1. © 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

2. © 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 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

3. © 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)

4. © 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

5. © 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

6. © 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 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

7. © 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 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

8. © 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 Opening sterile packages –Outer wrapper considered contaminated –Open and drop onto sterile field without touching inner contents

9. © 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 Pouring sterile solutions –Pour into sterile basin or cup without touching bottle’s rim or splashing solutions on sterile field

10. © 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. Methods of Sterilization Gas sterilization Dry heat sterilization Chemical (“cold”) sterilization Steam sterilization (autoclave) >>

11. © 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. 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

12. © 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. 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)

13. © 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. 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

14. © 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. 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

15. © 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. Additional Surgical Procedures Laser surgery –Light amplification by stimulated emission of radiation –Converts light into intense beam –Specialty surgery –Precautions

16. © 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. 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

17. © 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. Suture Material and Supplies Suture needles >> –Size –Shape –Radius of curve –Type of point Staples >> –Removal

18. © 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. Instruments Structural features –Form determines function –Handles –Ratchets –Serrations –Forceps –Teeth

19. © 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. Instruments Structural features –Guide-pin –Box-lock hinge –Prongs –Hooks –Loops

20. © 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. Instruments Categories and uses –Cutting Scissors and scalpels –Grasping/clamping Hemostats, forceps, clamps, needle holders –Dilating/probing Specula, scopes, probes, retractors, dilators

21. © 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. 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

22. © 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. Supplies and Equipment Drapes Sponges and wicks Solutions/creams/ ointments Top: 4x4s >> Bottom: Iodoform gauze >>

23. © 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. 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

24. © 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. Supplies and Equipment Anesthetics –Injectable anesthetics Drawing techniques –Prior to applying sterile gloves –After applying sterile gloves –Topical spray anesthetics Applied to surface

25. © 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. 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

26. © 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. 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)

27. © 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. 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

28. © 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. Patient Care and Preparation Postoperative instructions –Should be written –Clearly understood by patient –Include important telephone numbers –Follow-up call

29. © 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. Patient Care and Preparation Wounds, wound care, healing process –Open wounds –Closed wounds –Accidental wounds –Intentional (surgical) wounds –Superficial wounds –Deep wounds

30. © 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. 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

31. © 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. Basic Surgery Setup Assembling supplies and equipment Setting up surgery tray Getting patient and room ready Preparing to assist during surgery

32. © 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 Process Set up surgical tray Prepare room Prepare patient Assist with surgery Terminal care process of room and equipment

33. © 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. 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

34. © 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. 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