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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Chapter 31
Assisting with Office/Ambulatory Surgery
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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
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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)
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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
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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
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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
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Sterile Principles
• Opening sterile packages– Outer wrapper
considered contaminated
– Open and drop onto sterile field without touching inner contents
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Sterile Principles
• Pouring sterile solutions– Pour into sterile
basin or cup without touching bottle’s rim or splashing solutions on sterile field
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Methods of Sterilization
• Gas sterilization• Dry heat sterilization• Chemical (“cold”)
sterilization
Steam sterilization (autoclave) >>
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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
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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)
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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
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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
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Additional Surgical Procedures
• Laser surgery– Light amplification by stimulated emission of
radiation– Converts light into intense beam– Specialty surgery– Precautions
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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
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Suture Material and Supplies
• Suture needles >>– Size– Shape– Radius of curve– Type of point
• Staples >>– Removal
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Instruments
• Structural features– Form determines
function– Handles– Ratchets– Serrations– Forceps– Teeth
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Instruments
• Structural features– Guide-pin– Box-lock hinge– Prongs– Hooks– Loops
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Instruments
• Categories and uses– Cutting
• Scissors and scalpels– Grasping/clamping
• Hemostats, forceps, clamps, needle holders– Dilating/probing
• Specula, scopes, probes, retractors, dilators
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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
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Supplies and Equipment
• Drapes• Sponges and wicks • Solutions/creams/
ointmentsTop: 4x4s >>
Bottom: Iodoform gauze >>
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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
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Supplies and Equipment
• Anesthetics– Injectable anesthetics
• Drawing techniques– Prior to applying sterile gloves– After applying sterile gloves
– Topical spray anesthetics• Applied to surface
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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
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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)
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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
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Patient Care and Preparation
• Postoperative instructions– Should be written– Clearly understood by patient– Include important telephone numbers– Follow-up call
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Patient Care and Preparation
• Wounds, wound care, healing process– Open wounds– Closed wounds– Accidental wounds– Intentional (surgical) wounds– Superficial wounds– Deep wounds
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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
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Basic Surgery Setup
• Assembling supplies and equipment• Setting up surgery tray• Getting patient and room ready• Preparing to assist during surgery
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Surgical Process
• Set up surgical tray• Prepare room• Prepare patient• Assist with surgery• Terminal care process of room and
equipment
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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
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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