pre-operative preparation for orthopedic procedure.pptx

things you should know before you put scalpel on patient.

1. PRE-OPERATIVE PREPARATION FOR ORTHOPEDIC PROCEDURE DR. AJIL P ACHANKUNJU Junior Resident

2. RADIOGRAPHS IN THE OPERATING ROOM - The technician should have a clear understanding of aseptic surgical technique and drapings. -When an unsterile radiograph cassette is to be introduced into the sterile field, it should be placed inside a sterile pillowcase or plastic bag so that exterior remains sterile. -Operative wound should be covered with a sterile towel when AP view is taken. -Every time C-arm is brought to lateral position a sterile drape should be applied over the end of the c-arm & dropped off when complete.

3. RADIOGRAPHS IN THE OPERATING ROOM -Proper lead-lined aprons should be worn beneath sterile operating gowns. -Thyroid shields, lead-impregnated eyeglasses & rubber are to be used to decrease exposure. -Active fluoroscopy with c-arm should be avoided to prevent excessive radiation.

4. PREVENTING MISTAKES -Before entering the operating room, the surgeon and the awake, alert patient should agree on the planned procedure and surgical site. -Surgeon should mark the surgical site to prevent wrong site. - Once patient is under anesthesia , designated member of the team should state the name of the patient, the procedureand the correct site.

5. POSITIONING OF THE PATIENT -Maximal safety to the patient and convenience for the surgeon. -Free airway should always be maintained. -Avoid unnecessary pressure to chest and abdomen. - In prone position sandbags should be placed beneath te shoulders & thin pillow is placed beneath the symphysis pubis and hips to minimize pressure on the abdomen and chest.

6. POSITIONING OF THE PATIENT -In supine position, the sacrum must be well padded. -When the patient is lying on his/her side , the greater trochanter and the fibular neck should be padded. -When a muscle relaxant drug is used, the danger of stretching a nerve or group of nerves is increased. -The brachial plexus can be stretched when the arm is on arm board particularly if it is hyperabducted.

7. POSITIONING OF THE PATIENT -Arm should be suspended in flexion from an overhead frame and the position should be changed frequently. -Padding should be placed over the area where nerve may be pressed against the bone.( radial nerve in the arm, the ulnar nerve at the elbow, peroneal nerve at the neck of fibula)

8. LOCAL PREPARATION OF THE PATIENT -Superficial oil and skin debris are removed with a thorough 10 minute soap and water scrub preferably 7.5% betadine diluted approximately with 50% sterile saline solution. -After scrubbing skin is blotted dry with sterile towels. - With patient in proper position, solutions are applied, each with separate sterile sponge stick, beginning in the central area of the site on incision and proceeding peripherally.

9. LOCAL PREPARATION OF THE PATIENT -Once painted on, it is allowed to dry and is take off with plain alcohol. - Sponges should not be saturated. -If sterile drape becomes saturated with with antiseptic solutions, they should be replaced’ - Solutions should not be allowed to flow underneath a tourniquet. - Pooled alcohol based solutions must be removed from the field as they can be ignited by spark from a cautery unit.

10. LOCAL PREPARATION OF THE PATIENT -When traumatic wounds are present alcohol containing solutions should not be used to avoid tissue death. -in male patients genitalia should be displaced and held away from operative field with adhesive tape. - A long wide strip of tape helps cover gluteal cleft & may avoid potential infection. - in female patients, genital and gluteal cleft can be similarly covered.

11. LOCAL PREPARATION OF THE PATIENT -Instrument packs should not be opened until skin preparation and draping is completed.

12. DRAPING - During draping gloved hands should not come in contact withprepared skin -Should not be assigned to inexperienced assistant. - foundation drapes should be placed to overlap prepared skinat least 7.5cm(3 inches) -Foundation drapes should be fixed to the skin.

13. THANK YOU