Surgical Area Equipment

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Author:
tsbatiste
ID:
265108
Filename:
Surgical Area Equipment
Updated:
2014-03-15 15:27:57
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VTHT Anesthesia Surgery
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Description:
overview of equipment in surgery
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  1. Three specific areas of surgery
    • 1. Patient Treatment/Recovery room
    • 2. Preparation room
    • 3. Operating Room
  2. How must Patient Preparation room be configured to be AAHA compliant?
    A wall and door must separate it from both the Operating and Recovery rooms
  3. Specific Guidelines for Operating Rooms:
    • 1. Made of non-porous material and impervious to cleaning agents
    • 2. No more than 2 doors (1 for AAHA compliance)
    • 3. Air exchanges minimum of 12/hr, ideal at 17/hr
    • 4. Cidex to be used for all cleaning of surfaces
    • 5. Must wear mask, gown, cap and appropriate clothing
    • 6. Know sterile non sterile boundaries and aseptic techniques
  4. Measures to reduce fire hazards in the operating room (oxygen is flammable):
    • 1. anesthetics stored 3' away from electrical equipment
    • 2. Use 100% cotton textiles/clothing
    • 3. Drapes are used on hair/fur to reduce static electricity
    • 4. No explosive/flammable cleaning agents
    • 5. No smoking
    • 6. Humidity >/= 50%
    • 7. Temp below 68 F
  5. Early surgical equipment origins:
    • butchers
    • carpenters
    • blacksmiths
    • tailors
  6. Stainless Steel is an alloy composed of:
    • Chromium
    • Iron
    • Manganese
    • Molybdenum
    • Nickel
    • Phosphorus
    • Silicon
    • Sulfur
    • Titanium
  7. Two instrument basic compositions
    1. Martensitic - high carbon low chromium "Pakistani", often used for instruments that aren't used a lot

    2. Austenitc - high nickel and chromium, gives superior high tensile strength for instruments used constantly "German"
  8. List the Blade sizes and purposes
    • 10 - incising skin
    • 11 - severing ligament
    • 12 - lancing abscess
    • 15 - small/precise curved incision
    • 20 to 23 - generally for large animal sx (need #4 handle)
  9. This instrument only has coagulation/cauterization applications
    Hyfracator
  10. Other than the scissors in a standard general pack, what other types may be seen?
    • Iris scissors - mainly opthalmology
    • Bandage scissors
    • Suture scissors
  11. Another name for Rat Tooth Thumb Forceps
    Cushing Thumb Forceps
  12. Name the thumb forceps
    • Rat Tooth (Cushing)
    • Adson
    • Brown-Adson
  13. Name the dressing forceps
    • Bayonet
    • Adson
    • Rat Tooth (Cushing)
  14. Name the tissue forceps
    • Brown-Adson
    • Stille
    • Carmody
    • Allis
  15. This general category of instruments are used primarily to clamp off blood vessels and stop bleeding
    Hemostatic Forceps
  16. Name the Hemostatic Forceps
    • Halstead Mosquito Forceps (curved or straight)
    • Kelley Forceps (curved or straight)
    • Rochester Carmalt Forceps (curved or straight)
    • Crile Forceps (curved or straight)
  17. Name two grasping surface patterns of Hemostatic forceps
    • Transverse serrations
    • Longitudinal serrations
  18. (S)ASIF
    (Swiss) Association for the Study of Internal Fixation
  19. This is a cobalt-chromium material used for bone instrument and implantation devices
    Vitallium
  20. List the categories of Orthopedic instruments
    • 1. Cutting and shaping
    • 2. Bone holding
    • 3. Internal fixation/implantation devices
    • 4. External fixation devices
  21. How long have ligatures been used?
    over 4000 years
  22. Cautery in the form of fire rods was used where?
    Ancient Egypt
  23. In the 2nd century, this person suggested the use of what kind of suture?
    Galen, silk
  24. Arabian physicians used what type of material for sutures
    Harp strings made from sun-dried sheep gut
  25. Kid and buckskin sutures were produced by whom in 1806?
    Phillip Physick
  26. This chemical was found by Lister to delay suture absorption.
    Chromic acid
  27. Still used today, chromic acid impregnated sutures come in what 4 varieties?
    • Type A - plain
    • Type B - Mild
    • Type C - Chromic
    • Type D - Extra Chromic
  28. List characteristics of the IDEAL suture
    "NEEEHAM"

    • Non-reactive
    • Easy to handle
    • Easy to completely sterilize
    • Economical
    • High tensile strength at small sizes
    • Absorb predictably in 60-90 days
    • Maintain knot w/o slippage
  29. List the two major classes of surture material
    • Absorbable
    • Non-absorbable
  30. This is the first of the non-gut absorbable suture made from braided synthetic fibers and is the standard that all other synthetics are measured.
    Ployglycolic Acid "PGA" (Dexon)
  31. Absorption time for Polyglycolic Acid sutures
    40-60 days
  32. Suture sizes are determined by what feature?
    The number of woven strands
  33. This absorbable suture is easy to handle, stable for use in contaminated wounds, causes minimal tissue reaction and is dark PURPLE
    Polyglactin 910 or Polyglactic Acid (Vicryl)
  34. Absorption time for Polyglactic Acid sutures
    90 days
  35. This absorbable suture has a monofilament structure that causes less drag in tissue but does not hold a knot well like woven sutures.
    Polidioxanone (PDS)
  36. Absorption time for Polidioxanone sutures
    182 days
  37. This is the most reactive of the absorbable sutures usually made from the sub-mucosal layer of sheep or hog intestine
    Surgical Gut (Chromic Gut)
  38. What is the purpose of soaking gut with chromic acid salts?
    To prolong absorption time and decreases soft tissue reactions
  39. What are the two most common surgical gut sutures used today and their absorption times?
    • Plain gut - Type A (3-5 days)
    • Chromic gut - Type C (10-15 days)
  40. List the two things all non-absorbable sutures have in common:
    • High tensile strength
    • Produce minimal tissue reaction
  41. List the non-absorbable sutures according to their group
    • Metal:¬†
    • Stainless steel wire
    • Metal clips and staples

    • Natural fibers:
    • Silk
    • Cotton
    • Dermal, virgin, linen

    • Synthetic fibers:
    • Nylon (Ethilon)
    • Polymerized caprolactum (Vetafil)
    • Polyester fibers
  42. Advantage of nylon:

    Disadvantage of nylon:
    minimal tissue reaction/strength up to 6 months

    knot security due to monofilament structure however, now available in multifilament material
  43. This synthetic non-absorbable suture is most commonly used in veterinary medicine made of a twisted fiber structure with a smooth coating and often soaked in antimicrobial fluid
    Polymerized caprolactum (vetafil)
  44. This synthetic, braided non-absorbable suture is often coated with Teflon or silicone
    Polyester fibers
  45. What are the disadvantages of polyester fibers?
    • Most tissue reactive of the non-absorbables
    • Poorest knot security of the non-absorbables
  46. This natural fiber, non-absorbable suture is most commonly used in human medicine but used primarily in veterinary medicine for specialty surgeries
    Silk
  47. This natural fiber non-absorbables suture was last used during the Korean War, is the weakest of the natural sutures.
    Cotton
  48. What was the main disadvantage of cotton sutures
    Capillary action caused skin abscesses
  49. Stainless steel sutures were first introduced when and by whom?
    1934 by Babcock
  50. Another name for the 18 gauge stainless steel wire suture
    Cerclage wire
  51. What purpose is the cerclage wire used?
    Orthopedic procedures - holding bone together
  52. What are the advantages of stainless steel wire?
    • Least reactive of all the suture materials
    • Non-corosive
    • Does not support bacterial growth
  53. The disadvantage of stainless steel wire sutures:
    most difficult to handle
  54. Which stainless steel suture gauges are used for skin?
    32 and 40 gauge
  55. Which metal suture material causes scarring if not removed early and requires the use of special/expensive devices for application/removal?
    Metal clips and staples
  56. This suture class is more likely to be used when prolonged strength is not required or when infection is present or anticipated.
    Absorbable
  57. This suture class is more likely to be used when tissue reaction must be minimized
    Non-absorbable
  58. 5 characteristics of needle identification
    • Attachment
    • Shape of body
    • Point
    • Cross-section
    • Size
  59. Two types of attachment in needles
    Eye needles - reusable but creates a bigger hole, primarily used for skin

    Swaged needles - suture attaches to needle internally, not reusable, primarily used for cardio/intestinal surgery - smaller hole
  60. Two types of body shape
    Straight - driven by hand, rarely used in veterinary medicine

    Curved - driven by needle holders, e.g: 1/2, 3/8 or 5/8 circle
  61. This type of cross-section leaves small cuts in tissue so no leakage of fluid occurs and is preferred for intestinal surgery
    Taper point (atraumatic) - round cross-section
  62. This type of cross-section has three cutting edges that incise the tissue in the direction of the pull that leave a larger than needed hole
    Standard cutting (traumatic) - pyramid cross-section
  63. This type of cross-section has three cutting edges that have the apex of the triangle on the back of the needles and the flat edge in the direction of the pull
    reverse cutting (traumatic) upside-down pyramid cross-section
  64. Point types
    • round
    • triangular
    • spear
    • spatula (used for organ sx)
    • trocar
  65. What is the general rule of needle sizing?
    The larger the number the smaller the needle; the smaller the number the larger the needle.
  66. This is the most common knot used.
    Square knot
  67. This knot, in conjunction with a square knot will not come untied except in nylon or chromic gut.
    Surgical knot
  68. This knot is the result of superimposing one hand upon another without reversing the second overhand
    Granny or slip knot
  69. This pattern is commonly used with the peritoneum and fascia when closing abdominal wounds
    Simple continuous sutures
  70. The disadvantages to simple continuous suture:
    • Will unravel if cut
    • Poor tissue apposition
  71. This is a modified simple continuous suture pattern that has superior tissue apposition
    Ford Interlocking sutures
  72. This suture pattern maintains strength and tissue position even if part of it fails but takes more time and suture material
    Simple interrupted sutures
  73. This suture pattern is also known as the tension suture, incorporates large amounts of tissue and is used primarily with large animals
    Horizontal mattress suture
  74. This additional classification of suture patterns turns the tissue inward towards the patient
    inverting
  75. This additional classification of suture pattern tends to turn the tissue edges outward creating a palpable ridge
    everting
  76. List 5 purposes of the anesthesia machine and breathing circuit
    • 1. Delivery anesthetic inhalant to patient
    • 2. Help maintain arterial oxygenation
    • 3. Eliminate carbon dioxide
    • 4. Help monitor respiration
    • 5. Assist Ventilation when required
  77. Components of a rebreathing circuit
    • 1. fresh gas inlet
    • 2. unidirectional valves
    • 3. pop-off valve
    • 4. reservoir bag
    • 5. CO2 absorbing canister
    • 6.¬†pressure manometer
    • 7. air intake valve
    • 8. breathing tubes
    • 9. Y-piece (only with 2 tube system)
  78. This funnels gas from the patient breathing circuit into the scavenging system
    pop-off valve
  79. This measure positive and negative pressures within the circuit
    pressure manometer
  80. This allows smaller, portable compressed gas tanks to be attached to the anesthesia machine
    Yoke hanger
  81. List the 4 parts of the anesthetic delivery system:
    "GABS"

    • 1. Gas source
    • 2. Anesthetic machine
    • 3. Breathing system
    • 4. Scavenging system
  82. Two most common sizes of compressed gas tanks
    "H"(central bank system) and "E"(portable)
  83. Level of O2 in a full "E" tank
    700L
  84. Level of O2 in a full "H" tank
    7000L
  85. Pressure of both "H" and "E" tanks containing O2
    2200psi
  86. This is the common gas outlet where the oxygen/medical gas/anesthetic agent mixture exits the anesthesia machine to the breathing system
    oxygen flush valve
  87. This is calibrated for each gas used and controls the amount of gas entering the system
    Flowmeter
  88. How is the flowmeter read?
    At the widest part of the ball or float
  89. Formula to determine proper rebreathing bag size
    wt in kg x 10mL/kg x 6
  90. Purposes of the rebreathing bag
    • Bag movement ensures proper intubation
    • Easier for patient to breathe
    • Observation of patient respirations
    • Positive Pressure Ventilation
  91. Two types of absorbents used in rebreathing circuits
    • Barium hydroxide (Soda lime)
    • Sodium hydroxide
  92. The granules in the canister chemically react with CO2 to produce what 2 products?
    carbonate and water
  93. How often is the Soda lime changed?
    Every 8 hours of surgery time
  94. Three portions of a Vaporizor in Circle
    • Surface
    • Draw over
    • Wick
  95. Where is the VIC usually located?
    Inspiratory side of the circle
  96. What do the numbers on the dial of a VIC indicate?
    The degree to which it is opened
  97. 3 factors that control the output of a VIC
    • 1. Ambient temperaure
    • 2. Total gas flow
    • 3. Tidal volume
  98. Primary advantage of a VIC
    low cost and simplicity
  99. Primary disadvantage of a VIC
    lack of concentrations control
  100. Which gas is only used with a VIC?
    Methoxyflurane
  101. What method was the first attempts at VOC
    Bubble or Saturation Method
  102. List the parts of the anesthetic circle
    • 1. Flutter valves
    • 2. Hoses
    • 3. CO2 absorbing canister
    • 4. Pop-off valve
    • 5. Reservoir bag
  103. What do the numbers on the dial of a VOC represent?
    The percentage of anesthetic gas delivered
  104. Precision Vaporizers deliver exact concentrations because:
    they are temperature, flow and back flow compensated
  105. Another name for temperature compensated
    temperature stable
  106. Primary advantage of Precision vaporizers
    Desired percent concentration are delivered without being affected by variations in ventilation or temperature
  107. Disadvantages of Precision vaporizers
    • 1. Complexity - each vaporizer is calibrated for a specific gas and machine must be serviced every 1 - 3 years
    • 2. Cost
  108. Three common anesthetic breathing systems
    • Total Rebreathing - pop-off valve closed
    • Partial Rebreathing - pop-off valve partially open
    • Non-rebreathing - pop-off valve completely open
  109. This system allows for the recirculation of exhaled gases (CO2 removed) to the patient
    Rebreathing system
  110. This system has a relatively low oxygen flow rate that provides only the oxygen necessary to meet the patient's metabolic needs where the pop-off valve is closed.
    Total or Closed Rebreathing system
  111. Advantages of a total rebreathing system
    • 1. Uses less oxygen and anesthetic gas
    • 2. More economical surgery
  112. Disadvantages of a total rebreathing system
    • 1. Soda lime needs to be changed more often due to CO2 accumulating faster
    • 2. Increase pressure in anesthetic circle due to entrance of O2 without a scavenger
    • 3. Due to low O2 levels, more flushing is needed
  113. This system uses a much higher oxygen and anesthetic gas flow rate due to gases escaping from partially opened pop-off valve
    Partial or Semi-closed rebreathing system
  114. This system is used for patients under 15 pounds to avoid resistance and total dead space of the other breathing systems where the pop off valve is completely open
    Non-rebreathing or Open system
  115. List two non-rebreathing units:
    • Ayers-T
    • Norman Mask Elbow
  116. Reasons to use a non-rebreathing system
    • 1. No valves = no resistance to breathing
    • 2. Expired gases warm inspired gases
    • 3. Partial humidification of inspired gases by expired gases
    • 4. 60" tubing allow system to be away from patient
    • 5. No pressure on endo-tracheal tube
  117. Two types of scavenging systems:
    • Active - motorized vacuum to the outside
    • Passive - non-motorized through tubing to the outside

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