Preparation Of Surgical Team,Pack And Patient
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Preparation Of Surgical Team,Pack And Patient

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FROM Dr.MUDASIR BASHIR

FROM Dr.MUDASIR BASHIR
M.V.Sc SCHOLAR
VETERINARY SURGERY AND RADIOLOGY
I.V.R.I

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    Preparation Of Surgical Team,Pack And Patient Preparation Of Surgical Team,Pack And Patient Presentation Transcript

    • Preparation of surgical team,pack and patient Mudasir Bashir Roll no.-4856 Division of vety surgery and radiology-I.V.R.I
    • Preparation of surgical team
      • Each surgical team consists of 3-4 members.
      • Surgeon— captain of surgical team and performs surgical operation.
      • uses hand signals and talks slowly for necessary requests.
      • possess qualities of an ideal surgeon—thoghtful,kind,forgiving,understanding,quite,controlled,foresighted and gentle.
      • II Assistant surgeon –
      • assists surgeon during operation.
      • prepares and drapes surgical field of operation.
      • keeps operative field free of visual obstructions,particularly blood and clots.
      • should remember to blot tissues instead of wiping them.
      • avoids accumulation of instruments,soiled sponges,remnants of sutiures,abdominal packs.
      • keeps in mind detail helping the surgeon.
      • Anesthetist/helper—
      • prepares and administers preanaesthetics.keeps proper anaesthetic record.
      • records respiration,pulse,its quality and strength and temp.
      • keeps animal in recovery room after surgery .
      • preparations of surgical team involves:- Scrub suits: worn in the surgery area to limit amt .of dirt,debris and bacteria that surgical staff carry into operating room.
      • Shouldnot shrink ,easily laundered.
      • Available in cotton,polyester blends or disposable nonwoven material.
      • Usually consists of shirt and pant.
    •  
      • Not worn to examine patients or change bandages if additional surgery is to be done.
      • Head cover:- worn to reduce shedding of hair and bacteria{e.g;strept.viridens,e.coli,s.aureus} into incision.
      • All people in operating room wear head cover.
      • Present in caps,hoods and bouffants.
    •  
      • Shoe covers:- worn to exclude-
      • Bacteria on street shoes.
      • Reduce possibility of contaminating the operating room.
      • To protect shoes from blood and hospital bacteria.
      • Available in both reusable and disposable.
      • Use declining-no evidence of declining surgical wound infection.
    •  
      • Face masks:- recommended for anyone entering surgical room during surgery.
      • Covers nose and mouth and are secured behind top of head and neck for minimal venting.
      • Prevent surgical wound from saliva droplets and micro-organisms by radiating through sideways of mask.
    •  
      • Surgical hand scrub:- surgeons hands usually more contaminated than do the hands of other medical personnel-more exposure to scrub soln.and contaminated wound.
      • Brushes may or may not be used-no reduction in contamination.
      • Done by 2 methods-
      • Timed anatomic scrub- all surfaces scrubbed for specific time.
      • 5minute scrub is safe and effective.
      • Counted brush strokes method:- each surface 0f arm and hands receive specific number of brush strokes.
      • Usually 10-25 times is being done.
      • Gowns:- provide barrier between operating teams skin and patient.
      • Packaged individually and folded so that internal back region is outermost.
      • Gloves:- worn by the operating team to protect patient from micro-organisms present on operating teams skin.
      • Powders are placed inside the gloves to make them easy to wear.
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      • Remember:-
      • Ensure that nails are socially clean,short and without nail polish.
      • Ensure that hands are kept heigher than elbow.
      • Rings watches should be removed.
      • Use of gloves does not replace hand washing.
      • Keep safe distance away from obstacles of the gown.
      • Never touch anything which is non sterile.
      • Check there is no hole in gloves.
    • Preparation of patient
      • Dietary restrictions:-
      • Done to prepare animals GIT for surgery.
      • To prevent postoperative emesis causing undue stress on incision and tracheobronchial aspiration of stomach contents
      • Food intake is generally restricted for 12hrs in small animals and 24-48hrs in large animals.
      • If inadequate fasting time,emesis may be induced.
      • EXCRETIONS:- Shortly before anaesthesia animal should be allowed to defaecate and urinate-empty bladder is often required for abdominal surgeries.
      • Preparation of patient is divided into:-
      • Premedication:- done to:-
      • Reduce amt of general anesthetic needed and increase margin of safety.
      • Calm the patient-anaesthesia can be administered without fright or struggling.
      • Reduce salivary secretions and of mucus glands of respiratory tract.
      • Reduce gastric and intestinal motility-prevent vomiting while animal is under anaesthesia.
      • Block vagovagal reflex-prevent cardiac slowing or arrest.
      • Reduce pain,struggling and crying during the recovery period.
      • drugs used as preanaesthetics are:-
      • Anticholinergics.
      • Tranquilizers.
      • Opiate and non-opiate analgesics.
      • Tranquilizer-narcotic combination.ETC.
      • After applying pre-anaesthetics,general anesthetic is given to the animal.
      • General anaesthetics are generally given either through i.v route or by inhalation.
      • After attaining complete anaesthesia animal is intubated.
      • In ruminants general anesthesia is not preferred—prolonged lateral recumbency leads to accumulation of gases—respiratory distress.
      • In cat and horse never do surgery of eye or close to eye on local anesthetics—heart block.
      • Antibiotics should be applied before surgery.
      • In horse tetanus toxoid should be given prior to surgery[21days in elective surgery and before surgery in emergency surgery].
      • Application of fluids.
      • Anesthesia given should be balanced that is—hypnotic,muscle relaxant,andanalgesia.
      • Dosage of anesthetic is based on following factors—
      • Metabolic activity of animal.
      • Existing disease condition.
      • Pharmacological effect of drug.
      • Factors on which anesthetic is given:-
      • Age of animal.
      • Relative size of animal.
      • Body fat.
      • Sex.
      • Breeds.
      • temperament of animal .
      • Prolonged fasting.
      • Recent feeding.
      • Activity of animal.
      • Duration of surgery.
      • Nature of operation.
      • Site of surgery.
      • Surgical site preparation:- the skin and hair of animals are reservoir for bacteria{staph.micrococcus,acinetobacter,corynebacterium,strept,etc}.
      • Hair removal:- razors,depilatories and clippers have been used.
      • Razors-
      • Adv.:-leave minimal stubble.
      • Disadv.:-multiple laceration.
      • Skin erosion.
      • 10fold increase in surgical wound infection.
      • Depilatories:-
      • Adv:-a traumatic.
      • Disadv:-donot work on coarse animals skin.
      • Expensive.
      • Frequent skin reactions esp.cats.
      • Clipping:- recommended method.
      • Adv:-less skin trauma.
      • Fewer surgical wound infection.
      • minimum of 15cm on each edge of proposed incision is clipped.
      • For orthopedic procedures on limb-entire limb is clipped.
      • Skin preparation:- initial site preparation is performed outside the operating room with the animal positioned for easy access to the proper surgical site.
      • If limb is being prepared, it is suspended from ceiling or an i.v stand to have complete access.
      • The clipped area is scrubbed by applying gentle pressure in circular motion beginning at proposed incision site and moving centrifugally.
      • After scrub apply antiseptic soln.-70% ethyl alcohol,tinctures of chlorhexidine and iodine.
      • Positioning of patients:-
      • To ensure easy and complete access to surgical site to facilitate manipulation.
      • Patient is then secured with ropes,sandbags,adhesive tape,etc.to minimize movement during surgery.
      • Surgical site is wiped with antiseptic to complete the preparation.
      • Draping the patient:-
      • Isolates the surgical site from contaminated areas and provides sterile working area.
      • First of four drapes is opened,applied along one edge .similarly other three are kept on other edges.
      • Second drape layer consists of large single shroud with a central opening.
      • These art kept hold by using towel clamps.
      • Skin draping:-
      • Purpose-prevent bacteria present in hair follicles to contaminate the surgical wound.
      • Minimizes contamination of surgeons gloves.
      • PLASTIC DRAPES COMPARED TO CLOTH DRAPES CAUSE SIGNIFICANT REDUCTION IN POSTOPERATIVE COUNTS OF ENDOGENOUS BACTERIA.
    • PREPARATION OF SURGICAL PACK
      • General surgical pack consists of following instruments---
      • Mayo's scissors—blunt end,straight—1.
      • Mayo's scissors—blunt end, curved—1.
      • B.p.handle no.3 and no.4---------1 each.
      • Assorted blades for above handles—1 packet.
      • Mouse tooth tissue forcep----1.
      • Allis tissue forceps-----2
      • Cross bar towel clamp---4
      • Mosquito hemostats'-------4.
      • Artery foreceps,curved and straight—2 each.
      • Mathews needle holder---1.
      • Groove director---1.
      • Suture needles assorted(traumatic and a traumatic)-straight and curved---6.
      • Surgical gloves—2 pairs.
      • Surgical gown,mask,cap—2 each.
      • Surgical shroud(75×105cm) with 17×2cm slit in centre----1.
      • Surgical shroud without slit----1.
      • Surgical towels 20×30cm-------2.
      • Gauze sponges.
      • Surgical pack wrapper(90×120cm)—1.
      • General surgical pack should be prepared as follows:-
      • Surgical pack wrapper should be spread over diamond-wise on the table—one corner towards left and other towards right,one towards near side,fourth to far side.
      • Items assembled on pack wrapper in such a way that when pack is opened the articles may be removed in the order in which they are to be used.
      • All the instruments, surgical gowns,shrouds,gloves and towels should be cleaned dried before preparing a pack.
      • Surgical shroud should be folded by accordion-folding at 9-10cm intervals so that folds are At rt.angle to the window.
      • Pack should be sterilized. generally - 121 °c×15psi×15min.
    •