Lesson 3.
Asepsis. Organization of work in operation
unit. Caring for patients in the postoperative
period.
HYGIENE AND ORGANIZATION OF WORK in
surgical hospital
The organization of medical care, including surgery, the citizens of
On mass surgical care show hundreds of thousands annually performed in
The basis of the modern system of surgical care in
The organization of surgical care includes ascending, primary health
care, skilled and specialized surgical care. Surgical care is divided into an
ambulance, or emergency, which require patients with acute illnesses and
injuries, and planned, carried out for patients with chronic illnesses.
Primary medical emergency patients with acute surgical diseases and
injuries made in outpatient health posts in the district and rural hospitals -
in villages and in towns and equated localities - surgeon clinics, doctors and
emergency station crews, mostly specialized, stations "ambulance".
Patients with minor injuries, acute type, which do not require surgery or the
latter can be successfully performed by doctors of these stages, and patients
with acute illnesses that do not require hospitalization, primary care provided
in these stages are actually qualified and are completed. The essence of
primary care patients with acute surgical diseases and injuries in rural
clinics and district hospitals, as well as help in clinics cities, in those
cases where the patient requires such assistance, by its nature, exceeds the
amount programmed for the surgeon and clinic goes beyond its responsibilities,
is examining a patient at disposition paramedic or doctor (including
medicinal-ovarian-surgery clinic) means for establishing probable or,
sometimes, an accurate diagnosis and referral of the patient to the surgical
department district or central hospital with the definition of transport which
the patient must be addressed. In most cases, carrying machine station
"ambulance" or machine "ambulance" very hospital in which
the patient guides. Less can be requested aircraft - helicopter or plane even
if the life of the patient mortal danger. Patients with surgical polyclinics
cities sent to the appropriate surgical department district or municipal
hospitals, or through the station "ambulance" (by calling the last
machine) - acute internal diseases, or (rarely) - urban or own transportation
in case of acute lung diseases and injuries.
In clinics cities and towns that have surgical rooms and offices,
patients with minor superficial injuries and uncomplicated acute diseases
(small wounds of the soft tissues of the body are limited to burns, furuncles,
abscesses, subcutaneous felon, etc.) is also a qualified surgical care.
Qualified emergency and planned surgical care for patients with the most
common acute abdominal disease (acute appendicitis, incarcerated hernia, acute
cholecystitis, perforated gastric and duodenal ulcers, gastric bleeding,
pancreatitis, acute intestinal obstruction, etc.) and with injuries organs of
this cavity, injuries soft tissue, purulent processes, as well as patients with
chronic abdominal cavity and some other organs is in general surgical wards of
central district hospitals, urban and regional, rarely - in the district where
there is a surgical department and appropriate interventions for these
conditions (qualified surgeon , means for accurate laboratory and instrumental
diagnostics and anesthesia required). In large cities, including regional
centers, along with district and city hospitals to ensure patients of skilled
surgical means, the latter is also the regional hospitals to patients who are
sent here from district hospitals respective region.
The rapid development of surgery in the last half century, by which the
human body does not remain out of reach for hands and surgeon of a scalpel,
made it virtually impossible surgeon mastery of all the arsenal of modern
diagnostic and surgical diseases perfect technique surgery for all organs and
parts of the human body.
This led to the need for differentiation, division of surgery (and other
broad areas of medicine) into separate disciplines and sections. Thus was
launched surgeons specialize in certain sections of Surgery and Surgical
emerged specialized institutions that provide patients with specialized
surgical care.
Yes, surgery has long been separated into independent disciplines
traumatology and orthopedics, oncology, urology, neurosurgery. Earlier became
independent field of ophthalmology, otolaryngology and dentistry. In the
postwar period, has undergone further surgery even deeper differentiation. In
some disciplines evolved surgery lung and bronchus, esophagus surgery, cardiac
surgery, vascular surgery, rectal (proctology), gastroenterology, surgical
endocrinology. The process of differentiation surgery to separate sections
ongoing. Already exist, such as herniology and other clinical departments. All
regional and large urban hospitals are practically surgical departments of all
the major sections of surgery (thoracic, neurosurgical, surgical
gastroenterology, shelepno-facial, otolaryngology, ophthalmology, burn,
vascular or even cardiovascular et al.), Which is specialized surgical help
sick people from villages and cities.
Ethical and deontological requirements
for personnal
Beginning medical emblem is the serpent - bearer of health and wisdom.
This emblem characterizes the objective side of our profession. Along with it,
there is another, less well-known symbol, testament, which already reflects the
inner essence of medical practice. He left us his famous Dutch surgeon, Mayor
of Amsterdam Nicolaas van Tulpa-Tulpius (1599-1674). It lit candle.
"Shining way, burns himself."
And this covenant remained loyal to the last hours of his life many
doctors. Do not count all these humble, unknown medical workers who in the name
of service to the suffering man worked at the epicenter of epidemics, died of
typhus, showed great sacrifice on the fronts of the war, guerrilla detachments
behind enemy lines in Nazi death camps, Stalin's torture chambers and finally -
in modest circumstances ordinary, everyday work in peacetime.
History of medicine knows many cases of self-sacrifice scientists, who
for the sake of good people gave their property, health and even life. Not to
mention the case with great sacrifice, truly Spartan endurance and loyalty to
high ideals of Medicine, who presented at the last stage of his life known
Russian surgeon, innovator Dr. W. Oppel.
In 1931, during the development of creative forces, VA Oppel found a
malignant tumor of the maxillary sinus. When the tumor began to grow in the
eye, sharply raised the question of surgery - resection of the upper jaw with
enucleation of the eye. With courage hearing decision about surgery doctors, V.
Oppel took avtotrening. Tying handkerchief eye, which is subject to removal, he
taught himself to operate in the new environment. Indeed, shifting the
operation and left with one eye,
The term "ethics" is derived from two Greek words: deon -
proper, fit, and logos - word doctrine. Translated, it means "the doctrine
of duty," "doctrine of good."
Care, nursing or hipurhiya (from Gr. Hypuria - to help, to serve) - a
process that consists of a set of measures that provide comprehensive patient
care, establishment of proper hygienic conditions conducive uncomplicated
disease, accelerate recovery, alleviate suffering and prevent complication and
timely reporting them, and performing medical appointments.
Nursing - an integral part of treatment. Many patients, especially
surgical, does not itself recover, their nurse. Care is divided into general
and special.
General maintenance - is the sum
of measures that require any patients regardless of the nature of their disease
(pathology), age, sex, etc.. Among the general measures distinguished:
a) the maintenance of hygienic facilities, beds and
furniture, the patient, his clothes, utensils, toiletries, etc.;
b) strict implementation of all doctor's appointments
(compliance procedures and techniques regimen of drugs);
c) monitor the progress of the disease, the patient
and inform the doctor about a change in his condition;
d) feeding the patient. Actions medical personnel
associated with specific diseases or actual injury and
treatment constitute special care.
Nursing is younger sisters (nurses) who do not have special medical
education, and nurses with special health, including higher education. Younger
nurses take care of him or those items that do not require special medical
knowledge relating to providing care to center the patient, his personal
hygiene, nutrition and more.
These objectives are to ensure proper hygiene and sanitation chambers,
beds, clothes, proper hygienic condition of the patient (washing, washing,
dressing, translation and transportation, etc.), feeding patients, cleaning
toilets and helping patients in the exercise physiological acts, cleaning and
disinfection of toilets and utensils for excrement, etc..
Although listed duties carried out by persons without medical training,
they need them to appropriate knowledge, skills and conscientious attitude.
Teaching younger sisters meeting their responsibilities conduct sisters with
medical education. Recently, along with the control and direction of the work
of younger nurses have a wide range of duties of care, monitoring of patients
and their treatment is performed by a doctor. They are distributed and
administered medications, including by injection, perform many medical
procedures - impose compresses, mustard, put cans, washed stomach, put an
enema, etc., carry out strict monitoring of patients and inform physicians
about the changes in his body.
Immediately the work of nurses with special education department manages
older sister.
All those who care for the sick, should be familiar with their duties
and their meaning and role in the overall treatment process, place and time of
treatments, care for adequate hygienic and functional status of their place of
work. Nursing requires both the ability to perform a variety of hygienic and
therapeutic measures, and moral, fair and compassionate treatment of the
patient. It must be highly professional, ethical and aged. Merciful, humane
treatment of the patient is no less important than professional skills. This
truth is proved as practical medicine for centuries, and physiological studies,
especially IP Pavlov and his disciples and followers, as a second system of the
brain, based on the word - signal signals. Mental state of the patient always
depressed due to the influence of the central nervous system of anatomical and
functional disorders in the body and forced to move due to illness (often
sudden and prolonged, as is the case with trauma and acute surgical diseases)
in the unusual position (with the exception of the usual atmosphere and
employment, household inconveniences and restrictions, and often the inability
to self-realization and physiological acts).
Many patients suppresses feelings of shyness as necessary to carry out
physiological acts in the presence of staff or patients or neighbors for their
help. Therefore, careful execution personnel - nurses and nurse - their duties
and friendly attitude to help the patient eliminate many negative effects caused
by the disease.
The whole set of measures of treatment and care should be based on the
principles of safety-stimulated regime, laws of physiology and especially on
such fundamental positions it as traumatic impact of unusual irritants of
various kinds on the body, and, conversely, stimulative effect irritants, not
beyond the physiological range on organ function, including regenerative and
reparative processes. Maintenance of therapeutic agents at the optimal level of
physiological parameters of the life of the patient, including its major
systems - the nervous, cardiovascular and respiratory, providing favorable
conditions for recovery.
Creating a patient good, optimistic spirit, faith in a favorable course
of the disease, which is largely confirmed by the good care and sympathetic
attitude toward the patient, is an important and honorable duty of medical
workers in hospitals and clinics.
General maintenance includes the
following subsections:
• environmental health;
• Personal hygiene, prevention of hospital infection;
• personal hygiene of the patient;
• disinfection of patient discharge;
• hygiene underwear;
• hygiene gear and visitors;
• Hygiene transport;
• food hygiene.
Environmental health is a prerequisite for therapeutic interventions and
their effectiveness. Ski chamber, in which the patient and her space, heating,
lighting, air quality (ventilation) must comply with hygienic standards in all
respects. It should be light, well ventilated, well in winter, but not
excessively heated. Windows Chamber should have curtains to protect patients
from direct solar radiation. Floor in the ward should be covered with linoleum,
which enables her wet cleaning and silent movement of personnel, especially at
night.
Personal
hygiene. Staff that
cares for the sick, especially to be hygienically educated, healthy and tidy.
Each participant care should be familiar with hygiene rules within their
duties. Without this requirement, it can become a mediator in the transmission
of infection to the patient, externally, particularly from himself and from
other patients, that of intrahospital. In staff regularly check the condition
of health. Patients and bacilli-carrier not allowed to work until they have
recovered. Nurses and nurses before becoming to work, dress up in the hospital
in the form of separate, designated premises (rooms). Staff are not allowed to
carry out their functions in the shoes and clothes that he enjoys outside the
hospital. Clothing nurses or nurses should be neat laboratory coats and scarves
are clean, hair - hidden under the scarf or hat, shoes - soft and clean.
Decorations hands (fingers) and manicures are not allowed. Nails should be cut
short. Pleasant View staff has on patients with good effect, creating in them
optimistic. Personal hygiene is of exceptional importance for the prevention of
hospital infection. Compliance nurses rules of sanitation and asepsis in the
performance of their duties (use gloves during all procedures that can
facilitate the transfer of infection from one patient to the other, hand
washing after each treatment procedure, avoiding the use of unsterile
instruments and devices during invasive procedures and intraorganic -
injection, gastric lavage, setting enemas, dressing, etc.) and the maximum use
of tools, clothing, appliances and other disposable - the most important
measures to prevent the spread of in-infection.
Hygiene patient. Prevention of bedsores.
Before becoming a hospital
patient is sanitized. He takes a shower in the receiver, then disguised in a
hospital gown. Seriously ill staff washes in the bathroom. Some, especially the
terminally ill, only disguised (wearing hospital clothes, patients with home
clean clothes are still in it). Patients with the presence of head lice or nits
wash them and cut their head Lysol. If you find clothes clothing lice patient
sent to fumigatory for processing. Clean clothes or stored in a hospital cell,
or give to relatives of the patient. The department provides the patient with a
set of clean bed linen. In the morning after a night of sleep walking patients
wash in a special toilet and washing his bedridden patients younger nurses,
patients who can sit in bed,
Bedsore
poured from a pitcher in his arms and they wash
themselves, brush their teeth, and rubbing lying (face, hands) dipped towel or
cloth. There needs to be monitored, especially in critically ill after surgery
for mouth, nose, eyes. Oral cavity patients rinsed 1% solution of potassium
permanganate or sodium permanganate, and teeth and gums nurse rubbed seriously
ill gauze ball. Eyes sick washed cotton-gauze ball dipped digested water or
isotonic sodium chloride solution, and the presence of bacterial inflammation
of the conjunctival sac last instilled solution or applied ointment containing
sulfonamides (20-30% sulfatsil naitrium) or antibiotics. Catching ill shave
themselves, and lying barber shaves, observing all preventive measures against
infection. For patients walking in the restrooms (separate for men and women)
create conditions for washing of after defecation and washing for the evening
and clean areas genitals. Lying patients tempting younger nurses. To do so,
buttocks patient substituted vessel and sister one hand pours a pitcher or
better with Esmarch quart warm water on the crotch of the patient, and the
second, which keeps on kortsang swab, wash the skin around the anus and labia.
Completes procedure washing of drying skin clean cloth. Along with cleaning the
skin from pollution skin Seriously ill in areas of bone interventions -
buttocks, shoulder, spine, five - wipe camphor alcohol (ethyl or 60%). This, as
well as frequent turning of the patient in bed, smoothing underneath sheets
(smoothing it folds), etc. are important measures to prevent bedsores. Weekly
ill replace underwear and linens and wash them. Underwear, contaminated wound
or other secretions, change request. Patients should always be based on a clean
and dry laundry. To prevent pressure ulcers in critically ill, especially the
elderly, patients with diabetes need underlay under the buttocks rubber wheels
and under five - cotton-gauze or foam pads often return them, changing body
position. In recent years, to prevent bedsores widely used special aerial multi
sectional and other mattresses. In patients, especially obese should prevent
diaper rash, dermatitis and skin infection by rubbing inguinal folds, folds on
the abdomen and under the breasts 56-70% ethyl alcohol, sprinkle talcum these places
or tooth powder or - by the appearance of dermatitis - lubricated with ointment
zinc oxide paste or Lassara. The situation of the patient in the bed should be
physiological, that provide the most relaxing of all muscle groups. This
reduces the energy costs of his body and promotes optimal implementation
functions of all organs and systems. It meets the requirements of the position
on the back with a slight lifting the head and elongated legs. Lodge legs
patients should not be, because it promotes thrombosis leg.
However, the characteristics of the disease and the patient often
require (in order to alleviate the disease and prevent complications) of the
patient is somewhat different from the typical physiological conditions. Thus,
patients with peritonitis have Fovlera position: head high and knees bent legs
(below the knee enclose rollers that do not give the body the patient slides
down). This provision provides intraabdominal fluid draining from the upper
half of the lower abdominal, pelvic, in which the peritoneum less it sucks
compared to the phrenic. In addition, the accumulation of pus in it is easier
to diagnose and treat.
In some states the patient with prolonged nausea and vomiting,
especially after anesthesia, the patient is placed on his back, his head turned
slightly to one side. In the horizontal position (without raising the head end
of the bed) should also be patients with bleeding and anemia after bleeding.
This position promotes blood flow (oxygen) to the brain and heart. In contrast,
patients with respiratory failure become half-sitting position (orthopnea).
With increased head are also patients after operations on the oropharynx and
neck. Hygiene patient may be at an appropriate level, subject to his care beds,
bedding, clothes, clothing, care and transportation, that is all that surrounds
the patient. Bedside daily wipe clean with wet rags and periodically
disinfected with 3% solution of chlorine bleach or Lysol. Winders and litter must
be kept clean and in case of contamination of fluids - disinfected. Before
transporting patients wheelchairs or stretchers covered with dry clean sheet.
Patient during transport (transfer) is also covered with a clean sheet or
blanket.
Important and technically complex the
replacement underwear and bedclothes in seriously ill.
Most do younger nurses. Underwear, including a shirt, on a seriously ill
patient change it. First roll her on her back and then the front, to the level
of the blades and axillary areas. Then raise the patient's head, pulling a
shirt over it, releasing first the trunk, and only then remove from the hands
alternately. If the shirt spacious, then it after lifting the torso can be
removed first with each hand separately, and then, after raising the head of
the patient, transfer through the head and trunk release. Wear a shirt so.
Initially, her
Replacement underwear on patient
head on an extending neck, then alternately pull the sleeves up and
lowered down on the trunk, pulling the bottom edge and simultaneously raising
thoracic trunk. This makes the second or nurse, or one and the same with the
other hand. Changing dirty underpants begin with lowering them from the trunk
on the thigh. First, remove them from the healthy leg and gently with the
patient. Wear clean underpants first on affected leg, and then - to others.
To replace the bedclothes of the
patient first turn sideways and liberated Patients often bed sheets twisted in
roller (from edge of the bed toward the patient). Then put in place dirty
minimized half roller to the back of the patient clean sheet. The patient was
overturned on its back on a clean half-sheets, roller dirty sheets extracted
from the patient carefully and in its place (in the spread with half) deploying
removed from the patient to the second half of the bed roller clean sheets. In
patients whose condition does not allow them to turn aside (strict bed rest),
dirty sheets gently pull and clean - enclose, which is only possible with the
participation of two nurses.
Hygiene reclining patient to ensure that it provides special dishes for
the timely implementation of the physiological acts - bowel movements and
urination, retention which negatively affects the physical condition of the
patient, especially in the nervous and cardiovascular systems, as well as
mental state. For bowel patients isolated (on request) bedpan and urine for -
urinal. Last pure store usually in the House under the bed of the patient, so
that he could use it himself (and for the most seriously ill patients - even on
a separate nightstand), covering with clean cloth. Bedpans stored in
desinfected form in special cabinets or on shelves in the toilet. Younger
nurses serving sick during defecation or urination, working in the appropriate
attire - oilcloth or plastic apron, rubber or plastic gloves. They underlying
patient under buttocks and buttocks oilcloth (during defecation) and it put a
bedpan. During urination not need underlay under the patient protective
waterproof cloth. After patients shipments sister ship immediately withdraws or
urinal and covering their oilcloth, refers to the toilet, where either
immediately pours into the toilet or leaves for examination by a doctor or
disinfect. After emptying this same sister tempted patient wipes skin around
the anal opening, and then takes out from under him oilcloth. In the absence of
patient self-defecation he put a cleansing enema. This procedure takes a nurse.
After enema defecation occurs at the same sanitation provision as independent.
Patients, especially elderly men after surgery in the abdominal cavity often
delay urination. In cases where the patient has the urge to urinate and urine
produce not more than 6 hours, you can enter the bladder catheter to withdraw
it. But this procedure should be a doctor. However, in some cases the same
medical ward sister at the request of the patient can lead a soft catheter
urine, especially if the urethra obstructions. It should strictly observe the
rules of asepsis. Younger nurses during patient care in the exercise of
defecation and urination are cloth, aprons and disposable gloves, which are
then destroyed.
It should be emphasized that although the majority of procedures to
ensure the health of patients and their bedclothes and perform younger nurses (no
special medical education), their work should be carried out under the direct
supervision and with the participation of nurses with medical education.
Important role in providing quality care play learning his craft younger
sisters nurses with special training, respectful attitudes from the past and
physicians caring for them.
Work nursing staff in a surgical
department.
1.
Regulations on the surgical department
and its planning.
Modern surgical department - is a complex medical complex, normal activity
is regulated by the relevant sanitary norms. Surgical department recommended
place in separate rooms facing the south, southeast or southwest. This
orientation department creates conditions for lighting wards natural sunlight,
with a sufficient dose of ultraviolet rays, which adversely affects a variety
of infectious agents.
The main requirement for the
surgical department - its isolation from other hospital departments. General
surgery office district and city hospitals has admissions department, wards for
patients (hospital), additional rooms (dining room, manipulation, nurse, etc.).
Operational and dressing unit.
Admissions department.
Admissions department functioning
by type sanitary inspection, where they spent roughing patients. Admissions
department consists of registry, Cabinet initial evaluation of patients,
shower, bathroom, cells for clothes, toiletries. In some hospitals in the
admissions department create 1-2 diagnostic ward and isolation for infectious
patients. Review of patients spend on a couch covered with oilcloth, which
after review of each patient wipe damp cloth with disinfectant solutions. After
examination of patients, the study of wounds and change bandages staff washing
their hands with warm running water and soap for 3 min and handles hand
solutions bactericidal drugs (0.2% solution of chlorine, 0.1% dezokson-1, 760
ethanol, 0, 5% solution of chlorhexidine in 700 ethanol, sterylium
et al.).
In the emergency department
patient hold sanitary processing (hygienic shower, bath), disguised in a
hospital gown (robe, underwear, slippers). When urgent hospitalization of the
patient is carried out sampling of blood, urine and other body fluids for
analysis.
Surgery department
In large hospitals a specialized department for 30-40 beds to assist
patients with vascular, endocrine, pulmonary and others. pathology. To prevent
transmission of septic infection from one patient to another, it is desirable
to have a clean surgical department and department of surgical infection. They
need to be isolated from one another, have a separate inventory, equipment and
staff. If you can not make a separate department for septic patients assign
separate chambers and dressings. In these circumstances, it is important to
cleanliness and order in the department. All the work plan so that initially
conduct operations, then perform clean dressing patients, and only after all -
purulent dressings (dressings order). The composition of the surgical department includes wards
for patients, operating unit, dressings, manipulation and additional rooms
(toilet, bathroom, dining room, pantry, laundry room, staff, sterilization,
etc.)
Wards should be spacious, the
rate of 6.5-
ward for patient
Surgical department must be
equipped with central water system (cold, heat water), central heating,
sanitation and purge ventilation. Hygienic standards of air in the chamber is
27-
manipulation diner-room
Nursing post place
Nursing post
place, usually in a hallway near the wards. On the table nurse on duty should
be a light or audible alarm, telephone, desk lamp, etc..
In manipulation
are:
• cabinets for
medicines and sterile syringes labeled "domestic",
"injection", "outer", which closes with a key;
• table for
dressing box with sterile material and antiseptics (alcohol hlorheksedyn,
iodinol et al.)
• safe storage
and potent drugs;
• refrigerator
for intravenous solutions;
• sink with a
towel;
• couch and
chairs.
Workplace sisters surgical department shall refrain in perfect order.
The nurse must strictly observe the rules of personal hygiene, be neatly
dressed in a clean gown, hat or scarf. When the injection or intravenous
infusion should be required to use a mask and rubber gloves.
All work in the surgical
department based on the principles of security and treatment regimen. The
patient must be surrounded by attention and care of medical personnel.
Hospitalized patients in the department accompanied by a nurse or nurse
admissions department. Another nurse at the direction of the head office or
another surgeon places the patient in one of the chambers. All the terminally
ill and those requiring urgent surgical care (acute diseases of the abdominal
cavity, abdominal trauma, chest, etc.)., Delivered in surgical ward on a
gurney. Patients who need immediate surgery, is sent to the department for
intensive treatment for preoperative preparation or directly to the operating
room. All medical personnel should build their working day under the regime of
the surgical department.
Exemplary compliance, order and discipline in the department elevates
mood and causes the patient confidence in a quick recovery. All patients must
adhere to hospital treatment, the recommendations of the doctor. They are
familiar with the mode of surgery department in the emergency department, which
is painted in by hospital. For violations of patients discharged from hospital.
In the surgical department of the
leadership of nurses and nurses carries nurse who is directly subordinate head
of department, takes his instructions on care and services to patients and
takes full responsibility for the work of nurses. Given its remit, that job is
people who have worked as a nurse for at least 3 years and are usually those
who have certified the first category. This nurse surgical department appoints
and dismisses the
Function senior nurse surgical department:
1. Conducts appropriate selection of nurses with their
psychological compatibility.
2. Prepares
work schedules nurses and flight.
3. Provides
normal operation department through timely replacement nurses and nurses who
could not go to work due to illness or other reasons.
4. Keeps
timeliness and clarity of execution doctor appointments.
5. Keeps the
use, storage, distribution, copying mechanism and control of medicines, medical
instruments and items of care.
6. Keeps the
rules of storage and accounting of narcotic drugs.
7. Ensures
implementation of internal regulations department, the principles of
medical-protective regime.
8. Held under
the control diet for patients is a la carte food orders, according to the
dietary tables, monitors the quality of cooked food and its distribution.
9. Keeps
records of acceptance and discharge of patients, a report on the movement of
patients in the department, presents the admission and outpatient department
data about the availability of beds.
10. Participates in the Board of Nursing Hospital
nursing conferences.
Requirements ward nurse surgical
department:
A nurse in the department of services to patients department reports
directly to residents in part of the routine work - older sister branch. She is
responsible for the timely and correct implementation of medical appointments,
quality care for patients in wards or her assigned office (dressings,
manipulation).
The post of ward nurse administered nurses from the first level of
accreditation.
Duties ward nurse surgical
department:
1) hospitalized patients, validation of their
sanitization, familiarize the patient with the rules of the house;
2) collection of material for research (blood, urine,
feces) and send it to the lab;
3) prepare patients to
perform diagnostic tests (endoscopy, radiography, ECG, etc..) And support or
transport them to various diagnostic offices;
4) faithful implementation of all doctor appointments,
which are included in the special lists of appointments;
5) should be present on rounds physician reporting to
him about all the changes that have occurred in the state of the patient during
rotation;
6) measurement body temperature (morning and evening)
and recording temperature data sheet;
7) measurement of pulse rate, blood pressure,
breathing, of daily diuresis and post this data doctor;
8) surveillance of the wound (bandages) and discharge
of drainage;
9) careful and close supervision of the patient, if
necessary, immediately giving him first aid (CPR, indirect massage heart stop
bleeding);
10) monitor compliance by patients assigned to diet
preparation proportional requirements feeding critically ill, quality products
that bring families;
11) supervise the work of the technical process
(nurses, cleaners) and compliance measures for hygienic and sanitary conditions
in the unit (change of clothes, prevention of pressure sores, skin care, oral
patients and others.)
12) carefully maintaining medical records, which
include magazine reception and transmission duty magazine. Medicament and
portion requirements leaves medical appointments, temperature leaves others.
For the faithful performance of duties surgical nurse in a short period
of time it is necessary to examine a large section of general surgery, learn
the basic surgical diseases, their diagnosis and treatment, especially the care
of patients. Medical assistance is a sacred duty of every health worker,
regardless of its level of education and profession. Inattention or unjustified
failure to perform its obligations leads to legal liability.
Requirements for dressings should be the same as the operating (bright
room, the ceiling of which should be painted with oil paint, walls and floor
are lined with tiles).
The dressing should keep the premises clean. Table for instruments and
dressings cover as well as in the operating room.
Tools serves forceps. Ligation is
carried out only within the tool. Instruments are sterilized in the same
dressings or sterilization room operating unit. Dressings should be provided
with a central cold and warm water. Optimum temperature should be 18-20 ° C.
The dressing should not be foreign objects, clothes, except for table
dressings, table for instruments and dressings, cabinets for medicines and
instruments and chairs for patients. When conducting dressings must consider
the degree of purity wounds of patients. Patients with complications, purulent
wounds bandaged least. At the end of the day conducting wet cleaning dressings
and exposure to ultraviolet rays. In large surgical wards, usually has two
dressings - for "clean" and "septic" patients.
Dressing room
Function dressing nurse:
1. Performs assigned doctor-intern manipulations that
are allowed to perform nurse.
2. Accompanies seriously ill after manipulations performed
in house.
3. Strictly adhering to the rules of asepsis and
antisepsis.
4. Prepares to sterilize and sterilize bandages and
instruments in accordance with the operating instructions.
5. Provides systematic bacteriological control
dressings, instruments, placing dressing room.
6. Provides systematic replenishment, inventory,
storage and control spending medicines, dressings, instruments and clothes.
7. Instructs nursing staff dressings and controls its
operation.
8. Maintains accounting records.
9. Systematically increase their professional
qualifications.
10. Participates in sanitary - educational work.
In order to prevent festering
disease and compliance with sanitary norms of bacteriological laboratory sanitary
station, which is subject to the medical establishment has once in 15-20 days
bacteriological control of air pollution (operating, dressings, wards), quality
control disinfection treatment hands of personnel, material and sterile
surgical instruments. Control of microbial contamination of air in operating
and dressings spend once a month. Dirty air in the chamber and dressing can be
determined using sedimentation, filtration and method of shock air.
Sedimentation principle of the method is that the microorganisms that are in
the air, settle on a horizontal surface. For this study the use of Petri dishes
with nutrient medium (2% agar) that during the 15 minutes are left open at
predetermined locations operating or dressings. After that, the Petri dish is
placed in a thermostat at 24 h and counted the number of colonies that grew.
Filtration method of research is to draw 10-
Modern operation room
In the operating number of colonies of microorganisms on 1m3 of air
should not exceed 500 hours and 1000 - during and after the operating. For
dressings and preoperative allowed no more than 1000 colonies 1m3 in the air to
work. In addition, the sample volume of
Crops of the hands, usually spends elder sister operating so that the
staff did not know when and whom he will serve. Drill results should be
discussed and always match with a frequency of postoperative complications.
This control improves the quality of handwashing staff and reduce the number of
postoperative complications.
In addition to the mandatory daily
monitoring the effectiveness of sterilization in an autoclave (dressings,
linen) with standard vials or sulfur to every 10 days seeding with sterilized
material. Particular attention should be given to the quality of sterilization
of suture material. Crops of silk, catgut should be performed prior to
sterilization and its storage at least once in 10 days. To control the
sterility of the hands of medical personnel, dressings and sutures older
operating sister should have a special magazine.
To identify and sanitation carriers of pathogenic 1-2 times a year to
all employees of the surgical department doing swabs from the nose and throat
swabs special. Revealed carriers of pathogenic infections dignity without fail.
In the absence of positive results from the treatment of chronic inflammatory
diseases of the upper respiratory tract and oral cavity employees transferred
to another job.
Observation and care after surgery for
head, face and neck
Operations on the head, its soft tissues performed in surgical
wards general. Because these interventions are performed, or in the case of
open injuries (wounds) of soft tissues of the head without brain damage or mild
forms of shaking it, or pathological processes or diseases of soft tissues
(burns, tumors and tumor formation - atheroma, dermoid cyst) , caring for such
patients is virtually indistinguishable from the care of patients operated in
other parts of the body.
Mostly watched as bandages, soaking her color liquid
wets the bandage - blood or light pink liquid, and the provisions of dressing
on the wound. Soft tissues of the head is very well supplied blood in them, so
bleeding after operations on the head is more likely than in the case of
operations on the surface of the soft tissues and other body parts.
Strong soaking bandages should call the medical ward
sisters above all suspicion of significant bleeding from the wound, it should
inform the surgeon or doctor-intern. For minor bleeding according to the
decision of the doctor dressing can be replaced with a new or old floor impose
additional dressing material and other aids (applying bag of sand, a bubble of
cold water or other burden). For bleeding that can be caused by insufficient
mechanical hemostasis, rarely - bleeding disorders, and may continue,
especially in patients with possible variations in blood coagulation system,
considerable time and after changing bandages and other measures of
conservative nature, or cases of bleeding after subcutaneous hematoma, mostly
required operational audit wounds - taking the patient to another operating
table, removing stitches from the wound and stop the bleeding or remove the
hematoma - bleeding vessel ligation (ligaturing) thermocoagulation others.
However, not only common complications are possible in the operated on soft
tissues head. Through anatomical and physiological characteristics of
operations on the head more often in patients with possible reactions common
type of injury and anesthetics as dyspeptic phenomena (nausea, vomiting or
dizziness) or so-called orthostatic collapse (decrease in blood pressure and
fainting during a brief lifting of bed, go into the standing position).
In patients operated on the wound of the head, with a
history of brain dysfunction may develop later in the postoperative period of
severe brain damage syndrome - compression of his hematoma. This is accompanied
by such symptoms as headache, growing, slow pulse, dilated pupils, and
eventually unconsciousness and convulsions. Therefore, patients operated on
soft tissue injuries and a possible concussion syndrome, it is necessary in the
postoperative period very closely observe carefully listen to their complaints,
periodically determine the pulse and determine its frequency and occurrence of
even minor changes in the health condition of the patient to inform the doctor.
Surgical interventions on the head, usually performed
in specialized neurosurgical departments, including craniotomy with
manipulating the brain or cranial cavity revision of intervention in meninges
belong to very complex operations with possible various complications in the
postoperative period - swelling of the brain infection (meningitis or
meninho-encephalitis, brain abscess, sepsis), traumatic epilepsy, bleeding in
the cranial cavity and the outer like. All these complications cause
significant disruption of the brain and the mechanisms that regulate different
body systems, including respiration, circulation, metabolism, digestion and
others. The immediate postoperative period in these patients is often
complicated by vomiting, which may have dual genesis - as a result of traumatic
irritation centers medulla (parasympathetic) and chemical, drug. Therefore
resuscitation distance of patients after surgery lay on his back, turning his
head away (in the event of vomiting patient immediately put to the side). This
prevents aspiration of vomit and asphyxia. Often these patients are observed
and complications such as mental and motor stimulation (including convulsions
and traumatic epilepsy), during which patients can pluck the bandage.
Therefore, nurses should timely notice all abnormalities in patients with head
trauma or postoperative period and inform the doctor immediately for appropriate
action.
Care after surgery in the facial area (which is
preferably carried out under local anesthesia or intravenous narcotic)
performed on tumors, trauma and inflammatory processes, almost a little
different from care after surgery on soft tissues in other parts of the body.
After these operations, especially the inflammatory processes (anthrax lips,
abscesses, boil), patients should eat only liquid and semi-liquid food, talk
less.
Operations in the mouth and oral part of the pharynx
(cleft lip and palate, tumors, cysts, removal of teeth, jaw resection,
tonsillectomy, autopsy and retropharyngeal abscesses, etc.) difficult and
dangerous, so patients require more maintenance, especially to prevent
aspiration of saliva, blood, tissue particles in the respiratory tract, as it
may cause asphyxia or pneumonia and lung abscess, etc..
Operations on the palate malformations and tumors
tongue, tonsils, jaw, jaw osteomyelitis is usually performed under general
anesthesia, and therefore in the postoperative period, especially in the first
few hours it should strictly observe the patient in intensive care and
resuscitation to release his condition anesthesia . Patients should lie flat
without a pillow with head turned to one side - to prevent asphyxia tongue or
vomit. Under the chin and mouth should be put gauze or a piece of cotton wool
for draining saliva mixed with blood. Pain after surgery should be complete,
but one that does not inhibit respiration (without opiates). Patients should
receive oxygen through a nasal catheter. Inhibition of cough, salivation and
secretion of bronchial glands important for normal postoperative period
(creates calmness, improves breathing reduces the risk of aspiration and
asphyxia). His introduction of reach of small doses aminazine and atropine
sulfate.
Patients operated in the area of the mouth under
local anesthesia, immediately after surgery put aside slightly tilted his head
to his chest (to facilitate passive saliva and blood). Under the chin put the
tray in which the flow of saliva and blood.
On the second day after surgery patients operated in
the area of the mouth,
rinsed the last 0.001% solution of potassium permanganate and wipe with a
cotton ball dipped in this same solution teeth. Later, rinse your mouth with
water can be digested with sodium bicarbonate (1-2% solution).
Infants operated on cracks palate and lips, naturally
fed breast milk (rarely) or introduced through the nose into the stomach probe
mother's milk or infant sterile mixture.
Adult patients fed or sterile liquid cooled to room
temperature food or the same food through a tube (nasogastric).
Operations on the neck and its organs perform both
under general anesthesia or under local anesthesia. Because nursing is slightly
different and depends on full-time release of patients from the state of
anesthesia.
Drainage from wounds removed after 24 - 48 hours and
sutures removed early - after 4 - 5 days.
Infection of wounds in the neck after surgery for
non-infectious (noninflammatory) disease is rare due to good blood supply to
tissues and organs of the neck.
After operations on the neck on inflammation
(phlegmon) and penetrating injuries nature should pay attention to the general
condition of the patient, especially body temperature and pain of it spreading
to the mediastinum (mediastinitis) and also on the bandage, including soaking
her blood or saliva. Latest evidence of bleeding or penetrating trauma of the
esophagus.
In the presence of esophageal fistula patients fed by
injections into the stomach through the nose (or gastrostomy) probe, which pour
liquid dish. The bandage patient with esophageal or tracheal fistula (after
hysterectomy larynx or tracheostomy) should be changed often, and lubricate the
skin paste Lassara and ointments. containing corticosteroids for the prevention
and treatment of dermatitis and maceration of the skin.
Patients with pathological processes in the neck,
mainly with tumors of various tissues and organs of (larynx, thyroid gland),
stenosis of the larynx different origins, including bilateral paralysis of
inferior laryngeal nerve, and patients with brain injuries is often shown
tracheostomy ( temporary or permanent). In this case, the nurse must follow in
order to Tracheostomy tube was placed correctly and periodically clean it of
mucus and pus through their aspiration catheter. If the mucus is too thick,
dilute its introduction into the trachea 3% solution of sodium bicarbonate (2-3
ml) or chymotrypsin. Sister should be able to replace the inner tube in case of
blockage or loss of the trachea. If you have any difficulty performing this
procedure, the nurse must promptly inform the doctor.
OBSERVATIONS AND CARE Patients with
damage to the musculoskeletal system
In general
surgery department usually being treated several patients with diseases of the musculoskeletal
system. Often these are people who are hospitalized urgently with bone
fractures or dislocations of joints, seriously ill, requiring special treatment
and special care. In most cases, this recumbent patients who are on extraction,
or fixed cast limbs.
Caring for
trauma patients has a number of features. Staff who care for these patients
should know the dynamics of the pathological process, know exactly which bone
is damaged, opened or closed fracture, which is state of the vessels and nerves
of the limbs after injury, whether poor circulation in the limbs, which is an
operation done and what anesthesia. Patients with fractures of the spine or
pelvis is placed on a shield (usually wood), which cover the net beds. It
should be smooth, without cracks and fissures. Before connecting the shield
needs to be sanitized (pour boiling water, spray disinfects, what solution or
sprinkle powder). On the shield is placed a thin mattress and cover it with a
sheet, under which sometimes lay oilcloth. Because these patients lie
motionless for a long time, we must ensure that they do crease formed on the
sheet that put pressure on the skin. Often use prefixes to the bed, which put
the injured limb.
At the turn of
the cervical spine stretching exercise for the head special loop (Glisson) with
thick fabric or leather, it buckles and straps fastened to the neck and chin.
By tying lace loops that are moving through the block, and it hung burden. To
counterbalance the head end of the bed slightly raised. At feeding time the
patient front of the loop bud, so he could chew.
At the turn of
the femoral or tibial skeletal often used (in combination with sticky patch or
kleol) traction. Limb is placed in a special splint curved in hip and knee
joint position.
For any method
of stretching should monitor the status labels provisions limb choice burden
bones that act (to bedsores), the provisions of spokes. One of the most common
treatments for fractures is Cast. For this purpose, gypsum, which when mixed
with water becomes a mass that hardens in 5-7 minutes. This property is used
for the manufacture of gypsum plaster bandages, which immobilized limb. We must
remember that in time they can shift and press on soft tissues, causing pain,
and eventually - and bedsores. Sometimes in such cases, divide the plaster cast
and pushes her to the edge of extinction of pain. Particular attention needs
patients in the first hours after Cast as likely to develop complications such
as compression of blood vessels and nerves. Otherwise, it can lead to
paralysis, paresis, necrosis of the distal limb. Tightly imposed bandage can
cause sores, tissue necrosis, until gangrene. To prevent this complication
should carefully heed-automatically adjust to patient complaints (pain in limb,
tingling, coldness), watch the distal extremities, which should be open. The
appearance of pain, blanching and cold fingers or cyanosis - a signal that you
should immediately cut plaster and eliminate the cause of complications. Ending
with an applied plaster cast should be slightly raised, to avoid stagnation.
Upper limb should hang.
In the case of
open fractures and wounds that are imposed cut in a window plaster bandage
should monitor the temperature of the body, the appearance of pain in the
wound, blood picture. If the third or fourth day of fever body was sore, take
control wounds.
After surgery on
the bone and then imposing cast, make sure that the bandage is soaked with
blood. If the plaster cast of the patient on the back compresses the chest and
difficult breathing under it at chest level enclose a bag of sand. Patching
thus rises, releasing the chest. In the treatment of traumatic lesions of the
bone plays an important role physiotherapy. it should be done from the very
first days after the beginning of the extraction or Cast. While fixing injured
bones have cut muscles make movements in the joints, even fixed plaster cast.
Early movements
prevent the development difficult to move in joints, muscle atrophy after
removing skeletal extraction or cast. In this period should be physiotherapy
procedures, medical gymnastics, massage.
Asepsis.
When
the source of infection is aware of, reproduction of microorganisms. In
relation to the patient (injured) possible exogenous (outside the body) and
endogenous (inside it) Sources of surgical infection.
The
main source of exogenous infection are patients with purulent-inflammatory
diseases, at least - animals. From patients with purulent-inflammatory diseases
germs get into the environment (air, surrounding objects, hands of medical
personnel) with pus, mucus, phlegm and other secretions. Failure to comply with
certain rules of conduct, operation mode, special processing methods objects,
tools, hands, dressings germs can enter the wound and cause suppurative inflammation.
Microorganisms get into the wound from the environment in different ways:
contact - when faced with a wound infected subjects, instruments, dressings,
operating whiteness air - with ambient air in which microorganisms are;
Implantation - infection at left in the wound for a long time or permanently
certain items (sutures, bone fixators and other implants) infected while
performing surgery or as a result of violations of sterilization.
Animals
as a source of surgical infections play a smaller role. In processing the
carcasses of diseased animals possible anthrax infection. From the feces of
animals in the environment can get tetanus germs, gas gangrene. On the
surrounding objects in the ground a long time these microorganisms are in the
form of spores. At random injuries they may get into the wound with the earth,
scraps of clothing and other objects and cause specific inflammation.
The
source of endogenous infection is chronic inflammatory processes in the body as
outside operations (skin diseases, teeth, tonsils, etc..) And in bodies, which
made intervention (appendicitis, cholecystitis, osteomyelitis, and others.),
And the oral microflora mouth, intestine, respiratory, urinary and others. Ways
to infection with endogenous infection - contact, hematogenous, lymphogenous.
Contact
the wound infection is possible in violation of surgical technique, when the
wound can get fluid, pus, intestinal contents, or when transferring micro
instruments, swabs, gloves failure due precautions. Since inflammation located
outside operations, microorganisms can be entered with lymphoma (lymphogenous
way of infection) or bloodstream (hematogenous route of infection).
Aseptic
methods struggles to exogenous infection methods antiseptics - with endogenous
infection, particularly that penetrated into the body from the external
environment, as it happens at random injuries. For successful prevention of
infection need to struggle waged on all stages (source of infection - infection
of ways - the body) by a combination of methods of asepsis and antisepsis.
To
prevent infection environment for the source of infection - the patient with
purulent-inflammatory diseases - necessary in the first place arrangements:
treatment of such patients in special departments of surgical infections,
operations and dressings in separate operating and dressing; availability of
qualified personnel for treatment and care. The same rule exists for surgery in
an outpatient setting: receiving patients, treatment, and ligation operations
performed in special offices.
Asepsis.
Drugs that have antibacterial effect on purulent
microflora, divided into 2 groups of chemotherapeutic agents (see antiseptic)
and chemicals for disinfection and sterilization.
Drugs that are used for disinfection and sterilization
are used to prevent getting an infection in the wound, that is to fight
infection in the ways of its transmission. Some chemical antibacterial agents
may be used as a chemotherapeutic and facilities for disinfection and
sterilization (eg, chlorhexidine, hydrogen peroxide, etc.)..
With chemicals for disinfection and sterilization is
widely used in surgery iodine 5% and 10% alcohol solution used for lubricating
the skin around the wound, treatment of superficial wounds and abrasions,
surgical field. Iodine is part of the solution of iodine to sterilize catgut.
Yodonat (Iodonatum) contains about 4.5% of free iodine
before use it was diluted with distilled water 1:4,5. Apply for processing
surgical field.
Povidone-iodide - iodine compound of
polivinilpirrolidone containing 0.1-1% solution of iodine. Use hands to handle,
operating margins.
Chloramine B (chloraminum) used in a 1 - 2-3% solution
for disinfection of hands, objects nursing, nonmetallic tool premises.
Formic acid in combination with hydrogen peroxide
(pervomur drug C-4) is designed to handle hands before surgery. Prepare a
special solution (see Preparation of hands before surgery). The drug is also
used to handle surgical instruments and rubber gloves.
Mercury dichloride, or sublimate (Hydrargyri
dichloridum). In 1:1000 concentration used for disinfection gloves items care.
Gloves prevent the solution Sulima on I h, then extracted with sterile forceps,
dried on a sterile table and lace talc. The method used in the outpatient
setting. Application limited by toxicity of the drug.
Ethyl (Spirilus aethylicus) is used as a 70% or 96%
solution for the treatment of hand, operating margins, optical instruments,
suture material.
Formalin (Formatinum) - solution containing 36.5-37,5%
formaldehide. Applied as a 0.5-5% solution for disinfection of gloves,
instruments, catheters, drains.
Triple solution - powerful disinfectant, which is
composed of formalin -
Carbolic acid (Acidum carbolicum), son. - Phenol
(Phenolum). Apply a 3 ~ 5% solution for disinfecting objects nursing.
Lysol (Lyzolum). At a 2% solution, used to disinfect
care items.
Dehmitsyd (Degmicidum) containing 30% dehmitsynu
(quaternary ammonium compounds). Apply a 1% solution (ie, dilution 1:30) for
processing surgical field and hand surgery.
Rokkal (Roccal) - 5% or 10% solution mix
alkildimetilbenzilammoniya fluoride. Apply for sterilizing tools (1:1000
dilution; exposition -30 min), rubber gloves, drainage (in dilution 1:4000;
exposure - '24). In order to prevent corrosion of instruments added sodium
carbonate at the rate of
Chlorhexidine is available as bigluconate
(Chlorhexidinibigluconas). or hibitan. Available in a 20% solution. To handle
operating margins and disinfect instruments solution diluted with 70% ethanol
relative to 1:40. The resulting 0.5% aqueous-alcoholic solution treated the
operative field 2 times at intervals of 2 min. Instruments are sterilized by
dipping them in a solution of 2 min.
Fighting
microflora on air routes of infection
Surgical hospital
includes several major functional units, operating unit, wards surgical
department, dressings, procedural and others.
Success prevent
exogenous infection in surgical patients is possible if an integrated approach
in all phases of patient's stay in hospital: admissions department - surgical
treatment - diagnostic rooms - dressing room - operating.
All work on
preventing surgical hospital exogenous injection begins with the separation of
patients with "pure" and "pus". Patients with
purulent-inflammatory diseases hospitalized in surgical septic (infectious)
surgical departments that are completely isolated from the net outlets. In
these works his staff have their dressings, operational, procedural facilities
for performing injections, infusions, taking blood for laboratory tests, etc.).
This unit should be in a separate room. If only one surgical unit in it excrete
special wards for infected patients, wards are located in one of it (bay) with
a surgical dressing in the same compartment.
In the emergency
department, where the initial review and examination of those admitted
immediately share the flow of patients with "pure" and
"pus". In the emergency department perform sanitary and hygienic
processing, which involves washing patients (hygienic bath or shower) and
dressing them. Under certain conditions (pediculosis, scabies) conduct special
treatment and disinfection and disinsection underwear.
In the surgical
department to maintain sanitary regime conducted daily wet cleaning with the
use of antiseptics and
The main way of
infection of wounds in the operating room - contact (about 90%), only 10% of
cases of infection is by air. Each member of the surgical team, despite special
training for surgery, sterile operating underwear, compliance mode, emit into
the air up to 1500 organisms per minute. By 1-1.5 hours of one surgical team
bacterial contamination of air in operating increased by 100%. Allowable number
of microorganisms in
Surgical
hospital includes several major functional units: operating unit, surgical
department, dressings, procedural.
Operating
unit - a set of
facilities for special operations and activities that provide them. Operating
unit should be located in a separate building or wing of the building,
connected by a corridor of the surgical department, or on a separate floor of a
multistory building surgery.
Most are
separated by a transaction to perform surgery to "clean" and
"septic" patients, although it is more expedient to provide a
separate, isolated operating unit with purulent surgical wards.
Operating unit
is separated from the surgical departments special vestibule - often a part of
the corridor, which leave room operating unit general regime. To ensure
sterility in the operating mode of the block allocated special functional
space.
1. Zone sterile operating mode combines, preoperative
and sterilization. In areas of this zone is carried out: in the operating room
- direct operations, in preoperative - trained hand surgeon for surgery in
Sterilization - sterilize instruments needed during surgery or reused.
2. The area of strict regime includes such
facilities as changing rooms, consisting of rooms for undressing staff shower
facilities, cabins for donning sterile clothing. These facilities are
consistently, and the staff goes out of the cab for easy dressing or through
the corridor of the preoperative. In this same area includes storage space for
surgical instruments and apparatus, narcosis apparatus, medical office blood
transfusion room for another team, senior operating sisters, sanitary unit for
personnel operating unit.
3. Zone limited regime, or technical area, integrates
production facilities to ensure the operating unit: there are equipment for air
conditioning, vacuum units for operating supplies oxygen and Drug, here are
substation battery for emergency lighting, photo lab for the manifestation
X-ray films.
Mode
operating unit assumes its limiting visits, in the sterile zone regime must be
surgeons that only involved in the transaction, and their assistants, operating
sisters, anesthesiologists and anesthetists, nurse for the current operating
cleaning. The area sterile regime allowed students and doctors interns. Workers
operating unit wear special clothes: gowns or jackets and pants, different
colors of clothing employees of other departments.
Control for regime sterility operating unit conducted
periodically by bacteriological examination of air operating, swabs from walls,
ceilings, apparatus and appliances. For planting I take once a month on
Sundays, in addition, do selectively seeding with arms unit employees to
control sterility.
Sterile
operating mode is achieved by preventing entry here from other areas of microorganisms
and their distribution. Special device operating unit using a clean gateway in
front of the operating room, preparing the patient for surgery (washing,
changing clothes, shaving hair in the operating field), preparation for
operations personnel (as dressing, use sterile linen, donning shoe covers,
slippers, masks scrubbing) significantly limit the penetration of
microorganisms into the operating room.
Microorganisms
in the air pas subjects rarely found in isolation - they mainly fixed on microscopic
particles of dust. Therefore, thorough removal of dust, as warning its
penetration into the operating, reduce the degree of microbial contamination.
In operating under the following cleaning: previous,
current, postoperative, and final general.
Before the
operation a damp cloth wipe all items, appliances, window sills, remove dust
settled per night (pre-cleaning). In the lobby operations constantly clean
napkins, which fell to the floor, balloons, tools (current cleaning). In the
interval between operations when the patient taken from the operating, cleaning
clothes, tools, wipes soaked solution antiseptics, wipe become operational and
cover it with a sheet, floor wipe with a damp cloth (cleaning postoperative).
At the end of the day conducting final cleaning, which includes wet cleaning
with wiping ceiling, walls, window sills, and all items of equipment, floors
using disinfectant solutions (1-3/6 solution of hydrogen peroxide and
detergents, etc..) And subsequent inclusion germicidal lamps.
At the end of
the week perform general cleaning operating. Start it with disinfecting
operating: ceiling, walls, all subjects floor sprayed with disinfectant
solution, and then remove it by rubbing. After this is total wet cleaning and
include germicidal ultraviolet (UV) lamp. General cleaning can be extraordinary
- if dirty operating pus, intestinal contents, after surgery in patients with
anaerobic infection (gas gangrene).
For exposure to
air and objects that are in the operating room, using floor (mobile), wall,
ceiling germicidal UV lamp
In germicidal
lamps to disinfect the air in the operating room can be used aerosols
bactericidal substances sprayed with a special device type "Dezinfal"
as bactericides using a mixture containing 3% hydrogen peroxide and 0.5% lactic
acid. Cuts should be made before, at least - not less than 2 h before surgery.
Warning - air
pollution in the operating achieved mechanical ventilation system carried out
by feeding air from outdoors or through its recycling, With tidal ventilation
air is blown through the filters in the operating room. Together with the dust
that settles on the filters, settle and microbes. The air coming out of the
operating room through natural cracks. This direction of flow prevents penetration
of air pollution from neighboring operating rooms, including surgical
departments. In the absence of a centralized system of air purification from
dust and germs can be used special mobile air purifier (Vopr-1, 5). For 15
minutes of the apparatus of microbes in the operating reduced 7-10 times.
To perform
certain procedures (such as organ transplantation, which requires further use
of immunosuppressive drugs, prosthesis implantation, surgery for extensive
burns) use operating with laminar flow sterile conditioned air (Fig. 2). Number
of microorganisms in these operating ten times lower than conventional air
conditioning system. Laminar flow ensures an hour 500-fold air exchange, which
is injected under pressure 0.2-0.3 atm through a special filter, which is the
ceiling of the operating room, and out through the holes in the floor. This
creates a continuous vertical flow: a sterile operating incoming air, and
directed his stream carries bacteria that get into the air from the patient or
from people involved in the operation. Laminar air flow can be both vertical
and horizontal.
Fig. 2.
Operating with laminar air movement.
I - filter 2 -
air flow, 3 - fan, 4 - to filter, 5 - hole of the external air, 6 - perforated
floor.
In older operating possible to install special Boxing-insulator with
laminar air flow: wall box made of plastic or glass do not reach the floor, and pumped
through the filter ceiling sterile air creates a vertical laminar flow, which
replaces the existing air in the box in the gap that formed between its walls
and floor (Fig. 3).
Fig. 3.
Boxing-isolator with laminar air flow, install in the operating room.
Anti-microbial
resistance in the stages of wound infection
To prevent contact
infection need to be sterile everything. Honour faces wound. This is achieved
by special processing operating linen, dressings and sutures, gloves, tools.
treatment of hand surgery and operational scratch. Sterilization (sterifix -
sterile) - full exemption from microorganisms of all items, solutions and
materials. Disinfection involves the destruction of pathogenic microbial flora.
Sterilization suture material aimed at preventing a contact and implants
infected wounds.
Sterilization of
instruments, dressings and linen includes the following basic tenets: 1 -
presterilization preparing material: II - laying and preparation for
sterilization: III - Sterilization: IV - Storage of sterile material. All these
steps are performed in accordance with industry standard "Sterilization
and disinfection of medical devices."
Sterilization of instruments.
Stage I presterilization preparing. Its goal - a
thorough mechanical cleaning tools, syringes, injection needles, transfusion systems,
removal of pyrogenic substances and destroy hepatitis B virus. Staff should
work in rubber gloves.
Used, but not infected instruments thoroughly washed
under running water brushes in a separate bowl for 5 minutes (instruments
contaminated with blood, wash immediately, avoiding drying blood) and then
soaked for 15-20 minutes in one of the special cleaning solutions, heated to 50
° C. Syringes handle disassembled.
Composition cleaning solutions: solution A -
peryhidrol '20 detergent (like "News", "Progress",
"knave" and others.)
After soaking instruments are washed in the same
solution ruff, brushes (carefully cultivated locks, cloves, notches), then for
5 min, rinsed with warm water and within minutes washed in distilled water.
Then the tools and syringes placed in dry heat sterilizer at 85 ° C for drying,
after which they are ready for sterilization.
Instruments and needles contaminated with pus or
intestinal contents in advance placed in enameled container with 0.1% solution
diocidum or 5% Lysol solution for 30 min. Then in the same solution to wash
ruff, brushes, rinse under running water and immersed in one of the cleaning
solutions, carrying out further processing by the method described above.
Instruments after the operation carried out in
patients with anaerobic infection, soaked for 1 hour in a special solution
consisting of 6% hydrogen peroxide and 0.5% solution of detergent (washing
powder), then wash the brush in the same solution and hot water boiled for 90
min. Only then prepare instruments for sterilization as well as not infected
tools. After I day (time for germination of spores) they are subjected to
autoclaving or boiling.
Needle, injecting needles after use washed using a
syringe with warm hollow, and 1% sodium bicarbonate, needle washed with 0.5%
solution of ammonia. Then the needle boil for 30 minutes. in 2% sodium
bicarbonate, and after 8-12 hours. - Again one that distilled water for 40 min
and dried, then dried needles rope by blowing ether or alcohol using a syringe
or rubber bulb. Needles contaminated with manure, thoroughly washed, rinsed
them lumen running water, then placed on I h in 5% solution of Lysol, Lysol
additional rinsing channel using a syringe or rubber bulb, and subjected to
further processing the same as not contaminated manure needle.
Systems for transfusion of blood or drugs require
careful handling to prevent posttransfusion reactions and complications. In
modern terms used single system for transfusion, sterilized at the factory.
System is reusable immediately after blood transfusion or drug) drug dismantled
- separated glass parts, rubber dropper and stove. thoroughly washed with
running water, stretching fingers rubber tube (for better removal of residual
blood). Parts of the system is lowered by 2 h. heated at 60 ° C special
solution containing 1% sodium bicarbonate and 1% solution of ammonia. Then part
of the system is washed with running water and boiled in water, distilled, 30
min, again washed with water, stretching rubber tube, and re-boiled for 20
minutes in distilled water. After this system mounted and packaged for
sterilization.
Rubber gloves. Recently, more likely to use gloves
single use, sterilized at the factory. If necessary, re-use gloves,
contaminated blood, washed, without removing the hands. running water to
completely remove blood, dried with a towel and placed for 30 minutes in a 0.5%
solution of ammonia or detergent solution (A or B). Then wash thoroughly under
running water, hang to dry on a rope, and then packaged for sterilization.
Rubber gloves are contaminated with pus or intestinal
contents, be destroyed. In extreme need them washed in running water and put in
the washing solution for 45 min, then - in 5% Lysol solution for 30 min. washed
in a solution of Lysol, rinse under running water and packaged for
sterilization. These gloves can be used for operation in purulent dressings.
To complete the removal of blood from the subject,
passed presterilization processing, use benzidin test: the subject put 3 drops
of 1% solution of benzidine and hydrogen peroxide. The occurrence of blue-green
color indicates the traces of blood left on the subjects. In that case required
re-treatment.
Stage II to sterilize instruments in dryheat
sterilizers placed in metal boxes, stacking them vertically in a single layer.
Syringes disassembled wrapped in 2 layers of special thick paper. Covers of
boxes sterilized along. Lately, mainly used syringes single use, sterilized at
the factory.
For steam sterilization under pressure in steam
sterilizers (autoclaves) tools wrapped in a towel or cotton cloth on the type
of package and placed on a metal grid or complete. For certain common
operations toolkit prepared in advance ( operations on the lungs, heart, bones,
blood vessels), put on a special grid and wrapped in a sheet as a package.
The cylinder and
piston syringe placed separately in gauze napkins and wrapped in a piece of
cotton fabric in a package that is placed in a sterilization box (biks). When
the mass sterilization of syringes in autoclaves (centralized sterilization)
use special styling, sewn from cotton fabric with pockets. In the pocket is
placed syringes disassembled along - needles and tweezers. Each packing
contains up to 5 syringes. Boxes wrapped in cotton diapers in a package and
placed in the sterilizer.
Powdered latex
gloves lace talc (outside and inside), teach gauze pairs wrapped in cloth and
placed in a separate biks.
Assembled system
for blood tested for strength rubber tubes, the density of their connections
with glass detail and matching pavilions cannula needle. System roll into a 3-2
rings, avoiding inflection rubber tubes wrapped in a large gauze and then -
towel and lay in a sterilization box.
Stage III - sterilization. Sterilization instruments,
syringes (with a mark on the syringe 200 ° C), needles, glassware made in dry
heat sterilizers (Fig. 4). Subjects freely placed on the shelves sterilizer in
metal boxes (with cover removed) and include heating. When you open the door
brought the temperature to 80-85 ° C for 30 min. dried - remove the moisture
from the inner surfaces of cabinets and items sterilized. Then the door closed,
bring the temperature to the desired (80 ° C), supporting it automatically, and
sterilized for 60 min. After switching off the heating system and reduce the
temperature to 70-50 ° C open door sterilizer and sterile instrument close lid
metal box with tools. After 15-20 minutes. (After complete cooling sterilizer)
camera unloaded.
Fig.4. Dry heat sterilizer
When working
with dryheat sterilizer must comply with security measures: the machine must be
grounded, after sterilization should open oven door only when the temperature
drops to 70-50 sec. Do not use a defective machine.
Sterilization instruments, syringes, blood transfusion
systems can be performed in a steam sterilizer (autoclave) (Fig. 5). Packaged
items are placed in the sterilization chamber (drum). Seli package enclosed in
sterilization chamber, their lattice wine was opened. Drum or other packing
placed loosely to couple distributed evenly.
Surgical instruments and syringes sterilized for 20
min. at 2atm corresponding temperature 132,9 ° C. Time to start counting
sterilization after achieving an appropriate pressure. Rubber gloves system for
blood transfusion, rubber drainage tubes are sterilized at 1.1 atm (steam
temperature of 120 ° C) for 45 min. When unloading the autoclave cover the hole
in sterilization chamber.
Fig. 5. Steam sterilizer (autoclave).
a - side view, b
- front view; I - thermometer, 2 gauge, 3 - heat source, 4 introductory valve,
5 - exhaust valve, 6 outer wall of the sterilizer, 7 - inner wall sterilizer. I atm = 1.013 105 Pa.
Methods of sterilization in steam sterilizers,
dry heat and should be regarded as basic. Boiling method of sterilization used
in small hospitals where there is no centralized sterilization. Use stationary
or portable electric boilers, which can sterilize instruments, syringes,
needles, pieces from glass, rubber drains, catheters, gloves.
In kettle pour
distilled water to raise the boiling point of water and the destruction of
bacteria added
Tools
disassembled placed on a special grid and lower hooks on the bottom of the
kettle, leaving the handle hooks outside, and close the heater cover.
Sterilization time - 40 minutes after boiling oxen. After sterilization mesh
with the tools i pull hooks, bark drain and transfer to a special table covered
with a sterile sheet, folded in 4 layers. Operating sister lays tools on a
large operating table.
Syringes and
needles are sterilized separately from the tools, disassembled (boiling in
distilled water without adding sodium bicarbonate), 45 min. Syringes and
needles day lumbar puncture and intravenous infusions boiled in water twice
distilled without adding sodium bicarbonate.
Instruments,
syringes and needles contaminated with pus, stool, after special pretreatment
sterilized by boiling for 90 min. in a separate boiler.
Instruments,
syringes and needles used in patients with gas gangrene, be diligent treatment
and subsequent fractional sterilization by boiling. They boiled for I h.,
Extracted from the boiler and leave at room temperature for 12-24 h. (For
germination of spores), and then re-sterilized by boiling for 1 h. (Fractional
sterilization).
The basic method
of sterilization of rubber (drains, catheters, gloves) - autoclaving. In
exceptional cases, they are subjected to boiling for 15 min.
Fig. 6. Camera for gas sterilization.
Sterilization of
instruments and objects that are not subject to heat treatment (endoscopes,
torakoskopes, laparoscopes, instruments or apparatus blocks for artificial
circulation, hemosorption), carry a special gas sterilizer GPA-250. The items
to be sterilized, placed in sealed sterilization chamber (Fig. 6). Exposure
time - 16 hours. at 18O C Sterilization can also be a mixture of ethylene oxide
and methylene bromide at a temperature of 55o C for 6 h.
Sterilization of
instruments and optical devices (laparoscopes, torakoskopes) can be carried out
in alcoholic solution of chlorhexidine and pervomur. With such sterilization
(chemicals) used metal boxes with lids, which prevents evaporation of the drug
and air pollution areas in the absence of special dishes using an enamel or
glass. Tools pour solution (so that it completely covers them) and close the
lid.
In cases of
emergency when no sterilization of instruments in any of these ways, using the
method of firing. In a metal bowl or tray pour 15-20 ml. alcohol, several tools
are placed on the bottom and pour alcohol. The method is not reliable burning,
fire and explosive (the presence of oxygen, steam narcotic gases in the air
indoors), so it resorted to in exceptional cases, strictly observing fire
safety measures.
Cutting tools
(scalpels, scissors) with conventional methods of sterilization are not sharp
because it is conducted almost without heat treatment. After preparing to
sterilize instruments immersed in 96% ethanol for 30 min. or triple the
solution for 3 h. Allowed only a short boiling cutting tools. Scalpels are
placed in a separate grid, their blades wrapped in gauze and boil without
adding sodium bicarbonate for 40 min. then placed in 46% ethanol for 30 min.
Stage IV sterile material storage. Sterile material is
stored in a special room. Should not be kept in the same room sterile and
sterile materials. Sterility material in drums (if not opened) stored for 48 h.
If the materials were placed in a linen package (towels, prostyni, diapers) and
for sterilization enclosed in drums ( systems for blood transfusion, rubber
drains, syringes). they can be stored in these drums to 3 days. With
centralized sterilization syringes retain sterility within 25 days.
Sterilization of dressings, operating underwear stage
I - before sterilization training material. By dressings include gauze balls,
napkins. tampons, turundas, bandages. Apply them during surgery and bandaging
for draining wounds, stop bleeding or tamponade for draining wounds. Dressings
prepared with gauze and cotton, at least - with viscose and lignin. He must
possess the following properties:
1) to be biologically and chemically intact, has no
negative impact on the healing process;
2) have good water absorbency:
3) be minimally loose as threads separated, may remain
in the wound as a foreign body;
4) be soft, pliable, not injure tissue;
5) easily sterilized and not losing their properties;
6) be cheap to manufacture (including large
consumption of material). The rate of year on I surgical bed -
Dressings
prepared with gauze, which previously cut into pieces. Marla up, pidkruchuyuchy
edges inward to avoid free edge. Material prepare for the future, adding to its
reserves as spending. For ease of calculation spent th operation of its
material placed before sterilization in some way: balls-in gauze bags on
50-1000 pieces, napkins - in connection with 10 pieces. Dressings, bandages but
not contaminated with blood, after applying burn.
By operating
underwear include surgical gowns, bedsheets, towels, masks, caps, shoe covers.
Materials for their production are cotton fabric - calico, canvas. Operating
underwear reusable should have a custom label and seem to wash separately from
other laundry in special bags. In robes should not be pockets, belts, sheets
should be filed away. Dressing, prostyni, diapers, towels for sterilization are
in the form of rolls, so they could easily be turned around when in use.
Stage II - Bearings and prepairing material for
sterilization. Dressings and operating laundry placed in sterilization chamber
(Fig. 7). In the absence sterilization chamber allowed sterilization in linen
bags.
Fig.7.
Sterilization chamber.
When universal
conclusion in sterilization chamber (bag) stir material intended for one small
typical operation (appendectomy, herniotomy, flebektomy et al.). At the
conclusion of purposeful sterilization chamber (bag) provide the necessary set
dressings and operating laundry before designated for specific operations
(pulmonectomy, resection of the stomach and so on.). At the conclusion of the
species in sterilization chamber placed certain type dressings or linen (drum
with bathrobes, drum with napkins drum with balls, etc.).
First check
serviceability sterilization chamber, then stir deployed its bottom sheet, the
ends of which are outside. Dressings are placed vertically in sectors bundles
or packages. Material placed loosely to provide access pair is placed inside
the sterilization indicators mode (maximum thermometers, fusible substance or
test tube with the test microbe), edge sheets wrapped, drum close lid. To cover
sterilization chamber affix card of cloth with date of sterilization and family
who made it.
When
sterilization in the bag dressings or linen placed loosely, bag tied laces,
dipped it in drum. If necessary, use the material bag stir on a stool, nurse
solves top bag, separates the edges and moves downward. Operating sister
unleashes inner bag sterile hands, opens it and takes out the material.
Stage III - sterilization. Handling the autoclave is
allowed only with a permit inspections with a mark in the passport system, to
work with the autoclave allowed the person who passed the minimum technical
manual in the autoclave and had a permit. Working with autoclave requires the
precision of the instruction manual apparatus. You must comply with the general
safety rules.
- Necessarily
ground steam sterilizer with electric heating;
- Do not start
work on the defective unit;
- During not
leave the machine unattended;
- Do not fill up
the water during the sterilizer;
- After
sterilization disconnect the heater from the mains and valve cover inlet steam
sterilization chamber with pairform;
-
Open the lid
sterilization chamber only after the needle gauge drops to zero.
The countdown begins sterilization after reaching the set
pressure. Dressings and operating underwear sterilized for 20 min. at a
pressure of 2 atm. (temperature of 132,9 ° C).
Stage IV -
Storage of sterile material After sterilization, drums removed, immediately
close the play and carry them on a special table for sterile material. Drums
stored in cabinets locked in a special room. Allowable storage time dressings
and linen if drum not revealed - 48 hours. since the end of sterilization.
Dressings and linen, sterilized in bags, store up to 24 hours.
Control of sterility
Control of sterility of the material and mode of
sterilization in autoclaves made direct and indirect ways. Direct method -
bacteriological, sowing with dressings and laundry or use of bacteriological
tests. Planting is carried out as follows: in the operating reveal biks, small
pieces of gauze moistened isotonic sodium chloride, repeatedly spend on
underwear, then pieces of gauze dipped in a test tube, which is sent to the
bacteriological laboratory.
For bacteriological tests using tubes with known
spore-forming pathogenic bacterial cultures are dying at a certain temperature.
The tubes are placed inside biksa, and after sterilization is extracted and
sent to the laboratory. Absence of growth indicates sterility microbial
material. This test is carried out every 10 days.
Indirect ways to control sterility of the material
used constantly at each sterilization. This use of certain substances melting
point: benzoic acid (120 ° C). resorption (119 ° C), antipyrine (110 ° C).
These substances are produced in capsules. They are also used in test tubes (
Objective of the indirect methods of control mode of
sterilization is thermometry. In each sterilization chamber between material
that is sterilized, put I -2 thermometer. These figures reflect the maximum temperature, but do not indicate the
exposure time (during which period the temperature was maintained at drum), and
therefore this method does not exclude the direct control of sterility using
bacteriological tests.
Sterilization apparatus for inhalation anesthesia
Apparatus for
mechanical ventilation and inhalation anesthesia can cause cross-infection of
patients and distribution of nosocomial inspection. Infection with respiratory
patients is fraught with the development of postoperative inflammatory complications,
pneumonia, bronchitis, tracheitis, pharyngitis. In this regard, disinfecting
anesthesia and respiratory equipment - one of the important measures asepsis,
aimed at preventing contact and inhalation infection of the respiratory tract
of the patient.
To prevent such
complications should perform the following basic recommendations.
1. Endotracheal
tube should be single use sterilization to be carried out in a cold way to the
factory.
2. After anesthesia
of mechanical ventilation devices, respiratory circuit elements are processed
antiseptic chemicals. Devices processed in assembled form. Can be used 0.5%
alcoholic solution of chlorhexidine bigluconate: 1 ml. 20% aqueous
chlorhexidine dissolved in 40 ml. 96% ethanol. The mixture is poured into the
evaporator or humidifier anesthesia apparatus for artificial ventilation.
Ventilation is carried out by semi-enclosed loop for I h. at speed gas outflow
As an antiseptic
in such situations, you can use 40% aqueous solution of formaldehyde
(formatin). For this evaporator or humidifier instigate 100 ml. formalin and
spend ventilation for 20 min. Then remove the remnants of formalin, pour a
solution of ammonia and continue ventilation until complete disappearance of
the smell of ammonia.
For
sterilization apparatus assembled applicable gas metol (using ethylene oxide)
or UV irradiation.
3. If the devices
are used in patients with purulent diseases, tuberculosis lung or airway spend
disassembly respiratory circuit
(Remove the hose, connecting elements, valve
cover boxes, respiratory accurate, adsorbers). All parts must wash under
running warm water, then soaked in a hot detergent solution L or B (see
Sterilization instruments) for 15 min., In the same solution every detail
washed cotton-gauze pad for 30 min. Then rinsed running, and then with
distilled water. Actually sterilization processing components spend 0.5%
aqueous chlorhexidine, placing them in a capacity for 311 min. or 3% hydrogen
peroxide solution (80 min.), or 3% solution of formaldehyde (30 min.). In the
latter case, when infected with Micobacterium tuberculosis exposure increased
to 90 min. The best option - use in such situations, plastic hoses, masks,
disposable.
After treatment
with antiseptics flew thoroughly washed with sterile water for 10 min. dried,
and stored under aseptic conditions for use.
Sterilization of endoscopic equipment
The problem of
infection in endoscopy is crucial due to the risk "of infection of
patients and staff virulent microorganisms.
The main stages
of sterilization of endoscopic instruments and tools is their mechanical
cleaning, washing, presterilization processing and sterilization, drying and
storage.
To clean
endoscopes using solution A or B (see Sterilization instruments).
After endoscopy
with the endoscope immediately remove contamination (gastric, intestinal juice,
reduce, blood, etc.). Mechanically using detergents (solution A or B): from the
outer surface with cloth napkins, with channels (biopsy, surgical) - a special
brush, and by submitting them enough air, water or a solution of neutral soap,
hard endoscope disassembled before cleaning.
For processing
endoscopes using 0.5% aqueous or alcoholic solution of chlorhexidine
bigluconate, 70% ethanol, 2.5% solution of aldehyde drug "Saydeks",
3% and 6% solution of hydrogen peroxide at a temperature of 20 + -2 ° C.
Besides
immersion method may also 3x wipes clean the outer surface of the working part
of the endoscope (sequentially, first one cloth dipped heavily in an antiseptic
solution, then, after filling channel endoscope solution for 15 min. - Another
and a third).
Parts of the endoscope
handle antiseptic solutions by immersion in an enamel or glass container,
cover, just parts dipped rigid endoscopes (except optical instruments and parts
flexible parts fibroendoskopes). In recent years there have been new, so-called
over tight fibroskopiv model that can be completely immersed in an antiseptic
solution. Channels filled with a solution with a syringe or electric pumps.
Designed
specifically for install presterilization cleaning and sterilization of
flexible endoscopes, which differ in volume disinfectant that is poured into a
special bath.
Remains of
antiseptics removed from endoscopic equipment through one distilled oxen,
passing it through the channels of the endoscope and washing it out. Then, by
repeated air supply through the endoscope channels remove excess water.
Sterilization of
endoscopic equipment can be carried in the chamber for gas sterilization using
ethylene oxide or mixtures of ethylene oxide and methylene bromide.
Endoscope placed
in sterile bags with thick cotton stored upright in special cabinets.
Preparation hands before operation
Preparation of hands - an important means of
preventing contact infection. Surgeons, surgical dressings and sisters must
constantly worry about the cleanliness of hands to care for the skin and nails.
The greatest number of microorganisms accumulate under the nail, in nail
ridges, cracks in the skin. Hands care involves preventing cracks and calluses,
trimming of nails (they must be short), deburring. The work associated with
contamination and infection skin, need to take the gloves. Proper hand care
should be seen as a step in preparing them for surgery. Scrubbing any way
begins with mechanical treatment.
The classic way to handle arms are ways Fyurbrinhera,
Alfeld. Spasokukotsky-Kochergina. Ways Fyurbrinhera, Alfeld have only
historical significance. Method Spasokukotsky-Kochergina can be used as forced
as it is not possible to apply modern methods. The method involves mechanical
cleaning hands 0.596 solution of ammonia. Hand wash basins in 2 to 3 minutes.
cloth; consistently perform movements as when washing brush, starting with
fingers of his left hand. In the 1st wash hand basin to the elbows, in the 2nd
- to the border of the upper and middle thirds of the forearm. After washing
hands opoliskuyut solution of ammonia and hands lifted up, so that drops of
water trickled down to the elbows. Leather Hand dried with sterile towels,
first both hands (this napkin throw), then successively lower and middle third
of the forearm.
Skin disinfectant wipes moistened with 96% alcohol,
treating twice for 2-5 min. hands and lower third of the forearm, then - the
ends of the fingers and nail ridges, nail bed and skin folds fingers smeared
with 5% alcoholic solution of iodine.
Modern methods of treatment involving their hands
clean by washing with soap and running water or with liquid detergent and
further processing of chemical antiseptics.
Scrubbing pervomur (preparation C-4), Pervomur - a
mixture consisting of formic acid and hydrogen peroxide. First prepare the main
solution comprising 81 ml. 85% formic acid and 171 ml. 33% solution of hydrogen
peroxide. These parts are mixed in a glass bottle with a ground glass stopper
and transferred in the refrigerator for 2 hours., Occasionally shaking the
bottle. The interaction of formic acid and hydrogen peroxide is formed
pervomur, which has a strong bactericidal effect. With the number of basic
solution can be prepared
Scrubbing with chlorhexidine bigluconate. Available in
a 20% aqueous solution. To handle hands prepared 0.5% alcohol solution: to 500
ml. 70% alcohol is added 12.5 ml. 20% solution of chlorhexidine bigluconate.
Pre wash their hands with soap and running water, dried with sterile towels or
towel, and then within 2-3 minutes. rubbed with a gauze pad soaked prepared
solution.
Scrubbing agents AHD, evrosept. These products contain
preservatives such as ethanol, chlorhexidine. A few milliliters of the solution
was poured on her hands and rubbed into the skin of the hand to the middle third
of the forearm twice for 2-3 min.
Accelerated processing techniques hands used in
ambulatory practice or internally ( military field) conditions. For rapid
disinfection of hands using film-forming gel, featuring a strong bactericidal
effect. It consists polivinilbutrol and 96% ethyl alcohol. Hand wash with soap
and water and thoroughly dried. On hand pour 3-4 ml tseryhelyu thoroughly for
10 minutes with wet their finger nail bed and cushions, hand and lower forearm.
Bent fingers are kept in diluted position for 2-3 minutes until the skin is
formed film cerigel possessing protective and antibacterial properties. After
surgery film is easily removed with gauze balls soaked with alcohol.
Scrubbing can be done by rubbing the skin 96% ethanol
for 10 min (method Bruna) for 3 min or 2% alcohol solution of iodine.
Preparation of the operative field
Previous training is intended operating section
(operating margins) starts before the operation and includes general hygienic
bath, change clothes. On the day of surgery is performed shave dry place
directly in the operational access, then wipe the skin with alcohol.
Before the surgery on the operating table field
operations are widely smeared 5% alcoholic solution of iodine. Immediately
place the operation isolated sterile linens and again smeared with 5% alcoholic
solution of iodine. Before and after the imposition of suturing the skin it is
treated the same alcoholic solution. This method is known as a way
Hrossiha-Filonchykova. To handle surgical field using such iodine as iodonat,
Betadine.
When intolerance iodine skin in adults and children
processing operating field spend 1% alcoholic solution of brilliant green
(Bakkal way).
To handle surgical field using 0.5% alcohol solution
hibitan (chlorhexidine bigluconate), as well as for treatment of hand surgery
before the operation.
In emergency operations training surgical field is
shaving hair, skin treatment 0.5% solution of ammonia, and then one of the
methods described above.
INFECTION
PREVENTION OF WOUNDS
Infection by air
or by contact caused by short-term action while executing certain surgical
procedures (ligation, surgery, medical manipulation, diagnostic methods). When
entering the microflora of materials (grafting infected organism) that are
implanted, it is in the human body during your stay implant. Last, as a foreign
body, supports the inflammatory process develops, and treatment of this
complication will be unsuccessful until, at least until rejection or removal of
the implant (ligatures, prosthesis, body). Possible from the very beginning
(through the formation of a connective tissue capsule) isolation of
microorganisms with the formation of an implant infection "dormant",
which can be after a long time (three months, years).
To materials
that are implanted in the human body include suture, metal clips, brackets, and
vascular prostheses, joints, fabric with polyester, nylon and other materials,
human and animal tissues (blood vessels, bone, dura mater, skin) organs
(kidney, liver, pancreas, etc.)., drains, catheters, shunts, coffee filters,
vascular spiral and others.
All implants
must be sterile. Sterilization was carried them in different ways (depending on
the type of material), but with the following conditions: UV irradiation,
autoclaving, chemical, gas sterilization, boiling. Many dentures come in
special packaging, sterilized at the factory UV irradiation.
Most important
in causing implantation infection has suture. There are more than 40 types. For
connecting tissue during surgery using threads of different origin, metal
clips, brackets.
Apply thread as
the absorbable and non-absorbable. Natural fibers that dissolve are strings of
catgut. Extension of shelf dispersal catgut achieved impregnation threads
metals (chrome, silver catgut). Use sinthetic fibers that dissolve with Dekson,
Vickrey, oktsilon and others. To those that are non-absorbable threads of silk,
cotton, horsehair, flax, to synthetic - strands of nilon, poliester, Dacron,
nilon, ftorlon and others.
For sewing
fabrics used atraumatic suture. He is a seam thread, pressed into the needle,
so when puncturing tissues, carrying it through the punctured channel fabric
not injured..
Suture material must meet the following basic
requirements:
1) have a smooth, flat surface and cause a puncture in
additional tissue damage;
2) manipulator possess properties - good glide in the
tissues, be flexible (enough extensibility warns of davlennya and tissue
necrosis at their rising edema);
3) be strong in the node, do not have hygroscopic
properties and swell;
4) be biologically compatible with living tissues and
cause an allergic reaction in the body;
5) the destruction of threads should coincide with the
timing of wound healing.
Suppuration of
wounds is much less when using sutures that have antimicrobial activity due to
their structure imposed antimicrobials (letylan-polyester, ftorlonovi, acetate
and other threads, nitrofuran drugs that contain antibiotics, etc.). Synthetic
filament containing antiischemic the means have all the benefits such as
sutures and at the same time provide antibacterial activity.
Suture material is sterilized at the factory.
Atraumatic suture material produced and sterilized in special packaging, the
usual stuff - in ampoules. Atraumatic thread in packaging and ampouling skeins
of silk, catgut, nylon stored at room temperature and use as needed. Metallic
suture material (wire, brackets) are sterilized in an autoclave or by boiling,
linen or cotton thread, from polyester, nylon - in an autoclave. Silk, nylon,
polyester, linen, cotton can be sterilized by the method of Kocher. This is a
forced method, and it provides a thorough mechanical cleaning suture material
with hot soapy water. Coils are washed in soapy water for 10 min., Changing the
water twice, then washed free of detergent, dry sterile towel and wound on a
special glass coil, which is transferred into jars with ground glass stopper
and pour ether for 24 h. for degreasing, and then translated into banks with
70% alcohol for the same period. After extraction with alcohol silk boil for
10-20 minutes. in a solution of mercuric chloride 1:1000 and shift in airtight
jars, closing with 90% alcohol. After 2 days of conducting bacteriological
control, with a negative result of planting material is ready for use.
Synthetic filament can be sterilized by boiling for 30 min.
Sterilization of catgut. Heat treatment
catgut does not apply in the factory it is sterilized UV rays; basically just
such yarns are used in surgery. However, you can sterilize catgut in a hospital
setting. Sterilization of catgut chemical means involves a preliminary
degreasing, which rolled rings catgut strings moving in jars hermetically
sealed with ether for 24 hours. When sterilization by Kdaudius air from the jar
drained and flooded the ring suture 10 day aqueous iodine (iodine net -
Gubarev method involves sterilization of catgut
alcoholic solution of iodine (pure iodine and potassium iodide -
Sterilization
prosthesis designs sutures. The method of sterilization in a hospital
determined by the type of material from which the implant is made. Yes, metal
structures (paper clips, brackets, wires, plates, pins, screws, spokes)
sterilized at high temperature and dry heat closet autoclave, boiling (if not
cutting surgical instruments). Prostheses complex structures consisting of
metal, plastic (heart valves, joints), sterilized by chemical antiseptics (eg,
chlorhexidine) or gas sterilizers.
Prophylactic implantation
of infection in organ and tissue transplantation involves taking organs under
sterile conditions, ie close to the operational work. Careful adherence to
aseptic thus involves the preparation of hands and clothes surgeons sterile
operating underwear, processing surgical field, sterilization of instruments,
etc. The body was taken under sterile conditions (after washing it with sterile
solution, and if necessary, washing the blood vessels and ducts - from
biological fluids), stir in a special sterile sealed container, coated with
ice, and transported to the site of transplantation.
Prostheses of
polyester, nylon and other synthetic materials (vessels, heart valves, mesh to
strengthen the abdominal wall during herniotomy etc.). Sterilized by boiling or
placing them in antiseptic solutions. Prostheses, sterilized in an antiseptic
solution should be thoroughly washed with sterile isotonic sodium chloride
solution before implanting them in humans.
Hospital infection
Hospital or
nosocomial infection raises the frequency of complications of diseases or
operations of which is associated with infection of patients in the surgical
hospital.
The original
source of infection - patients with purulent diseases.
Microorganisms
through objects, air, laundry in the surgical patient can move from one patient
to another. Frequent aureus, Escherichia coli, Proteus, synehniyna coli.
Microbial flora is highly resistant to antibacterial agents. In frail operated
patients this flora can cause the development of septic complications.
Infection is possible with both exogenous and endogenous sources of where
nosocomial flora came before: nasopharynx, pharynx, the skin of the patient.
Perhaps the development of mass illness (complications) - an outbreak of
hospital infection.
To combat this
infection are important organizational measures: strict sanitary treatment
department: closing offices thorough sanitization during outbreaks of
infection: shortening the pre-and postoperative patients stay in hospital;
rational antibiotic therapy (changing antibacterials, bacteriological
monitoring of the therapy ), using combined methods of antisepsis, the use of
closed drainage techniques, and others.
The
problem of AIDS in surgery
Distribution of
AIDS among the population threatens contamination of surgical personnel of
hospitals in contact with the blood of infected patients during operations,
dressings, injections, injections, punctures, taking blood samples, the
diagnostic procedures and others.
Preventive
measures include early identification of infected patients, for which all
patients surgical hospitals examined for AIDS. In order to identify and isolate
patients. Clinical examination included such manifestations of disease, such as
pneumonia, Kaposi's sarcoma, the presence of immune deficiency, diarrhea,
weight loss, candidiasis of the respiratory tract. Emergency blood analysis for
AIDS antigen to confirm or reject the diagnosis of patients in this group.
Important for
prevention has been widely used syringes, instruments, systems for intravenous
infusion disposables.
Caring for patients in the postoperative
period.
Early
postoperative period. Early postoperative complications and their treatment
Postoperative period
is called the period of treatment the patient from the end of surgery to
recovery.
The main challenges faced by medical personnel after
surgery are:
1) treatment and care of patients;
2) Prevention and treatment of possible complications;
3) early rehabilitation.
Phases of postoperative period
Postoperative period - this time from the end of the
operation the patient to recovery and rehabilitation or transfer it to a group
of disability. Depending on the severity of the disease, the size and nature of
operations, the postoperative period may last from several days to several
months. There are early postoperative period - the first 5-6 days after
surgery; late postoperative period - to discharge the patient from hospital;
remote postoperative period - to a full recovery and restore its ability to
work or transfer to disability group.
In the
postoperative period should carefully monitor the status and function of the
major organs and systems as surgery and anesthesia lead to relevant
pathophysiological changes in the body. Under the influence of surgery and
anesthesia changing intensity of metabolic processes disturbed balance of
catabolism (the accumulation of toxic products in the body due to the collapse
of substances and cells) and anabolic (set of processes aimed at the formation
of organic substances - components of cells and tissues).
During the postoperative period are three phases
(stages): catabolic, anabolic and reverse development.
Catabolic phase. The duration of this phase - 3 - 4
days. Severity of the disease depends on the severity and volume operations,
type of anesthesia, their duration and intensity of postoperative treatment
(inadequate, unbalanced treatment, the presence of complications). It should be
noted that the catabolic phase is primarily a defensive reaction of the
organism, which aims - to increase body resistance due to energy and plastic
materials. On the one hand, this is due to increased breakdown of proteins,
fats and carbohydrates, on the other - the significant amount of toxic
substances, which leads to acidosis (changes in acid-base status), disruption
of redox processes in tissues and organs (liver, kidney , heart, etc.)., which
negatively affects the overall operated patients.
Anabolic phase. Its length - 4 - 6 days. During this
period begins active synthesis of protein, fat, glycogen (carbohydrate
material), increasing amount of energy and plastic materials. Clinical features
of this phase is to improve the general condition of the patient, reduce pain,
normalization of body temperature, the appearance of appetite. Improves the
cardiovascular system, the respiratory system. Restored activity of the
gastrointestinal tract, intestinal peristaltic contraction, begin to depart
gases.
Phase reverse development. Clinically, it is
characterized as a period of recovery. In this phase, improves health of
patients, appetite and normalize the function of internal organs: heart, lungs,
liver, kidneys, etc.. Duration anabolic phase - 2-5 weeks. Its progress depends
on the severity of the disease, the amount transferred operation, duration
catabolic phase. She completed the restoration of body weight, complete wound
healing and the formation of a reliable postoperative scar.
Changes in the patient associated with
surgical trauma
In the
postoperative period may develop some metabolic functions and internal organs.
They tend to occur in seriously ill patients after complicated operations.
After the smaller operations such as routine hernia or appendectomy, these
changes are expressed slightly and do not require special treatment.
1. Violation of protein metabolism. One of the serious
violations of homeostasis operated patients is a violation of protein
metabolism. In the body of a healthy person weighing
2. Disorders of lipid metabolism. Postoperatively,
marked changes occur and fat metabolism. For its correction using mostly fat emulsion
(venolipid, intralipid, emulsan et al.), Which is the energy source of
unsaturated fatty acids (linoleic, linolenic, arachidonic, and others.) That
ensure the normal functioning of body cells, inhibit catabolic processes. It
should be noted that caloric fat is 2.5 times higher than that of protein and
carbohydrates. Fat emulsions poured at a rate of 1.5 -
3. Carbohydrate metabolism after surgery. In 90% of
patients in the first 2-3 days of sugar in the blood is reduced and there is
hypoglycemia. With 3-4th day watching increase blood glucose (hyperglycemia),
sometimes glucosuria, which is associated with an increase in its formation and
decreasing absorption. With 2-3rd day the amount of glucose in the blood is
reduced and there is hypoglycemia. Note that the number of substances in the
body depends on the intensity of metabolic processes and methods of their
separation from the body. This is in violation of the carbohydrate metabolism
in the body mainly accumulate oxidized products that reduce backup alkalinity
and affect blood pH. Changing the pH of blood by only 0.3-0.4 units (normal pH
- 7,35-7,45 ED) in any direction leads to a pronounced violation of enzymatic
activity, redox processes in the body that can result in death patient.
Timely, correct and intensive preoperative
preparation, careful nursing, and correction of carbohydrate metabolism
(introducing a sufficient quantity of 5-10% glucose with insulin at the rate of
1 IU of insulin on glucose 4-
4. Violations of water-electrolyte metabolism cause
many complications in patients after surgery. There are three forms of
disorders of water metabolism:
1) real deficit
caused by insufficient flow of water in the body;
2) the excess
water caused by the mismatch between revenues and its withdrawal from the body;
3)
redistribution of water in some parts of the body associated with changing
ratios of electrolytes.
After an operation and rehabilitation
of the patient are three periods of observation of the patient. After a short
period of immediate postoperative observation anesthesiologist in restorative
ward to ensure normalization consciousness, respiration, blood pressure, pulse,
and if no hits for his transfer to the department of intensive care, the
patient is transported in a general ward. After discharge from the surgical
department patient may still require supervision and rehabilitation of a
surgeon. It is provided during outpatient treatment in the clinic, sanatorium
or program of gradual recovery in activity in rehab.
Oral Care. After
the operations required diligent oral care. If dry mouth is recommended
systematic rinsing with water and lubricating mucosal vaseline oil.
To prevent
inflammation of the parotid glands should rinse your mouth with warm water and
lemon juice. The nursing staff must follow to ensure that patients are
regularly cleaned teeth.
Care. All patients should daily wash
hands and face. Seriously ill wash nanny. It should monitor the purity skin
seriously ill.
To prevent bedsores lying sick enclose
inflatable rubber wheels, regularly (2-3 times a day), rubbed the back, pelvis
and sacrum camphor alcohol. We must change the position of the patient in bed.
When the initial signs of bedsores altered skin smeared 5-10% solution of
potassium permanganate.
To prevent intertrigo should
systematically wipe 0.1% solution of potassium permanganate and powder talc
inguinal and axillary areas, navel, women - folds under the breasts.
Especially
should carefully monitor the purity of the perineum. After defecation perineal
area washed with a cotton swab with warm water or a 0.1% solution of potassium
permanganate. Women of the night washed crotch.
The time when the patient is allowed
to get out of bed, depending on the severity and nature of the operation, its
condition and the postoperative course. In normal condition of the patient and
no complications after appendectomy, hernioplasty he was allowed to get up at
1-2-day. After more sophisticated operations (gastric resection,
cholecystectomy, and others.) - 3-4th day as directed by your doctor. After
operations on the thoracic cavity, the extremities for fractures, injuries of
blood vessels, nerves, etc. permitted to get up at different times individually
for each patient.
Care bandage is one of the main duties
of nurses. We follow closely to dressing well rested and not exposed to the
wound. If bandage slid off and the wound exposed, you should immediately make
dressing. Dressing can be a little leak blood in the first day after surgery.
In these cases it lightly grease an alcoholic solution of iodine. When the
impregnation bandages blood should immediately call a doctor and take measures
to stop the bleeding.
The bandage change in the first three days after surgery
and removal of sutures. When purulent wound dressings do often depending on the
state and wound dressings.
Removal of sutures. Sutures are removed in most patients
at the 7-8th day, children can be removed earlier - to 5-6th day after surgery
in elderly and frail patients with sutures removed later - on 10-12-th day.
Eating
a patient after surgery. Dining patient after surgery depends on the nature of
it. When operations on the abdominal organs, usually during the first day are
not allowed to drink.
Later
in 5-7 days patients prescribed a liquid, easily digestible food (soup, pureed
soups, yogurt, liquid porridge, pudding, soft-boiled egg, etc.).. Diet set
depending on the nature of the disease and surgical intervention. So, after
surgery for gall bladder prescribed liver diet after surgery for stomach ulcers
over - ulcer diet, etc.
To quench your thirst rubbed lips and
mouth moist cotton wool.
After operations on the stomach and
intestines at 2-day permitted to drink warm boiled water a teaspoon per hour.
On the 3rd - 4th day after surgery in the recovery of peristaltic activity
intestinum patients can eat soup, pudding, soft-boiled egg in the next few days
- liquid semolina, pureed soups. Crackers can eat on the 5-6th day.
After operations gall bladder and
liver patients prescribed liver diet. give to eat from 2-3rd day, designate a
small portion of the liquid, pureed food.
Diet patients after operations on the
small intestine following: drink permitted on the 2nd day, further small
portions for 5-7 days produce liquid foods (soup, soft-boiled egg, pudding,
etc.). Crackers can eat for 7-8th day.
After operations on the large
intestine, patients prescribed a liquid, easily digestible food for 5-7 days.
In the same period to delay emptying give opium tincture (5-10 drops 3 times a
day).
During the first days after
appendectomy patient can drink, ranging from 2-day prescribed liquid foods,
crackers, 3-4th day - white bread.
After removal of the hernia operations
on extremities patients prescribed overall diet.
After radical surgery on the esophagus
sick for five days are on parenteral nutrition. At the 6-day allowance to drink
small sips and then gradually prescribed liquid diet.
Diet patients after operations on the
chest, lungs and heart consists of liquid, easily digestible food with plenty
of protein, carbohydrates and vitamins. During the first 3-5 days should limit
the amount of food to prevent complications of the heart and gastrointestinal
tract.
After operations on the lungs in
patients with 5-7-day, if there are no complications, appointed overall diet.
DIRECT afteoperation care for pation
Diagnosis
and treatment of major life threatening complications that may arise during
this period, is functional duty doctor department of intensive care together with the surgeon.
Airway obstruction. Airway should always be kept
clean and passable. The main causes of obstruction following.
1. Tongue may occur in unconscious patients after general anesthesia.
Loss of muscle tone leads to the tongue to the posterior pharyngeal wall and
may increase spasm of masticatory muscles during exit from the unconscious
state. Complicating factor of various manipulations of anesthesia may be injury
tongue or soft tissues of the mouth or throat.
2. Foreign bodies such as dentures and broken teeth, secretions and
blood, stomach contents or intestines - frequent source of airway obstruction.
Before the surgery, dentures should be removed and taken precautions to prevent
aspiration of gastric contents.
3. Laryngospasm can occur during mild loss of consciousness and increase
with inadequate anesthesia.
4. Laryngeal edema can occur in young children after traumatic
intubation attempts or during infection (epihlosyt).
5. Compression of the trachea may occur during surgery on the neck and
especially dangerous when hemorrhage after thyroidectomy or remodeling vessels.
6. Bronchial obstruction and bronchospasm may develop due to ingress of
foreign body aspiration or irritating substance, it could be an allergic
reaction to medication or complication of asthma.
Attention doctors should aim to
identify and eliminate the cause of airway obstruction as a matter of extreme
urgency. When satisfactory patency airways hypoxia may be due to complications
from after venting complications mismatch between ventilation and perfusion.
Since this is usually a good job anesthesiologists, venting lung gas mixture
with a high oxygen content. Determined by gas analysis of blood.
Myocardial ischemia. Postoperative
heart failure may increase in the early period, especially in patients with a
history of previous heart disease, myocardial ischemia. Patients with ischemia
may complain of squeezing chest pain. In the period of recovery of
consciousness may be the only symptom of hypotension. If suspected ischemia,
ECG performed immediately and the measures for continuous monitoring of cardiac
activity (kardiomonitoring).
Respiratory failure. Respiratory
failure is defined as the inability to maintain normal partial pressure of
oxygen and carbon dioxide (PO2 and PCO2) in arterial blood. Determination of
blood gas should be conducted in the dynamics in patients with previous
respiratory diseases. Normal PO2 - more than 13 kPa at age 20, decreases in
patients up to 60 years to about 11.6 kPa; respiratory failure accompanied by a
value less than 6.7 kPa. Severe hypoxemia clinically evident cyanosis of skin
and mucous membranes, with independent breathing - severe dyspnea.
FEATURES
postoperative period in patients elderly.
People senile require special
attention and approach. The reaction to the disease process they delayed and
less pronounced resistance to drugs normally reduced. In the elderly
significantly reduced pain sensation and therefore complications arising
without symptomatic may occur. So should listen carefully to the patient
himself assesses the development of the illness, and therefore need to change
therapy and treatment.
Usually in elderly patients gavage,
drainage, depriving them of mobility are removed as soon as possible, to
minimize intravenous fluids. Their early rise from bed after surgery for
abdominal, lower limbs, which is the prevention of many complications.
Postoperative
management in general surgical ward
TOTAL
CARE
After returning
the patient to the ward regularly, almost every hour or every 2 hours, the
control pulse, blood pressure and respiratory rate. Patients who underwent
complicated surgery on the stomach or intestines, shown hourly emissions
control by nasogastric tube, diuresis and selections from the wound. Observations
carried nurse under the supervision of the attending physician, surgeon or
another (if necessary and other consultants).
In most hospitals survey patients
medical personnel to ascertaining its condition, health and dynamics of basic
life functions carried out in the morning and evening. Worries that suddenly
appeared, disorientation, inappropriate behavior or appearance - often the
earliest manifestations of complications. In these cases, pay attention to the
state of general circulation and respiration, pulse, temperature and blood
pressure levels. All data is monitored and recorded in medical history. The
need for conservation probes, catheters decided on the basis of monitoring
renal function and bowel, full tour of the chest. Thoroughly researched chest,
sputum examined.
Lower limbs inspected for appearance
of swelling, pain calf muscle, skin discoloration. In patients receiving
intravenous fluids, controlled liquid equilibrium. Everyday determined plasma
electrolytes. Intravenous infusion terminated as soon as the patient begins to
drink liquids on their own. A few days of fasting in the first days after the
operation can not bring a lot of damage, but enteral (tube) or parenteral
nutrition is always necessary if the strike lasts more than a day.
For some patients, painful and
depressing problem after surgery may be insomnia, and it is important to
recognize and promptly treat such patients (including silence, the mode of
communication with staff and relatives).
Caring
for patients after operations on the abdominal organs.
Anterior abdominal wall and stomach
examined daily to detect excessive swelling, muscle tension, pain, of wounds -
leakage from the wound or where drainage is installed. The main types of
complications in this group of patients: the slow recovery of peristalsis bowel
anastomosis failure, bleeding or abscess formation.
The presence of intestinal noises,
self discharge gas and the appearance of stool indicates restore peristalsis.
If after the intervention was delivered nasogastric tube, he kept open
constantly (which facilitates the discharge of gases) and allows further
draining the intestine. Passive drainage may be supplemented by continuous or
intermittent suction content. The probe is stored to reduce the amount of
hourly aspiration and can be removed when there is self discharge gases and
there is a chair (usually 5-6 days). Nasogastric tube causing inconvenience to
the patient and should not be kept for longer than necessary.
CARE
FOR WOUND.
Frequent dressing is not always necessary in the treatment of surgical
wounds, after planned operations in the absence of pronounced pain in the
wound, the normal temperature of the patient's wound may look back in 1-2 days,
but it should be examined daily in detecting even small signs of infection:
redness , swelling, increasing pain.
Draining wounds done to prevent the
accumulation of fluid or blood and allows you to control any selection - in
insolvency anastomosis cluster of lymph or blood. Many surgeons in recent years
prefer to use closed drainage vacuum system with a small force of aspiration
(corrugated vacuum drainage produced by the domestic industry) after operations
on vessels. Usually drain is removed when the amount of fluid received each
day, reduced to a few milliliters.
Skin sutures traditionally not removed
until such time as the wound heals completely. Terms of healing depends on many
factors. Thus, appropriate early removal of sutures in the neck or face (3-4 days)
to prevent the formation of unsightly scars. Then place sutures can be pasted
sticky strips (like plaster) to avoid differences and better healing. On
exposed skin (face, neck, upper and lower limbs) are preferred subepidermal
sutures placed absorbent or non-absorbent synthetic fibers. If the wound
becomes infected, you will need to remove one or more sutures prematurely, the
wound edges are raised, running drainage.
The difference between the edges of
wounds of the abdominal wall is rare and mostly in patients who underwent
surgery for a malignant tumor. This process is supported by factors such as
hypoproteinemia, vomiting, prolonged paresis and intestinal bloating, purulent
wound and pulmonary complications.
To distinguish the wound edges
characteristic sudden discharge from the wound a large number of serous fluid.
On examination, the wound is eventeratsiya with protruding loop of intestine or
omentum fragment. In these cases, the operating conditions is replaced internal
organs and the wound closed nodal seams.
Complications
in the early postoperative period
Long-term intravenous irritant drugs or solutions may cause bruising,
hematoma, phlebitis or venous thrombosis. Intravenous catheters, which are
placed in large veins should be securely sealed to prevent air embolism.
Arterial catheters or accidental needle punctures the artery - the most common
cause of damage. This can lead to arterial occlusion and even gangrene because
most damage is diagnosed late.
Nerve paresis may be caused by
stretching or compression of the main nerve trunk or extravascular
administration aggressive solution. Most damaged ulnar nerve in the elbow
fossa, radial nerve on the shoulder and brachial plexus in the supraclavicular
area.
Development nerve paresis may occur in an
awkward position the patient on the operating table - long limbs or local
compression of compression with the patient on the side or stomach. Following
precautions to prevent nerve paresis of limbs in the early postoperative
period.
CARDIO-PULMONARY
COMPLICATIONS.
In the early postoperative acute heart failure is the most common
complication. In patients with coronary artery disease or valve defects,
arrhythmia surgery after massive phenomenon can be observed heart failure. The
reason for its increase may be excessive in volume intravenous infusion of
fluids in the early postoperative period, which can be avoided by carrying out
monitoring of central venous pressure. Heart failure treatment is to avoid the
further fluid overload, diuretics and cardiac prescribing drugs.
Once the patient is fully recovered
consciousness after anesthesia, the major problems of the respiratory system
may collapse lung and pulmonary infection. Exponentiating factors in their
development may reduce the mobility of the diaphragm, general lethargy,
abdominal wall tension and pain in the wound. Occurrence of complications
prevents explanation patient having to go to bed, breathe deeply and of cough.
Great importance is attached physiotherapy, coughing and deep breathing with
simultaneous use of small doses of analgetics. This abdominal wall in the wound
must be maintained using a temporary bandage. Bronchospasm eliminated
inhalation bronchodilator drugs, and hypoxia treated with oxygen through a mask
or nasal tube. Antibiotic therapy administered after bacteriological
examination of sputum.
Renal
failure.
Acute renal failure after surgery may be the result of prolonged
hypoperfusion of the kidneys, which may result from hypovolemia, sepsis, or
transfusions of incompatible blood. Patients with previous renal disease and
jaundice are particularly susceptible to the condition of renal ischemia and
more likely to develop acute renal failure. The importance of monitoring hourly
urine output necessitates bladder catheterization, all patients who performed
major surgery, as well as those who are at risk of developing renal failure.
Early diagnosis and treatment of
bacterial and fungal infections are also important in preventing renal failure.
Acute renal failure is characterized by oliguria combined with low specific
gravity of urine (less than 1010). Oliguria in combination with high
concentrations of urine suggests that kidney function, but inadequate blood
supply to them. This is to show to the introduction of more liquid. Rapid
infusion of saline increased urine output in these patients, but careful
inspection eliminates the cause of hypovolemia ( bleeding).