TERMINAL OBJECTIVE OPERATE SELECTED OR EQUIPMENT IAW MANUFACTURER’S USER MANUAL

ENABLING OBJECTIVES State selected items of OR equipment. Define selected terminology related to OR equipment State the uses of selected items of OR equipment State the factors that determine the anatomical placement of the grounding pad for an electro surgical unit

ENABLING OBJECTIVES State the safety precautions for using an electrosurgical unit Operate a surgical table Prepare a suction unit for operation Operate a surgical spotlight Ground a simulated patient

ENABLING OBJECTIVES Prepare an electrosurgical unit for operation

OR FURNITURE Clock –Time is critical during surgery –Used to time: Cardiac and respiratory arrest Tourniquet application Birth and death Operation start and stop

Intercom /phone/Call light system –Allows team members to communicate with others in the department without leaving the room OR FURNITURE

X-ray view box –Used to view any x-rays required by surgeon, examples: –Plain films –CT Scan –MRI

OR FURNITURE Outlet for gases/suctions Piped in from central location Outlets located on the wall or suspended from the ceiling

OR FURNITURE Suction units Minimum of two suction units per room: –One for surgical team –One for anesthesia

OR FURNITURE Wall suction –Powered by central vacuum unit –Fluid must not enter central unit

CENTRAL UNIT

OR FURNITURE Direct motorized suction –May be battery powered

OR FURNITURE Electrical outlets –Located above floor level –Explosion proof plugs may be mounted lower

OR FURNITURE Surgical lights Designed to provide a range of intensity Mounted on tracks or hang freely from ceiling Produce the blue-white color of daylight Halogen lamps most common

OR FURNITURE Doors Ideally, sliding doors should be used on the OR –Eliminate air currents

SURGICAL TABLE Types: General Orthopedic Tower Chick Fracture

GENERAL

CHICK TABLE

FRACTURE TABLE

SURGICAL TABLE Urology –Fluroscopic

SURGICAL TABLE PARTS Rectangle metal top –Divided into head, body, and leg Detachable head section –Permits insertion of headrests

MAYFIELD HEADREST

SURGICAL TABLE Hydraulic, wheeled base –Up and down motion operated by foot pump –Wheels locked by foot lever Side rails –Located along both sides of table

SURGICAL TABLE Positions of table –Laterally/ side to side –Raised or lowered

SURGICAL TABLE Attachments/equipment Safety belts Anesthesia screen –Necessary for all cases –Separates sterile from unsterile fields –Prevents drape from covering patient’s face

SURGICAL TABLE Arm boards –Inadequate space on table –Procedures on arm or hand –Supports arm for IV infusion – Padded to height of table –Never abducted beyond 90 degree angle

OR FURNITURE Fiberoptic headlight –Designed to focus an intense light beam on specific small area poorly illuminated by the overhead OR lights

OR FURNITURE Mayo stand Back table Ring stand Kick bucket Anesthesia equipment

ANESTHESIA MACHINE

OR FURNITURE Supply Cabinets IV poles –IV solutions –Irrigation –Anesthesia screen

OR FURNITURE Environmental controls –Air exchanges and circulation –Temperature/Humidity –Laminar air flow

OR FURNITURE Pneumatic Tourniquet Uses compressed gases (air or oxygen) to occlude blood vessels Tourniquet presser on a average adult arm usually ranges from mmHg

OR FURNITURE Pneumatic tourniquet cont: Tourniquet time should be kept to a minimum Tested prior to each use Webril is wrapped smoothly around the limb Extremity is first exsanguinated with esmark bandage

OR FURNITURE Sequential compression stockings –Used as a Precaution against: DVT Venous stasis Pulmonary embolus

DVT/EMBOLUS

VENOUS STASIS ABCESS

OR FURNITURE Microscopes Used to improve precision of surgical procedures –Reimplantation of amputated parts –Reconstructive surgery –Commonly used in ENT, Neuro & Ocular cases

MICROSCOPE

OR FURNITURE Hypothermia/Hyperthermia mattress or blanket –Use to warm and cool patients inraoperatively

F HYPOTHERMIA MACHINE F “BAIR HUGGER” F HYPERTHERMIA F BLANKET

OR FURNITURE Autotransfusion unit –Recovery of blood lost during surgery –Reinfused into patient

OR FURNITURE Types of Auto transfusion units –Automated cell salvage processor –Canister Collection Method –Salvage collection bag

ELECROSURGICAL UNIT

ESU (BOVIE) Used to coagulate or cut tissue Parts –Generator Power component –Bovie pencil Active electrode Electrode tips

ESU (BOVIE) Grounding Pad –Inactive dispersive electrode Bipolar units –Current flows only between tips of forceps and returns to generator –Grounding pad is unnecessary

BIPOLAR FORCEPS

ESU (BOVIE) Monopolar units –Current flows from generator to active electrode through patient to inactive dispersive electrode back to generator –Grounding pad necessary

ESU (BOVIE) Foot switch –May be used with bipolar forceps or endoscopic instruments Controls –Regulates type & amount of current –Cutting & coagulation functions –Monopolar & bipolar functions

ESU (BOVIE) Coagulating current Cutting current Blend current

GROUNDING PAD PLACEMENT Placed as close as possible to the surgical site Placed in an area of sufficient fleshiness Should cover an area that is free of hair or scar tissue

GROUNDING PAD PLACEMENT Should not be placed on skin over a metal implant Should be clean, free from bent edges and adhere uniformly to skin Infants and children require smaller size grounding pad

SAFETY PRECAUTIONS Grounding pad: Never slide the pad beneath the patient –Roll, lift, or turn patient before the pad is applied –Prevents items from getting between pad and pt

SAFETY PRECAUTIONS Grounding Pad Ensure pad is placed correctly and all surfaces are in contact with skin Rings and other jewelry removed

SAFETY PRECAUTIONS When pad is removed, inspect for: –Skin lesions –Irritation –Other injury

SAFETY PRECAUTIONS Grounding cable: Ensure grounding cable is intact Make sure connection is secure between cable and grounding pad Check connections, ensure they are clean & dry Never release cable by pulling on it

SAFETY PRECAUTIONS Power unit: Never store liquids on top of generator Be alert for malfunctions

REVIEW & SUMMARY

INFORMATION SHEET

SET-UP PROCEDURE FOR ELECROSURGICAL UNIT Position unit near operating table Connect power cord and plug into electrical source Test the power switch Turn off once test is complete Connect foot control Set controls to zero

PROCEDURE Ground patient Receive active electrode cable wire from surgical team Connect to monopolar or bipolar insert Position foot control prn Activate power switch Adjust controls to desired settings

PROCEDURE FOR OPERATING A SURGICAL TABLE Raise/lower the bed Floor lock Trendelenberg hand control Selector control: back, sides, flex, foot

PROCEDURE TO PREPARE A SUCTION UNIT FOR OPERATION Perform electrical safety checks Ensure proper fit of tubing adapter to wall fixture Inspect canisters for cracks Place lid on canister to prevent air leaks Attach tubing adaptors to canister lids

SUCTION UNIT Attach tubing from suction source to flow regulator Attach tubing from regulator to canister Turn on suction unit Troubleshoot system for proper vacuum flow

PROCEDURE FOR OPERATING A SURGICAL SPOTLIGHT Inspect housing/lights Position lights Intensity setting lowest Turn on lights Adjust intensity Adjust beam focus prn

SUMMARY OR FURNITURE OR EQUIPMENT ELECTROSURGICAL UNIT

F THE END