asepsis copyright © 2012 by mosby, an imprint of elsevier inc

AsepsisAsepsis

Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 2

Sterile FieldSterile Field

Scrubbed personnel function in a sterile Scrubbed personnel function in a sterile field. field.

Surgical gown is considered sterile:Surgical gown is considered sterile: from 2 in above the elbow down to the from 2 in above the elbow down to the

edge of the cuff and the front of the chest edge of the cuff and the front of the chest to the level of the surgical table.to the level of the surgical table.


Unsterile parts of surgical gown:Unsterile parts of surgical gown: NecklineNeckline ShouldersShoulders Top of the cuffTop of the cuff Lower portion of the gownLower portion of the gown Back Back

Sterile Field


Sterile DrapesSterile Drapes

Cover the entire animal, furniture, and Cover the entire animal, furniture, and equipment.equipment.

Watch for strike-through.Watch for strike-through.


Opening Items for Use in Opening Items for Use in Sterile FieldSterile Field

Inspect for sterility:Inspect for sterility:

No holes or tearsNo holes or tears Sterile indicatorsSterile indicators


Opening Items for Use in Opening Items for Use in Sterile FieldSterile Field

Open, dispense, and transfer by methods Open, dispense, and transfer by methods that maintain sterility and integrity of that maintain sterility and integrity of product.product.


Opening Fluids for Use in Opening Fluids for Use in Sterile FieldSterile Field


Moving Around the Sterile FieldMoving Around the Sterile Field

Be aware of sterile and nonsterile areas in Be aware of sterile and nonsterile areas in the surgery room.the surgery room.

Unscrubbed personnel should always face Unscrubbed personnel should always face the surgical field. the surgical field.

Unscrubbed personnel should not step Unscrubbed personnel should not step between two sterile fields or scrubbed between two sterile fields or scrubbed personnel. personnel.

There should be minimal talkingThere should be minimal talking Surgery room door should remain closed Surgery room door should remain closed

as much as possible.as much as possible.


Circulating NurseCirculating Nurse

Opens packs and is the runner for the Opens packs and is the runner for the surgical team.surgical team.


Opening Peel-Away PouchesOpening Peel-Away Pouches


Opening Wrapped PacksOpening Wrapped Packs

Open on a clean, flat, dry surface in surgery room.Open on a clean, flat, dry surface in surgery room.


Opening Wrapped PacksOpening Wrapped Packs


Opening Gowns and GlovesOpening Gowns and Gloves

Open on a clean, flat, dry surface in Open on a clean, flat, dry surface in surgery room.surgery room.


Surgical Assisting—Duties during Surgery

Copyright © 2012 by Mosby, an imprint of Elsevier Inc.


Accepting Sterile PacksAccepting Sterile Packs

Be careful not to inadvertently Be careful not to inadvertently contaminate the assistant or the sterile contaminate the assistant or the sterile field. field.

Be aware of the nonsterile portions of Be aware of the nonsterile portions of the packaging. the packaging.


Scalpel Blades and HandlesScalpel Blades and Handles

Use needle holders to place blades.Use needle holders to place blades.


Threading Eyed NeedlesThreading Eyed Needles

Place needle holder about two-thirds of Place needle holder about two-thirds of the way into the needle’s curve for the way into the needle’s curve for secure and controlled handling. secure and controlled handling.

The suture passes through the needle The suture passes through the needle eye from inside the needle’s curve to eye from inside the needle’s curve to the outside.the outside.

The suture and the needle should be in The suture and the needle should be in a needle holder so the surgeon can use a needle holder so the surgeon can use them immediately.them immediately.


Threading Eyed Needles


Suture Preparation Suture Preparation

Procedure from circulating nurse to Procedure from circulating nurse to surgical assistant or technician to surgical assistant or technician to surgeon.surgeon.


Passing Ring-Handled Passing Ring-Handled InstrumentsInstruments

Close ratchet Close ratchet Ring handles Ring handles

facing the floorfacing the floor


Passing Ring-Handled Passing Ring-Handled Instruments, CurvedInstruments, Curved


Instrument CountInstrument Count

Why is this important?Why is this important?

How to do it right.How to do it right.


Sponge CountSponge Count

How to do it right.How to do it right.


DrapingDraping

Cloth hand towelsCloth hand towels Fenestrated drapesFenestrated drapes Ground drapesGround drapes LinenLinen PaperPaper Commercially prepared paper or Commercially prepared paper or

plasticplastic


Lateral nearLateral near Lateral, farLateral, far CranialCranial CaudalCaudal TopTop

Draping


DrapingDraping

Secure ground drapesSecure ground drapes


Place towel clampPlace towel clamp

Draping


DrapingDraping

Place penetrating towel clampPlace penetrating towel clamp


Place nonoperative towel clampPlace nonoperative towel clamp

Draping


DrapingDraping

Finished draped surgical siteFinished draped surgical site


SUTURE MATERIALSUTURE MATERIALNEEDLESNEEDLESSUTURE PATTERNSSUTURE PATTERNS

SUTURING TECHNIQUESSUTURING TECHNIQUES


Assistant’s Suture-Related DutiesAssistant’s Suture-Related Duties

Cut the suturesCut the sutures

Run the sutureRun the suture

Recognize suture patternsRecognize suture patterns


Common Suture PatternsCommon Suture Patterns

Categorized by how they appose tissue Categorized by how they appose tissue or by the tissue layer in which they’re or by the tissue layer in which they’re placedplaced


Suture PatternsSuture Patterns

SubcutaneousSubcutaneous

SubcuticularSubcuticular



Continuous: simpleContinuous: simple

Most frequently usedContinuous pattern



Continuous: Ford interlockingContinuous: Ford interlockingCommonly used in largeAnimal medicine and createsA very strong suture line



Continuous: Lembert, Connell, or Continuous: Lembert, Connell, or CushingCushing Lembert is an inverting patterin generally used to Lembert is an inverting patterin generally used to

close a hollow organclose a hollow organ Connell and Cushing’s patterns can also be Connell and Cushing’s patterns can also be

inverting patterns but are less commonly usedinverting patterns but are less commonly used



Interrupted: simpleInterrupted: simple

Most frequently used suture Pattern of all patterns



Interrupted: horizontal mattressInterrupted: horizontal mattress

Time consuming to place, butIs ideal in areas of tension

If pulled too tightly, can resultIn an everting pattern



Interrupted: cruciateInterrupted: cruciate

Modification of theHorizontal mattress



Interrupted: vertical mattressInterrupted: vertical mattress

Aka “far-far, near-near” Because of how the needleIs passed

Used in areas of tension

Not as likely to cause everting of wound edges like the Horizontal mattress


Suture RemovalSuture Removal

Use suture (stitch) removal scissors and Use suture (stitch) removal scissors and a thumb tissue forcepsa thumb tissue forceps

Remove 10 to 14 days after surgeryRemove 10 to 14 days after surgery Process for removing interrupted Process for removing interrupted

suturessutures Process for removing continuous Process for removing continuous

suturessutures

asepsis copyright © 2012 by mosby, an imprint of elsevier inc

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