Chapter 8 Surgical Tech
Localized collection of extravasated blood that is often clotted
When does the body use the process of coagulation
to achieve hemostasis. As soon as a vessel is injured, a period of vasoconstriction begins, in which the muscular walls of the vessel constrict to help slow the flow of blood.
What happens after vasoconstriction
platelets begin to adhere to the sides of the injured vessel walls, clumping together to form a plug at the cut end of the injured vessel. Once the platelets adhere to the vessel walls, they begin to release their contents, including epinephrine, serotonin, and, most important, adenosine diphosphate (ADP)
What does the release of ADP cause?
more platelets to clump on the first layer, resulting in an initial thrombus.
is the most common of these and manifests itself as a clotting deficiency. Preoperative testing is useful in determining whether these conditions exist.
What do drug therapy cause in OR patients
platelet dysfunctions also affect hemostasis in the OR. Patients may be requested not to take aspirin for 1 week prior to surgery because of its anticoagulant properties.
hemostasis can be achieved with the use of several types of devices to control bleeding until a clot forms.
are used to compresscompressTo apply pressure compress To apply pressure the walls of vessels and to grasp tissue. Most commonly used is the hemostathemostatA device or agent used as a coagulant hemostat A device or agent used as a coagulant that is available with either straight or curved jaws.
or ties (referred to as “stick ties” when a needle is attached), are strands of suture material used to tie off blood vessels. are made of either natural or synthetic material and are designed either to dissolve over a period of time or to remain in the body tissue permanently
are often used in place of suture ligatures when many small vessels need to be ligated in a short period of time. are made of a nonreactive metal, such as titanium or stainless steel, or plastic material and come in various sizes as well as absorbable or permanent varieties. They are applied either from a manually loaded applicator or from any of several preloaded disposable applicators.
are used to apply pressure on bleeding areas or vessels and to absorb excess blood or body fluids
also called 4 × 4’s (the size of the sponge)
Sponges (Laparotomy Sponges)
also referred to as lap sponges or “tape” sponges due to the radiopaque strand or tape that hangs from the sponge.
(cottonoids) are smaller compressed radiopaque sponges used for neurosurgical procedures.
and peanuts, also referred to as dissecting sponges, which consist of small pieces of tightly rolled gauze
When bleeding occurs through needle holes in vessel anastomosis, small squares of Teflon® are used as buttresses over the suture line. Using suture, these are sewn over the hole in the vessel and exert outside pressure over the small needle holes to prevent bleeding and promote clotting. These are often used in peripheral vascular and cardiovascular surgery.
made of refined and sterilized beeswax, is used on cut edges of bone as a mechanical barrier to seal off oozing blood
The act of sucking up air or fluids through a device, such as a tonsil suction tip
is the intraoperative aspiration of blood and body fluids by mechanical means to keep the surgical site clear. Several different styles are available for different types of procedures, and most are disposable. It is important that it is always available during surgery and until the patient has left the room, It is also vitally important that anesthesia personnel have suction available for them at the beginning and end of every surgical procedure when the patient is intubated and extubated.
are used postoperatively to remove blood and body fluids from the operative site to prevent edema and hematoma formation, and aid in removing air in order to prevent dead spaces within the surgical wound.
as with the use of a tourniquet, occludes the flow of blood until a clot has time to form. Prophylactically, pressure devices, such as sequential stockings, may also be used to prevent venous stasis and deep venous thrombosis.
are often used on extremities to keep the operative site free of blood. The provision of a bloodless field makes visualization easier and reduces the operative time. Bleeding must be controlled prior to removal , however, because the use alone does not achieve hemostasis
One of the most common means of obtaining hemostasis during a surgical procedure is with the use of heat. Several different types of devices are available for achieving
is the most commonly used thermal hemostatic device. The components are the active electrode or Bovie pencil, electrosurgical or generator unit (ESU), and inactive or dispersive electrode, also called the grounding pad
provides an intense and concentrated beam of light that is able to cut and coagulate tissue at the same time with very little surrounding tissue destruction.
Argon Plasma Coagulation
involves the use of argon gas in combination with monopolar electrical energy in the form of a noncontact, white light beam. The argon beam coagulator provides rapid hemostasis that travels from a generator to a pencil-like hand-piece. There is little to no tissue adherence since the handpiece does not come in direct contact with the tissue that is bleeding. There is less charring of the tissue compared to the ESU.
Ultrasonic (Harmonic) Scalpel
consists of a single-use titanium blade attached to a handpiece and a portable generator. The generator converts the electrical energy into mechanical energy, thus causing the blade to move by rapid ultrasonic motion that simultaneously cuts and coagulates tissue.
- Absorbable gelatin (Gelfoam®)
- Collagen (Avitene®)
- Oxidized cellulose (Nu-Knit®; Surgi-Cel®)
- Silver nitrate
is monitored by several means intraoperatively to aid the surgeon and anesthesia provider in making decisions regarding the patient’s status and potential need for transfusion or autotransfusion. is charted by the circulator and reported to the surgeon upon request or immediately in extreme-loss situations.
Calibrated suction devices (canisters)
are used between the suction tubing and the vacuum source to collect and monitor the amount of blood and body fluids suctioned from the field. The surgical technologist should keep close track of the amount of irrigation fluids used; the amount of irrigation fluid used is subtracted from the total volume of fluid in the canister to give a more accurate measurement of blood loss.
What does the circulator do to keep track of blood loss?
may weigh sponges removed from the field to provide an estimate of blood. may use a scale and a predetermined sponge weight formula; alternatively, some hospitals have a bloody-sponge weight estimate that is used and multiplied by the number of sponges removed from the field.
How must bloody sponges be weighed?
The sponges must be weighed wet as the formula is based on the dry and wet weights of the sponges. This is not an exact method but provides the surgeon and anesthesia provider with a fairly reliable estimate of blood loss.
involves the administration of whole blood or blood components such as plasma, packed red blood cells, or platelets via an intravenous (IV) line. This is used to increase the circulating blood volume, to increase the number of red blood cells, and to provide plasma-clotting factors.
From the same species
is the use of the patient’s own blood, which has been processed for reinfusion.
What is important when using homologous banks
blood typing and cross-matching are essential to prevent transfusion reactions.
Four Main blood Types
A, B, O, and AB
Due to these factors, blood is carefully typed and cross-matched prior to being administered.
Rh (Rhesus) factor
Genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals; if the antigen is present the individual is Rh1 (positive) and if absent Rh– (negative)
If blood given to an Rh-negative individual is Rh positive, hemolysishemolysisThe destruction of erythrocytes hemolysis The destruction of erythrocytes occurs, leading to anemia
Handling of Blood Replacement Components
If the products are not to be used immediately, they should be stored in a refrigerator at a temperature between 1° and 6°C (33.8°–42.8°F).
Two individuals should perform this identification; individuals who can perform the identification are the surgical technologist, registered nurse, surgeon, and anesthesia provider.
In addition to suctioned blood, blood may be drained from bloody sponges into a basin of saline, and then aspirated into the autotransfusion machine.
Hemolytic Transfusion Reactions
If blood is not properly matched including Rh factor prior to transfusion, a hemolytic transfusion reaction may develop. This may result from Rh incompatibility from mismatched blood transfusions. Severe hemolytic reactions can be fatal and must be treated immediately.
Symptoms of Hemolytic Reactions
conscious patient may exhibit fatigue and complain of lack of energy. The patient may experience rapid pulse, shortness of breath, and pounding of the heart. The skin may appear jaundiced and pallor may be exhibited, especially in the palms of the hands.
Prior to Surgery indicators to watch for
- Difficulty breathing
- Chest pain
- Changes in skin color
- Changes in vital signs
- Open bleeding wounds or visible punctures not indicated on the patient’s chart
- Inability to move an extremity
- Misshapen/misaligned body part
- Disorientation or confusion
Following these first two priorities, treatment is provided for the following:
- Chest injuries
- Wound protection/closure
- Vital sign monitoring
- Provision of reassurance and comfort for the patient
concept applied to both in-hospital and out-of-hospital arrests addresses the ABCs—airway, breathing, and circulation—as well as providing the “D,” definitive treatment. Successful resuscitation requires:
The new concept of “push hard, push fast”
is to be applied to CPR. The recommendation is at least 100 compressions per minute. The depth of compression for adults has changed from a depth of 1½ inches to 2 inches to a consistent depth of 2 inches
In the surgical setting, the “D” of the C-A-Bs of cardiac arrest What is a surg tech role?
in this situation is to protect the sterile field from contamination during the resuscitation efforts. In some cases, the surgical technologist may be required to assist by providing artificial respiration (“bagging the patient”) or providing chest compressions.
Disseminated intravascular coagulation (DIC)
is a pathological process in the body that occurs when blood begins to coagulate within the body. The body’s blood clotting mechanisms are activated throughout the body instead of being localized to a specific area of injury. may result in clotting symptoms or, more often, in bleeding due to the depletion of the body’s blood clotting mechanisms
Factors that may stimulate DIC
- Infection of the blood by bacteria or fungus
- Severe tissue trauma, e.g., head injury, shock, or burns
- Leukemia or cancer
- Severe liver disease
- Recent blood transfusion reactions
- Obstetric complications
One important symptom of Anaphylactic reactions
. Hives or urticaria may be present on the skin with severe itching.
During the anaphylactic reaction what must the surgical team maintain
the airway and provide supplemental oxygen or the patient may die of respiratory failure. The symptoms of vascular collapse and shock must also be treated to prevent death from cardiovascular failure.
is the first-line drug in the treatment of a severe anaphylactic reaction.causes bronchodilation, reduces laryngeal spasm, and raises blood pressure.
is an all-encompassing term that refers to the many different emergencies
are defined as those that require the emergency response of outside assistance, which may be at the local, county, state, or federal levels.
the term “all-hazards preparation” is used
provides a template for generalized training and emergency preparation that can be applied to all disaster situations rather than training that is focused on a limited number of local or regional types of emergencies.
What is the most common type of disaster?