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Surgical Prep & Assisting Qs & As with 100% Correct
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surgical assistant tasks - ✔✔preoperative, intraoperative, postoperative preoperative tasks - ✔✔patient prep and positioning intraoperative tasks - ✔✔instrumentation, instrument handling postoperative tasks - ✔✔wound and patient care preparing as sterile assistant - ✔✔prepare surgery - drape pack, instrument pack, gown, gloves, scrub brush for you and surgeon, anesthetic machine, heating device, monitors, final prep bowl, surgical paint and sterile gloves for circulating nurse, mask and cap for you/circulating nurse/surgeon/anesthetist scrubbing - ✔✔wet and apply soap to hands/forearms lather well pick under nails rinse lather both hands/forearms using sponge begin scrub - fingertips, 4 planes of fingers/palm/wrist/arm rinse repeat other arm rinse 12 strokes per plane 5 min contact time methods of gloving - ✔✔open cuff, closed cuff
gowning - ✔✔dry hands put on gown circulating nurse ties back hand strings to person tying - don't touch hands common errors as sterile assistant - ✔✔no cap or mask before scrub accidently touch gloves forget to remove jewelry/nail polish hair sticking out of cap touch fingers to glasses/mask surface of hand towel not separated for each hand/arm forget to add sterile gloves in pack before scrubbing patient prep - ✔✔assess clip and surgical scrub for sufficient hair removal and aseptic preparation, positioning of patient according to surgical approach/surgery being performed/draping technique/number and type of surgeries, warming blanket away from surgical site, electrocautery plates in direct contact with patient at all times maintaining patient position - ✔✔tape, sandbags, vacuum bag, thoracic positioner operating room sterility - ✔✔hands above waist and below shoulders, breaks in sterility often happen during draping/surgical and instrument table setup/back of gown isn't sterile instrument table - ✔✔instruments used first at one end, all like instruments together, remain sterile, attach sterile scalpel blades, count gauze squares before and after surgery wrappers - ✔✔add an unsterile bowl within reach of surgeon for used instruments and body parts, saves on using wrappers to take dirty instruments to sink drapes - ✔✔after site prep, impervious barrier, use quarter drapes with towel clamps or one large drape (lap sheet)
vascular and nervous system scissors - ✔✔2 handed, points or tips only for cutting, cut only what told to surgical implants - ✔✔permanent - orthopedics temporary - passive drains, active drains clotting - ✔✔don't wipe/rub bleeding site, blot/pat bleeding site release of clamps - ✔✔release only what told to, release slowly postoperative management - ✔✔clean wound and surrounding skin, sterile wound cover, attend to any biopsy material, surgical reports suture needles - ✔✔swaged on or loading required, size, shape, type of point suturing considerations - ✔✔wound type, construction, size and strength, handling, knot security suture placement and removal - ✔✔package handling, handle tissue infrequently, interrupted or continuous patterns absorbable suture material - ✔✔broken down by body, used in rapidly healing tissues, looses tensile strength as it breaks down, surgical gut nonabsorbable suture material - ✔✔not broken down by body, must be removed, used in slow healing tissue, nylon, stainless braided nylon - ✔✔small filaments braided together, conduct fluid by capillary action, not used when part of suture is exposed to contamination
monofilament - ✔✔single fiber, smooth, pass through tissues easily, poor knot characteristics, several throws necessary for knotting natural suture - ✔✔from natural source, cotton, silk, surgical gut synthetic suture - ✔✔man made, vicryl wound edges - ✔✔appositional, everting, inverting appositional - ✔✔bring wound edges together so they touch, simple interrupted, simple continuous everting - ✔✔turn wound edges outward, only on skin when excessive tension is pulling edges apart, vertical/horizontal mattress inverting - ✔✔turn wound edges inward, close/seal internal hollow organs, prevents leakage simple interrupted - ✔✔appositional suture, each individually tied, easily replaced, more expensive, more suture material required, more time, prevent inversion of skin, square knot simple continuous - ✔✔simple interrupted but tied at beginning and end, continuous between 2 points, minimal use of suture material, more complete tissue apposition, slippage of either beginning or end knot horizontal mattress - ✔✔tension suture, usually skin, small amount of suture material, rapidly applied, watch for eversion, parallel to skin vertical mattress - ✔✔tension suture subcutaneous closure - ✔✔fast, reduces dead space, bury knot, only absorbable material
