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

2. 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))

3. 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)

4. 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

5. 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

6. 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

7. 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

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

9. 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)

10. 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)

11. 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)

12. 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)

13. 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

14. 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

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

16. 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

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

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

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

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

21. 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)

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

23. 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

24. 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)

25. 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

26. 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)

27. 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

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

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

30. 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)

31. 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)

32. 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)

33. 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)

34. 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)