Chapter 31
Assisting with Office/Ambulatory Surgery
© 2014 Cengage©Learning.
2014 Cengage
All Rights
Learning.
Reserved.
All Rights
May not
Reserved.
be scanned,
May not
copied
be scanned, copied
or duplicated, or or
posted
duplicated,
to a publicly
or posted
accessible
to a publicly
website,
accessible
in wholewebsite,
or in part.
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
© 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)
© 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
© 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
© 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
© 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
© 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
© 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
© 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)
>>
© 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
© 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)
© 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
© 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
© 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
© 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
© 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
© 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
© 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
© 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
© 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
© 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 >>
© 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
© 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
© 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
© 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)
© 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
© 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
© 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
© 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
© 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
© 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
© 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
© 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
© 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.
