Assisting with Office/Ambulatory Surgery Chapter 31 Assisting with Office/Ambulatory Surgery

Surgical Asepsis and Sterilization Surgical asepsis: all microbial life destroyed before invasive procedure performed All equipment to be used is sterile Procedures to promote sterile technique Surgical hand washing Sterile gloving Preparing patient’s skin for surgery Sterile draping (See Procedure 31-1: Applying Sterile Gloves) (See Table 31-1: Differences between Medical and Surgical Hand Cleansing (Hygiene))

Surgical Asepsis and Sterilization Hand cleansing (hand hygiene) for medical and surgical asepsis Removing pathogenic microorganisms from hands after they become contaminated Crucial step in preventing health care associated Infections (HAI)

Surgical Asepsis and Sterilization Hand cleansing (hand hygiene) for medical and surgical asepsis Antimicrobial soap, warm water, vigorous scrubbing of hands, wrists, forearms At least 3 minutes Rinse hands and arms; maintain hands above elbows and avoid contact with surfaces of sink Thoroughly dry hands and arms; don sterile gloves

Sterile Principles Sterile object may not touch nonsterile object Sterile objects must not be wet 1-inch border between sterile area and nonsterile area Do not turn your back on sterile field

Sterile Principles Anything below waist considered contaminated Surgery trays positioned above waist Sterile objects held in front and away from body and above waist Do not cough, sneeze, talk over sterile field

Sterile Principles Do not reach over sterile field Do not pass contaminated dressings or instruments over sterile field Place contaminated instruments in separate container or area Be aware of actions to determine whether sterile field has been contaminated

Sterile Principles Opening sterile packages Outer wrapper considered contaminated Open and drop onto sterile field without touching inner contents [FIGURE 31-43E]

Sterile Principles Pouring sterile solutions Pour into sterile basin or cup without touching bottle’s rim or splashing solutions on sterile field [FIGURE 31-44] (See Procedure 31-7: Pouring a Sterile Solution into a Cup on a Sterile Field)

Methods of Sterilization Gas sterilization Dry heat sterilization Chemical (“cold”) sterilization Steam sterilization (autoclave) >> [FIGURE 31-1] (See Procedure 31-3: Preparing Instruments for Sterilization in Autoclave)

Common Surgical Procedures Assisting with office/ambulatory surgery Dressing change Wound irrigation Preparation of patient’s skin before surgery Suturing of laceration or incision repair Sebaceous cyst excision (See Procedure 31-8: Assisting with Office/Ambulatory Surgery) (See Procedure 31-9: Dressing Change) (See Procedure 31-10: Wound Irrigation) (See Procedure 31-11: Preparation of Patient’s Skin before Surgery) (See Procedure 31-12: Suturing of Laceration or Incision Repair) (See Procedure 31-13: Sebaceous Cyst Excision)

Common Surgical Procedures Incision and drainage of localized infection Aspiration of joint fluid Hemorrhoid thrombectomy Suture/staple removal Application of sterile adhesive skin closure strips (Steri-Strips) (See Procedure 31-14: Incision and Drainage of Localized Infection) (See Procedure 31-15: Aspiration of Joint Fluid) (See Procedure 31-16: Hemorrhoid Thrombectomy) (See Procedure 31-17: Suture/Staple Removal) (See Procedure 31-18: Application of Sterile Adhesive Skin Closure Strips)

Additional Surgical Procedures Method used determined by provider’s preference Electrosurgery Electric current in concentrated areas to cut or destroy tissue when pathological examination not required Useful in removing benign skin tags and warts

Additional Surgical Procedures Cautery Application of caustic chemical or destructive heat Chemical tissue destruction Silver nitrate or sodium hydroxide Cryosurgery Destruction of tissue by freezing Liquid nitrogen or nitrous oxide

Additional Surgical Procedures Laser surgery Light amplification by stimulated emission of radiation Converts light into intense beam Specialty surgery Precautions

Suture Material and Supplies Suture/ligature Bring together edges of a wound Hastens healing and lessens scarring Most material comes fused or swaged to needle and packaged in various lengths

Suture Material and Supplies Suture needles >> Size Shape Radius of curve Type of point Staples >> Removal [FIGURE 31-8 and FIGURE 31-9A]

Instruments Structural features Form determines function Handles Ratchets Serrations Forceps Teeth [FIGURE 31-11A]

Instruments Structural features Guide-pin Box-lock hinge Prongs Hooks Loops

Instruments Categories and uses Cutting Grasping/clamping Scissors and scalpels Grasping/clamping Hemostats, forceps, clamps, needle holders Dilating/probing Specula, scopes, probes, retractors, dilators

Instruments Care of instruments Special care to prevent excessive wear and tear Careful and frequent inspections Basic rules and rationales Ultrasound cleaning Chemical “cold” sterilization (See Procedure 31-2: Chemical “Cold” Sterilization of Endoscopes)

Supplies and Equipment Drapes Sponges and wicks Solutions/creams/ ointments Top: 4x4s >> Bottom: Iodoform gauze >> [FIGURE 31-30B and FIGURE 31-31]

Supplies and Equipment Dressings and bandages Dressings: sterile material applied directly onto surface of wound or surgical site Bandages: supportive material applied over top of dressings and are not sterile

Supplies and Equipment Anesthetics Injectable anesthetics Drawing techniques Prior to applying sterile gloves After applying sterile gloves Topical spray anesthetics Applied to surface (See Table 31-2: Supplies and Equipment Commonly Used in Minor Surgery)

Patient Care and Preparation Patient preparation and education Diet modification Medication adjustment Acquire special supplies Insurance approval obtained Postoperative period prepared for Allergies checked for

Patient Care and Preparation Informed consent Informs of medical or surgical procedure to be performed Describes actual procedure in lay terms Cites alternative treatments Lists possible undesirable outcome and risks Advanced Beneficiary Notice (ABN)

Patient Care and Preparation Medical assisting considerations Home health care Ability to follow standard instructions Financial ability to afford supplies needed Prior medical history Be a patient advocate

Patient Care and Preparation Postoperative instructions Should be written Clearly understood by patient Include important telephone numbers Follow-up call

Patient Care and Preparation Wounds, wound care, healing process Open wounds Closed wounds Accidental wounds Intentional (surgical) wounds Superficial wounds Deep wounds

Patient Care and Preparation Wounds, wound care, healing process Inflammation normal process of wound healing Best treatment for infection is prevention Wound care is extremely important (See Procedure 31-10: Wound Irrigation)

Basic Surgery Setup Assembling supplies and equipment Setting up surgery tray Getting patient and room ready Preparing to assist during surgery (See Table 31-3: Guidelines for Sterile Tray Setups)

Surgical Process Set up surgical tray Prepare room Prepare patient Assist with surgery Terminal care process of room and equipment (See Table 31-4: Preparations for Office/Ambulatory Surgery) (See Procedure 31-8: Assisting with Office/Ambulatory Surgery)

Preparation for Surgery Applying sterile gloves Setting up and covering a sterile field Opening sterile packages of instruments and supplies and applying them to a sterile field (See Procedure 31-1: Applying Sterile Gloves) (See Procedure 31-5: Setting Up and Covering a Sterile Field) (See Procedure 31-6: Opening Sterile Packages of Instruments and Supplies and Applying Them to a Sterile Field)

Preparation for Surgery Pouring a sterile solution into a cup on a sterile field Preparation of patient’s skin for office surgery Using dry sterile transfer forceps (See Procedure 31-7: Pouring a Sterile Solution into a Cup on a Sterile Field) (See Procedure 31-11: Preparation of Patient’s Skin before Surgery)