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

2. 2 Sterile Field  Scrubbed personnel function in a sterile field.  Surgical gown is considered sterile:  from 2 in above the elbow down to the edge of the cuff and the front of the chest to the level of the surgical table.

3. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 3  Unsterile parts of surgical gown:  Neckline  Shoulders  Top of the cuff  Lower portion of the gown  Back Sterile Field

4. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 4 Sterile Drapes  Cover the entire animal, furniture, and equipment.  Watch for strike-through.

5. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 5 Opening Items for Use in Sterile Field Inspect for sterility: No holes or tears Sterile indicators

6. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 6 Opening Items for Use in Sterile Field  Open, dispense, and transfer by methods that maintain sterility and integrity of product.

7. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 7 Opening Fluids for Use in Sterile Field

8. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 8 Moving Around the Sterile Field  Be aware of sterile and nonsterile areas in the surgery room.  Unscrubbed personnel should always face the surgical field.  Unscrubbed personnel should not step between two sterile fields or scrubbed personnel.  There should be minimal talking  Surgery room door should remain closed as much as possible.

9. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 9 Circulating Nurse  Opens packs and is the runner for the surgical team.

10. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 10 Opening Peel-Away Pouches

11. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 11 Opening Wrapped Packs Open on a clean, flat, dry surface in surgery room.

12. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 12 Opening Wrapped Packs

13. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 13 Opening Gowns and Gloves  Open on a clean, flat, dry surface in surgery room.

14. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 14 Surgical Assisting—Duties during Surgery Copyright © 2012 by Mosby, an imprint of Elsevier Inc.

15. 15 Accepting Sterile Packs  Be careful not to inadvertently contaminate the assistant or the sterile field.  Be aware of the nonsterile portions of the packaging.

16. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 16 Scalpel Blades and Handles Use needle holders to place blades.

17. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 17 Scalpel Blades and Handles

18. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 18 Scalpel Blades and Handles

19. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 19 Threading Eyed Needles  Place needle holder about two-thirds of the way into the needle’s curve for secure and controlled handling.  The suture passes through the needle eye from inside the needle’s curve to the outside.  The suture and the needle should be in a needle holder so the surgeon can use them immediately.

20. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 20 Threading Eyed Needles

21. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 21 Suture Preparation  Procedure from circulating nurse to surgical assistant or technician to surgeon.

22. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 22 Passing Ring-Handled Instruments  Close ratchet  Ring handles facing the floor

23. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 23 Passing Ring-Handled Instruments, Curved

24. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 24 Instrument Count  Why is this important?  How to do it right.

25. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 25 Sponge Count How to do it right.

26. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 26 Draping  Cloth hand towels  Fenestrated drapes  Ground drapes  Linen  Paper  Commercially prepared paper or plastic

27. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 27  Lateral near  Lateral, far  Cranial  Caudal  Top Draping

28. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 28 Draping Secure ground drapes

29. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 29 Place towel clamp Draping

30. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 30 Draping Place penetrating towel clamp

31. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 31 Place nonoperative towel clamp Draping

32. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 32 Draping Finished draped surgical site

33. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 33 SUTURE MATERIAL NEEDLES SUTURE PATTERNS SUTURING TECHNIQUES

34. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 34 Assistant’s Suture-Related Duties  Cut the sutures  Run the suture  Recognize suture patterns

35. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 35 Common Suture Patterns  Categorized by how they appose tissue or by the tissue layer in which they’re placed

36. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 36 Suture Patterns  Subcutaneous  Subcuticular

37. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 37 Suture Patterns Continuous: simple Most frequently used Continuous pattern

38. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 38 Suture Patterns Continuous: Ford interlocking Commonly used in large Animal medicine and creates A very strong suture line

39. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 39 Suture Patterns  Continuous: Lembert, Connell, or Cushing  Lembert is an inverting patterin generally used to close a hollow organ  Connell and Cushing’s patterns can also be inverting patterns but are less commonly used

40. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 40 Suture Patterns Interrupted: simple Most frequently used suture Pattern of all patterns

41. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 41 Suture Patterns Interrupted: horizontal mattress Time consuming to place, but Is ideal in areas of tension If pulled too tightly, can result In an everting pattern

42. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 42 Suture Patterns Interrupted: cruciate Modification of the Horizontal mattress

43. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 43 Suture Patterns Interrupted: vertical mattress Aka “far-far, near-near” Because of how the needle Is passed Used in areas of tension Not as likely to cause everting of wound edges like the Horizontal mattress

44. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 44 Suture Removal  Use suture (stitch) removal scissors and a thumb tissue forceps  Remove 10 to 14 days after surgery  Process for removing interrupted sutures  Process for removing continuous sutures