Radiography in Surgery PDF

Chapter 21 Radiography in Surgery  Objectives  Define the term sterile corridor and explain the significance of this concept to the radiographer.  List the correct clothing for a radiographer preparing for imaging in the operating room.  Describe steps t...

Chapter 21 Radiography in Surgery  Objectives  Define the term sterile corridor and explain the significance of this concept to the radiographer.  List the correct clothing for a radiographer preparing for imaging in the operating room.  Describe steps to prevent contamination from imaging equipment that is brought into the operating room from an outside area.  Correctly identify furnishings and equipment commonly found in an operating room.  List typical members of a surgical team and identify which members must scrub and wear sterile attire.  Describe the general procedures involved in laparoscopic cholecystectomy and surgical cholangiography and the radiographer’s role in these procedures.  List ways in which imaging localization is used in surgery.  List three urologic procedures that involve imaging in the surgical suite.  Key Terms  Cholecystectomy  Laparoscope  Lithotripsy  Patent  Sterile corridor  Trocar C- arm  Surgical Suite (1 of 2)  Access to the surgical suite is limited to personnel and items with a legitimate reason to be there.  Special surgical clothing must be worn in a surgical suite.  Radiographic equipment must be wiped down with an appropriate aseptic solution. Sterile cover is placed over portion going over the patient.  Surgical Suite (2 of 2)  Some hospitals have imaging equipment reserved for use only in surgery.  Some surgery suites have permanent imaging equipment installed. Reduces contamination  Surgical Clothing  Nonsterile shirt and pants  Mask—covers nose and mouth  Hat or hood—covers all hair (including a beard, if applicable)  Shoe covers—may be optional  Gloves—donned to handle anything contaminated with blood Radiographer in Surgical Attire  Surgical Environment  Surgical Team  Surgical Setup https://www.southcom.mil/MEDIA/NEWS- ARTICLES/Article/944234/every-move-counts-for-jtf-bravos-mobile- surgical-team/  Surgical Team (1 of 2)  Members classified as: Sterile Nonsterile  Sterile members include: Surgeon Assistant to the surgeon (physician) Nonphysician assistant Scrub person (registered nurse, licensed vocational nurse, or surgical technologist)  Surgical Team (2 of 2)  Nonsterile team members include: Anesthesiologist or anesthetist Circulating nurse or surgical technologist Various other technologists Biomedical Orthopedic Radiologic  Surgical Setup  Sterile corridor Area between the patient drape and the instrument table Only those wearing sterile attire allowed in this area  Guidelines Be aware of the sterile field. Do not wear anything that dangles. Avoid putting objects that can fall out in pockets. Pass behind the back of a sterile team member to avoid contamination. The Sterile Field Operation Room(OR) Suite: 3 zones  1st – Unrestricted, people may enter in street clothes.  2nd – Semirestricted, persons who are dressed in scrub clothing, mask, and shoe covers.  3rd – Restricted zone, persons wearing scrub suits, masks, caps, shoe covers, and sterile applications.  Those directly involved in the operation are dressed in sterile gowns and gloves and are often called “being scrubbed.” Operating Suite  Unrestricted Areas:  Reception  Tea Room  Administration Offices  Loan Set Rooms  Semi-Restricted Areas: Peripheral support areas of Theatre are limited to authorised personnel and patients e.g.  Holding Bay  Post Anaesthetic Care Unit (PACU) / Recovery Room  Day Surgery Post Anaesthetic Care Unit (PACU)  Restricted Areas:  Surgical clothing must be worn in these areas  e.g. freshly laundered scrubs, clean, enclosed shoes, mask, protective eyewear, lead apron, thyroid protector Operating Rooms Anesthetic Rooms Setup Rooms Procedural Rooms eg. Radiology  Strictly observe the sterile field – advise if you breach it  Restricted Areas – cont.: Restricted access: Surgical clothing must be worn e.g. freshly laundered scrubs, clean, enclosed shoes Theatre Corridors Scrub Sink Areas Sterile Stock Rooms Central Sterile Supply Department (CSSD) The Sterile Field X-ray Equipment  Barrier Draped X-ray Equipment Barriers: Draped IIT Machine  Radiography in the Operating Room and Special Procedure Area  As a radiographer, it is your responsibility to protect yourself and others from radiation.  You are also responsible for the knowledge and awareness concerning the areas that are sterile and avoiding contamination.  The radiographer must wear his or her radiation detection monitor outside of the lead apron while working in the OR. Surgical Procedures Involving Radiography or Fluoroscopy  Cholecystectomy  Surgical or postoperative (T-tube) cholangiogram performed to check for residual stones  Usually follows cholecystectomy, most often performed using a laparoscope. https://ntmconline.net/services/ surgery/cholecystectomy/ Laparoscope cholecystectomy  Open-Fracture Reduction  C-arm used to check fracture fragment alignment and hardware placement  Surgical Localization  Locate foreign bodies, misplaced surgical equipment  Guide placement of special catheters and pacemakers  Urological Procedures  Retrograde urograms  Ureteral stent placements  Stone extractions  Lithotripsy Stone fragmentation by laser, ultrasound, or other energy  Chapter 11 Surgical Asepsis  Objectives  Compare and contrast medical asepsis, disinfection, and sterilization.  List five types of sterilization used in clinical settings, describe each, and state their principal applications.  Correctly identify sterility indicators on sterile packs.  Demonstrate correct procedure for establishing a sterile field.  Demonstrate correct procedure for adding items to a sterile field without contaminating the field.  Demonstrate correct procedure for performing the skin preparation, a surgical hand scrub/hand rub, sterile gowning with closed gloving, open sterile gloving for a sterile injection procedure such as an arteriogram or a myelogram.  Key Terms  Autoclave  Free radical  Sterile conscience (integrity)  Sterile field  Sterilization  Surgical asepsis  Surgical hand rub  Surgical hand scrub Sterilization  Definitions  Medical asepsis (Chapter 9) Methods of reducing pathogenic microorganisms in the environment and intervening in the process by which microorganisms are spread  Surgical asepsis The process of creating and maintaining an area that is completely free of pathogens  Sterilization The complete destruction of all organisms and spores from equipment used to perform patient care or procedures  Chemical Sterilization  The immersion and soaking of clean objects in a bath of germicidal solution followed by a sterile water rinse  Not recommended for surgical asepsis One of the less satisfactory methods because control of effectiveness factors (time, solution strength and temperature, and contamination detection) is difficult  Autoclaving  An autoclave is a device that provides steam sterilization under pressure.  The most commonly used sterilization method  Quickest and most convenient means for items that can withstand heat and moisture  Conventional Gas Sterilization  Method that uses a mixture of gases heated to 135°F (57°C)  Used for items that cannot be autoclaved Electrical, plastic, rubber items, and optical ware Telephones, stethoscopes, blood- pressure cuffs, and other equipment used in isolation rooms  Very effective but has drawbacks: Gases used are poisonous. Must be dissipated by aeration in a controlled environment. Process is time-consuming.  Gas Plasma Technology  Safer than conventional gas sterilization No toxic by-products  Able to sterilize heat/moisture-sensitive items in greater volume More cost-effective than conventional gas Cannot completely replace gas because it is not effective on items with long, narrow lumina Cannot be used on cellulose items (linens, etc.)  Sterility Indicators (1 of 2)  Chemical indicators that change color when sterilization has occurred  Used to identify whether a pack has been sterilized  Placed inside and outside the pack to show that the gas, heat, steam, or gas plasma has penetrated to all surfaces  Sterility Indicators (2 of 2)  The tape that seals this pack was originally a plain, light color.  The stripes appeared on the tape when conditions for sterility were achieved.  Sterile Field  Defined as a microorganism-free area prepared for the use of sterile supplies and equipment The Sterile Field  Steps to Establish a Sterile Field  Place the pack on a clean surface within reach of the physician.  Just before the procedure begins, break the seal and open the pack.  Unfold the first corner away from you; then unfold the two sides.  Pull the front fold down toward you and drop it. Do not touch the inner surface.  The inner wrap, if there is one, is opened in the same manner.  You have now established a sterile field.  Surgical Asepsis: Standard Principles  Any sterile object or field touched by an unsterile object or person becomes contaminated.  Never reach across a sterile field. Organisms may fall from your arm into the field. Increases the risk of brushing the area with your uniform  If you suspect an item is contaminated, discard it.  Do not pass between the physician and the sterile field.  Never leave a sterile area unattended. No one would know if field were contaminated.  A 1-inch border at the perimeter of the sterile field is considered a “buffer zone” and is treated as if it were contaminated.  Skin Preparation for Sterile Procedures  Skin prep – The purpose of a skin prep is to remove as many microorganisms as possible by mechanical and chemical means to reduce the potential of infection.  There are two aspects to skin preparation for a sterile procedure: Mechanical Chemical Skin Prep  Chemical Method of Skin Preparation  The area to be penetrated should be cleaned with an antiseptic solution.  Once you start to clean the area of interest, do this in a circular motion beginning in the center and working outward.  Do not cross anything over the area that has been prepped.  Sterile technique is maintained during the skin prep for sterile procedures!  Draping for Sterile Procedure  After the skin has been prepared, place sterile drapes around the area of interest. Must be handled as little as possible They must not be flipped or fanned  Draping for Sterile Procedure—(cont.)  Disposable sterile cloth towels are mainly used; however, a fenestrated drape may be used. Place them so that they are within the limits of the area prepared. They are folded so that they overlap and the folds face the operative site. Sterile Scrubbing, Gowning, and Gloving SURGICAL SCRUB SURGICAL SCRUB  Sterile Gowning and Gloving  If the radiographer must open his or her own sterile gown and towel pack, he or she must do this before beginning the surgical scrub.  Sterile gloving There are two types of gloving for sterile procedures: open and closed. As a radiographer, the open method is more practical. Sterile Gloving Sterile Gloving—(cont.)