Aseptic Technique Terms of interest Angiography- imaging of blood vessels following introduction of contrast Arthrography- image of joint after injection Auscultation- listening for sounds within body Foley- indwelling catheter Lithotomy- `having a baby position’ VCUG- voiding cysto urethrogram Aseptic= sterile Why aseptic (sterile) technique? Purpose of aseptic technique is to reduce the # of harmful microorganisms **(box 15-1- basic principles) Surgical- protection against infection at surgery Medical- removal of infected material Radiologic procedures: Angiography Arthrography Hysterosalpingography Radiography in the OR Myelogram, angiogram, biopsy trays: Include- injectable local anesthetic, syringes, needles, sterile drape, collection tubes Sterile Draping Confirm package is sterile- not expired, open, dry Procedure: Place package- center surface top flap set to open away Pinch 1st flap on outside of wrapper – open and lay flat Right hand open RT flap Left hand open Lt flap Grasp turned down corner and pull the 4th flap open Never reach over the package- always reach around Drop contents onto the sterile field-6 inches above- angle ensure package wrapping does not touch sterile field. Open solutions and pour into sterile containers- confirm name, strength and expiration date- only sterile if used immediatelyonce set down, no longer sterile. Surgical Scrubbing Purpose- 1) remove debris, transient microorganisms from hands, nails and forearms 2) reduce resident microbial count 3) inhibit rapid rebound growth of microorganisms. Two types- number stroke and timed scrub 1) Number stroke- 20X -above elbow to mid forearm, 20X mid forearm to hand, 20x hand and another 20 for nails. 2) Timed scrub- remove all jewelry, include watch, wash hands and arms with antiseptic soap, clean nails with nail brush, scrub sides/between ea finger and front/back of hand for 2 min, scrub arm with hands higher than elbowsea side of arm washed to 3” above elbow for 1 minrepeat on other extremity- keep hands above elbowshold hands up and back into OR room. Sterile gowning Self gowning- 12 inches from sterile area, pick up gown at folded edges, lift up, step back and with nothing near you- grasp the gown at neck band, hold arms length, unfold and shake, face inside of gown and hold it by shoulder seems, raise arms and slip on- gown adjusted by unsterile worker or “spin you” Gowning another- sterile person picks up gown by neck, hold arms length, all it to unfold, gown held at shoulder seems with outside facing sterile person, sterile gloves protected by placing hands under back panel at shoulder, arms slipped into sleeves in downward motion, another person pulls gown over the arms and shoulders and fastens at waistband or “spins them.” Sterile Gloving Self gloving- after gowning- glove package open and facing the person- Rt glove on rt side Closed- hands/fingers covered by gown- glove of dom hand picked up nondom hand, palm of glove and fingers face elbow, bottom part of cuff grasped with fingers of dom hand- non dom hand pull over dom, gloved hand picks up other, ungloved hand hold cuff though sterile gown, gloved hand pulls other hand in. *Open- hands though sleeves- cuff of dom hand glove picked up with non dom, do not touch outside surface of glove- dom hand slipped into glove, pull on with non dom, gloved (sterile) dom hand picks up other glove reaching under cuff- touch only outside surface with sterile hand, glove pulled onto nondom hand w/o touching inside of glove. Glove another- sterile person hold glove from sides- push hand down into gove and repeat Sterile Procedures Chest tube- remove fluid, blood and air from pleural cavity- reinflate collapsed lungs (atelectasis) and alleviating (pneumothorax), also thoracotomy and open heart surgery. 3 compartments in chest drainage system st collection chamber- collect fluid leaving lung 1 nd water seal chamber- water- prevent air from entering 2 chest cavity by the tube rd suction control- water and unwanted fluid/air from pleural 3 cavity Remember to keep the drainage box lower than the pt’s chest if pt comes to the dept or when portable do not knock it over or roll machine over tubes Sterile procedures contd. Urinary catheters (Foley)- retention balloon Insertion of tube into bladder using aseptic tech Range from 8-18 French- (2.6- 5.9 mm)- larger better Urine bag must be kept below the bladder- prevent reflux Do not empty drainage bag w/out nurse- volume measure Insert cath for vcug- sterile cath, sterile colelcting bag, syringe, sterile water, cath kit- sterile gloves, antiseptic soln, sterile cotton, lubricant, container for urine, sterile drape Place females in lithotomy- male supine Insert cath about ½ inch for women- see urine flowing and men 8 inches. IV Lines Called central venous and arterial lines Used to introduce meds, IV fluids, measure pressure Swan-Ganz- measure pumping of hrt Hickman, Broviac- triple lumen- other types Gloves, mask, gown- pt in Trendelenburg when placing the line Often chest and KUB films are taken for line placement Portable OR/ C-Arm/Neonates (1) OR- sterile corridor- area btw pt drape and instrument table- must only go though if sterile Keep a good distance around anything draped Careful moving portable machine into OR- keep in sight sterile fields, wires, tubes, and people. (2) C Arm- drape c arm with snap cover- tension band snapped over II and C- physician can touch the c arm. (3) Neonates- shielding- cross infection- need to keep aseptic as possible- small lead shilds can contaminate a crib- also can use a shadow- hanging piece of lead in the beam- less used or reliable.