Post on 16-Jan-2016
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Intraoperative Case Intraoperative Case Management, Management,
Anticipation, Routines, & Anticipation, Routines, & CountsCounts
ST230Concorde Career College
Objectives:
Outline basic intraoperative routines and describe appropriate responses to variations in the routine.
Define the term anticipation and implement critical thinking activities that allow surgical team members to predict the needs of the patient and other surgical team members.
Identify and respond to verbal and nonverbal communication techniques utilized in the surgical environment.
Objectives:
Define the term hemostasis and describe the principles that relate to hemostasis.
List and describe the methods utilized to maintain and achieve hemostasis.
Explain the principles related to exposure of the surgical site and explain the techniques utilized when retracting tissue.
Intraoperative routines
Anticipation/critical thinking
Verbal/nonverbal communication
Memorize this routine!Clamp (one side of tissue/blood vessel)Clamp (the other side)Cut (with appropriate tissue scissors)Tie (with appropriate suture material)Cut (with suture scissors)Tie (with same suture material)Cut (with suture scissors)
Anticipation IS critical thinking1. Identify the goal or problem2.Gather and evaluate as much information as
possible. (Using the A POSitive CARE Approach)3.Generate one or more responses and consider
the implications. (A response may be a series of actions)
4. Implement the best response5.Assess the results of the action taken and make
adjustments, if necessary
Communication
Verbal “Metzenbaum scissors, please”
Nonverbal
Hemostasis
Maintenance of the normal blood level within the body by prevention or stoppage of bleeding.
Failure to maintain hemostasis may result in death.
Method of Achieving Hemostasis
Mechanical
Thermal
Pharmaceutical
Mechanical Hemostasis
Direct pressure (e.g., pack with sponges) Instrumentation (clamping/occluding) Suture (tie or ligature) Pledgets Hemostatic clip Tourniquet
Thermal Hemostasis
HeatColdElectrosurgical unitLaser
Pharmaceutical Hemostasis
Vasoconstrictors (e.g., epinephrine) Absorbable gelatin Collagen Oxidized cellulose Silver nitrate Topical thrombin
ExposurePlan ahead to be sure that you have the
necessary instrumentationReview regional anatomy to reduce the risk of
injury to nearby structuresProtect underlying structuresIdeally, the surgeon or surgical assistant will
place/position the retractor(s)Apply only the necessary amount of tension to
the retractorBe sure to avoid leaning on the patient
Halstead's principles Basic principles of surgical technique regarding tissue
handling, vascular occlusion etc. If followed, the soft tissue surgical success rate is greatly improved
Strict asepsis during preparation and surgery. Good hemostasis to improve conditions for the procedure and
limit infection and deadspace Minimize tissue trauma Use good Surgical judgment ensuring elimination of deadspace
and adequate removal of material Minimize surgery time through knowledge of anatomy and
technique Correct use of instruments and materials used
Counting
Click Here to Review AST RSOP
What is the importance of counting instruments, sponges, sharps, and
incidental items?
What is meant by the term incidental items?
How many counts are needed for each procedure?
When are the counts performed?
Are there any exceptions?
Who is responsible for counting?
How?
What is the counting procedure?
What happens if additional items are added to the field during the procedure (after the
initial count)?
What if…
The count is incorrect?