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Positioning, skin prep, incision & draping
 

Positioning, skin prep, incision & draping

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Credits to Ma'am Evangeline Teruel

Credits to Ma'am Evangeline Teruel

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    Positioning, skin prep, incision & draping Positioning, skin prep, incision & draping Presentation Transcript

    • Putting patient in proper bodyalignment to exposethe operative site or area
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.1 Safety belt
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.2 Anesthesia screen
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.3 Armboard
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.4 Double armboard
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.5 Wrist or arm strap
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT2.6 Upper extremity table (hand table)
    • 2. Special bed equipmentPOSITIONING and Bed attachment EQUIPMENT2.7 (thyroid elevator)- Shoulder bridge towel roll
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.8 Body rests and braces-support maintain a lateral position
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.9 Lateral positioner (kidney rests)
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT2.10 Adhesive tape-for anal procedures
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.11 Stirrups
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT  2.12 headrests
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.13 Clamps and sockets
    • 2. Special bed equipmentPOSITIONING and Bed attachmentEQUIPMENT 2.14 Leg Prepper
    • 1. Site of operation2. Age and size of the patient3. Type of anesthetic used  regional – position patient first  general – position patient last
    • 4. Pain normally experienced by the patient upon movement5. Must not hinder respiration and circulation
    • 1. IDENTIFY2. Explain purpose of position.3. Mobility4. Precaution in transferring the pt fr. One bed to another. ▪ 2: Conscious ▪ 4: unconscious, anesthetized, weak and obese.
    • 5. OR bed is securely locked6. The anesthesia provider guards the HEAD7. Operative site must be adequately exposed.8. Avoid undue exposure.9. Strap the person to prevent falls.10. Maintain adequate respiratory function.
    • 11. Maintain good body alignment.12. Do not allow the persons extremity dangle over the sides of the table13. Avoid excessive muscle strain.
    • 14. Avoid person resting on hands which may impede circulation.15. Precautions for patient’s safety must be observed, particularly with thin, elderly or obese patients.16. Don’t cross ankles (cause
    • Pre-operative
    •  face neck shoulder induction of general anesthesia
    • HeadAbdomen
    • Clamshell top viewUSED FOR:- surgeries that involve unrestrictedaccess to both sides of abdomen asin laparoscopic surgery
    • Supine frog leg
    • USED FOR: Procedures of the anterior body such as:  Neurosurgical Procedures  Posterior Cervical Spine Procedures
    • Surgery of lowerabdomen or pelvis
    • trendelenberg
    • USED FOR: Procedures of the anterior body such as: laparoscopic surgery abdominal thoracic facial anterior upper and lower extremity procedures
    • For: neurological procedure
    • rectalsurgery
    •  For:  surgical procedures of the kidneys
    •  For  rectalexaminati on in an obese patient
    • For: vaginal, perineal like D&C and rectal procedures like hemorrhoidectomy
    •  DESCRIPTION: The patient is positioned so that the hips and knees are flexed and elevated to facilitate surgical access to the perineum and abdomen. USED FOR: Procedures of the anterior body such as: gynecologic procedures perineal perirectal/anal
    •  DESCRIPTION: The patient is positioned so that the hips and knees are flexed and elevated to facilitate surgical access to the perineum and abdomen. This is the most physiologically compromising of any position, especially if the patient is obese. USED FOR: Procedures of the anterior body such as: gynecologic procedures perineal perirectal/anal
    • bone section is raised 45 degreesFor: cranial procedure
    • Sitting may fieldsSitting may fields Sitting may fields
    • SittingBeach chair
    •  Abdominal surgeries  Supine Bladder surgery  Slightly trendelenburg Perineal surgery  Lithotomy Brain surgery  Semi-fowler’s Spinal cord surgeries  Prone mostly Lumbar puncture  Side lying, flexed body
    •  Abdominal Aneurysm Surgery: Fowlers Cataract Surgery:Semi fowlers Craniotomy  Supratentorial:semi fowlers  Infratentorial:flat
    •  Gastrectomy - supine Femoropopliteal by-pass graft – affected extremity (extended) Hemorrhoidectomy – side lying Hip surgery – keep legs in abduction Hypophysectomy – elevate head Laminectomy – keep back straight
    •  Laryngectomy – semi fowler’s Liver biopsy – right side lying Lobectomy – semi fowler’s Lumbar Puncture –  lateral side lying: during procedure  Flat: post-op
    •  Mastectomy – elevate on pillow (affected extremity) Thyroidectomy – semi fowler’s Tonsillectomy – side lying or prone Vein Stripping & Ligation - keep legs elevated.
    •  The removal of as many bacteria as possible from the patient’s skin through shaving, mechanical, washing, and chemical disinfection
    • Prevention of infection
    • 1. Determine the area to be shaved and its extent; know the operation to be done; the organ involved and its location and the proposed incision.
    •  Cranial surgery – depends upon surgeon Thyroid or neck surgery – chin to nipple plus shoulder and axilla Eye surgery – cut eyelashes of affected eye Nasal surgery – no shaving unless with mustache Ear surgery – 2 ½ inches around ear Chest surgery – base of neck to waist, axilla and inner arm Abdominal and pelvic surgery – nipple to symphysis pubis, vulva, perineum, thigh Kidney – anterior – nipple to perineum, side to side; supra scapular region to buttocks Vaginal, scrotal, rectal – waist to perineum plus anterior and inner aspect of thigh and 6 inches from groin; posterior – entire buttocks and anus Lower extremities – digits 2 inches above knee, entire extremity and groin Upper extremities – distal arm 2 inches above elbow; elbow up to axilla
    • 2. Practice modesty and provide privacy
    • 3. Ask the patient’spermission in cutting theeyelashes and hair.
    • 4. Examine the area to be shaved for any signs of irritation or any abnormal condition. Report this to your head nurse
    • 5. Do not cut the patient’s skin.6. In abdominal operations, pay particular attention to the umbilicus.
    • 7. Shave the operative site the day or the night before the operation8. Discard soiled sponges in your kidney basin.
    • 9. In shaving, follow the direction of the growth of the hair while the free hand exerts an opposite force by pulling the skin to the opposite direction.10. If a wound is present on the area to be shaved, start from the clean area to the dirty area
    •  Definition:  Is the procedure of covering patient and surrounding areas with a sterile barrier to create and maintain an adequate sterile field during operation
    • 1. Allow sufficient time to permit careful application2. Allow sufficient space to observe sterile technique3. Handle the drape as little as possible4. If a drape becomes contaminated, do not handle
    • 5. If in doubt as to its sterility, consider it contaminated.6. If end of sheet falls below waist level, discard it.7. Never reach across the operating room table to drape the opposite side; go around the table
    • 8. Take the towel clips to the side of the table from which the surgeon is going to apply them before handling them to him9. Carry the folded drapes to the operating room table, watch the front of the sterile gown; it may bulge and touch the nonsterile table or blanket of the patient...Stand well back from the nonsterile table.
    • 10. Hold drapes high enough to avoid touching them on the blanket but avoid touching the light.11. Do not let your gloved hand touch the skin of the patient.12. Hold the linen high until it is directly over the proper area then lay it down where it is to remain.
    • 13. If a drape is incorrectly placed, the circulating nurse discards it from the table without contaminating other drapes or site.14. In unfolding the sheet on the operative site, toward the foot or the end of the table, protect the gloved hand by enclosing it in the turned back cuff of the sheet provided for that purpose.
    • 15. A towel clip that has been fastened through a drape has its point contaminated. Removed it only if absolutely necessary then discard it.16. Place a drape on a dry area.
    • 1. Blood and fluid resistant to keep the drape dry and prevent migration of microorganism.2. Lint free to prevent airborne contaminants and shedding into the surgical site.
    • 3. Antistatic to eliminate risk of spark from static electricity.4. Sufficiently porous to eliminate heat build-up so as to maintain an isothermic environment appropriate for pt body temp.
    • 5. Drapable to fit around contours of the patient, furniture, and equipment6. Dull, nonglaring to minimize color distortion from reflected light.7. Free of toxic ingredient, such as laundry
    • 8.Flame resistant to self-extinguish rapidly on removal of an ignition source