Ot notes for nurse

allnotes of ot

1. The design of OT should provide with optimum facilities and minimum inconvenience in the management of different areas. The prime requirements in the design to theatre are the control of infections and safe environment for the pt . Operation theater Made By- Shivang patel

2. Ideal location OT Location near to- All OTs in an OT complex Emergency Blood bank Radiology Intensive care unit Central sterile supply department Laboratory Made By- Shivang patel

3. Types of OT Based on Sterility Ultra sterile (CTVS, Transplant OT) Sterile Septic Based on construction Modular Non modular Based on timing of surgery: Routine Emergency Made By- Shivang patel

4. Requirement for OT Central AC: 20-22 deg centigrade Humidity: 50-60% Positive pressure ventilation Air change: 20 times/hr with recycled air; of which 5 times with fresh air HEPA filter of “S” class Laminar air flow through diffuser General Lighting: Cold light, even distribution, varying intensity Operating light: Ceiling mounted, cold light, shadow less focusable beam Medical gas pipeline: Anesthesia gas, Air, Oxygen & Suction Power supply: Uninterrupted (UPS) and generator back up (safety) Earthing : All electrical equipment (safety) Fire safety: Fire/smoke detectors. Fire hydrants & extinguishers (Safety) Power switches: Away from Operating area ( Safety ) Made By- Shivang patel

5. Sterile zone ( OT attire mandatory in this area ) Operating suite Sterile preparation area Scrub station Gowning area Anesthesia induction area Clean zone ( OT attire mandatory in this area ) Sterilization area Store area Preoperative area/room ZONE of OT Made By- Shivang patel

6. Post operative recovery area/room OT Staff & Doctor’s rooms Protective zone ( OT attire not mandatory in this area ) Changing rooms Reception area Waiting area Trolley bay Disposal zone ( OT attire mandatory in this area ) Dirty utility area Disposal corridor Made By- Shivang patel

7. Made By- Shivang patel

8. The structure of operation theatre- The wall should be hard and easily washable material e.g marble Pipes and central oxygen , nitrous oxide, suction should be fitted to the walls. Adequate air conditioning should be provided In the absence of window adequte light should provided. Fire extinguisher should be adequate Floor: Non slippery, antistatic, non reflective, non porous, water, stain and fire resistant. Seamless Made By- Shivang patel

9. Walls: Same quality as the floor Seamless Usually stainless steel Ceiling Same quality as floor Usually stainless steel Diffuser for laminar air flow Mounting for lights Wide doors: sound proof, non reflective surface, radiation resistant fire resistant. Sliding type of door Glass cut out for visibility Made By- Shivang patel

10. Preparing drug for induction and those to use in case of emergency- Local anaesthesia(lidnocaine) Benzodiazepine(diazepam) Catecholamine to treat allergic reaction Opiod(fentanyl,sufentanol) Made By- Shivang patel

11. Anaesthesia room- Preparation of an anesthetic room- attach an anaesthetic breathing system with a proper size face mask. Confirm proper functioning of mechanical ventilators Confirm availability and proper functioning of wall suction. Intravenous solution and connecting tubes Suction catheter Made By- Shivang patel

12. Sterilzer room- a sterilizer room should be built adajecent to the OT with a window.the equipment can be passed between the rooms without repeatedly opening doors Recovery room - the main purpose of recovery room is to given nursing care to the post operative pt . The resuscitation equipment must be available and facilities for O2 and suction should also be there. Essential articles such as IV infusion, fluids, IV stand, stethoscope, BP apparatus etc. should be there. Made By- Shivang patel

13. Store room- Cylinder of O2 and nitrous oxide, additional equipment, infusion fluid bag , syringes, needles, drugs, and operation instrument are kept in this room . Changing room- a room is provided for theatre personnel to change into OT clothes from their sweat clothes, foot wear, sterile caps and mask also kept in this room. Scrub room - the surgeon and the nurses scrub in this room and this room open into the OT. Made By- Shivang patel

14. Operation table- a modern operation table has adujustments to enable the surgeon to give proper and safe position to the pt. some tables are designed for specific type of operation but most are made as an all purpose. Made By- Shivang patel

15. Theatr e technique- Surgical scrub technique Gowning and gloving Position used for surgery Position used for surgery- Supine, dorsal, recumbent position- used for operation of eye , ea r , fa c e,ch e st,a b dome n ,b r eas t ,leg s , feet and hands. Lateral position-used for operation on kidney,liver,hip . Lithotomy position-used for operation on external genetelia , vagina, and anl infection Made By- Shivang patel

16. Prep a r at ion of theatre Theat e re cleaning- Cleaning is a process which physically removes organic matter but does not necessarily destroy microorganism. Daily routine cleaning- the operation theatre is cleaned at least 1 hr before operation are started. the floor is cleaned whenever it gets dirty. it also cleaned at the end of the days work. ideally the floor is cleaned with machine with scrub and suction dries. Made By- Shivang patel

17. Cleaning between cases- Area which is contaminated or dirty have to clean between cases.if blood spills on the floor it is covered by 1% hypochloride solution for 10 min then it is mopped away. Daily cleaning at the end of the day- cleaning routine is as the same, but attention should be paid to the wall . Weekly cleaning- the floor is wshed after removing all equipment and furniture from the theatre. Cleaning after an infected cases- Routine cleaning is carried out. Fumigation should be done either with the formalin vapor or hypochloride spray.in case the pt have an infection that can be transimitted through blood, all linen and instrument are soaked in 1%hypochloride solution before washing. Made By- Shivang patel

18. Deep clean- this is a 6 monthly programmed clean of the clinical area of the theatre departments which will be undertaken by a dedicate deep clean team. the clean includes all the pt areas ,preparation room, ceilings, walls etc. Non clinical area such as store rooms and offices will receive a yearly clean The deep clean programme will be drawn up in the consultation with cleaning managers, facilities staff,infection control team and thetre manger Made By- Shivang patel

19. Preparation of equipments for sterilization- instrument are prepared on a metal tray which is covered by a large drape which is secured to the rim of the tray. Cleaning and care of instru m ent- instrument must be thoroughly washed either by hand or by using a sonic washer. Paid to joint and grooves. Made By- Shivang patel

20. Instument and different type of disinfection- the precise type of disinfection depends on the type of instruments. medical devices, equipment and surgical materials are divided into three general categories depending on the potential risk of infectio- a. Critical item- these are instrument or objects that are introduced directly into the bloodstream or into other normally sterile areas of the body. b. Non critical items- these are items that do not ordinarily penetrate, but touch only intact skin. such items include crutches ,bed board, blood pressure cuff. Instrument preparation- Clean all the instrument and material prior to sterilization. Dirt,blood and all contamination are should be completely removed as they Made By- Shivang patel

21. e.g; cardiac catheter b. Semicritical items- these instrument are induced into body cavities and therefore come into contact with intact mucous membranes, but do not ordinarily penetrate body surfaces.E.g; endotracheal tube Compromise sterilization Always soak instrument in water and detergent immediately after surgery to remove blood. Rinse instrument throughly after washing to remove any residue from the cleaning agents Dry instrument should be pack loosely Made By- Shivang patel

22. Method of sterelization - HEAT STERALIZATION- Moist heat method- an autoclave provides moist heat under pressure which achieves temperature higher than that of boiling point of H2O. autoclave is used to sterilize most of the equipment in common use like dressing,metal wire and instrument. Dressing should be wrapped in paper or cloth . Glassware should be packed individually Rubber gloves wrapped in glove cover or paper Rubber catheter,suture,and treatment trays should be wrapped in paper or muslin cloth. Made By- Shivang patel

23. Dry heat- here the sterelization is done in hot air oven at 1600c for 1 hr.it is usually fitted with internal fan to provide an even distribution of heat . Steam and formeldeyde - low temperature steam with formaldehyde autoclave can be used to steralize heat labile material such as plastic and anesthetic. Saturated steam under pressure- the flash stralizer is frequently used in the operation theatre for urgently needed unwrapped instrument.the temp used is 270 degree for a period of 3-10 mi cycle. Made By- Shivang patel

24. COLD STERILIZATION- Gama- irradiatin - gamma rays ionizing radiation can be used commercially for steralization of a wide range of articles such as suture ,syringes needles,catheters , dressing materials. Ethylene oxide- this is colorless liquid with boiling point with a 10.70c and it is highly inflammable and explosive. it is especially used for sterilizing anesthetic machine,sutures,dental equipment etc . Pasteurization- I is a method of low temperature disinfection particularly used for endoscopic instrument. the cleaned instrument is totally immersed in an electrically heated water tank at 75 degree foe at least 10 min. Made By- Shivang patel

25. Boiling- each instrument should be totally immersed in a container of distilled water and boil for 5 min. at a temp. of 90-100 degree Celsius. Made By- Shivang patel

26. Suture- a stitch or row of stitches holding together the edges of a wound or surgical wound. Purpose of suture- to hold a wound together in good apposition until such time as the natural healing process is sufficiently well established to make the support from the suture. Choice of suture material- Choice is depend on- Properties of suture material. Absorption rate Size of suture Type of needle Handling characteristics of knotting properties. Made By- Shivang patel

27. Natural suture material - Non-absorbable- Silk Linen Stainless steel wire Synthetic suture material- Absorbable- Polyglycolic acid Polyglactin Polydiosone Non-absorbable- Polyamide(nylon) Polyester( dacron ) Type of suture Made By- Shivang patel

28. Needle point- Five points of needle points are in common use- Conventional cutting needle Reverse cutting needle Blunt point needle There are several shapes of surgical needles.these include- Straight ¼ circle 3/8 circle ½ circle 5/8 circle Half curve Made By- Shivang patel