Skill Assessments 12 8 Laparotomy Draping 9 1

Skill Assessments • • • 12 -8 Laparotomy Draping 9 -1 Sellick’s Maneuver 9 -2 Syringe off field 9 -3 Syringe into field 9 -4 Accept meds to field

Draping • Please refer to Draping lecture for this content as well as textbook pages 357 -363

Laparotomy Draping • • • Prep Towel out with four towels Surgeon preference for securing towels – Apply towel clips – Apply skin staples – Apply Incise sheet (Ioban) • Laparotomy sheet – Pass to surgeon on same side – Move to other side of the OR table – If on patient’s right side: Form cuff with right hand push drape away from you while holding onto the other part of the drape with your left hand, release when patient’s lower body is covered (reverse hand position if on left side of patient) – Take right end and form cuff, push drape away from you making sure arm is covered by wing of sheet and hold if necessary for anesthesia to secure – Retrieve mayo stand to begin case, getting light handle covers, bovie pencil passed off and suction tubing passed off

Sellick’s Maneuver • The application of cricoid pressure • Applied to immobilize the trachea and create occlusion of the esophagus between cricoid ring and six cervical vertebrae • Designed to prevent stomach contents from ejecting during vomiting, hence reducing the risk of aspiration into the respiratory tract • Aspiration can result in drowning or aspiration pneumonia

Sellick’s Maneuver

ET Tube

LMA

Sellick’s Maneuver • Applied prior to and during general anesthesia endotracheal intubation • Applied when patient is suspected to have a full stomach or during CPR • Side benefit is that it also provides exposure of the glottis which helps the anesthesia provider place the endotracheal tube • Hence may be utilized when visibility is obscured

Sellick’s Maneuver • Procedure – Stand on side of the table that will allow for the person providing cricoid to be out of the way – Student must be able to identify thyroid cartilage and locate cricoid cartilage inferiorly – Form a “V” with the thumb and index finger • May vary with patient size – Wait form permission from the anesthesia provider prior to releasing cricoid pressure

Medication Delivery • Refer to Chapter 4 in your Pharmacology book Pharmacology for the Surgical Technologist • You are responsible for all content covered during lab • Refer to your index of your Pharmacology book to locate covered material

Antimicrobials • • • Antibiotics Antivirals Antiprotazoals Antifungals Antiparasitics

Antibiotics • Given for prophylaxis (for prevention) of postoperative wound infection • Administered IV (parenteral) per anesthesia preoperatively, intraoperatively and postoperatively • Also administered in the form of irrigant for the surgical wound intraoperatively • Will be mixed with normal saline on the field • Typical concentration of antibiotic is 500 ml NS to one vial of antibiotic (500 mg or 1 g) • Follow facility protocol and pharmacy recommendations

Antibiotics • Major categories – Aminoglycosides – Cephalosporins – Macrolids – Penicillins – Tetracyclines

Cephalosporins • Ancef (cefazolin) • Most commonly used for irrigation and IV adminsitration

Aminoglycosides • • • Gentamicin Vancomycin Typically used IV May see as eye drops Will NOT be administered as an irrigant as it can cause tissue necrosis

Sulfonamides • Silvadene • Typically used with burn patients

Miscellaneous • Bacitracin (Baci IM) • Substitute for cephalosporins used for surgical wound irrigants • Comes in vial 50, 000 ut mix with 500 ml of NS • Refrigerated in pharmacy • Also seen as an ophthalmic agent

Miscellaneous • Neosporin • Topical ointment • Neosporin/polymixin B Sulfate • GU irrigant (bladder only) • Mix in 3 L or 3000 ml irrigant bags

Anticoagulants • Heparin • Systemic administration by anesthesia during surgical procedures where clotting is a possibility that can lead to embolus formation which can cause pulmonary embolism which leads to death • IV (parenteral) based on patient weight • Also used as an irrigant when an artery or vein is open to prevent clot formation at the surgical site • Revert to regular irrigation after an artery is closed

• Also used as an irrigant when an artery or vein is open to prevent clot formation at the surgical site • Revert to regular irrigation after an artery is closed • Typical concentration on surgical field when used as an irrigant: 1, 000 ut per 250 ml NS

• Will see straight Heparin used to flush ports on catheters such as Hickmans/ Vas caths, Broviacs, and other central lines • Concentration will be 5, 000 ut/ml • Standard is 1 ml of 5, 000 ut per port you are flushing • Utilized to maintain the patency of these catheters

Antagonist or Reversal Agent for Heparin • The state of anticoagulation is reversed with the administration of Protamine sulfate • Given Iv by anesthesia provider dose based on patient weight • This is used as we want a person to resume normal clotting after vascular or cardiac surgery • However, sometimes the patient may be maintained in a state of anticoagulation postoperatively • FYI: Protamine functions as a reversal agent ONLY when it is in the PRESENCE of Heparin – Alone, it actually causes anticoagulation, but is never used for this alone – Created from salmon sperm – Have seen reactions in males whop have had vasectomies and have developed antibodies to sperm as a result of that surgery

Topical Hemostatics • Used to enhance the clotting process at a surgical site • Most common: • Surgicel or Nu-Knit • Avitene • Gelfoam • Thrombin (typically used with gelfoam) – Comes in powder that must be reconstituted – 5 ml, 10 ml or 20 ml – 20 ml vial or spray kit

Local Anesthetics • Most common: • Xylocaine (Lidocaine) • Bupivicaine (Marcaine)

Xylocaine (Lidocaine) • Injected (parenteral) by surgeon on surgical field • Strengths: 0. 5%, 1%, 2%, 3% • May come with or without epinephrine (epi) • Duration 30 -60 minutes • With epinephrine duration increases • With epinephrine vasoconstriction occurs at wound site minimizing sit bleeding

Xylocaine (Lidocaine) • Also used IV by anesthesia provider in situations of bradycardia, hypotension and cardiac arrythmias such as fibrillation as well as cardiac arrest

Bupivacaine (Marcaine) • Injected (parenteral) by surgeon on surgical field • Strengths: 0. 25, 0. 50%, 0. 75% • May come with or without epinephrine (epi) • Longer duration than xylocaine • 4 times more potent than xylocaine

Hormones • Epinephrine (Adrenalin) – Three functions: • Cardiac stimulant (cardiac arrest) • Bronchodilator (anaphylaxis or sever allergic reactions) • Combined with local anesthetics (vasoconstriction at surgical wound site and prolonged anesthetic duration)

Hormones • Pitocin (oxytocin, syntocin) • Causes uterine muscle contraction • Use: – Promote uterine contraction to facilitate delivery of a fetus – Promote uterine contraction (enhances clotting) post delivery to facilitate clotting in situations where hemorrhage post-delivery is occurring

Hormones • Pitressin (vasopressin) • An antidiuertic hormone used to stabilize fluid balance in diabetics • DO NOT confuse it with Pitocin! • I’ve seen this happen

Medications used for Injection • • Must be preservative free or safe for parenteral use Irrigants are not for injection Read your medication labels! Label all meds on your field including irrigants and syringes or aseptos used to administer them • Prelabel for anticipated meds you have reviewed on the surgeon preference card • This facilitates surgery preventing unwanted delays • Check meds prior to accepting them onto YOUR field! (5/6 rights)