Preparation Of Surgical Team,Pack And Patient

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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

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

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