A drug is used to treat the surgical field. Preparing a patient for a planned operation: how is it carried out. How to prepare the operating field

LIST OF PRACTICAL SKILLS

(simulation training)

specialty: MEDICAL BUSINESS

discipline: GENERAL SURGERY, RADIATION DIAGNOSIS

MODULE 1 General issues of surgery

3. treatment of the surgical field

4. local infiltration anesthesia

5. Anesthesia according to Oberst-Lukashevich

6. care for drainage

7. colostomy care

8. nasogastric tube insertion and care

9. elastic bandaging of the lower extremities

10. bladder catheterization in men with a rubber catheter

11. catheterization of the bladder in women with a rubber catheter

12. emergency tetanus prophylaxis (subcutaneous injection)

13. parenteral nutrition (intravenous injection)

14. wound treatment (without infection)

15. treatment of an infected wound

16. skin sutures

16. removal of skin sutures

MODULE 2 Providing first aid for injuries and injuries

1. application of a tourniquet

2. application of a tourniquet-twist

3. applying a pressure bandage

4. finger pressing of the vessel

5. transport immobilization in case of injury of the upper limb (Kramer splint)

6. transport immobilization in case of lower limb injury (Diterichs splint)

7. transport immobilization in case of head injury

8. applying an occlusive dressing

9. dressing the amputation stump

10. dressing the mammary gland

11. applying a bandage to the shoulder joint

12. Dezo dressing

13. applying a bandage "knight's glove"

14. bandage "turtle"

15. bandage "bonnet"

MODULE 3 preparation of instrumentation and algorithms for performing individual surgical procedures

1. lumbar puncture

2. skeletal traction

3. PHO wounds

4. instrumental dressing of the wound

5. pleural puncture

6. drainage of the pleural cavity

7. opening of the abscess

1. preoperative hand preparation

Hand skin contains many microbes not only on the surface, but also in pores, folds, hair follicles, sweat and sebaceous glands. Especially a lot of bacteria under the nails. Hand care is about caring for them. Surgeons should wear gloves when touching infected wounds, instruments, etc. They need to avoid scratches, cracks, wash their hands more often and lubricate them with some kind of fat (glycerin, petroleum jelly) at night. Before the operation, the surgeon takes off his outer dress, puts on an oilcloth apron and special underwear, carefully examining his hands. In the presence of pustules, inflammatory wounds or eczema, it is impossible to operate.

Before washing hands, it is necessary to clean the nails of dirt, cut them short and even, and remove the burrs. Hands are washed in special washbasins, in which the tap is opened and closed with the elbow, or in enameled basins (in this case, the water is changed at least 2 times). Boil-sterilized brushes are stored in metal containers or glass jars. Wash your hands with a brush should be methodical and consistent. First, they wash the hands and the lower part of the forearm, especially the fingers in those areas where there is the greatest accumulation of bacteria (around the nails and in the interdigital spaces). Then the hands are wiped dry with a sterile towel, starting with the fingers, then moving to the area of ​​​​the wrist joints and forearm, and not vice versa.

The methods of processing the surgeon's hands before the operation are divided into two groups: mechanical cleaning of the skin, followed by exposure to antiseptic agents or tanning, and techniques based only on tanning (tannin, iodine solutions) to compact the surface layers of the skin and close existing pores.

A common method of hand sterilization is the Spasokukotsky-Kochergin method. It is based on the action of alkalis that dissolve fats and remove microbes with them. Hands are washed in a warm 0.5% solution of ammonia 2 times for 3 minutes. If hands are washed in basins, then the solution is changed. The solution is prepared before use. Distilled water is poured into a sterile basin and ammonia is added from a beaker in the amount necessary to obtain a 0.5% solution. Hands must be immersed in the liquid all the time, each part of the hand is treated sequentially from all sides with a gauze napkin. After washing, the hands are wiped dry with a sterile towel and washed with 96% ethyl alcohol for 5 minutes. This method has long been recognized as one of the best. Many surgeons still use it today. The skin of the hands retains its properties, remains elastic. According to the Furbringer method, hands are washed with a brush in hot water and soap for 10 minutes. Then wipe with a sterile towel, treat with 70% ethyl alcohol for 3 minutes and 3 minutes with a solution of mercury dichloride (sublimate) 1:1000. In conclusion, the ends of the fingers are smeared with iodine tincture.

The group of methods based on tanning includes the Zabludovsky method and the Brun method - a 10-minute handwash with 96% ethyl alcohol. It can be used in cases where there is no water or you need to quickly prepare your hands.

The method of washing hands with a 1:5000 solution of diocide (diocide consists of 1 part of ethanolmercury chloride, 2 parts of cetylpyridinium chloride) has become widespread. In this solution, at a water temperature of 20-30 ° C, hands are washed for 2-3 minutes, then wiped dry with a sterile towel, treated with 70% ethyl alcohol solution.

No method of hand sterilization provides sufficient asepticity to perform the operation, so surgeons, assistants and operating nurses wear sterilized rubber gloves after cleaning their hands before the operation. Before work, gloved hands are thoroughly wiped with a sterile cloth moistened with 96% ethyl alcohol. When changing gloves during the operation, the hands are also wiped with alcohol.

2. putting on sterile clothes

The technique of dressing in sterile operating clothes by a nurse

Indications: participation in the operation

Contraindications: no.

Equipment:

Bix stand

Sterile gown, gloves

Note: the nurse is already dressed in shoe covers, a cap and a mask, her hands are treated

according to the method adopted in the department.

No. Stages Rationale

2. Take the robe and unfold it. The outer surface of the gown should not touch neighboring objects.

3. Put on the dressing gown first on the right and then on the left hand.

4. The nurse pulls the dressing gown up behind the edges and ties the ribbons.

5. Having wrapped the cuff of the sleeve 2-3 times, tie ribbons on it.

6. Take the gown belt and hold it at a distance of 30-40 cm from you so that the free ends of the belt hang down.

7. The nurse, without touching the sterile gown, ties the ends of the belt at the back.

8. Put on sterile gloves.

The technique of dressing in sterile operating clothes by the surgeon

Purpose: compliance with the rules of asepsis

Indications: participation in the operation

Contraindications: no.

Equipment:

Bix stand

Sterile gown, gloves

Note: the surgeon is already dressed in shoe covers, a cap and a mask, his hands are processed according to the method adopted in the department.

1. Use the foot pedal to open the bix cover

2. The operating nurse gives the unfolded gown to the surgeon.

3. The operating nurse throws the upper edge of the dressing gown over the surgeon's shoulders with her hands thrust into it.

4. The surgeon, with the help of an operating nurse, ties the ribbons on the sleeves.

5. The nurse pulls on the back, the dressing gown ties the ribbons and the belt.

6. Puts on sterile gloves with the help of the operating room nurse

7. The operating nurse takes the glove to be put on by the cuff, turns it inside out while covering her fingers with the cuff. Both thumbs are taken to the side.

8. After the surgeon puts on the glove, the nurse straightens the cuff.

9. Similarly with the second glove.

Main stage:

1. Wash the hands with water and liquid soap (pH neutral), without using hard brushes (they wash the palmar, back surfaces of the fingers, interdigital spaces, nail beds, then the palmar and back surfaces of the palms, forearms, up to the elbow joint). The hands should be above the elbow joints.

2. Use the foot pedal to open the bix, where a sterile hand towel is located on top. Take out a towel with sterile tweezers (individually wrapped and served by a nurse) and dry your hands with it (2 min). Carry out in the same sequence, for each hand with a separate side of the napkin (1/3 for the fingers, 1/3 for the palms, 1/3 for the forearm).

3. Perform surgical level hand antisepsis.

4. Attach the mask to the face and hold it by the ends of the ribbons so that the nurse from behind can grab the ribbons and tie them.

5. Remove the robe (by the loop) with your hand, turn it around so that it does not touch surrounding objects and clothes, take it by the edges of the collar, while the left hand should be covered with a robe, and carefully put it on the right arm and shoulder girdle. Then, with the right hand, with a sterile gown already on, take the left edge of the collar in the same way, that is, so that the right hand is covered with a gown, and put the left hand in. After that, stretch both arms forward and up, and the nurse comes up from behind, takes the dressing gown by the ribbons, pulls it on and ties it. Then independently tie the ribbons at the sleeves of the bathrobe.

6. Then remove the sterile belt with your hand and unfold it in such a way that the nurse can grab both ends of the belt from behind, without touching the sterile gown and sister's hands, and tie it at the back.

7. Without assistance, put on sterile gloves as follows: with the first and second fingers of the right hand, grab the edge of the left glove that is turned away (in the form of a cuff) from the inside and pull it over the left hand. Then, hold the fingers of the left hand (in a glove) from the inside under the lapel of the back surface of the right glove, pull it on the right hand and, without changing the position of the fingers, return the turned edge of the glove to its place. Do the same with the folded edge of the left glove.

3. Treatment of the surgical field

Treatment of the surgical field with bactericidal preparations

Treatment begins immediately (if the operation is under local anesthesia), or after the patient is put into anesthesia.

The operating field is treated with antiseptic agents.

Indications:

1) disinfection and tanning of the skin of the surgical field.

Workplace equipment:

1) sterile dressing material;

2) sterile forceps;

4) sterile operating linen;

6) gloves;

7) antiseptics;

8) tool table;

9) containers with solutions of disinfectants for disinfection of surfaces and used equipment.

Preparatory stage of the manipulation.

1. The day before, inform the patient about the need to perform and the nature of the manipulation.

2. Wash your hands with running water, lathering twice, dry them with a sterile cloth.

3. Carry out surgical treatment of hands.

4. Put on a mask, gloves.

5. Put the necessary equipment on the tool table.

The main stage of the manipulation.

1. Widely treat the surgical field from the center to the periphery with an antiseptic agent with two balls on the forceps.

2. Limit the incision site with sterile surgical linen.

3. Re-treat the surgical field with an antiseptic agent (before the incision).

4. Before suturing, treat the skin around the surgical wound with an antiseptic.

5. After suturing, treat the surgical field with an antiseptic.

The final stage.

1. Place used tools and dressings in different containers with disinfectant solutions.

2. Remove rubber gloves and place in a container with a disinfectant solution.

3. Wash hands under running water with soap and dry

4. Conducting local infiltration anesthesia

Local anesthesia during operations is used according to the method of tight creeping infiltrate and in the form of regional (intraosseous, plexus, conduction, epidural and spinal) anesthesia.

Local infiltration anesthesia. For the introduction of a local anesthetic in the production of infiltration anesthesia, 2 syringes are used: 2-5 and 10-20 ml. In addition, needles of various lengths and diameters are used. As a local anesthetic, a 0.25% solution of novocaine or trimecaine (preferably warmed up) is used.

With a small syringe with a skin needle attached to it, 5 ml of novocaine solution is injected intradermally along the intended incision, forming a skin nodule in the form of a so-called "lemon peel". Each subsequent injection of the needle is done along the periphery of the nodule formed by the anesthetic solution during the previous injection so that the patient does not experience additional pain from injections. They try to introduce the needle, if possible, intradermally to its entire length, while prescribing a solution of novocaine forward.

After the end of anesthesia of the skin, the syringe is changed, a longer needle (needles) is taken, and novocaine solution is also injected over the entire length of the proposed incision, first into the subcutaneous tissue, and then directly under the aponeurosis (carefully, feeling its puncture). Further anesthesia of the tissues during the operation is carried out in layers, under the control of the eye to obtain tight, creeping massive infiltrates. This should be done, if possible, before opening the fascia, peritoneum, etc., since only in this case it is possible to create a tight infiltration, prevent the pouring of novocaine into the wound and achieve effective anesthesia. Injections are made slowly, the solution is preceded by the movement of the needle. Infiltrates can be directed from different sides towards each other, surrounding the anatomical area where the operation is performed.

Material support: syringes 2-5 and 10-20 ml and needles of various lengths and diameters

The operating field is the area of ​​the body within which surgery is performed. Before the operation, the skin of the surgical field needs careful preparation; on its surface, as well as in the depths of the sebaceous glands and hair follicles, microbes are always contained, the entry of which into the surgical wound can lead to its suppuration. Before any operation, a hygienic bath or shower and a change of linen are required. During operations on the limbs in case of severe contamination, repeated foot or hand baths are needed. In case of emergency operations, it is possible to perform partial sanitation and washing the skin of the surgical field with gasoline or a solution of ammonia (0.25-0.5%). On the day of the operation, it is necessary to shave in the area of ​​​​the surgical field and adjacent parts of the body. Shaving should be done with sharp razors that do not irritate the skin. It is impossible to shave on the eve of the operation, as infection of small skin cuts is possible.

Immediately before the operation, mechanical cleaning and degreasing of the skin of the surgical field is performed, wiping it for 1-2 minutes. gasoline or; then the skin is treated with alcohol and smeared twice with a 5% alcohol solution of iodine. This causes compaction (tanning) of the skin and prevents the entry of microbes from its depth into the surgical wound. The skin of especially sensitive areas of the body (neck,) is lubricated with a 5% alcohol solution of iodine, diluted in half with alcohol. With increased sensitivity of the patient's skin to iodine, as well as in patients after radiation therapy, the skin of the surgical field is treated with a 5% alcohol solution, 1% brilliant green alcohol solution, 96% wine alcohol. Regardless of the solution used, the treatment of the skin of the surgical field is carried out from the line of the proposed incision to the periphery. After treatment, the surgical field is delimited from the surrounding skin, covering it with sterile sheets or napkins, and after the incision is made, tissues and organs (stomach, intestines) are protected from contact with the edges of the skin incisions. When moving from one stage of the operation to another, linen and napkins delimiting the surgical field are changed, the skin is re-treated with a 5% alcohol solution of iodine, alcohol or another solution.

Surgical field - a part of the body within which surgical intervention is carried out.

The operating field requires special preparation, as its contamination threatens with suppuration. Preparation of the operational field is based on the same principles of mechanical cleaning, disinfection and tanning, as processing of hands (see). Sometimes the preparation of the surgical field begins long before the operation. With folliculitis and furunculosis, ultraviolet irradiation, systematic hygienic baths, vitamins, autohemotherapy are prescribed. In case of fistulas, the skin in the area of ​​the surgical field is lubricated with Lassar paste or a strong solution of potassium permanganate. Before plastic surgery, the preparation of the surgical field is especially thorough; it includes, in addition to daily baths, alcohol dressings.

Before a planned operation, the patient takes a bath or shower the night before, changes underwear. If the patient's condition does not allow taking a bath or shower, the body is wiped with a damp towel. 1-1.5 hours before the operation, the surgical field is shaved without water and soap. Shaving on the eve of surgery is contraindicated due to the possibility of infection caused during shaving scratches and cuts.

Substances used for processing the surgical field should not damage the skin, spoil linen and instruments. The most popular method is Filonchikov - Grossich - double lubrication of the surgical field. 10% alcohol tincture of iodine. To avoid burns, 5% tincture of iodine is often used or, after lubrication with 10% tincture, the surgical field is wiped with alcohol. It is dangerous to lubricate the folds and those areas where the skin is thin and tender with iodine. Lubrication of the surgical field with iodine after preoperative radiotherapy or with increased sensitivity to it is contraindicated. There are other methods to disinfect the surgical field. According to the Spasokukotsky-Kochergin method, the surgical field is wiped 2 times with a cotton or gauze ball moistened with 0.5% ammonia solution, then wiped dry with a sterile cloth and tanned with 96 ° alcohol, 5% picric acid solution, 5% chromic acid solution, 2% solution tannin, etc. During bone operations requiring special asepsis, some surgeons lubricate the skin of the surgical field with cleol and seal it with one layer of gauze; the incision is made through gauze. During emergency operations, especially for industrial or street injuries, the operating field is repeatedly wiped with gasoline, ether or 0.5% ammonia solution.

Regardless of the method, the processing of the surgical field is carried out from the incision line to the periphery; if there is a purulent wound or fistula on the operating field, then in the opposite direction. The fistulous opening or wound is closed with a napkin or glued with glue. The treated area of ​​the skin should significantly exceed the size of the surgical field. After treatment, the surgical field is covered with sterile sheets, which are strengthened with special clamps.

When moving from one stage of the operation to another, linen and napkins covering the surgical field are changed and the skin is re-lubricated with iodine and alcohol. To prevent contamination of the surgical field during the operation, the skin after treatment can be covered with a moisture-proof film (for example, with BF-6 glue). The incision and suturing of the wound is carried out through this film.

Illumination of the surgical field is carried out with shadowless lamps in such a way that the light is uniform and does not distort the true color of the tissues. For enhanced illumination of certain areas of the surgical field, side, portable or forehead lamps are used. Bactericidal lamps can be mounted in fixtures.

Preliminary preparation of the site of the proposed surgical incision (surgical field) begins on the eve of the operation and includes a general hygienic bath, a change of linen. On the day of the operation, the hair is shaved in a dry way directly at the site of the surgical access, then the skin is wiped with alcohol.

Before surgery on the operating table, the operation field is widely lubricated with a 5% alcohol solution of iodine. The operation site itself is isolated with sterile linen and again lubricated with a 5% alcohol solution of iodine. Before and after suturing the skin, it is treated with the same alcohol solution. This method is known as the Grossikh-Filonchikov method. For processing the surgical field, iodine preparations are also used, for example, iodine + potassium iodide, povidone-iodine; apply them according to the same method as the iodine solution.

In case of skin intolerance to iodine in adult patients and in children, the treatment of the surgical field is carried out with a 1% alcohol solution of brilliant green (Bakkal's method).

To treat the surgical field, use a 0.5% alcohol solution of chlorhexidine, as well as to treat the surgeon's hands before surgery.

In case of an emergency operation, the preparation of the surgical field consists in shaving off the hair, treating the skin with 0.5% ammonia solution, and then using one of the methods described above.

Prevention of implantation infection of wounds

Under implantation understand the introduction, implantation into the human body of various materials, tissues, organs, prostheses.

Infection by air or contact is caused by short-term exposure during the performance of certain surgical procedures (dressings, operations, therapeutic manipulations, diagnostic methods). When introducing microflora with implantable materials (implantation infection of the body), it is in the human body during the entire period of the implant. The latter, being a foreign body, supports the developing inflammatory process, and the treatment of such a complication will be unsuccessful until the rejection or removal of the implant (ligature, prosthesis, organ) occurs. It is possible from the very beginning (due to the formation of a connective tissue capsule) to isolate the microflora together with the implant with the formation of a “dormant” infection, which can manifest itself after a long time (months, years).

The materials implanted in the human body include suture material, metal clips, brackets, as well as prostheses of blood vessels, joints, canvas made of lavsan, nylon and other materials, human and animal tissues (vessels, bones, dura mater, skin), organs (kidney, liver, pancreas, etc.), drains, catheters, shunts, cava filters, vascular coils, etc.

All implants must be sterile. They are sterilized in various ways (depending on the type of material): γ-radiation, autoclaving, chemical, gas sterilization, boiling. Many prostheses are produced in special packages, factory-sterilized with γ-radiation.

The most important in the occurrence of implantation infection is suture material. There are more than 40 types of it. To connect tissues during the operation, threads of various origins, metal clips, brackets, and wire are used.

Both absorbable and non-absorbable sutures are used. Absorbable natural threads are catgut threads. Lengthening the resorption of catgut is achieved by impregnating the threads with metals (chrome-plated, silver catgut). Synthetic absorbable sutures made of Dexon, Vicryl, Occilon, etc. are used. non-absorbable natural threads include threads from natural silk, cotton, horsehair, flax, synthetic threads - threads from kapron, lavsan, dacron, nylon, fluorolone, etc.

Used to connect (stitch) tissues atraumatic suture material. It is a suture thread pressed into the needle, so when the threads are passed through the puncture channel, the tissues are not additionally injured.

The suture material must meet the following basic requirements:

1) have a smooth, even surface and do not cause additional tissue damage when punctured;

2) have good manipulation properties - slide well in tissues, be elastic (sufficient extensibility prevents compression and necrosis of tissues during their increasing edema);

3) be strong in the knot, not have hygroscopic properties and not swell;

4) be biologically compatible with living tissues and not have an allergic effect on the body;

5) the destruction of the threads must coincide with the timing of wound healing. Suppuration of wounds occurs much less frequently when using

suture materials with antimicrobial activity due to the antimicrobial preparations introduced into their structure (letilan-lavsan, fluorolon, acetate and other threads containing nitrofuran preparations, antibiotics, etc.). Synthetic threads containing antiseptic agents have all the advantages of suture materials as such and at the same time have an antibacterial effect.

The suture material is sterilized γ-radiation in factory conditions. Atraumatic suture material is produced and sterilized in a special package, conventional material - in ampoules. Atraumatic threads in the package and ampouled skeins of silk, catgut, nylon are stored at room temperature and used as needed. Metal suture material (wire, staples) is sterilized in an autoclave or boiling, linen or cotton threads, threads from lavsan, kapron - in an autoclave. Kapron, lavsan, linen, cotton can be sterilized according to the Kocher method. This is a forced method, and it provides for a preliminary thorough mechanical cleaning of the suture material with hot water and soap. The coils are washed in soapy water for 10 minutes, changing the water twice, then washed from the washing solution, dried with a sterile towel and wound on special glass coils, which are placed in jars with ground stoppers and poured with diethyl ether for 24 hours to degrease, after which they are transferred in jars with 70% alcohol for the same period. After extraction from alcohol, the silk is boiled for 10-20 minutes in a 1:1000 mercury dichloride solution and transferred to hermetically sealed jars with 96% alcohol. After 2 days, bacteriological control is carried out, with a negative result of sowing, the material is ready for use. Synthetic threads can be sterilized by boiling for 30 minutes.

Sterilization of catgut. In the factory, catgut is sterilized with γ-rays, mainly these threads are used in surgery. However, it is possible to sterilize catgut in a hospital environment, when it is not possible to use the material sterilized in the factory. Chemical sterilization of catgut provides for preliminary degreasing, for which the threads of catgut rolled into rings are placed in hermetically sealed jars with diethyl ether for 24 hours. according to Claudius diethyl ether is drained from the jar, catgut rings are poured for 10 days with Lugol's aqueous solution (pure iodine - 10 g, potassium iodide - 20 g, distilled water - up to 1000 ml), then Lugol's solution is replaced with fresh one and catgut is left in it for another 10 days . After that, Lugol's solution is replaced with 96% alcohol. After 4-6 days, they are sown for sterility.

Gubarev's method provides for sterilization of catgut with Lugol's alcohol solution (pure iodine and potassium iodide - 10 g each, 96% ethanol solution - up to 1000 ml). After degreasing, diethyl ether is drained and the catgut is poured with Lugol's solution for 10 days, after replacing the solution with a new catgut, the catgut is left in it for another 10 days. After bacteriological control, with favorable results, the use of the material is allowed.

Sterilization of prostheses, structures, stitching materials. The method of sterilization in a hospital environment is determined by the type of material from which the implant is made. So, metal structures (paper clips, brackets, wire, plates, pins, nails, screws, screws, knitting needles) are sterilized at high temperature in a dry-heat cabinet, autoclave, boiling (as non-cutting surgical instruments). Complex prostheses, consisting of metal, plastics (heart valves, joints), are sterilized using chemical antiseptic agents (for example, in chlorhexidine solution) or in gas sterilizers.

Prevention of implantation infection during organ and tissue transplantation involves taking organs under sterile conditions, i.e. operating theaters close to work. At the same time, careful observance of asepsis provides for the preparation of the hands and clothes of surgeons, sterile surgical underwear, processing of the surgical field, sterilization of instruments, etc. The organ removed under sterile conditions (after washing it with a sterile solution, and, if necessary, washing the vessels from blood and ducts from biological fluids), is placed in a special sterile sealed container lined with ice and delivered to the transplantation site.

Prostheses made of lavsan, capron and other synthetic materials (vessels, heart valves, a mesh to strengthen the abdominal wall during hernia repair, etc.) are sterilized by boiling or placing them in antiseptic solutions. Prostheses sterilized in an antiseptic solution should be thoroughly rinsed with a sterile isotonic sodium chloride solution before implanting them into the human body.

Preliminary preparation of the site of the proposed incision (surgical field) begins on the eve of the operation and includes a general hygienic bath, shower, change of linen, dry shaving of hair directly at the site of surgical access (for planned operations, not earlier than 1-2 hours before surgery, in order to avoid infection of possible excoriations and abrasions by hospital strains of pathogenic microorganisms). After shaving the hair, the skin is wiped with a 70% alcohol solution.

The most common way to process the surgical field is the classic Filonchikov's method (1904) - Grossikh (1908). Currently, instead of the 5% alcohol solution of iodine proposed in the classical version, according to order No. 720, the surgical field is treated with a 1% solution of iodonate or iodopyrone. It is also possible to use a 0.5% alcohol solution of chlorhexidine bigluconate in the same sequence.

Methodology. Before surgery on the operating table operas. the field is widely lubricated with 1% iodonate solution, applying the first smear in the area of ​​the proposed incision (stage I). The immediate site of the operation is isolated with sterile linen and again lubricated with 1% iodonate solution (stage 2). When the patient is on his back, it is necessary to ensure that the iodine solution does not flow into the skin folds (inguinal, axillary) - wash off with alcohol. When positioned on the side, the skin is treated from above to remove streaks. Local anesthesia or an incision under anesthesia is performed. The edges of the surgical wound are delimited with napkins or special protectors that are glued to the skin. The walls of the wound are delimited with napkins to prevent infection. If it is necessary to open a hollow organ, an additional delimitation is made by wrapping it with napkins. Perform an operation.

At the end of the operation, before applying (stage III) and after suturing the skin (stage IV), it is again treated with 1% iodonate solution. In case of iodine intolerance, the treatment of the surgical field in adults and children is carried out with a 1% alcohol solution of brilliant green (method Bakkala)

0one from modern methods treatment of the surgical field - the use of domestic antiseptic "SEPTOTSIDA-K".

The contaminated surface of the skin of the surgical field is cleaned with soap and water or an antiseptic, after which it is dried with a sterile napkin and treated twice with a napkin moistened with 5 ml of the above antiseptic with a 30 second interval for 5 minutes. At the end of the operation, before and after suturing the skin, the wound is lubricated with an antiseptic for 30 seconds.

Abroad, to isolate the operating field is widely used special sterile protective films, securely fixed to the surface of the skin using a special adhesive base.

An operation is a mechanical effect on the human body with the help of special equipment and instruments in order to restore health to it. Therefore, it is necessary to prepare both the patient and the team of doctors for the operation. All activities that are carried out between the admission of a person to a surgical hospital and the operation itself are called preoperative preparation.

The time that the patient spends under observation before surgical treatment is divided into two periods:

  • diagnostic;
  • period of preoperative preparation.

Their duration depends on the urgency of the operation, chronic diseases, complications, the severity of the patient's condition, and the skills of the medical staff.

Training standard

Preparation for surgery is necessary in any case, even if the patient is urgent (i.e. emergency). It provides for the following actions:

  1. Twelve hours before the operation and in the morning before it, the patient should be washed. Further processing of the surgical field depends on how clean the patient is.
  2. Before the operation under general anesthesia, you need to do a cleansing enema or drink a laxative. This is necessary so that after the introduction of muscle relaxants and relaxation of the smooth muscles of the intestine, there is no sterilization of the operating room.
  3. On the day of the procedure, you can not eat or drink anything.
  4. More than half an hour before the operation, it is necessary to call an anesthesiologist for sedation.
  5. The main task to be performed at this stage is to maximally protect both the patient and surgeons from surprises during the operation.

Psychological preparation

A lot depends on how trusting relationships have developed between the patient, the surgeon and the anesthetist. Therefore, it is extremely important for the doctor to show sensitivity, care and understanding to the patient's situation, give him time, explain the essence of the intervention, its stages, tell what and how will take place in the operating room. This will help to calm the patient, give him confidence in the qualifications of the doctor and the professionalism of his team.

The surgeon needs to be able to persuade the patient to the most correct decision, because, having a lot of disparate information, it is difficult for an unprepared person to understand it. On the day of the operation, the doctor should go to his ward in the morning, find out his state of health, mood. Calm again if necessary.

Features of the preparation of children and the elderly

Since the child's body is still growing and developing, and many systems are not fully formed, they need a special approach. First of all, it is necessary to find out the exact age and weight of a small patient (for calculating medicines). Forbid parents to feed their child six hours before surgery. Cleanse his intestines with an enema or mild laxative, and in case of stomach surgery, lavage is recommended. The surgeon must work closely with the pediatrician to build a relationship with the child and postoperative care.

For the elderly, the surgeon invites the therapist to consult. And already under his control prepares the patient for intervention. It is necessary to take a complete history, make an ECG and a chest x-ray. Anesthesiologists need to take into account the peculiarities of senile physiology and calculate the dose of the drug not only for weight, but also to make allowances for the deterioration of all body systems. The surgeon must remember that, in addition to the main one, the patient also has comorbidities that require attention. As with children, it is difficult to build trusting relationships with older people.

Work algorithm

When the patient is transported to the operating room, the sister begins to conjure over him. It should prepare a workplace for the surgeon. And it always works according to the same plan.

The processing of the surgical field, the algorithm of which every nurse should know, begins with the preparation of tools:

  • sterile dressing material;
  • forceps;
  • caps and clamps;
  • sterile operating linen, masks, gloves;
  • preparations of an antiseptic agent and containers for disinfection;

Before the processing of the surgical field begins, the surgical nurse must wash her hands according to the rules of asepsis and antisepsis, put on sterile underwear and transfer all the necessary instruments to the operating table.

Treatment of the patient

Methods for processing the surgical field may differ depending on the type of surgical intervention, but the most common option is according to Filonchikov-Grossich. It includes four obligatory lubrication of the patient's skin with an antiseptic solution:

  • before covering with sterile linen;
  • after the imposition of surgical linen;
  • before suturing;
  • after suturing.

Antiseptics

Antiseptics for processing the surgical field may be different. But most often it is iodonate at 5% concentration, diluted five times. Processing of the surgical field can be carried out even on dirty skin. The effect of the drug should last at least a minute.

The next remedy is iodopyrone. It is a mixture of iodine and a synthetic antibacterial drug. Compared to ordinary iodine, it is easy to store, water-soluble, odorless and allergy-free.

And the last drug is gibitan. It is already produced in the form of a solution, but before the operation it is diluted another forty times. The processing of the surgical field lasts longer, since the exposure of the antiseptic should last more than three minutes, and it must be repeated twice.

Final processing step

But the treatment of the surgical field does not end with the use of antiseptics. The algorithm should be logically completed by cleaning your workplace. To do this, the nurse places all used tools and material in containers with disinfectant solutions. Then he takes off rubber gloves and washes his hands under running water, according to the rules of asepsis and antisepsis.

The patient is ready for the operation, it remains only to wait for the surgeon and the anesthesiologist - and you can start.

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