Intro Sterile Technique
Terms
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- Principles of Surgical Asepsis
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-Moisture may cause contamination.
-Prevent splashing and check for moisture.
-Always assume that an object is UNsterile
-Check integrity of packaging
-Check labels for expiration date.
-Always face the sterile field.
-Keep sterile equiment above the waist. - Principles of Surgical Asepsis-cont.
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-Opened unused materials are no longer sterile.
-A person who becomes contaminated must re-establish sterility.
-Sterile solution must be marked.
-Date, Time opened, Nurse's initials.
-Discard sterile solutions 24-28 hrs. after opening. - Dressing Change Procedure
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-Check for allergies of PT
-Tape, latex, betadine...ect.
-Check order for dressing change
-May need an order for first dressing change.
-WASH HANDS
-Open all bottles and packages before donning sterile gloves.
-Peel all sides apart, keep wrappers above waist, place on sterile field from side.
-Cut anticipated amt/length of tape.
-Stick to edag of table.
-Have bag for disposal of soiled dressings and gloves. - Donning Sterile Gloves
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-Place first sterile glove on dominant hand by grabbing turned down part of cuff.
-Touch only the inside of glove with unsterile hand.
-Push out and away as you pull on glove.
-Slip sterile gloved hand underneath second cuff.
-Adjust fit only after gloves are on.
-Touch only sterile part of gloves.
-Maintain gloved hands above waist. - Removing Sterile Gloves
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-Grasp outer surface of gloved hand
-Roll off first glove, placing it in the palm of your other gloved hand.
-Place ungloved hand under remaining gloved hand.
-Slide off remaining glove, covering first glove.
-Discard both in balled condition. - Dressing Materials-Gauze Pads
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2x2's, 3x3's, 4x4's
Folded Gauze
Can be sterile or non-sterile
Used as primary dressing next to incision.
Select size depending on size of wound.
Special Types
-iodoform
-Vaseline
-xeroform - Dressing Material-Fluffs-Kerlix-Rolled Gauze
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Large pieces of layered gauze or roll.
Loosely folded to absorb drainage.
Also used to pack wounds.
Comes in various widths.
Used for packing/wrapping wounds.
Used to secure dressings
-Extemities
-Head - Dressing Material-ABD's
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Combine, combination pads
Large absorbent pads
Manys are mosture resisant on one side
Normally used as secondary dressing
Used when high absorbency is needed - Dressing Materials-Hydrocolloid
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-Duoderm
-Soft wafer that can be cut to desired size and shape.
-Absorbs drainage
-Impermeable to both small and large molecules.
-Autolytic debriding of necrotic wounds - Hydrocolloid-cont.
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Used on Stage 1 and 2 pressure sores.
Protects high Friction areas on intact skin.
Prevents contamination.
Absorbs exudates in superficial or shallow wounds.
Maintains moist enviroment for healing clean, shallow-mod. deep wounds.
Can remain in place up to one week if keep clean and dry - Dressing Material-Montgomery Straps
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Anchoring pieces applied to intact skin adjacent to wound.
Laces criscross over wound to secure large/bulky dressings that need changed frequently.
Helps to avoid skin irrition caused by repeated tape removal. - Dressing Material-Non-Adherent
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Non-stick sterile dressings like Telfa
Can be impregnated with
-Petroleum
-Antimicrobials
-other agents
Used directly on wound or incision to pervent injury to tissue when dressing is removed. - Dressing Material-Transparent
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Manage superfical wounds
Provides skin protection
Allows visualization
-IV
Used post laparoscopic surgery
Allows autolytic debridement of small wound when removed. - Dressing Material-Moist-Vapor-Permeable
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Allows gases to pass through.
Drainage, bacteria cannot pass through.
One surface adhesive to dry areas only.
Used over small wounds and IV sites.
Used over black escher/necortic debris.
-helps to liquify material. - Dressing Materials-Skin Barrier/Dainage Bags
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Karaya, Stomadhesive
Protects skin from stool/urine after ostomy.
Used around heavily draining wounds.
Comes in wafer, paste and powder.
Wafers can be cut to size.
Wafers can also be used as an anchor for tape to prevent skin irritation. - Skin Barries/Drainage Bags con.t
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Dosposable or recleanable
Attach with adhesive
Most have a ring
Ostomy bag
Used over profusly draining wounds
Allows for measuring drainage and observering wound.
Contorls order and moisture. - Dressing Materials- TAPES
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Various widths
Various Material
-Paper(Hypoallergenic)
-Silk
-Plastic
-Adhesive
Steri-strips
-Used to approximate incisions/lacerations not requiring stitches - Dressing Materials-Isotonic Solutions
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No Anitbacterial Action
Removes Exudates
Moisturize wound surfaces
Sterile normal saline (NS, 90% NS)
Lactated Ringer's(more in OR) - Dressing Materials-Sterile Hydrogen Peroxide
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Causes mechanical debridement of open wound.
Removes blood clots.
Used in 1/4 to 1/2 strength with sterile water or saline.
No suntained antiseptic action
Cause too much trauma w/ effervescent action for deep, tunneling wound.
Not used in fresh bleeding wounds. - Dressing Materials-Povidone Iodine(Betadine)
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Kills
-Bacteria-Spores-Viruses-Fungi
-Affective per-op skin disinfectant, surgical scrub.
-Toxic to granulation tissue.
Use only in infected wounds at a strength of 1% or less. -
Dressing Materials- Sodium Hypochlorite
(Dakin's) -
Chlorine Compound
Inhibits blooding clotting
Used for debridement
Locally irritating to intact skin and granulation tissue.
Apply zinc oxide/petroleum jelly to surrounding skin for protection.
Strenght of 5 % conc. or less. - Dressing Materials-Acetic Acid
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Affective against:
-pseudomonas aeruginosa
-Trichomonas
-Candida
Irritating to healthy skin
Correct Conc. 0.12%
-toxic to cells at 0.25% - Drains
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Purpose
-Enhances flow of drainage from wound
-Prevent accumulation of drainage
-Promotes wound healing
Closed wound suction devices must be compressed to create suction. - Types of Drains
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Penrose
Jackson Pratt
Hemovac
Duvol