Chapter 8 Surgical Tech

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1

Hemostasis

Localized collection of extravasated blood that is often clotted

2

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.

3

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)

4

What does the release of ADP cause?

more platelets to clump on the first layer, resulting in an initial thrombus.

5

Hemophilla

is the most common of these and manifests itself as a clotting deficiency. Preoperative testing is useful in determining whether these conditions exist.

6

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.

7

Mechanical Methods

hemostasis can be achieved with the use of several types of devices to control bleeding until a clot forms.

8

Clamps

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.

9

Ligature

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

10

Clips

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.

11

Sponges

are used to apply pressure on bleeding areas or vessels and to absorb excess blood or body fluids

12

Sponges (Raytec)

also called 4 × 4’s (the size of the sponge)

13

Sponges (Laparotomy Sponges)

also referred to as lap sponges or “tape” sponges due to the radiopaque strand or tape that hangs from the sponge.

14

Sponges (Tonsil)

round sponges

15

Sponges (Patties)

(cottonoids) are smaller compressed radiopaque sponges used for neurosurgical procedures.

16

Sponges (Kitners)

and peanuts, also referred to as dissecting sponges, which consist of small pieces of tightly rolled gauze

17

Pledgets

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.

18

Bone Wax

made of refined and sterilized beeswax, is used on cut edges of bone as a mechanical barrier to seal off oozing blood

19

Suction

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.

20

Drains

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.

21

Pressure Device

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.

22

Tourniquets

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

23

Thermal 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

24

Electrosurgery

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

25

Lasers

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.

26

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.

27

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.

28

Pharmacological Agents

  • Absorbable gelatin (Gelfoam®)
  • Collagen (Avitene®)
  • Oxidized cellulose (Nu-Knit®; Surgi-Cel®)
  • Silver nitrate
  • Epinephrine
  • Thrombin
29

Blood Loss

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.

30

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.

31

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.

32

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.

33

Blood Replacement

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.

34

homologous

From the same species

35

Autologous

From oneself

36

Autotransfusion

is the use of the patient’s own blood, which has been processed for reinfusion.

37

What is important when using homologous banks

blood typing and cross-matching are essential to prevent transfusion reactions.

38

Four Main blood Types

A, B, O, and AB

Due to these factors, blood is carefully typed and cross-matched prior to being administered.

39

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

40

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.

41

Autotransfusion

In addition to suctioned blood, blood may be drained from bloody sponges into a basin of saline, and then aspirated into the autotransfusion machine.

Cell Saver

42

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.

43

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.

44

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
45

Following these first two priorities, treatment is provided for the following:

  • Chest injuries
  • Shock
  • Wound protection/closure
  • Fractures
  • Vital sign monitoring
  • Provision of reassurance and comfort for the patient
46

A chain-of-survival

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:

47

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

48

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.

49

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

50

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
51

One important symptom of Anaphylactic reactions

. Hives or urticaria may be present on the skin with severe itching.

52

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.

53

Epinephrine

is the first-line drug in the treatment of a severe anaphylactic reaction.causes bronchodilation, reduces laryngeal spasm, and raises blood pressure.

54

all-hazards preparation

is an all-encompassing term that refers to the many different emergencies

55

Emergencies

are defined as those that require the emergency response of outside assistance, which may be at the local, county, state, or federal levels.

56

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.

57

What is the most common type of disaster?

Natural disasters