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Chapter 31

Assisting with Office/Ambulatory Surgery

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

• 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)

• 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

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

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

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

Sterile Principles

• Opening sterile packages– Outer wrapper

considered contaminated

– Open and drop onto sterile field without touching inner contents

Sterile Principles

• Pouring sterile solutions– Pour into sterile

basin or cup without touching bottle’s rim or splashing solutions on sterile field

Methods of Sterilization

• Gas sterilization• Dry heat sterilization• Chemical (“cold”)

sterilization

Steam sterilization (autoclave) >>

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

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)

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

• 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

• Laser surgery– Light amplification by stimulated emission of

radiation– Converts light into intense beam– Specialty surgery– Precautions

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

Suture Material and Supplies

• Suture needles >>– Size– Shape– Radius of curve– Type of point

• Staples >>– Removal

Instruments

• Structural features– Form determines

function– Handles– Ratchets– Serrations– Forceps– Teeth

Instruments

• Structural features– Guide-pin– Box-lock hinge– Prongs– Hooks– Loops

Instruments

• Categories and uses– Cutting

• Scissors and scalpels– Grasping/clamping

• Hemostats, forceps, clamps, needle holders– Dilating/probing

• Specula, scopes, probes, retractors, dilators

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

Supplies and Equipment

• Drapes• Sponges and wicks • Solutions/creams/

ointmentsTop: 4x4s >>

Bottom: Iodoform gauze >>

• 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

• Anesthetics– Injectable anesthetics

• Drawing techniques– Prior to applying sterile gloves– After applying sterile gloves

– Topical spray anesthetics• Applied to surface

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

• 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)

• Medical assisting considerations– Home health care– Ability to follow standard instructions– Financial ability to afford supplies needed– Prior medical history– Be a patient advocate

• Postoperative instructions– Should be written– Clearly understood by patient– Include important telephone numbers– Follow-up call

• Wounds, wound care, healing process– Open wounds– Closed wounds– Accidental wounds– Intentional (surgical) wounds– Superficial wounds– Deep wounds

• Wounds, wound care, healing process– Inflammation normal process of wound healing – Best treatment for infection is prevention– Wound care is extremely important

Basic Surgery Setup

• Assembling supplies and equipment• Setting up surgery tray• Getting patient and room ready• Preparing to assist during surgery

Surgical Process

• Set up surgical tray• Prepare room• Prepare patient• Assist with surgery• Terminal care process of room and

equipment

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

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

2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a...

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