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

3. 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

4. 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

5. ENABLING OBJECTIVES Prepare an electrosurgical unit for operation

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

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

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

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

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

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

13. CENTRAL UNIT

14. OR FURNITURE Direct motorized suction –May be battery powered

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

16. 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

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

19. SURGICAL TABLE Types: General Orthopedic Tower Chick Fracture

20. GENERAL

21. CHICK TABLE

22. FRACTURE TABLE

23. SURGICAL TABLE Urology –Fluroscopic

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

25. MAYFIELD HEADREST

26. 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

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

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

29. 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

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

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

33. ANESTHESIA MACHINE

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

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

36. OR FURNITURE Pneumatic Tourniquet Uses compressed gases (air or oxygen) to occlude blood vessels Tourniquet presser on a average adult arm usually ranges from 250- 300 mmHg

37. 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

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

39. DVT/EMBOLUS

41. VENOUS STASIS ABCESS

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

43. MICROSCOPE

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

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

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

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

48. ELECROSURGICAL UNIT

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

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

51. BIPOLAR FORCEPS

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

53. 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

54. ESU (BOVIE) Coagulating current Cutting current Blend current

55. 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

56. 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

57. 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

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

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

60. 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

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

62. REVIEW & SUMMARY

63. INFORMATION SHEET

64. 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

65. 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

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

67. 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

68. 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

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

70. SUMMARY OR FURNITURE OR EQUIPMENT ELECTROSURGICAL UNIT

71. F THE END