Sx Skills - Lab Intro & Hemostasis

drraythe's version from 2016-01-30 14:56


Question Answer
What are the applications for ligatures?HEMOSTASIS!! Only for blood vessels. (Used to tie off ovarian or testicular pedicles, Ligation of blood vessels)
What are the 3 types of ligatures & where are they used/placed?(1) Circumferential → applied most proximally(to the body) on the pedicle
(2) Transfixation → applied most distally on pedicle (3) Miller’s knot → useful when there is tension on the pedicle; can use in lieu of circumferential ligature
What is “Thumb-to-thumb”?Used to manually tighten the 1st 2 throws of all ligatures
What is flashing?Loosening of the hemostatic forcep (distal to the ligature being applied) as the 1st 2 throws of the ligature are being secured
Which way does the curve of the hemostat point in the 3 clamp technique?The curve of hemostat is pointing toward the ovary
The proximal hemostat is...The 1 closest to the body
Describe the 3-clamp technique3 hemostats are applied proximal to the ovary/testicle during castration or OHE
(1) 1st ligature is applied to the pedicle at the site of the most proximal hemostat (suture is placed at site of the “crushed” tissue created by the hemostat. can be circumferential or millers knot)
(2) 2nd ligature is applied btwn the 1stligature & middle hemostat (transfixation ligature).
(3) Transect pedicle btwn middle + distal hemostats

Surgical knots + knot tying

Question Answer
What is a square knot?2 Successive throws are tied in opposite directions
What is a granny knot?BAD!!! 2 simple throws tied in the same direction
What is a surgeons knot? Pros & cons?1st throw consists of a double twist, followed by a 2nd regular throw
PRO: Higher knot friction allows for greater knot security
CON: bulky
What is a slip knot? When would you want to use it?A slip knot is created by applying uneven tension to both strands or pulling up on strands when tightening. Useful when tying knots in deep cavities or tight spaces
What are 3 major principals of knot tying?(1) Always apply eventension to both strands when tightening (exception = slip knot)
(2) A knot is always secured by placing an additional 2 simple throws (minimum)
(3) Avoid excessive tightening of the knot
What are the 2 methods of knot tying?(1) Hand ties
(2) Instrument ties
Pro & con of hand ties?PRO: Useful in confined spaces
CON: Uses a little more suture material than instrument tie
What is an instrument tie?Uses needle holders to help create & tighten knot

Introduction to Suture Patterns/ suturing skin

Question Answer
(Based on complexity) what is a simple pattern?1 pass through tissue on each side of incision
(Based on complexity) what is a complex pattern?2 passes through tissue on each side of incision (eg. mattress)
(Based on continuity) what is an Interrupted pattern?Sutures are placed individually
(Based on continuity) what is a continuous pattern?Sutures are placed consecutively after initial knot
(Effect on incision edges) what is an appositional pattern? WHEN do you use it?brings incision edges together. Use when no excessive tension on skin
(Effect on incision edges) what is an inverting pattern? WHEN do you use it?Incision edges turned inward. use on hollow organs to minimize risk of luminal content leakage
(Effect on incision edges) what is an everting pattern? WHEN do you use it?Incision edges turn upward. use in areas under tension
(Effect on incision edges) what does a Tension-relieving pattern do?↓ tension on suture line
Goals of Suturing → Close dead space → why do we want this?Minimizes risk of seroma formation
Goals of suturing → Appose like-tissues → why do we want this?Apposition of unlike tissues will delay healing +/-cz dehiscence
Why would you want to avoid eversion or inversion when closing skin?Delays healing
What is the preferred type of suture for skin?Monofilament
What is the surgical needle preferred for skin?Cutting needle (conventional or reverse)
When placing sutures & tying knots in skin, remember...That skin incision edges may swell after Sx
Where do you start/end an interrupted pattern on the skin?Inside end of incision
Where do you start/end a continuous pattern on the skin?Start 5mm beyond end of incision
What should the Distance from incision edge be when suturing skin?~3 to 5mm (¼”)
What should the Distance btwn sutures be when suturing skin?~5mm (¼”)
How long should you leave the tags of suture after you cut?~4 to 8mm long…will vary w/ circumstance & suture material type


Question Answer
What is SURGICAL BLEEDING?Bleeding which results from surgical manipulation of tissues
What is hemorrhage?Bleeding which arises spontaneously due to natural czs
What is hemostasis?Measures/actions taken to prevent or control surgical bleeding
What are the 3 types of surgical bleeding & describe what they're like(1) ARTERIAL: Bright red, occurring in pulsating spurts
(2) VENOUS: dark red, continuous bleeding
(3) CAPILLARY: continuous oozing
What are 3 ways to TEMPORARILY control surgical bleeding?(1) Digital pressure (large vessels)
(2) Pressure bandage (larger vessels-post-op)
(3) Bull dog & Satinsky clamps (temporary occlusion of vessels)
Which 2 clamps are used as TEMPORARY occlusion of vessels?Bull dog & Satinsky clamps
TQ: Does electrocautery = electrocoag?False. They are diff. cautery relies on unidirectional flow of current. Usually little handheld device. electrocoag uses bidirectional flow of energy, PTx on a grounding plate
Electrocautery vs electrocoagulation?CAUTERY= UNIDIRECTIONAL FLOW. COAG= BIDRIRECTIONAL FLOW (needs grounding plate!!)
What are 4 ways to PERMANENTLY control bleeding?(1) Digital pressure (small vessels + capillaries)
(2) Ligatures
(3) Coagulation
(4) Hemostatic agents
What are 4 methods of coagulation?(1) Electrocoagulation
(2) Photocoagulation
(3) Cryocoagulation
(4) Fulguration (type of coag that uses sparks of energy (she says she never personally seen it) this is used specifically for parenchymal organs (like liver, kidney, spleen) )
3 examples of hemostatic agents?(1) Gelatin or fibrin sponge
(2) Bone wax, zeolite
(3) Oxidized cellulose
***If you are using gauze to clear blood of a surgical site, HOW must you do this?DAB away the blood! DO NOT WIPE
Ex of a Bleeding disorder which can cz excessive Sx bleeding?vWf deficiency (Doberman pinscher)
Thrombocytopenia can cz excessive Sx bleeding... 4 reasons this condition may be present?↓ production
↑ destruction
↑ consumption
↑ sequestration