Preparation Of Surgical Team,Pack And Patient

FROM Dr.MUDASIR BASHIR
M.V.Sc SCHOLAR
VETERINARY SURGERY AND RADIOLOGY
I.V.R.I

1. Preparation of surgical team,pack
and patient
Mudasir Bashir
Roll no.-4856
Division of vety surgery and
radiology-I.V.R.I

2. Preparation of surgical team
•Each surgical team consists of 3-4 members.
•Surgeon—
captain of surgical team and performs
surgical operation.
uses hand signals and talks slowly for
necessary requests.
possess qualities of an ideal surgeon—
thoghtful,kind,forgiving,understanding,quite,c
ontrolled,foresighted and gentle.

3. II Assistant surgeon–
assists surgeon during operation.
prepares and drapes surgical field of operation.
keeps operative field free of visual
obstructions,particularly blood and clots.
should remember to blot tissues instead of wiping
them.
avoids accumulation of instruments,soiled
sponges,remnants of sutiures,abdominal packs.
keeps in mind detail helping the surgeon.

4. •Anesthetist/helper—
prepares and administers
preanaesthetics.keeps proper anaesthetic
record.
records respiration,pulse,its quality and
strength and temp.
keeps animal in recovery room after surgery.

5. preparations of surgical team involves:-
Scrub suits:worn in the surgery area to limit
amt .of dirt,debris and bacteria that surgical
staff carry into operating room.
•Shouldnot shrink ,easily laundered.
•Available in cotton,polyester blends or
disposable nonwoven material.
•Usually consists of shirt and pant.

7. •Not worn to examine patients or change
bandages if additional surgery is to be done.
•Head cover:-worn to reduce shedding of hair
and
bacteria{e.g;strept.viridens,e.coli,s.aureus}
into incision.
•All people in operating room wear head cover.
•Present in caps,hoods and bouffants.

9. •Shoe covers:-worn to exclude-
•Bacteria on street shoes.
•Reduce possibility of contaminating the
operating room.
•To protect shoes from blood and hospital
bacteria.
•Available in both reusable and disposable.
•Use declining-no evidence of declining
surgical wound infection.

11. •Face masks:-recommended for anyone
entering surgical room during surgery.
•Covers nose and mouth and are secured
behind top of head and neck for minimal
venting.
•Prevent surgical wound from saliva droplets
and micro-organisms by radiating through
sideways of mask.

13. •Surgical hand scrub:-surgeons hands usually
more contaminated than do the hands of
other medical personnel-more exposure to
scrub soln.and contaminated wound.
•Brushes may or may not be used-no reduction
in contamination.
•Done by 2 methods-
•Timed anatomic scrub-all surfaces scrubbed
for specific time.
5minute scrub is safe and effective.

14. •Counted brush strokes method:-each surface 0f
arm and hands receive specific number of brush
strokes.
Usually 10-25 times is being done.
•Gowns:-provide barrier between operating
teams skin and patient.
•Packaged individually and folded so that
internal back region is outermost.
•Gloves:-worn by the operating team to protect
patient from micro-organisms present on
operating teams skin.
•Powders are placed inside the gloves to make
them easy to wear.

21. •Remember:-
•Ensure that nails are socially clean,short and
without nail polish.
•Ensure that hands are kept heigher than
elbow.
•Rings watches should be removed.
•Use of gloves does not replace hand washing.
•Keep safe distance away from obstacles of the
gown.
•Never touch anything which is non sterile.
•Check there is no hole in gloves.

22. Preparation of patient
•Dietary restrictions:-
•Done to prepare animals GIT for surgery.
•To prevent postoperative emesis causing undue stress
on incision and tracheobronchial aspiration of
stomach contents
•Food intake is generally restricted for 12hrs in small
animals and 24-48hrs in large animals.
•If inadequate fasting time,emesis may be induced.
•EXCRETIONS:-Shortly before anaesthesia animal
should be allowed to defaecate and urinate-empty
bladder is often required for abdominal surgeries.

23. •Preparation of patient is divided into:-
•Premedication:-done to:-
Reduce amt of general anesthetic needed and
increase margin of safety.
Calm the patient-anaesthesia can be
administered without fright or struggling.
Reduce salivary secretions and of mucus
glands of respiratory tract.
Reduce gastric and intestinal motility-prevent
vomiting while animal is under anaesthesia.

24. Block vagovagal reflex-prevent cardiac slowing
or arrest.
Reduce pain,struggling and crying during the
recovery period.
• drugs used as preanaesthetics are:-
•Anticholinergics.
•Tranquilizers.
•Opiate and non-opiate analgesics.
•Tranquilizer-narcotic combination.ETC.

25. •After applying pre-anaesthetics,general
anesthetic is given to the animal.
•General anaesthetics are generally given
either through i.v route or by inhalation.
•After attaining complete anaesthesia animal is
intubated.
•In ruminants general anesthesia is not
preferred—prolonged lateral recumbency
leads to accumulation of gases—respiratory
distress.
•In cat and horse never do surgery of eye or
close to eye on local anesthetics—heart block.

26. •Antibiotics should be applied before surgery.
•In horse tetanus toxoid should be given prior
to surgery[21days in elective surgery and
before surgery in emergency surgery].
•Application of fluids.
•Anesthesia given should be balanced that is—
hypnotic,muscle relaxant,andanalgesia.
•Dosage of anesthetic is based on following
factors—
•Metabolic activity of animal.
•Existing disease condition.

27. •Pharmacological effect of drug.
•Factors on which anesthetic is given:-
•Age of animal.
•Relative size of animal.
•Body fat.
•Sex.
•Breeds.
•temperament of animal.
•Prolonged fasting.
•Recent feeding.

28. •Activity of animal.
•Duration of surgery.
•Nature of operation.
•Site of surgery.

29. •Surgical site preparation:-the skin and hair
of animals are reservoir for
bacteria{staph.micrococcus,acinetobacter,cor
ynebacterium,strept,etc}.
•Hair removal:-razors,depilatories and clippers
have been used.
•Razors-
•Adv.:-leave minimal stubble.
•Disadv.:-multiple laceration.
•Skin erosion.
•10fold increase in surgical wound infection.

30. •Depilatories:-
•Adv:-a traumatic.
•Disadv:-donot work on coarse animals skin.
•Expensive.
•Frequent skin reactions esp.cats.
•Clipping:-recommended method.
•Adv:-less skin trauma.
•Fewer surgical wound infection.
• minimum of 15cm on each edge of proposed
incision is clipped.
•For orthopedic procedures on limb-entire limb is
clipped.

31. •Skin preparation:-initial site preparation is
performed outside the operating room with the
animal positioned for easy access to the proper
surgical site.
•If limb is being prepared, it is suspended from
ceiling or an i.v stand to have complete access.
•The clipped area is scrubbed by applying gentle
pressure in circular motion beginning at proposed
incision site and moving centrifugally.
•After scrub apply antiseptic soln.-70% ethyl
alcohol,tinctures of chlorhexidine and iodine.

32. •Positioning of patients:-
•To ensure easy and complete access to surgical
site to facilitate manipulation.
•Patient is then secured with
ropes,sandbags,adhesive tape,etc.to minimize
movement during surgery.
•Surgical site is wiped with antiseptic to
complete the preparation.

33. •Draping the patient:-
•Isolates the surgical site from contaminated
areas and provides sterile working area.
•First of four drapes is opened,applied along
one edge .similarly other three are kept on
other edges.
•Second drape layer consists of large single
shroud with a central opening.
•These art kept hold by using towel clamps.

34. •Skin draping:-
•Purpose-prevent bacteria present in hair
follicles to contaminate the surgical wound.
•Minimizes contamination of surgeons gloves.
• PLASTIC DRAPES COMPARED TO CLOTH
DRAPES CAUSE SIGNIFICANT REDUCTION IN
POSTOPERATIVE COUNTS OF ENDOGENOUS
BACTERIA.

35. PREPARATION OF SURGICAL PACK
•General surgical pack consists of following
instruments---
•Mayo's scissors—blunt end,straight—1.
•Mayo's scissors—blunt end, curved—1.
•B.p.handle no.3 and no.4---------1 each.
•Assorted blades for above handles—1 packet.
•Mouse tooth tissue forcep----1.
•Allis tissue forceps-----2
•Cross bar towel clamp---4

36. •Mosquito hemostats'-------4.
•Artery foreceps,curved and straight—2 each.
•Mathews needle holder---1.
•Groove director---1.
•Suture needles assorted(traumatic and a
traumatic)-straight and curved---6.
•Surgical gloves—2 pairs.
•Surgical gown,mask,cap—2 each.
•Surgical shroud(75×105cm) with 17×2cm slit
in centre----1.

37. •Surgical shroud without slit----1.
•Surgical towels 20×30cm-------2.
•Gauze sponges.
•Surgical pack wrapper(90×120cm)—1.
•General surgical pack should be prepared as
follows:-
•Surgical pack wrapper should be spread over
diamond-wise on the table—one corner
towards left and other towards right,one
towards near side,fourth to far side.

38. •Items assembled on pack wrapper in such a
way that when pack is opened the articles may
be removed in the order in which they are to
be used.
•All the instruments, surgical
gowns,shrouds,gloves and towels should be
cleaned dried before preparing a pack.
•Surgical shroud should be folded by accordion-
folding at 9-10cm intervals so that folds are At
rt.angle to the window.
•Pack should be sterilized. generally
-121°c×15psi×15min.