial chapping and drying of hands. shedding. Comfortable, supportive shoes should be worn to minimize Closely woven material void of dangerous electrostatic fatigue and for personal safety, shoes should have enclosed properties. The garment must meet the fire protection toes and heels; clogs, slippers standards, including resistance to flame. External apparel that doesn't serve any functional purpose Nylon and other static spark-producing materials are should not be worn in the OR. forbidden as outer garments. COMPONENTS OF OPERATING ROOM Resistant to blood, aqueous fluids, and abrasions. Body cover or Scrub suit Designed for maximal skin coverage. One piece overall with attached hoods and boots are Hypoallergenic, cool, and comfortable convenient garb for visitor whose presence in the OR will be Non generative brief like the pathologist Easily to don and remove Pantsuits are preferred than the one-piece overall. 90% of Effective barrier to microorganisms bacteria Made of pliable material to permit freedom of movement Must be don a scrub suit before entering a semi restricted for the practice of sterile technique area Colored to reduce glare under lights Shirt and waistline drawstrings are tucked inside pants to avoid their touching sterile areas and to reduce fallout of DRESS CODE skin debris from thoracic and abdominal areas Scrub suit should be changed as soon as possible whenever These are written policies and procedures for proper attire it becomes wet or visibly soiled to be worn within the semi-restricted and restricted areas Person who will not be sterile team members should wear of the OR suite long-sleeved jackets Should include personal hygiene Headcover/ Cap/ Turban Protocols must be abided All facial and head hair must be completely covered. Location of the dressing room Cap or hood is put on before a scrub suit to protect the Street clothes are never worn beyond the unrestricted garment from contamination by hair. area Types include disposable, lint-free, nonporous, nonwoven Only approved, clean, and/or freshly laundered or attire fabrics. A reusable cap should be made of a dense woven worn within the semi-restricted area. material and laundered daily. (after use put it in the hamper This applies to all, both professional, non-professional and and send it to the department) visitors alike. Net caps are not acceptable OR attire should not be worn outside the or suite. Hair should not be combed while wearing a scrub suit Before leaving the or suite, everyone should change to Persons with scalp infection should be excluded from the street clothes OR and treated first ▪ *lab gowns and smock gowns If the hair is long, a helmet or hood must be worn to cover A clean, fresh scrub suit should be put on after return for the neck area. It should be well fitted to confine and prevent reentry to the suite. escape of any hair. OR attire should be hung or put in a locker for wearing a Caps of different colors are helpful to differentiate second time. If disposable, discard in the trash one use. personnel Personal hygiene must be re-emphasized Shoe cover - A person with an acute infection Should be clean, washable and soft-soled - Persons with cuts, burns or skin lesions should not scrub or Protect the wearer from spilled into or onto shoes during handle sterile supplies because serum may seep from the procedures eroded area Maybe worn in semi-restricted and restricted areas - Sterile team members who are known to carry are Shoes restricted to wear in the OR or shoe cover overshoes pathogens. are preferable in reducing microbial transfer from the outside into the OR suite. GUMAPAC, E. & SOLIS, N. 7  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Can inadvertently become solid and harbor microorganisms Contains protein antigen & is cured with agents that may should be removed from entering the dressing room and cause an allergic dermatitis or systemic anaphylaxis after leaving the OR Vary in thickness (minimum 0.1mm) Protective gloves should be worn to change shoe covers Petroleum-based lotions or lubricants should not be used whenever they become wet, soiled, or torn. on the hands before dining latex gloves. Hydrocarbons will Mask penetrate latex, causing a change in its physical Worn in the operating room characteristics, including tear resistance. Should be worn at all times in the restricted areas where Surgical Gloves- clean objects and sterile packages should not be sterile supplies are exposed handled with contaminated; worn in surgical procedures Reusable cotton masks are obsolete because they filter Hands must be washed thoroughly after removing the ineffectively as soon they biome moist gloves At least 95% efficient in filtering miscorebed from droplet Lead gloves particles Thick gloves- should be worn for skin protection from ethylene oxide Disposable mask made of soft, cloth-like material in very exposure if sterilized packages must be handled before operation fine synthetic. Working Gloves- utility gloves are worn for cleaning and A fluid-resistant mask is advantageous housekeeping. Cool, comfortable, and nonobstructive to respiration Sterile and non-sterile single-use disposable latex and vinyl Non-irritating to the skin because of its polypropylene, gloves are discarded after use. They should not be washed polyester, or rayon fibers. or reused Should be worn over both nose and mouth and should Sterile Gown conform to facial contours to prevent leakage of expired Is worn over the scrub suit to permit the wearer to come air within the sterile field. Double masking is NOT recommended because the extra Differentiates sterile from unsterile members. thickness can cause venting from the effort to breathe Although the entire gown is sterilized, the back is not sterile, through it. nor any area below table level, once the gown is donned To prevent cross-infection, masks should be handled by the Wrap around sterile gowns that provide coverage strings. DO NOT handle the mask excessively; If the gown is close by ties along the back, a sterile vest Never be lowered to hang loosely around the neck, on top should be put on to cover the back of the cap, or put in a pocket. Avoid disseminating The cuffs of the gowns are stockinette (rib-knit) to tightly fit microorganisms the wrists. Sterile gloves cover the cuffs of the gown (close Be promptly discarded into proper receptor method gowning) Changed frequently. Do not permit the mask to become Should be resistant to penetration by fluids and blood wet. Talking should be kept at a minimum. Should be comfortable without producing excessive heat Eyewear/Goggles build-up. Worn to reduce risk of blood or body fluids from the px Reusable gowns must be made of densely woven material. splashing into the eyes of sterile team members, or bone Pima cotton with a 270-280 thread count per sq inch chips or splatter alike. treated with a moisture-repellant finish With side shields, anti-fog goggles, combination surgical Some reusable are cotton-polyester blend. mask with a visor eye shield. Seams of the gown should be constructed to prevent Eyewear or face shield that becomes contaminated should penetration of fluids. be decontaminated or discarded promptly. Woven textile gowns withstand about 75 launderings and Laser eye must be worn for eye protection from laser sterilizing cycles before discarding them. beams If punctured or torn, gown should be changed during the Eyewear with a face shield should be worn when handling procedure. or washing the instruments when the activity could result in All woven and some non-woven gowns are not flame a splash, spray or splatter to the eye or face. retardants. Fire-resistant gowns should be worn for laser surgery and when electrosurgery is used Sterile Gloves Gowning Non-sterile latex or vinyl gloves should be worn when The circulator brings the gown over the shoulder by handling contaminated materials reaching inside to the shoulder and arms seams. The gown Surgical gloves are made of natural latex rubber, synthetic is pulled on, leaving the cuffs of the the sleeves extended rubber, vinyl, or polyethylene over the hands. The back of the gown is securely tied or fastened at the neck and waist; touching the outside of the Latex - polymeric membrane of natural rubber with an infinite gown at the line of ties or fasteners, in the back only. number of holes between lattices The scrub nurse, putting down, gently shakes out folds, then Better barrier than vinyl tape slips both arms into the armholes of the sleeves GUMAPAC, E. & SOLIS, N. 8  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. simultaneously without touching the sterile outside of the reusable brush may be wrapped to provide sterile individual gown with bare hands. packages. After drying your hands, pick up the sterile gown, lift it Reusable nail cleaners should be used to clean under the directly upward and step away to avoid touching the edge nail. of the wrapper. Orangewood sticks are not used because the wood may Drying Hands and Arms splinter & harbor Pseudomonas After scrubbing, hands and arms must be thoroughly dried before the Antiseptic Agents sterile gown is donned to prevent contamination of the gown by Antiseptic agents are approved by FDA strike-through of microorganisms from wet skin. Different agent has different specific microbial agent. Apron Agents alter the physical or chemical properties of the cell Fluid proof aprons membrane of microorganisms, thus destroying or inhibiting Lead aprons cellular functions. A decontamination apron should be worn over the scrub Should be a broad spectrum antimicrobial agent; suit to protect against liquids and cleaning agents during Should be fast acting and effective; cleaning procedures. This should be a full front barrier Should be nonirritating and non sensitizing; Lead Apron Should be prolonged-acting; Protects against radiations exposure or when handling Should be independent of cumulative action radioactive implants (x-rays,C-arms, coronary angiogram) 4% Chlorhexidine Gluconate- produces effective, immediate, and REVIEW OF SURGICAL HAND SCRUBBING cumulative reductions of resident & transient flora. The effect is Description: maintained for more than 6 hours. Nonirritating to the skin but Surgical hand scrubbing is the process of removing as many highly irritating if splashed in the eye. microorganisms as possible from the hands and arms by mechanical Iodophors- is a povidone-iodine complex against gram positive washing & chemical antisepsis before participating in surgery. & gram-negative microorganisms; irritating to the skin; not - Mechanical washing with friction removes transient sustained for a prolonged period (6hrs). organisms. 1% Triclosan- nontoxic, non-irritating, & develops a prolonged - Chemical antisepsis reduces resident flora & cumulative suppressive action when used routinely. Less effective inactivates microorganisms with antiseptic agents. than Chlorhexidine Gluconate and Iodophors - Done before gowning & gloving for each surgical 60% / 90% Alcohol- nontoxic, does not have residual activity, has procedure. drying effect on skin. 5. 3% Hexachlorophene - most effective after buildup of cumulative suppressive action. Available by prescription only Preparation for Surgical Scrub Purpose of Surgical Hand Scrub Skin & nails should be kept clean and in good condition and To help prevent the possibility of contamination of the cuticles should be uncut. operative wound by bacteria on the hands and arms. Fingernails should not reach beyond the fingertip to avoid To remove soil, debris, natural skin oils, hand lotions and glove puncture. transient microorganisms from the hands & forearms of Fingernail polish should not be worn. Artificial devices must sterile members. not cover natural fingernails. To decrease the number of resident microorganisms on skin Remove all jewelries from fingers, wrists and neck. to an irreducible minimum. Ensure to fold the sleeves of the scrub suit at least 2 to 3 To keep the microorganisms to minimum during the inches above the elbow. surgical procedure by suppression of growth. Before proceeding to the scrub sink To reduce the hazard of microbial contamination of the Open out the sterile gown pack onto a clean back table, only surgical wound by skin flora. grabbing the outermost edges to maximize the sterile field. Materials needed for Surgical Hand Scrub Open the sterile glove packet and let it drop onto the open Scrub Sink sterile gown pack is adjacent to the OR for safety and convenience Preparations Immediately Before scrubbing automatic control or foot or knee operated faucets; - sink is Inspect the hands for cuts and abrasions. Skin integrity deep & wide enough should be intact. Should be used only for scrubbing or hand washing only. All hair is covered properly by headgear including the Should not be used to clean or rinse contaminated/ soiled pierced ear studs. instruments and equipment. Adjust disposable mask snugly & comfortably over nose & Scrub Brush mouth. reusable scrub brushes Clean eyeglasses if worn. disposable sponges Adjust comfortably in relation to the mask. Adjust water to single use disposable brush-sponge combination with a comfortable temperature and amount. impregnated antiseptic detergent agents. Types of Surgical Scrub Procedure Brush should not cause skin abrasion GUMAPAC, E. & SOLIS, N. 9  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Time Method B. Gown packages preferably are opened on a Complete scrub (5-7 minutes) separate table from other packages to avoid Short scrub (3 minutes) contamination from dripping water. Brush-stroke Method or counted Method C. Avoid splashing water on scrub attire during 30 strokes method surgical scrub because moisture may 15 strokes method contaminate the sterile gown. Steps in 5-minute time scrub method Wearing of Sterile gown by self 1. Wet hands and forearms. Apply 2 to 3 ml (6 gtts) of After scrubbing, hands and arms must be thoroughly dried antiseptic agents to the hands before the sterile gown is donned to prevent contamination 2. Lather & Wash hands several times up to 2 inches above the of the gown by strike-through of microorganisms from wet elbow. Then rinse thoroughly under running water with skin. hands upward. After drying of hands, pick up the sterile gown, lifts it 3. Take the sterile brush, apply antiseptic agent & scrub directly upward and steps away to avoid touching the edge following the time allotted per part: * 30 seconds each nail, of wrapper. *30 seconds each finger, *30 seconds each hand The scrub nurse, putting on a gown, gently shakes out folds, 4. With brush in hand, clean under fingernails with nail cleaner then slips both arms into the armholes of the sleeves on running water then discard after use the cleaner simultaneously without touching the sterile outside of the 5. Again scrub each individual finger, nail and hands with the gown with bare hands. brush a half minute for each The Circulator brings the gown over the shoulder by 1. hand, maintaining lather reaching inside to the shoulder and arms seams. The gown 6. Rinse hands and arms and discard is pulled on, leaving the cuffs of the sleeves extended over brush; Reapply the antiseptic agent and wash the the hands. hands & arms with friction up to the elbow for 3 minutes. The back of the gown is securely tied or fastened at the neck Interlace the fingers to cleanse between them and waist; touching the outside of the gown at the line of 7. Rinse the hands and arms thoroughly. ties or fasteners, in the back only. 8. Stay for a few seconds at the scrub sink for the dripping of Serving of sterile gown water, then proceed to the assigned OR suite. DO NOT 1. Open the hand towel and lay it on the surgeon’s hand, being careful INTERLACE THE FINGERS. not to touch the hand. Steps in Brushstroke method (15 Strokes Method) *If no towel is available, the lower part of the gown may be 1. Wet hands and arms up to 2 inches above the elbow used to dry the hands of the surgeon.* 2. Lather with antiseptic agent. 2. Keeping your hands on the outside of the gown under a protective 3. With the hands held under running water, clean under cuff of the neck and shoulder area, offer the inside of the gown to the the fingernails of both hands with nail cleaner & discard surgeon. The surgeon slips the arms into the sleeves. after use 3. Release the gown. The surgeon holds arms outstretched while the 4. Rinse both hands and arms under running water, keeping circulator pulls the gown onto the shoulders and adjusts hands up the sleeves, so the cuffs are properly placed. In doing so, only the 5. Take a sterile brush and apply an antiseptic agent and inside of the gown is touched at the seams. start doing the brush stroke method on ONE HAND first Donning of sterile surgical gloves by Closed glove technique following: 1.Using the left hand and keeping it within the cuff of sleeve, a a. 15 strokes each nail gowned scrub person picks up the right glove. Palm of glove is placed b. 15 strokes all sides of each finger against palm of right hand, grasping top edge of glove cuff above c. 15 strokes each dorsum palm. d. 15 strokes each palm CORRECT POSITION: Fingers of glove are pointing towards you e. 15 strokes for each third of the arm up and the thumb of the glove is aligned with the thumb of the to 2 inches above the elbow. hand. The thumb side of the glove is down. 6. Repeat the above steps for the other hand and 2, Back of the cuff is grasped in the left hand and turned over the right arm sleeve and hand. Cuff of the glove is now over the stockinette cuff of 7. Rinse the hands and arms thoroughly the sleeve, with the hand still inside the sleeve. 8. Stay at the scrub sink for a few seconds for the 3.Top of the right glove & underlying sleeve of the gown are grasped dripping of water while maintaining the hands up. with the left hand. By pulling the sleeve up, the glove is pulled onto GOWNING AND DONNING OF SURGICAL GLOVES the hand. Purpose: 4.Using the gloved right hand, the left glove is picked up and placed - Sterile gown is worn to exclude skin as a possible with the palm of the glove against the palm of the left hand. Back of contaminant and to create a barrier between the sterile the cuff is grasped, above the palm in the right hand & turned over and unsterile areas. the left sleeve and hand. General Considerations 5.Cuff of the left glove is now over the stockinette cuff of the sleeve, A. The scrub person gowns & gloves self, then may with the hand still inside the sleeve. Top of the left glove and gown and glove the surgeon & assistants. GUMAPAC, E. & SOLIS, N. 10  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. underlying gown sleeve are grasped with the right hand, and the Grasp the right shoulder of the loosened gown with the left hand and sleeve is pulled up, pulling the glove onto the hand. pull the gown downward from the shoulder an off the right arm, Serving of Sterile gloves turning the sleeve inside out; 1. Pick up the right glove, grasp it firmly, with the fingers 1. Turn the outside of the gown away from the body under the everted cuff. Hold the palm of the glove toward with flexed elbows; the surgeon. 2. Grasp the left shoulder with the right hand and 2. Stretch the cuff sufficiently for the surgeon to introduce remove the gown entirely, pulling it off (inside the hand. Avoid the touching the hand by holding your out); thumbs out. 3. Discard in a laundry hamper or in a trash 3. Exert upward pressure as the surgeon plunges the hand receptacle (if disposable) into the glove Glove removal 4. Unfold the everted glove cuff over the cuff of the sleeve; The key to removing both sterile and non-sterile gloves is "Dirty to Repeat for the left hand. Dirty - Clean to Clean" that is, contaminated surfaces only touch other 5. If a sterile vest is needed, hold it for the surgeon to slip the contaminated surfaces: your bare hand, which is clean, touches only hands into the armholes. Be careful not to contaminate clean areas inside the other glove. gloves at the neck level. If the gown is a wraparound, assist 1. Take hold of the first glove at the wrist. the surgeon. 2. Fold it over and peel it back, turning it inside out Donning of sterile surgical gloves by Open glove technique as it goes. Once the glove is off, hold it with your gloved This method of gloving uses a skin-to-skin, glove-to-glove hand. technique. The hand, although scrubbed, is not sterile and must To remove the other glove, place your bare not come in contact with the exterior of the sterile gloves. The fingers inside the cuff without touching the glove everted cuff on the gloves exposes the inner surface. exterior. Peel the glove off from the inside, turning it The first glove is put on with skin-to-skin technique, bare hand to inside out as it goes. Use it to envelope the other inside cuff. The sterile fingers of that gloved hand then may touch glove. the sterile exterior of the second glove, that is glove-to-glove SURGICAL INSTRUMENTS technique Historical Background Open Glove Method Code of Hammurabi (Circa 1900 BC)- describes a bronze lancet 1. With the left hand, grasp the cuff of the right glove on the Incas of Peru- use razor-sharp flint and animal teeth fold. Pick up the glove and step back from the table. Egyptians (1900 - 1200 BC) - blades made of flint, reed, and bronze 2. Insert the right hand into the glove and pull it on, leaving Hippocrates (460 -377 BC)- advocated the heating of tips of the cuff turned well down over the hand. rounded and pointed blades before using 3. Slip the fingers of the gloved right hand under the everted Rome (1st century AD)- use of scalpel handles with blunt dissecting cuff of the left glove. Pick up the glove and step back. ends, knives, saws, forceps, and clamps with locking handles, probes, 4. Insert the hand into the left glove and pull it on, leaving the and hooks for retraction. cuff turned down over the hand. Ambroise Pare (1509-1590)- 1st person to grasp blood vessels with a 5. With the fingers of the right hand, pull the cuff of the left pinching instrument that was the predecessor of the hemostat used glove over the cuff of the left sleeve. If the stockinette is not today. tight, fold a pleat, holding it with the right thumb while pulling American Civil War (1861-1865) - trademark of this period were the glove over the cuff. Avoid touching the bare wrist. amputations 6. Repeat step 5 for the right cuff, using the left hand and - In some instances, amputations were performed on kitchen thereby completely gloving the right hand. tables with heavy knives and instruments. Even tables Reminders in Glove technique forks were used as retractors. Avoid contact of sterile gloves with ungloved hands during 18th-19th centuries closed-gloving procedure. Surgical tools were made by skilled silversmiths, For close gloving method, never let the fingers extend coppersmiths, and woodworkers. Some instruments beyond the stockinette cuff during the procedure. Contact handles were made of ivory, bone, or wood with velvet with ungloved fingers constitutes contamination of the cases gloves. 20th Century: For open glove method, touch only the cuff of the glove Instruments are made entirely of metals such as carbon with the ungloved hand, and then only glove to glove for steel, silver, and brass, and the velvet case was replaced by the other hand. sterilizer trays. If contamination occurs during either procedure, both gown 1900s and gloves must be discarded and new gown and gloves Development of stainless steel from Germany, Sweden, must be added. France, England, Pakistan, and United States When removing gloves after a procedure is finished, the Made of titanium, cobalt-based alloy (Vitallium), stainless gloves are removed using glove-to glove, skin to skin steel or other metals technique, after the gown is removed inside out technique. Stainless steel: alloy of iron, chromium and carbon. It may Removing of gown also contain nickel, manganese, silicon, molybdenum, GUMAPAC, E. & SOLIS, N. 11  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. sulfur and other elements to prevent corrosion or add Handle # 3, 7, 9 – Blade # 10, 11, 12, 15 tensile strength. Alloys make the instruments resistant to corrosion when exposed to blood and body fluids, cleaning solutions, sterilization, and atmosphere. Parts of the Surgical Instrument Tip Serrated Jaws Boxlock Shank Ratchet Finger ring or Ring Handle Handle # 4 – Blade # 20, 21, 22, 23 Blade # 10- most frequently use; has a rounded cutting edge along one side Blades # 20, 21, 22- have the same shape but larger Blade # 11- straight edge that comes to a sharp point; known as the stab knife Blade # 12- shaped like a hook with the cutting edge on the inside curvature Blade # 15- has a smaller and shorter curved cutting edge than no. 10 blade Blade # 23- has a curved cutting edge that comes to more of a point than nos. 20, 21, and 22 Classification of instruments Cutting and Dissecting Grasping and Holding Clamping and Occluding Exposing and Retracting Suturing and Retracing Suturing and Stapling Viewing Suctioning and Aspirating Knives Dilating and Probing Comes in various sizes and configuration Accessory Instruments Usually have a blade at one end and the blade CUTTING AND DISSECTING have one or two cutting edges Have sharp edge Some have detachable Use to dissect, incise, separate, and excise tissues Scissors Should be protected during cleaning, sterilization, Blades of the scissors maybe straight, angled or and storing; curved, pointed or blunt at the tips, and the Should be kept separate from other instruments Handles maybe long or short; and demand careful handling at all times Used only to cut or dissect tissues Scalpels Metzenbaum scissors (Metz)- used to cut delicate tissue; also Made of brass and the blade is made of carbon known as tissue or operating scissor steel; Most frequently used has a reusable handle May also be available in disposable type GUMAPAC, E. & SOLIS, N. 12  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. GRASPING AND HOLDING Straight MAYO scissors (Suture scissors) used to cut sutures Tissue Forceps and supplies; also known as suture scissor - used often in pairs, to pick up or hold soft tissues and vessels Curved MAYO scissors - available in regular and long sizes. used to cut heavy and tough tissues (fascia, muscles, uterus, breast) Thumb Forceps/smooth, non-toothed forceps - used to hold delicate tissues; are tapered with serrations at the tip; maybe straight or angled, short or long and delicate or heavy. Wire scissors (stitch)- have short, heavy blades; used instead of suture scissors to cut stainless steel scissors; heavy wire cutters are used to cut bone fixation wires. Toothed/ pick up/ Rat tooth Forceps- have a single tooth on one side that fits between two teeth on the opposing side; use to hold tough tissues - Allis Forceps- has a scissor action. Each jaw curves slightly inward with a row of teeth at the end; Dressing / Bandage scissors - used to cut drains and dressings o holds tough tissue gently but securely and to open items such as plastic packets - bandage is used to cut the uterus and umbilicus during CS operation Babcock Forceps- maybe used in fallopian tube The end of each jaw is rounded to fit around a structure or to grasp tissue without injury. Sharp Dissectors - includes biopsy forceps and punches, curettes (has a sharp edge with loop, ring or scoop on the end), snares (loop of wire may be put around a pedicle to dessert tissue such as a tonsil Stone Forceps GUMAPAC, E. & SOLIS, N. 13  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Used to grasp calculi such as kidney stones or gallstones either curved or straight forceps have blunt loops or cups at the end of the jaw Crile / Stet / Tag Forceps- for shallow layers of tissues Tenaculum - curved or angled points on the ends of the jaw penetrate tissue May have single tooth or multiple teeth (dilatation & curettage) Kelly Forceps: for deep layers of tissues or cavity Crushing Clamps- used to crush tissues or clamp blood vessels; - fine tips are used for small vessels and structures while longer and sturdier jaws are needed for larger vessels, dense structures and Bone Holders - includes vice-grip, pliers and other types of heavy thick tissues holding forceps use to stabilize the bone Kocher or Ochsner Forcep- usually used in colon surgery; for placing cardiac wires when performing sternotomy CLAMPING AND OCCLUDING Hemostatic forceps Usually have two opposing serrated jaws that are stabilized by a box lock and controlled by ringed handles When closed, the handles remain locked on ractchets Non-crushing Vascular Clamps most commonly used surgical instruments used to occlude peripheral or major blood vessels temporarily used primarily to clamp blood vessels minimizes tissue trauma either straight or curved slender jaws, either straight curved or S shaped, have opposing rows of finely GUMAPAC, E. & SOLIS, N. 14  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. EXPOSING AND RETRACTING Handheld or Non self-retaining Retractors Malleable ribbon retractor (straight, thin, bendable) usually used in pairs and held by the first or second assist; Some have blades on one end, either curved or angled, dull or sharp while some have blade on both ends used by the assistant surgeon used to pull soft tissue and muscle aside to expose Self – retaining Retractors surgical site May have shallow or deep blades, some have Army-navy retractor - abdominal operation ratchets or spring locks to keep the device open, while others have wings to secure the blades; some holding devices have 2 or more blades that can be inserted to spread the edges of incision and hold them apart Balfour abdominal retractor - Bladder retractor Deaver retractor -for deeper retraction SUTURING AND STAPLING Needle Holder used to grasp and hold curved surgical needles resembles hemostatic forceps but the basic difference is the jaws Harrington Retractor - to protect the organ; minimizes the trauma has a short, sturdy jaws for grasping a needle without damaging it or the suture material. the size of the needle holder should match the size of the needle either long or short, with serrations on jaws, some are non Single end richardson retractor - used in cesarean section the higher the number, the smaller the needle Goulet retractor - intended for the abdominal procedure Tungsten Carbide Jaws - jaws with an insert of solid tungsten carbide with diamond cut precision teeth designed to eliminate twisting and turning if the needle in the needle holder; o can be identified by the gold plating on the handles o intended for handling needles GUMAPAC, E. & SOLIS, N. 15  NUR 1213: MSN- PAIN AND SURGERY DATE: November 16, 2021 | REFERENCE: PPT & HANDOUTS | CREATED BY: GUMAPAC, E. & SOLIS, N. Smooth jaws needle holder- needle holders that have jaws without serrations which are used for small needles like in plastic and microsurgery SUCTIONING AND ASPIRATING Suction- is the application of pressure to withdraw blood or fluids, usually for visibility at the surgical site; made of style tip and sterile tubing; style of the suction tip depends where it is to be used and the surgeon’s preference Castroviejo Needle Holder - intended for sutures; for smaller needles; blood vessel repair Staplers- available in reusable and disposable type Poole Abdominal Tip- straight hollow tube with a perforated outer VIEWING INSTRUMENTS filter shield that prevents the adjacent tissues from being pulled into Speculum- has a hinged, blunt blessed that enlarges and holds a the suction apparatus canal open such as the vagina used during abdominal laparotomy or within any cavity in which copious amount of fluid or pus are encountered Frazier Tip Suction- right angle tube with a small diameter used when little or no fluid except capillary Nasal speculum- funnel like and used to visualized the inner parts of bleeding an irrigating fluid is encountered such as the nose brain, spinal, plastic, and ortho procedures o keeps the field dry without the need for sponging Ear speculum- is like used to visualize the inner parts of the nose Yankauer Tip - hollow tube that has an angle of mouth; connected is connected to rubber tubing; used in tonsillectomy Endoscopes- made of a round or oval sheath that is inserted into a body orifice or through a small skin incision used