Chapter 31

1. Chapter 31 Assisting with Office/Ambulatory Surgery

2. 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. 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. 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. 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. 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. 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. Sterile Principles • Opening sterile packages • Outer wrapper considered contaminated • Open and drop onto sterile field without touching inner contents

9. Sterile Principles • Pouring sterile solutions • Pour into sterile basin or cup without touching bottle’s rim or splashing solutions on sterile field

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

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

16. 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. Suture Material and Supplies • Suture needles >> • Size • Shape • Radius of curve • Type of point • Staples >> • Removal

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

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

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

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

23. 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. Supplies and Equipment • Anesthetics • Injectable anesthetics • Drawing techniques • Prior to applying sterile gloves • After applying sterile gloves • Topical spray anesthetics • Applied to surface

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

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

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

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

33. 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. 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