Download A complete Hospital Manual of Instruments and Procedures

BISMILLAH-E-ALLAHU AKBAR
A complete Hospital Manual of Instruments and Procedures
DR LOLA HUSSAIN FROM RUSSIA……….
Date 04/04/16
Admission Procedure
1.
2.
3.
4.
5.
Patient reports to the reception of the hospital.
Front desk executive enquires about the patient's problem.
Reception office refers the patient to the concerned department/doctor.
Patient reports there, and concerned doctor investigates the patient's case history.
If required, patient is advised for admission in the hospital. In case of admission, the
patient is given the admission date and admission form is filled for further formalities.
6. Except for emergency cases, admission to the hospital is done by appointment. This will
be recommended by the specialist during the patient's outpatient consultation.
7. Before admission, the patient is counseled by the front desk executive regarding the
treatment package which includes:
8. Estimated bill size
9. Average length of stay
10. Various modes of payment accepted
11. Documents to bring on day of admission
12. When the patient arrives at the ward, our ward staff will orientate the patient to the ward
and the facilities available. Patient will then be clerked by the ward doctor - this involves
taking a detailed medical history and ordering of tests if necessary.
13. During the patient's stay in the hospital, he/she will be attended by a team doctors
comprising of medical specialists, assisted by medical officers and house officers. Every
care is taken in respect of patient care, treatment, meals, dress and health recovery.
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14. The daily routine in the ward includes activities such as ward rounds by doctors,
medication, meals, visiting hours and bedtime. However, this routine may vary as
laboratory tests, x-ray, treatment and other procedures will take place when required.
15. If required, the doctors operate the patient as part of the treatment.
16. The patient's medical records and information on their medical condition are confidential.
We will only share this information with the patient and the next-of-kin. If the immediate
family members wish to know more about the patient's condition, they can approach the
appropriate coordinator to arrange for convenient time to meet the concerned doctor.
17. The safety and wellbeing of our patient is our utmost concern to us. We advise our
patients to remain within the hospital premises until they are discharged by the concerned
doctor.
18. A discharge summary certificate will be given to the patient before leaving the ward. In
case the patient needs a medical certificate, he/she has to inform the doctor or nurse in
advance so that it can be prepared before the patient's leaves
19. Before leaving the ward, patient is handed over with detailed discharge summary, which
includes doctor's advice on their further follow-up treatment, daily routine diet, and
medical prescription.
20.
21. The doctors may give the patient an appointment for follow-up at the Specialist
Outpatient Clinic. If the patient needs to reschedule the outpatient appointment after
discharge, they can feel free to contact the concerned doctor.
TRANSFER PROCEDURE
1. The patient should be transferred to the operation table by two persons which is necessary
to stabilize stretcher as close as possible to the operation table, taking care to lock wheels
of the stretcher as well as of operation table.
2. One person (at least) must stand on the opposite side of operation table to receive the
patient and prevent him/ her from falling.
3. If the patient is alert and physically able he / she is given directions for moving on to the
operation table.
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4. In case patient is unable to move without assistants adequate enough should be sought
before transferred is made.
5. The employees should prevent injuries to its own back (muscular skeletal system) while
lifting the patient by using proper body mechanism and by arranging adequate help.
6. The patient should be lifted simultaneously while bending their knees and used the thigh
muscle to provide strength during lifting patients.
7. During transfer care is taken to protect all catheters and tubing from becoming tangled
and pulled out.
8. While transferring patient restraint (safety) strap is fasten securely across patient’s thigh 3
inches above the knees. Do not apply straps too tight to avoid tissue damage as well as
the nerve damage.
9. Boney prominences and the extremities must be provided to prevent damage to the skin
and move. Some hospitals have special teams for lifting patients and heavy objects
known as “lifting team”.
10. Never leave a patient in unattended in theatre.
11. The patient’s bony pints should be well padded.
12. Once anesthetics assume charge of patient, the patient is never be moved without his
permission.
13. Excessive flexion or extension of joint of patient should be avoided to prevent injury to
the patient especially those of arthritis or paralysis.
14. Sometimes you may have air mattresses on the table to prevent injury to the patient.
15. The patient’s body should not hang over the table otherwise the skin of patient shall
become a grounding site when electro surgery is employed resulting in skin burns.
16. Padding’s, towels, or rolled blankets can be used under the chest to facilitate adequate
lung expansion when the patient is in prone position. i.e. face down position stimulating
extra padding is placed to prevent damage the breasts and generation of the patient.
17. To avoid strain on low back muscles pillows are placed under the knees.
18. Hyper extension an over extension to the arms, hands, fingers, neck, and lower
extremities. Including foot and toes should be avoided.
Environment control in operation theatre:
Aim or objective:
Prevention of infectious disease as well as transmission of disease:
It is of two types:
Standard Method and
Universal Method
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Standard environment control is for specific operations for example HIV, Hepatitis-B and
hepatitis-C. Because in these operations the risk of disease is more to the OT team. So to
avoid these diseases a specific suit is given to the OT team which includes 99 masks, double
gloves, surgical hat and gown, which are all disposable without gown, Gown is autoclaved
and then reused but the other ones are not used again.
(OR)
These methods are mainly directed to health care facilities and transmission of infectious
diseases. Basically these guidelines were initially promoted by HIV/ AIDS emergency, but
are now applicable to all infectious diseases.
Universal environment control is same for all type of operations. The suit used in such type
of operations is universally used. In this type every patient is operated using the same suit.
(OR)
It includes measures to safety deal with blood products bodily fluids including vaginal
secretions as well as seminal fluids. As a result the following measures have come into force
or existence.
1. Practice of hand washing.
2. Utilization or use of gloves, masks fascial shields, gowns, clinical control, lining
processing etc.
By observing these measures the spread of pathogenic organisms can be controlled and limited.
These following steps came into observance.
1. Each operation room including furnishing and equipments should be cleaned with
germicidal solutions after any procedures.
2. In addition the entire surgical departments including into corridors, store rooms and other
associated areas are also cleaned with germicidal agents regularly.
3. The operation room should be restricted area from general public in the hospital.
4. Air borne contamination reduced by using efficiency particulate air filters.
5. Sterilized dress, gown etc. are worn in operation room disposal head coverings masks,
protective fascial shields and water proof fire retarding guns, gown and shoe coverings
are used.
6. To prevent noso-comial infections frequent hand washing with antimicrobial agents is
required.
7. Hand washing should be done as the first major while entering the theatre as well as
while leaving the theatre.
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8. Hands should be washed also carrying for each individual case and gloves should be
changed.
9. Following their initial washing of bands, individuals who are not working within the
sterile area may use a water less antimicrobial gel.
10. Jewelry like rings, watches and bracelets are to be removed.
11. Caps, masks, eye glasses should be warn before scrubbing(washing) for this purpose
disposable masks and caps should be preferred as cloth masks are preventable to the
passage of pathogens.
Trays .
Major trays,
Minor trays.
Scicessrion trays.
ASEPTIC TECHNIQUE
1.
2.
3.
4.
5.
Care must be given to the controlled sterilization of instruments, Instrument trays and
other supplies in the theatre by specifically noting time and condition of the sterility
indication and the wrappers.
All wrapped items are to be unwrapped by holding the package away from once the body.
Disposal of waste materials and the removal of laundry into specifically marked and
labeled plastic bags are containers to prevent contamination of the environment inside
and outside.
To prevent blood and other contaminates from drying on the instrument an enzymatic
foaming agent can be spreaded on the instruments tray is taken out of the theatre. This
sometimes overlooked and it drys on the instrument or drys inside the lumen of
instrument in hospitals were this foaming faculty is not available instruments should be
covered with a sheet and carefully transported out of the theatre.
Spills are to be mopped up with a germicidal solutions.
ELECTRO SURGERY
Electro Surgery Unit (ESU) is commonly employed in operation for coagulation
or cutting the tissues.
TYPE OF ESU:
There are two types of ESU:


Bi-Polar ESU:- in this the current flows from a generator to an active electrode i.e. one
side of the forcep. The electricity is passed to the tissues and gets returned to the
generator through an inactive electrode i.e. another side of the forcep.
Mono-Polar ESU:- in this the active electrode is usually an electro surgical “pencil” and
the inactive electrode is the grounding pad. The grounding pad is known as dispersive
pad. Which is placed on the patients skin as close as possible to the operation site. To
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minimize the pathways of the current through the patient’s body. This inactive pad has to
be in perfect contact with the skin as such shaving of the skin may have been undertaken
for good contact. This must be placed as for as possible from ECG leads to prevent
interference it is also important that all connections must be secure and tight.
Safety Measures To Prevent Burn Injury To The Patient
1.
2.
3.
4.
The connections must be secure.
The active electrode should be close contact in the skin necessitating shaving of the part.
Patient’s body should not touch any metal surface when ESU is on.
The electro surgical pad, should placed as for as possible from the ECG leads to avoid
interference with heart electric field force.
COUNTING PROCEDURE:
Each hospital has its own policy and procedure regarding the counting of sponges, sharp objects
and instruments so, following should be adopted as counting measure particularly regarding
these items which can easily get into the wound.
1. The scrub (nurse/ person) and the circulatory person should count all sterilized
items and the scrub nurse will touch each item practically.
2. The circulating nurse will immediately record the number of each type of the
item on the operation theatre records. In case of any confusion counts are
repeated.
3. Additional item sponges and needles etc are introduced to the sterile field OT
during with the circulator and the person adds the new count of items to the
register.
4. No item including laundry instrument are sponges should may be removed from
an operation room when the procedure is on and until the final count is done and
acknowledgement correct.
5. The only exception is when the report is sent to the laboratory from examination.
6. Whenever there is a change in a team member count is taken refresh. The name
of the living person and the name of the replacement person has to be
documented on the records of the theatre.
7. Counts are taken before surgery begins before the wound is closed and when the
skin is closed.
8. An additional count is again taken when an organ or a cavity like uterus or
bladder or bowl is closed.
9. In correct counts must be repeated immediately.
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10. If incorrect the circulator alert the surgeon who will impact the wound for the
missing item and if the item is not located an examination x ray must be carried
out.
NOTE:- Any item left accidentally in a wound can become a source of infection and
resulting in subsequent litigation.
SPONGE COUNTS:




All sponges are counted as per their types and sides and are kept separate.
All sponges used within the wound must be x-ray detected.
Solid sponges are counted by scrub person and the circulate together and then bagged in
previous plastic bags according to pre-determining numbers (usually in sets of five or
ten).
The circulator wears sterilize gloves when separating or counting solid item and inform
the surgeon of the result of the counting.
SHARP COUNTS:
1. All knife blades and electro surgical tips and other sharp edged items are counted.
2. The needles in peaks may be counted according to the package.
3. Used needles , blades, and other sharp items should be retained on the magnetic pad
to prevent loose and facilities counting.
4. All types of any needle or any sharp item must be counted entirely.
INSTRUMENT COUNTS:
1. Instruments are counted before the surgery begins and after the surgery using the same
protocol as per sponges etc.
2. All broken parts can be accounted for in entirely.
STERLISATION MODALITIES:
1. All items come in contact with the sterile field or the wound must be sterile.
2. After completion of a procedure all solid instruments are cleaned in washer, sterilizer
for decontamination.
3. These instruments after washing sterilizer are put to the ultra clear to remove any
spoilage.
4. And alter as even available an enzymatic foaming agent is sprayed on an instrument
before they are taken out for decontamination.
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Most Commonly Used Sterilization procedures:
1. Saturated steam sterilizer.
2. Gas chemical sterilization.
3. Liquid chemical sterilization.
4. Low temperature hydrogen peroxide sterilization.
Saturated steam sterilizer:- this method is used in operation room for urgently needed
equipments, unwrapped instruments and trays. In this procedure temperature in the sterilizer is
set at 270oF (132oC) for a cycle depends upon density of items to be sterilize. Denser the items
more numbers of such cycles wrapped instruments trays , basins and other items are usually
sterilize in per vacuum high temperature steam sterilize. In addition a heat sensitive indicator
with each wrapped tray is to be placed in the sterilizer along with the load. The packing of
instruments and trays must be unwrapped by holding the items away from the body. In
unwrapped first followed by either of the sides and lastly the corner closest to body is
unwrapped.
Chemical Gas Sterilization:- In this procedure the gas used in ethylene oxide gas for items
which are vulnerable to heat or mixture ethylene oxide sterilization depends on concentration of
gas temperature of gas and exposure time and vacuum is created in the sterilizer which helps the
gas centration around the equipments (load). Ethylene oxide sensitive indicator is placed inside
package to indicate that the gas has reached to all the items. In this type of sterilization the
temperature is controlled at 65OF (18OC) to 72OF (22OC) for a period of 7 hours.
Liquid Chemical Sterilization:- In this type of procedure 2% activated aqueous glycerol
dehyde solution marked as cidex solution is often the agent used is used in this procedure. The
instrument must be completely immersed in the solution for period of ten hours. After
sterilization with the chemical the instrument must thoroughly rinsed in the sterile distilled water.
Another chemical used for sterilization is “Steris 20” in this chemical the equipment should be
completely immersed for 12 minutes at 50OC temperature.
Low Temperature H2O2Gas Sterilization:- in this method we use 1.8 ml of 58% H2O2 i.e.
vapourized in a sterilization chamber after creating a vacuum in the chamber the vapour is
converted into plasma by radio frequency energy. This sterilizes the equipment at the low in one
hour.
Re-Use of Single Used Instrument:There are two categories:



When you have only opened the packing and the instrument will not be used.
When we have used the single and want to use it again.
NOTE:- This subject is still controversial.
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Emergency & Disaster Considerations:
Operation room has to be equipped with a special emergency signal which is usually a flsh red
light, to alert others about an emergency.
In case a patient suffers from a cardiac pulmonary arrest. The anesthetist as well as the
surgeon should immediately undertake Cardio Pulmonary Resuscitation (CPR).
A crash cart trolley should be readily available in the operation theatre. It contains:
1. Emergency drugs, needles, syringes, infusion equipments, defibrillator, a ventilation
device (Amu-Bag) and monitoring equipments.
2. For pediatric patient the theatre team should have Pediatric Advanced Life System
(PALS) skills to access and assist in the treatment of (at risk) pediatric patients.
Malignant Hyper Thermia:
It is a race but lethal condition which is triggered by the use of inhalation anaesthesia and muscle
relaxants.
 In such a situation the anesthetic should administer a drug named as “Dantrolene”
(Dantrom), steroids, IM, IV solutions and the patient has to be cooled with ice packs.
Hence, the establishment of a malignant cart or tray is high recommended. Also is highly
important that the treatment given to such patient should be noted on patient chart.
Infection Control & Sterilization & Care of Surgical Instruments:
1. Ventilation Of Operation Theatre:- ventilated operation theatre harbouros less
infection.
A specific temperature has to be maintained in O.T at 20 – 23OC (68 – 70 OF)
along with humidity of 30 – 55% this can be monitored by independent temperature
control system for O.T.
2. Air Flow: To screen out unwanted particles of different nature and air efficient
particulate air system (HEPA) and sure at least 15 air exchanges are of fresh air. The
HEPA system acts through vents in ceiling and near floor. The air circulates through
vents in the walls close to floor.
The air ventilation system should routinely inspected and air filters change
regularly.
3. Infection Control In Theatre: Pre-operative, operative and post-operative sterilization
is respect to instrument should be observed to avoid infection as the presence of infection
can produce anything from a minor wound to major disaster condition like Tetanus.
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The infection control in a hospital is primarily functional by ICC (Infection Control
Community) the hospital in ICC is comprised on a physician, a nurse, an epidemiologist.
The job of the ICC is as follows
 To investigate on identified source of infection in each case who gets infected the
source of infection could be the patient itself or the theatre staff or any other
person.
 In case necessity the ICC can change rules to prevent future infection or out break
of infection.
 Provide effective isolation of the infected patient.
 In patients staphylococci and streptococci are main bacterial pathogens. A
bacteria which lives with oxygen i.e. Aerobes, which live without oxygen i.e.
Anaerobes.
 Aerobes E.Coli enterococci, proteus, enterobacteria, pseudomonas, streptococci,
staphylococci, anaerobes fusobacteria, veillnelle, propinobacteria, clostridium,
peptostreptococci.
NOTE: The above list of pathogens has isolated are found from patients with
intra-abdominal infection. Anaerobic bacteria are usually found in pineal
abscesses and sometimes a mixed infection of aerobes and anaerobes has been
found perineal abscesses.
Wherever infection is suspected a bacterial soup is taken fungal infection
particularly of the nails can be recognized by sending nail clips for mycology.
 How to Avoid Infection in Theater.
1) By careful aseptic technique.
2) Proper sterilization of instruments and dressings.
3) Care of viral infections like hepatitis A B or C and HIV AIDS etc.
ASEPTIC TECHNIQUE:
Technique requires the following steps:Entering the theatre:a) Entry to the theatre should be limited to surgical team only.
b) The theatre team should change in the room into OT shoes, suits, masks and the gown
before the entering the operation theatre hence it is the duty of the operation room
assistant (ORA) to keep all these items available in the theatre complex.
-: Scrubbing Technique:1. Whole surgical team must scrub in the scrub room outside the operation theatre.
2. Taps in the scrub room should be elbow operated.
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Technique of scrubbing:a)
b)
c)
d)
e)
f)
g)
Wet your hands.
Apply soap or detergent and work good foam.
Scrub your hands and forearms up to 5 cm’s above your elbow for 1 min.
Raise your hands and the fore arm.
Take a sterilized brush and put soap on it.
Scrub the lateral and medial side of each finger.
Scrub nails and back and front of your hands also the fore arms scrub for 4 min’s making
it a total of scrubbing for 5 min’s.
Hold your hands up turn off the taps with your elbow dry hands with a sterile towel
now put on the gloves.
GOWNING:(a) Hold the gown away from the body high enough so that it does not touch the
floor.
(b) Allow it to open now and put your arms in the sleeves of the gown.
(c) Flex your arms and the nurse shall lie the taps of the gown the back, the neck
position and on the medial position.
GLOVING:(a) Dust your hands with the powder and rub the hands together to spred it all
over the hands.
(b) Touch only the inner side of the gloves only (cuffed) and pull it on to your
opposite hand.
(c) Put the finger of your already gloved hand under the inverted cuff of the glove
and pull it on to your other hand. one can wash the gloved hands in sterile
water to wash the powder.
Eye Protection:This is for the safety of surgeon and rest of the team masks. Protective eye wear
face shield should be warn during surgery to prevent your mouth, nose and eyes
from droplets of blood or other body fluid from the patient.
Preparation Of Patient (Or) Operation Site:Area to be cleaned shaved disinfected before the patient send to the theatre.
Once the patient reaches the theatre the skin is to be prepared as soon as
patient is anaesthetized.
Steps of Preparation:
 Wash the area with soap solution.
 Apply iodine and alcohol iodine.
 Dry with a sterile swab on a holder and start from middle of the operation
site and work out wordily.
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


This swab as well as the holder and repeat the antiseptic application with a
second swab depending upon the requirement one may have to apply the
antiseptic solution even three types.
Lastly apply spirit which does not mid drying as it evaporates itself.
Prepare wide enough area of skin e.g. in abdominal surgeries you have to
prepare a skin from nipple to the groil.
DRAPING:- After preparing the skin.
1. Put a towel across the lower parts of the operation site place more
towels at right angles near the edge of the tap and the sites.
2. Retain these towels in position with towel clips in abdominal
surgeries, a sterile sheet covers the operation site and has an opening
in its needle.
SWAB:- A 10 cm gauze is folded and held with sponge forceps for swabbing.
PACKS:- There are large square multi layered gauze used to pack the abdominal cavity so as to
save vital organs from sharp instrumental injuries.
DAILY CLEANING:- After each day surgeries done routinely but complete cleaning is done
once a week.
(Steps)
1) All the items are to be cleaned and then disinfected.
2) Floors to be cleaned using a wet vacuum cleaner either by centralized build up system or by a
portable wet rectum. In case where the two systems are not available one can undertake the
following steps:
a) Fit two buckets with disinfected detergent.
b) Use disposable mops.
c) The mops, the buckets and the disinfectant solution have to be changed each time.
d) Beds or tables are to be removed and the surfaces clean with special attention to hinges.
e) Doors, windows and walls are thoroughly cleaned with disinfectant material.
End Of the Days Clean Up:
1)
2)
3)
4)
5)
6)
7)
Clean surgical lights.
All mounted equipments or the sealed are to be cleaned.
Clean all furniture.
All shelves, counters, tables, autoclave taps have also to be cleaned.
Floor of the theatre should be cleaned.
Scrub the skin.
Soap dispenser.
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Weekly Cleanup:
In addition to all items, mention in daily cleaning special attention has to be given to the
following items in addition to the items taken care ion daily cleaning.
I.
II.
III.
Ventilation, air conditioner, air heating grills they all need to be cleaned by the vacuum
cleaner.
Attention to utility rooms including the supply room linear room sweeper boppers.
Operation theatre fumigation.
Cleaning Of Instrument:
Scrubbing the hinges and the serrations of the instrument with an old scrub brush.
Procedures adapted in case of accidental injuries to surgical team members in theatre:This applies to the injuries that a member of a surgical team may be injured accidentally the
following step are to be taken.
1)
2)
3)
4)
Allow the person to leave for some time to wash out any infection introduced to the person.
Thoroughly clean with soap and wash.
The part should be dressed aseptically.
The details of the injured person should be recorded in the registered of the theatre.
Sterilization and disinfectant of instruments: Is a process by means of which we kill all
bacterial germs viruses and the spores.
Sterilization: Word sterilization means full sterilization and does not include any partial
sterilization or any description like near sterilization.
Dis Infection:- this process aims at reduction of population or number of organisms. In this
process the spores are not destroyed.
There are four methods of sterilization or disinfecting of instruments:
1)
2)
3)
4)
Application of antiseptic solutions.
Boiling.
Hot air own.
Auto-calving.
1. Antiseptic Solutions (disinfecting solution)
 Alcohol –It is a combination of ethyl isopropyl makes Alcohol 70% was used previously
commonly used disinfectants presently are as under.
Phenolic Compound:- this is used to disinfect walls, floors and furniture.
Iodine Compounds:- this is used to disinfect dark floors, dark furniture and dark walls.
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Formal dehyde:- 4- 10 % used to Dis-infect instrument.
Alcoholic fluorine:- used to Dis infect instruments.
Glutaral dehyde:- this is also used for Dis infect instruments.
Chlorohexodine:- this is the common antiseptic used these days . it disinfects instrument in two
minutes only.
Aldehyde:- it is a powerful disinfectant. In 10 minutes it disinfects the instrument and is 10
hours it sterilizes the instrument.
2.
Boiling
This method is still widely used for disinfecting instruments.
Advantages:a. It is simple process and is quick.
b. Instruments are cleaned and boiled for 5 minutes at 100OC
temperature.
Dis-advantages:a. Boiling doesn’t destroy some spores like tetanus gas gangrene and
some of the viruses.
3. Hot Air Oven
This is thermostatically controlled electric oven similar to domestic electric oven.
Advantages:
1. It can be used to sterilize powder petroleum products and the sharp instruments.
2. All microorganisms are killed at 160OC for 2 hours.
Disadvantages:
This is not suitable for rubber and plastic objects.
4. Auto-Claves
This is the most efficient & successful method of sterilization of instrument packs and dressing it
is basically a pressure cocker (even a domestic pressure cocker can be used to sterilize small
number of instruments).
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The autoclave offers a choice of :
a) Temperature.
b) Pressure.
c) Time.
The boiling temperature under pressure can be raised to 121OC from 100OC by adjustment
of pressure knobs.
Adjustment of Autoclaves:
Mainly two adjustments slow cycle and quick cycle is being maintained.
1. Slow Cycle: - More the cycle is more suitable for plastics, heating the water to 121OC under
pressure of 15 LBS for 15 minutes.
2. Quick Cycle: - In this cycle you heat the water to 134OC under the pressure of 30 LBS for
3.5 minutes.
Working of Autoclave
1. It must be on appropriate temperature under appropriate pressure and for appropriate time.
2. The whole autoclave should be saturated with steam.
3. It must displace all air in autoclave chamber to leave only the steam in the “chamber of items”
to be sterilized.
4. The steam must reach all the parts of the load it should be steamed only and not in the droplet
form as it shall soak the porous material loaded inside.
5. As the chamber of autoclave is full of steam at the desired temperature and pressure. It must
be held at that time for the indicated known time which shall be known as “holding time”. The
standard holding time is 15 minutes at 120OC and 15 lbs pressure but one can vary as per
requirement.
Requirement of Autoclave:Stages will be as follows:
The chamber and close the autoclaves.
Stage 1. Prevaccum) The vacuum is created by vacuum pump and the required vacuum should
be 0.5 mm Hg.
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Stage 2. (This is a stage of sterilization) this means holding process of sterilization under a
particular temperature and pressure for a specific time e.g. In quick cycle you have to raise the
temperature to 134OC, pressure at 30 lbs to be maintained for 3.5 minutes.
Stage 3. (Drying) this is achieved by remove the steam. This can be checked by taking out a
sample towel and is allowed to cool if the vacuum created is sufficient this towel will not remain
dry.
Stage 4. You will put air in autoclave through a glass fiber or ceramic type filter. After stage 4
the chamber is unloaded.
Types of steam sterilizers:1. Gravity displacement sterilizer.
2. Pre vacuum sterilizer.
3. Flash sterilizer.
Gravity displacement sterilizer:- principle of working of this sterilizer “air is heavier than
steam ” within the sterilizer there is an inner chamber where goods are loaded and an outer
chamber jacket type ejects forcibly into this sterilizer is constructed in such a way that once you
force in steam the air gets push downwards by gravity hence the name Gravity Displacement
Sterilizer.
Pre vacuum sterilizer:- In this sterilizer air is pulled out of the chamber and a vacuum is
created in the chamber to replace the air.
Advantages of this sterilizer:- It is more efficient as vacuum is immediately created and steam
quickly comes and contact with the load.
Flash sterilizer:- This is quick working sterilizer smaller in size invariably used in theatre for
dropped instruments or contaminated instruments.
Sterilization by Ionic Radiation:
Sutures, sponges, syringes and powders etc. are sterilized by ionic radiations.
Sterilization by low temperature steam and Formaldehyde (LTSP)
The combination of physiochemical kills spores and most viruses in addition to bacteria.
Methods Of Disposal.
Incineration:- Is a method of all infected materials like syringes, plastics, needles etc in addition
to disposable linen and infecting cloting.
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Sterilization Control:
1. Chemical Monitoring: Some substances, chemicals or a special ink impregnated on the piece
of paper change its color when sterilization is completed.
2. Combined temperature and time control monitor: The equipment gives a graph indicating the
level of sterilization.
3. Biological method: This is the successive method to determine the sterility of items in a steam
sterilizer.
PROCEDURE
A strain of highly resistant non- pathogenic spare forming bacteria are put in a glass vial along
the load of the goods in an autoclave after a sterilization the glass vial containing the spores are
taken out and are cultured.
If number of spores grows it will mean that sterilization is of high quality. That has
killed highly resistant spore forming non-pathogenic bacteria.
Dis –Advantages:
This procedure is time taking and cannot be adopted on daily basis but being the most perfect
indicator of sterilization should be performed once a week definitely without fail.
Common Sterilization Agents:
1. Cobalt-60 Radiations: It is used for pre-packed like syringes, powder, ointments etc.
2. Ethyl-Oxide Gas: It is highly inflammable oxide but it sterilizes as well.
3. Glutaral Dehyde: This chemical is used for sterilization and the items have to be dipped into
the solution.
Electrical Equipments Used in a Theatre
All equipments in theatre are usually operable on mains and most of them are of A.C current.
Hazards of such currents:1. Electrocuital.
2. Local burns.
3. Loose connection can lead to sparkling which can lead to burning of inflammatory gasses in
the operation theatre hence important measures are required to be taken to avoid these hazards.
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Failure of Current:Main input voltage required for electrical instruments is 220 Volts in case of failure of mains the
alternative source of electricity has to be a generator delivering the same voltage or the source of
light can be voltage of 12 – 24 V you may have one source available or combination of both in
the theatre.
It is wise to use energy saving lights and equipments and that the load on the energy of
source can be load or should taken to use electrochemical equipments away from the anesthesia
equipments , sparking plugs and electric connection can burn any loading anesthetic equipments
with in a distance of 25 Cm’s.
Care of Electrical Equipments:
1. Before use check and test all electric equipments.
2. You have to take care of electric cables.
3. Ensure earth connection which can sometimes use or can break, during repairs incorrect
alteration can result in dangerous voltage which can reach the patient through the equipments.
4. Simple checks of plugs, cables, and fuses should made regularly by OTT staff and at the
intervals inspection by a qualifying electrician has to be undertaken as per the recommendation
of the manufacture.
5. Earth connections and major fuses should be checked. Damaged cables, damaged sockets
should be replaced immediately.
6. All equipments working from main voltage should have a circuit breaker in the supply lines.
7. All electrically powered equipments should be kept dry.
8. Equipments like Cardiac Defibrillators which delivers high voltage of thousands Volts and be
checked by a qualified electrician.
Low Voltage Batteries:
These batteries are generally safe for the OTT staff as well as for the patient.
List of the electrical equipments that works on low voltage in an Operation Theatre:1. Laryngoscope:- Endoscopic equipment used to visualize the anterior of the Larynx.
2. Bronchoscope:- Endoscopic equipment used for visualization of the interior of the Bronchus.
3. Cyst scope:- An endoscopic equipment used to visualize interior of the urinary bledder.
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4. Head lamps
All other endoscopes that work on 1.5 to 10 Volts
5. Diathermia Machines.
Care of low Voltage Equipments:
1. All connections should be kept clean dry and free from corrosion.
2. Good contact of the connections must be maintained and loose connections if any should be
immediately repaired otherwise current does not pass.
3. Lamps should be tightly secured in positions.
4. Current source should remain constant therefore battery should be placed before the exhaust.
5. Batteries should not be stored in instrument because the sweat can cause corrosion.
Rechargeable Battery Packs:
1. Rechargeable Nickel Cadmium batteries are used in medical equipments as they are
electrically safe.
2. These batteries deliver high voltage currents or discharge so should not be shorted as they
might result in sparkling.
3. Their life gets extended by repeated charging and recharging.
4. Rechargeable batteries can fail anytime so backup batteries have to be kept ready and
available side by side.
DEFIBRILLATORS:These are the equipments that allows electric stimulus to heart which control ventricular
fibrillation to sinus system.
This fibrillation can function on main supplies and also can be battery operated.
This fibrillation can apply shock through chest wall or through electrodes placed directly on the
heart.
 It charges a condenser to maximum energy of 320 Joules for external application, 50 J
have to be applied for internal electrodes if electrodes are placed on a heart wall. This
shock is given for 3 milliseconds.
In arterial fibrillation this defibrillator is connect to an ECCT and the shock is
delivered for 40 milliseconds after the pack or wave.
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Surgical Diathermy
It is equipment that delivers high voltage current. It has two electrodes
1. Small
2. Big
Small electrode: - Electrode is connected to the patient the small one remains in the hand
of surgeon. This small electrode is known as live electrode.
As the surgeon applies his live electrode to the tissue the current passes through the
touched tissue cells and owing to the tissue electric resistance heat gets generated at the
small contact point of the live electrode the effect of the diathermia is located.
Big electrode: - The bigger electrode also indifferent electrode is a flexible metal plate it
can either be placed under the patient’s body (scrotum) or it can be bandaged around the
thigh sharing of the part may be necessary or application of an electrode jelly became
necessary to ensure close contact.
In case the patient’s body is dry, moist with water and saline became necessary the
electrode is connected to an earthing wire to avoid shock to the patient.
Before the equipment is put to use as a major of safety the surgeon must check the
bigger electrode or bigger plate as well as the alarm system.
Safety Measures:
There is an alarm system attach to the diathermy equipments which needs to be checked
before the machine is put to use in case the plate is not in good contact with the patient
the alarm sound will put a machine On.
Steps to training (the determination or priorities for action in an emergency eliciting the
alarm system):  Connect the plate to the patient.
 Return lead is connected to the plate.
 Diathermy machine is switched on. The alarm should sound. After the alarm is there
connected return the lead to a diathermy machine the alarm silence.
The area under the plate should have a good blood supply to absorb any heat
generated by the plate.
Good skin contact of the patient is essential.
While taking diathermy some care is to be taken by the patient as well as by the theatre
staff:  Patient should not touch any metal object like drip stand metallic screens or the operation
table.
 Spirit based fluids if used on skin should be allowed to evaporate completely.
 Only surgeon should activate and control the machine.
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 In case diathermy works poorly one should check the fittings of the electrode and the
leads instead of increasing the dial settings.
Isolated Generators: These are modern type of generators smaller in size and transistor based the generators produce
high frequency current 400 – 600K Hz.
Surgical Cautery
This is small equipment used in the theatre to destroy skin lesions. In this equipment there is a
wire-loop which is raised to red heat by an electric current. The heated point is used to coagulate
the tissues.
The apparatus can work on mains as well as battery but the constant voltage is
provided only if mains are using transformers. The transformer has a knob to regulate the
current.
Cautery points are of various shapes and sizes for different applications
Lasers
Light I sin the form of beams all laser waves travel in the same direction the beams carry laser
energy measured in Joules. Laser beam system has the following components:
1. Laser Head.
2. Excitation Source.
3. Ancillary component.
4. Central Panel.
5. The delivery system.
Laser equipment is to produce a parallel beam of high intensity light which can be
focused on a very small spot.
The laser beam helps in micro surgeries as follows:
 Suture less micro vascular anaesthesis.
 Excision of posterior capsule of lens through transparent cornea.
 Coagulation of bleeding peptic ulcers using a flexible gastroscope.
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Method of working of Laser Beam:
1. The laser beam heats the target tissue and causes tissue destruction by causing local Oedema
(swelling) and then cause deneturation of proteins.
2. It also causes contraction of tissues due to alteration of fibrous tissue proteins.
3. It finally causes boiling of the cell water and vaporization
4. Low laser energy exposure, it causes coagulation of the blood vessels.
5. High energy exposure produces a precise incision by vaporization of the tissue at the target
point.
NOTE: - One has to always wear eye protection.
Guide lines to eye protection during Laser surgery:1. Before activation of laser everybody present in the theatre should wear eye protection glasses.
2. For the using laser operated endoscopy a special lens cover is placed over the eye piece to
protect physician from ‘Leaser back lash.
3. For the viewing the procedure during microscopic an automatic lines shelter should be
connected to the microscope lead so that the shelter automatically closes when ever this back
lash of laser beams.
4. The patient’s eyes have to be protected with moisturized gauze pads.
5. Whenever the patient is awake during laser procedure appropriate goggles should be worn by
the patient.
6. During laser surgery near the eyes special laser eye shields should be placed on the patient’s
eye.
7. Eye protection glasses worn by the surgical team and the patient has to be scratch free as
scratches decrease the protection ability of the goggle.
Cryosurgical system: - (Those which work on opposite principle to the laser)
It is a system were in extreme cold is applied to tissue to destroy or kill an unwanted tissue. It
is characterized by minimum bleeding or pain during operation and post operation period. This
method can be used in following surgeries.
1. General surgery.
2. Gynecological surgery.
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3. Dermatology surgery.
4. Neurology surgery.
5. Urology.
The first such equipment was discovered in the year 1962 in which Nitrogen gas was used to
have temperature of 196 OC.
Later on Amoils developed more simple apparatus which used Nitrous Oxide gas to have a
temperature of 70OC. it has been used to treat easily skin cancers. Efforts are on to use the
technique in the treatment of prostate and bone.
Ultra Sonic Equipments (CUSA) : Cantron Ultrasonic Surgical Aspirator. This instrument is used in the body to fragment and
aspirate relatively soft tissue tumor.
Uses:1. Usually this equipment is used in neurosurgery to remove rapidly and efficiently and
intracranial or spinal cord tumor.
2. The other use of the equipment is to reset of direct liner, kidneys, spleen, pancreas or
urological elements. This equipment is basically a vibrator consisting of these components.
Transducer: - it is magnetic device which converts electromagnetic energy into mechanical
vibrations. The other aspect is a connecting body it changes the motion of the transducer into
surgical tip. It also amplifies the vibrations of the transducer.
Surgical tip: - It is connected to provide adequate motion amplification while it contacts the
tissue.
The electric coli which is permanently fitted in the hand piece (Jacker) surrounds the
transducer the coil receives 23000 cycles per second and activate the transducer, the hand piece
is connected by a cable which includes the cooling water consistor in a console and the head.
Since the electric coli has a current following through and the transducer lamination are moving
back and forth 2300 times/ sec. heat gets generated and gets absorbed by the water or the fluid
circulating within the hand piece , this keeps the hand piece at the comfortable temperature for
the surgeon.
Electric and pipe line.
Suction apparatus:- it is a vital equipment for aspirating fluids may be from abdominal cavity,
nasopharynx etc.
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Prevention of cross Electrocuital in operation theatre:1. Avoid portable electric distribution board as much as possible.
2. Use ceiling mounted electric points so that there is no risk of water or short circuit.
3. Avoid the use of long mains supply cables.
4. Avoid damaged cables.
5. Consult electric engineer on even minor faults in the electricity.
6. Make sure to regular maintenance regards electricity in the theatre.
OPERATION ROOM COMPLEX
It should be separately build and in the operation theatre complex operation room should be
centrally placed.
Present trend in the hospital construction design suggests only 2 or 43 staged buildings
and not multistoried.
The operation complex should be separate from general traffic and air movements.
Good planning relationship should be there in between the operating department, intensive care
unit, surgical wards etc. with easy access to accident emergency department, radiological
department as well as the lab facilities.
Design and Environment control of the operation theatre:1. Size of the room: - it should be at least 400 sq ft. in area with minimum 20 ft. distance from
the cabinets and the wall shelves.
Cardial, artrhopaedices, neurosurgical and theatres or laparoscopic should have the
utility room should be separate.
The operating suit should be designed for maximum patient safety.
The floors, lightings and other surfaces should be smooth non porous and constructed of
fireproof material, the smooth surface allows hollow cleaning and prevents the trapping of
biological material which can catch infection and can get contaminated easily.
The surface of furniture etc. should be such that the theatre air is not contaminated by
outside air.
Clean air is derived from outside as the air inside may be contaminated by passage through
the other areas of the hospital. Humidity should be optimum to control ignition of any
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inflammable gas or liquid (dry air helps ignition) idle humidity also reduces microbial growth by
30-55% the temperature in the theatre also should be comfortably maintained at 20-24 centigrade
in addition to the most important system that should be available in a theatre is emergency
alarm system which should raise an alarm in case of any threaten life emergency.
Operation Table: Modern operation table gives a variety for patients undergoing surgeries the table can be
adopted for specialized procedures by addition of accessories like for surgeries of brain, spine
and bones. Modern operation table are non sophisticated and are available with base position in
the centre of the theatre on the top which is fitted a removable top.
Essentials of Modern Operation Table: 1. It can be tilted towards head or towards foot end
2. I t should also be tilted side to side.
3. The table can be broken at the hip for gynae operation.
4. We should be able to disengage the foot end of the table the head end of the table.
5. For special surgeries accessories should be attached to the table like neurological frame.
Position Of Patients in Various Surgeries.
1. Supine: - This position is with face upwards surgeries that are possible in this position are
eye, ear, face, chest, abdomen, legs, feet, arms, hands, breast etc.
2. Prone: - This is a face down position operation sites are all those parts that are at the back of
the patient.
Additionally this position can be adapted for retro-peritoneal approach.
3. Neck Position: - This is a supine position with sand bag or pillows under the shoulder with a
paddle horse show support your head.
4. Supine Hip Position: - This is a supine position with pelvis (hip) supported by a
supplementary table top which is translucent X rays e.g. nailing femoral neck fractures etc.
5. Treden brug position: - This is a position of patient with head side down. The aim of this
position is to allow intestines to display away from pelvic cavity by gravity towards upper
abdomen in this position the patient is in supine condition.
Another position is supine with back elevated to produce extension of the abdomen to
push the gall bladder anteriorly.
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6. Lithotomy Position: - It is a supine position with legs flex at the level of the hips and the
knees along with legs raised and feet supporting on webbing rings this position is for perineal
and gynecologist surgeries.
7. Lateral position of extension: - This position is a lateral position with lumber area supported
by a supplementary table top. This position is required for the surgeries of chest and kidney etc.
8. Sitting Cranial Position: - This is a sitting position, head supported by a cranial support this
position is required for surgeries of head and the upper part of the neck.
Preparation Of Personal In OT
Washing of hands, changing into OT clothes and the foot wear. Cover to prevent infection, cover
head and wear masks, the theatre usually of cotton or poplin material. The color of theatre suit
can be blue, grey and white, the operation gown is usually green or white the masks should be
synthesized fiber or fiber glass.
Instruments have to be sterilized, operation table light should be working before
surgery, equipments like diathermy, and suction machine has to be tested first.
Preparation of Operation Theatre: Clean all equipments particularly the OT with damp duster in addition to the floors.
 Sterile make brushes, scrub solutions, gown packs and all other required items.
 Bottles, flasks of sterile saline or water for hand latian bowls are kept ready and placed
ate the proper position.
 Bandages strapping, splints and all required latians are kept ready before surgery.
Equipments required should be prepared for sterilization.
 Operation table and the accessories are checked and ensured that they are in working
order.
 Other important equipments like diathermy and suction machines are switched on and
tested before the surgery.
Preparation of Instrument Trolley: Instrument trolley should be prepared before surgery.
 Cover all metal surfaces of trolley and tables which are to be used for setting out sterile
instruments should be covered with a sterile water proof material before material before
application of sterile drops.
 The instruments are laid out by assistant wearing sterile gown and gloves.
Note: - Half dipped instrument in a disinfectant should never be used in theatre.
 Prepare sterile packs containing all necessary equipments.
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SCRUB NURSE





Scrub nurse scrubs herself, puts on a gown and gloves like others.
While scrubbing hands care must be taken to scrub hands and forearms thoroughly.
Nails and fingers should receive special attention while scrubbing.
Any person with respiratory infection or skin disease should not be allowed scrub.
All anticipates are required, instruments should be sterilized during counted including the
swabs.
CIRCULATING NURSE
 In addition to scrub nurse one or two nurses remain on duty as circulatory one of the
nurse has to be essentially available in a theatre and the other nurse has to see that the
instruments and the trolleys are ready.
 She will also render help to place patient on the operation table if required.
 She will identify the patient to be operated and she will keep the patients documents
ready in the theatre.
Swab checking and the operation register:  Before closing the wound counting of swab packs, sponges, needles and instruments
has to be done similarly before beginning of the surgery note regarding the number
of each individual item as mentioned above should be recorded on the patients file.
 No loose swab should be allowed in the theatre the once used by the anesthesia
should be of different sixe to discriminate them.
 Swabs should be packed in fined numbers.
 Swabs used in the theatre should have a radio opaque marker.
 For wiping and surgeons broke a small sterile towel should be used.
 Any blood stain or soiled floor a wet mop should be used to clean it.
 A swab packed in the wound then a mop should be used to clean it.
 Now the swab must be prepared from gauze containing a radio opaque thread so that
the same is visible on x-ray while searching a missing swab.
Preparation of soft supplies: 1. Swab packs: - These should be in bundles of fiber tied with a thread which are checked and
rechecked by a person and then to two persons before surgery begins.
2. Large abdominal packs: - These are 18 inch sq. in size comprising of 36 layers of gauze
stitched around the edges and a short tape (radio opaque) attach to its corner.
 During surgeries while the abdominal pack is placed in position a forcep is clipped
to this tape which is left protoding.
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 Solid packs should not be reused on another person as these packs predispose to
abdominal adhesions because of detergent or soap residue.
3. Large swabs or sponges: - Their size is 9 inch or 3 inch containing 24 layers of the gauze.
These large packs or sponges could be even of the size 6 inch / 4 inch or 9 inch / 9 inch.
4. Large Packs: - The size of these is usually 2inch / 2 inch or 3 inch/ 4 inch having 16 layers.
Preparation of dressings: - Is usually a job of theatre staff although readymade dressings are
available in a market. The gauze used for making a dressing should have radio opaque material,
readymade swabs with radio opaque character of cellulose are also available which have high
absorbency.
Disposal and treatment of the regulated medical waste: -There are mainly three procedures
adopted.
1. Heart treatment: - E.g. Incineration, autoclave or microwing.
2. Chemical treatment: - By hypochlorite and chlorine dioxide.
3. Radiation treatment: - Like Gamma radiations & electro radiations.
 DEFINITIONS
 Antiseptic: - It is a process where pathogenic (disease causing) microorganisms are destroyed.
(Or)
it is a process of inhibition of growth and multiplication of organism.
 Bactericidal: - These are drugs (chemicals) that kill bacteria.
 Bacteriostatic: - Drugs that inhibit the growth of micro organisms but does not kill them
 Cavitation: - It is process in which air burst inwards to discharge particles of soil or
tissue debris from the instrument in an ultrasonic cleaner.
 Simple cleaning: -Cleaning is a process to remove organic or inorganic residue or debris.
 Contamination or contaminated: Any instrument or any item which is unsterile and
may harbor microorganisms.
 Process of decontamination: - It is a process of disinfection.
 Disinfection: - It is a process by which most but all not pathogenic micro organisms are
destroyed.
 Critical items: - are those which need to be sterilized essentially before use on patient.
 Sterilization: - Is a process by which all micro-organisms in all forms are destroyed.
 Ultrasonic cleaners: - It is equipment that cleans instrument through the process of
cavitysation.
 Washer sterilizer: - It is equipment that washes and partially sterilizes the instrument.
 Formide: - A substance or an agent that can be infected and can transmit disease.
 Host: - Organisms that provide nutrition to parasites.
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 Pathogenic agent: - Those agents that cause disease.
 Strict aerobes: - Bacteria that can’t survive without oxygen.
 Strict anaerobes: - bacteria that can’t survive in presence of oxygen e.g. tetanus and gas
gangrene.
Complication of General anesthesia:
All complications which occur in intra peritive period can occur in post operative period,
post operative period with which is usually 7 hours.
Respiratory complications: 

It arises usually because of aspiration it is the major cause of death associated with
anesthesia.
Regulation of gastric contents into the lungs.
Size and symptoms:

Tachycardia quick heart rate increases.
Tachy_____ respiration.
NECK SURGERIES
Thyroidectomy:Aim:
Removal of all or portion lobe of the thyroid gland.
Discussion:
Indication hyperthyroidism.
Thyroid mass or lesions.
Hyperthyroidism is characterized by:
 Increased metabolism.
 Weight loss.
 Fatigue.
 Hyper excitability.
 Emotional liability.
 Heart in tolerance.
 Cardiac symptom and palpitation.
 Impaired swallowing due to mechanical obstruction.
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Complication of Thyroidectomy.
1. Laryngeal nerve injury.
2. Post operative bleeding.
 Later on the symptoms of hyperthyroidism.
 The patient must be post operatively look for signs of hypolakemia due to
accidental excision of the parathyroid gland.
 The gland is highly vascular with two lobes connected by an isthmus.
 The gland is located on the anterior spot of the trachea adjust to 2nd, 3rd and 4th
tracheal ring.
 For thyroid nodule or even for localized malignancy only partial Thyroidectomy
is done (lobectomy).
Before surgery various medical regimens and radioactive iodine (RAI) are
employed to obviate (delay) surgery in same case.
Total Thyroidectomy is indicated for cortex carcinomas and to release tracheal
or esophageal compression. In case investigations like physical examinations, CT
scan if they indicate a thyroid malignancy has spread to other structures in the
neck, radial neck distraction is performed. This necessitates more extensive
surgery.
There is an another type of surgery video assistant neck surgery (VANS) can
also be performed using calavicular lateral cervical, trans maxillary approach an
approach through areola of the breast.
Procedure:
Anesthesia: - Endo-tracheal intubation.
 A transverse curvilinear line for the skin incision is made
above the sterna notch a natural skin crease.
 The incision is deepened and the external jugular veins are
legated.
 Blunt and sharp dissection is employed till we reach the
cricoids cartilage and the thyroid isthmus.
 The recurrent and superior laryngeal nerves are identified
and protected avoiding parathyroid gland.
 The larger vessels and the supporting tissue should not be
divided before identifying these structures particularly the
branches of these recurrent laryngeal nerves.
 The gland is mobilized.
 As per the indication all the portion of the gland is
removed.
 Homeostasis is achieved.
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 The divide strap muscle is repaired and the wound is
irrigated and a drain is inserted. Incision is closed by
interrupted sutures.
Para-Thyroidectomy:They could be one or more of the four parathyroid.
Discussion:hyperthyroid symptoms may be mild or even un-detectable. The condition is detectable on
routine blood tests which reviles high blood of calcium level with the blood.
Non- sympathetic symptoms of Para Thyroidectomy









Feeling of depression.
Body aches and pains.
Loss of appetite.
Nausea
Confusion.
Bone loss
Peptic ulcers
Hypertension.
Pancreatitis.
Indication: 1. Adenomas.
2. Carcinomas.
3. Hyperplasia normal or atrophic are usually untouched. In case of hyperplasia were all four
glands appear to be involved only three and a half gland is excised. In conditions were all the
four glands are carcinogenic all the four are removed, but a portion of one gland is transplanted
into the musculature of fore arm added by hormone replacement therapy (HRT).
Total excision of all four parathyroid results in tetiny (Acovenches hand) and death post
operatively calcium and phosphate levels has recently revolutionized the activity of parathyroid
gland.
Procedure:
1. Endoscopic approach: this is minimally invasive radio guided Para Thyroidectomy.
2. Anaesthesia: Is used local with suggestion.
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 Cervical plexus block.
 General anaesthesia.
1. A one inch incision is made above the supra strenal notch.
2. Radioactive endoscope and neoprene are inserted into the neck through the incision.
3. Hyperthyropied gland gives an audible dissect out from the adjusted glands.
4. The enlarge gland is carefully dissected out from the adjust glands.
5. Its arteries and veins are clipped, care is taken to preserve or spare nerves.
6. The lesions or the parathyroid gland is excised or removed.
7. The excise specimen is then scanned and if the radioactive signal is similar to the pro
operative level, the dissection is then required.
8. Homeostasis is ensured and the wound is closed.
Procedure for standard or open method.
1. The procedure and the approach is the same as far as Thyroidectomy.
2. The thyroid gland is metabolized and rotated to either side of the neck taking care that the
laryngeal nerve is preserved.
3. Once parathyroid glands are identified they are isolated and excised as per the indication and
according to the pathology.
4. A portion of the gland may be left un excised or embedded in forearm muscle.
5. Homeostasis is achieved.
6. The wound is irrigated and drain is inserted.
7. The incision is closed with interrupted sutures.
THYROGLOSSAL CYSTECTOMY:Definition: - excision of Thyroglossal duct cyst in continuity with the mid portion of hyoid bone
to the foramen cecum this surgery is also known as “sis trunk operation”
Discussion:
It is an embryological remoment running from base of the tongue to thyroid gland. It can
sometimes form cyst and is usually seen in childrens.
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Procedures:1. An incision is made between the hyoid bone and the thyroid cartilage along natural skin
crease.
2. A flap is raised superiorly to the level of the hyoid bone an inferior flap is raised until the cyst
is identified.
3. Platysma muscle is incised and retracted and strap muscles are separated and divided.
4. The cyst is identified and mobilized along with the duct with sharp as well as blunt dissection.
5. A central portion of the hyoid bone is removed to prevent recurrence and the proximal duct is
legated and dissected to the foramen cecum.
A specimen is excised with 5-10 mm case of muscle at the base of the tongue.
A drain may be inserted and wound is closed in interrupted sutures.
Please forgive if any mistake is found…..
Notes compiled by :
Zakir Hussain Parray
Shopian.
Student of OTT 1st Year 2016
Contact:
+919797297634
+919018736994
+919103374011
Email me : [email protected]
Zakir Hussain Parray
OTT I YEAR
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BISMILLAH-E-ALLAHU AKBAR
Zakir Hussain Parray
OTT I YEAR
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BISMILLAH-E-ALLAHU AKBAR
Zakir Hussain Parray
OTT I YEAR
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