Chapter 025 ppt

Chapter 25

Minor Office Surgery

Today's Medical Assistant

2nd edition

INTRODUCTION TO MINOR OFFICE SURGERY

Surgery: Branch of medicine that deals with operative and manual procedures

Correction of deformities and defects

Repair of injuries

Diagnosis and treatment of certain diseases

Minor Office surgery: Surgical procedure that is restricted to:

The management of minor conditions

Does not require the use of general anesthesia

Characteristics of minor surgical procedures:

Performed in an ambulatory healthcare facility (e.g., physician’s office, clinic)

Performed in a short period of time

Less than 1 hour

Characteristics of minor surgical procedures:

Requires either:

Local anesthesia

Topical anesthesia

No anesthesia

Can be performed with a minimum amount of discomfort to the patient

Does not pose a major risk to

Function of an organ

Body parts

Minor office surgery performed in a medical office

Insertion of sutures

Sebaceous cyst removal

Incision and drainage of infections

Mole removal

Needle biopsy

Cervical biopsy

Ingrown toenail removal

Physician explains nature of surgical procedure and risks to patient

Offers to answer questions

MA responsible for

Explaining patient preparation

Obtaining patient's signature on consent to treatment form

Consent to Treatment Form

MA responsible for

Additional responsibilities

Preparing treatment room

Preparing patient

Preparing MOS tray

Assisting the physician during the procedure

Administering postoperative care to the patient

Cleaning the treatment room

Patient positioned and draped according to procedure

Skin is prepared as specified by the physician

Shave skin around operative site

Cleanse skin

Apply antiseptic: reduces number of microorganisms

Prepare minor office surgery tray using sterile technique

Instruments and supplies on tray vary based on:

Type of surgery

Physician preference

During the surgery:

Assist the physician

Lend support to the patient

Remain with patient after surgery

Safety precaution

To explain postoperative instructions

Remove and properly care for used instruments/supplies

Clean the treatment room

SURGICAL ASEPSIS

Also known as sterile technique

Refers to practices that keep objects and areas sterile or free from all

living microorganisms and spores

Protects patient from pathogens that may enter and cause disease

SURGICAL ASEPSIS

Surgical asepsis employed when

Caring for broken skin (open wound)

Skin surface is penetrated (surgical incision for a mole removal)

Administration of an injection

Body cavity is entered that is normally sterile

Example: insertion of a urinary catheter

SURGICAL ASEPSIS

Sterility of instruments and supplies is achieved:

Through use of disposable sterile items

Sterilizing reusable articles

Sterile object that touches any nonsterile object is considered

contaminated

Must not use

If in doubt about sterility of article

Do not use it – replace it with a sterile article

SURGICAL ASEPSIS

Sanitizing hands renders them medically aseptic

Sanitize hands before and after a surgical procedure

Sterile gloves must be worn when picking up or transferring sterile articles

SURGICAL ASEPSIS

Guidelines to Maintain Surgical Asepsis

Prevent sterile packages from becoming wet

Wet pack draws microorganisms into pack resulting in contamination

1-inch border around sterile field is considered contaminated

SURGICAL ASEPSIS

Always face the sterile field

If you must leave: cover the sterile field with a sterile towel

Hold all sterile articles above waist level

If out of sight: might become contaminated

Place all sterile items in center of sterile field

SURGICAL ASEPSIS

Do not spill water or solution on sterile field

Draws microorganisms up onto field from area beneath field, causing

contamination

Do not talk, cough, or sneeze over a sterile field

Water vapor from nose, mouth, and lungs contaminates sterile field

SURGICAL ASEPSIS

Do not reach over a sterile field

Dust or lint from clothes may fall onto the field

Unsterile clothing may accidentally touch the sterile field

Do not pass soiled dressings over the field

Always acknowledge if you contaminate the sterile field

Steps can be taken to regain sterility

INSTRUMENTS USED IN MINOR OFFICE SURGERY

Most instruments are made of stainless steel

MA must know:

Names of instruments

Proper care

Surgical Instruments

Named by one or more of the following:

Function (splinter forceps)

Design (mosquito hemostatic forceps)

Individual who developed the instrument (Kelly hemostatic forceps)

Part of an Instrument

SCALPELS

Small, straight surgical knife consisting of a handle and thin, sharp blade

Used to:

Make a surgical incision

Divide tissue with least possible trauma

SCALPELS

Disposable scalpel:

Nonslip plastic handle

Permanently attached steel blade

Individually packaged to maintain sterility

Reusable scalpel:

Reusable stainless steel handle

Disposable blade: individually packaged for sterility

SCALPELS

SCISSORS

Cutting instruments that have ring handles, straight or curved blades

s/s: both blade tips are sharp

b/b: both blade tips are blunt

b/s: one tip is blunt and the other sharp

Box lock: hinge joint where two parts come together

SCISSORS

Operating scissors

Straight delicate blades with sharp cutting edges

Used to cut through tissue

Blade tips available:

SCISSORS

Operating Scissors

SCISSORS

Suture scissors

Used to remove sutures

Hook on tip: for getting under suture

Blunt end: prevents puncturing of tissues

SCISSORS

Suture Scissors

SCISSORS

Bandage scissors

Inserted beneath a dressing or bandage to cut it for removal

Flat blunt prow: protects from puncturing patient's skin

SCISSORS

Bandage Scissors

SCISSORS

Dissecting scissors

Thick blades with a fine cutting edge

Used to divide tissue

Available with straight or curved blades

Both blades are blunt

SCISSORS

Dissecting Scissors

FORCEPS

Instruments for grasping, squeezing, holding tissue or an item (e.g., sterile

gauze)

Two prongs and a spring handle: provide proper tension for grasping

object (tissue, foreign object, sterile gauze)

Examples: thumb forceps, tissue forceps, splinter forceps, dressing forceps

FORCEPS

Serrations: Sawlike teeth that grasp tissue and prevent it from slipping out

of the jaws of the instrument

Thumb forceps and hemostatic forceps

Ratchets: Toothed clasps on handle (hemostatic forceps)

Holds tips securely together

Allows closure at three or more positions

FORCEPS

Thumb forceps

Serrated tips

Used to pick up tissue or hold tissue between adjacent surfaces

FORCEPS

Thumb Forceps

FORCEPS

Tissue forceps

Teeth: Used to grasp tissue and prevent them from slipping

Identified by number of opposing teeth on each jaw

Example: 2 x 3

Teeth should approximate tightly when instrument is closed

May be referred to as: “rat-toothed” forceps

Pointed projections resemble teeth of a rat

FORCEPS

Tissue Forceps

FORCEPS

Splinter forceps

Sharp Point that are useful in removing foreign objects from the tissues

(splinters)

FORCEPS

Dressing forceps

Application and removal of dressings

To hold or grasp sterile gauze or sutures during MOS

Blunt ends with coarse cross-striations: for grasping

FORCEPS

Hemostatic forceps

Serrated tips, ratchets, ring handles, and box locks

Available with straight or curved blades

Used to clamp off blood vessels and establish hemostasis

Until vessels can be closed with sutures

Ratchets: when closed, keep hemostat tightly shut and locked in place

FORCEPS

Hemostatic forceps

Ring handles:

Allow for secure grasp of hemostat

Used to select desired ratchet position

Serated blades

Should mesh together smoothly when hemostat is closed

If they spring back open: instrument is in need of repair

Serrations: Prevent blood vessels from slipping out of jaws of the hemostat

FORCEPS

Mosquito hemostatic forceps

Small, fine tips

Smaller and more delicate than standard (Kelly) hemostatic forceps

Hold delicate tissue

Clamp off smaller blood vessels

Standard hemostatic forceps: Used to grasp and compress larger blood

vessels

FORCEPS

Hemostatic Forceps

FORCEPS

Sponge forceps

Ring handles, ratchets, box locks

Large serrated rings on the tips for holding sponges

A sponge is a porous, absorbent pad used to:

Absorb fluids

Apply medications

Cleanse an area

FORCEPS

Sponge Forceps

MISCELLANEOUS INSTRUMENTS

Needle holder

Serrated tips, ring handles, ratchets, and box locks

Used to firmly grasp a curved needle

To insert through skin flaps of an incision

Needle holder

Serrated tips: Designed to hold a curved needle securely without damaging it

May be referred to as a “driver”

Drives the curved needle through the skin

Retractors

Used to hold tissue aside

To improve exposure of operative area

CARE OF SURGICAL INSTRUMENTS

Surgical instruments will last for many years if handled and maintained

properly

Care given to an instrument depends on the parts making up the

instrument

Examples: box lock, ratchet, serrations

MA works with instruments when:

Setting up a sterile tray

Performing procedures (e.g., suture removal)

Cleaning up after MOS

Sanitizing and sterilizing instruments

Guidelines

Handle instruments carefully

Dropping on floor or throwing into a basin: could damage them

Guidelines

Do not pile in a heap

Become entangled – could be damaged when separated

Keep sharp instruments separate from rest of instruments

Prevents damage or dulling the cutting edge

Guidelines

Keep instruments with ratchets in open position when not in use

Prolongs proper functioning of ratchet

Rinse blood and body secretions off as soon as possible

Prevents them from drying and hardening on instrument

Guidelines

Always use instrument for intended purpose

Substituting instruments could damage an instrument

Sanitize and sterilize instruments using proper technique

COMMERCIALLY PREPARED STERILE PACKAGES

Frequently used in medical office

May contain

One article (sterile dressing)

Complete sterile setup (suture removal)

Directions for opening package stated on outside of package

Carefully follow directions to prevent contamination of sterile contents

Guidelines

Do not pile in a heap

Become entangled – could be damaged when separated

Keep sharp instruments separate from rest of instruments

Prevents damage or dulling the cutting edge

To open a peel-apart package

Peel-pack: has edge with two flaps that can be pulled apart:

Grasp each nonsterile flap between bent index finger and extended thumb

Roll hands outward to pull apart

Inside of wrapper and contents are sterile

Must not be touched with bare hands

Opening a Peel-Apart Package

Contents of peel-apart package can be placed on sterile field by

Stepping back

Prevents wrapper and MA’s hands from crossing over the sterile field

Ejecting or "flipping" contents on center of the field

Contents of peel-apart package can be placed on sterile field by

Removing contents with a sterile gloved hand

Used when physician needs additional supplies during MOS

MA opens pack: physician removes contents with gloved hand

Inside of peel-apart package can be used as sterile field

Open peel-apart package completely

Lay flat on a clean dry surface

WOUNDS

Wound: Break in continuity of an external or internal surface caused by

physical means

Can be

Accidental

Intentional: physician makes an incision during MOS

WOUNDS

Closed wound: Injury to underlying tissues without break in skin surface

or mucous membrane (contusion)

WOUNDS

Closed wound: Injury to underlying tissues without break in skin surface

or mucous membrane (contusion)

Contusion: Tissues under skin are injured

Often caused by blunt object

Commonly occurs with fractures, sprains, strains, black eyes

Blood vessels: rupture; blood seeps into tissues – results in bluish

discoloration of skin; color turns greenish-yellow after several days

WOUNDS

Contusion

WOUNDS

Open wounds: Break in skin surface or mucous membrane that exposes

underlying tissue

Incision: Clean smooth cut caused by a sharp instrument (e.g., knife, razor,

glass)

Deep incision: accompanied by profuse bleeding; may damage muscles,

tendons, nerves

WOUNDS

underlying tissue

Laceration: Tissues are torn apart, leaving ragged and irregular edges

Can be caused by: dull knife, large objects driven into skin, heavy

machinery)

Deep lacerations: result in profuse bleeding; scar often develops

WOUNDS

Laceration

WOUNDS

underlying tissue

Puncture: Wound made by sharp pointed object piercing skin layers (e.g.,

nail, needle, splinter, knife, bullet, animal bite)

Very small opening; bleeding is usually minor

Tetanus bacteria: grow best in warm anaerobic environment such as a

puncture

May need a tetanus booster

WOUNDS

Puncture

WOUNDS

underlying tissue

Abrasion (scrape): Outer layers of skin are scraped or rubbed off (e.g., falling

on gravel and floors)

Blood oozes from ruptured capillaries

Results in skinned knees and elbows

WOUND HEALING

Skin: protective barrier for body; considered first line of defense

When skin is broken: easy for microorganisms to enter and cause infection

PHASE 1

Inflammatory Phase

Begins as soon as body is injured

PHASE 1

Lasts 3 to 4 days

Fibrin network forms

Results in blood clot: "plugs" up opening and stops flow of blood

Blood clot becomes scab

PHASE 1

Phase 1: Inflammatory Phase

PHASE 1

Inflammatory process occurs

Inflammation: Protective response of the body to trauma and entrance of

foreign matter (microorganisms)

Blood supply increases: brings WBCs and nutrients to the site to assist in

the healing process

PHASE 1 Inflammatory process occurs

Four local signs of inflammation

Redness

Swelling

Warmth

Purpose of inflammation: to destroy invading microorganisms and remove

damaged tissue debris so proper healing can occur

PHASE 2

Granulation Phase

Lasts 4 to 20 days

Fibroblasts migrate to wound: begin to synthesize collagen

Collagen: White protein that provides strength to wound

PHASE 2

Fibroblasts migrate to wound: begin to synthesize collagen

As amount of collagen increases:

Wound becomes stronger

Decreases chance that wound will open

Growth of new capillaries: provides damaged tissue with blood supply

Tissue becomes translucent red color: known as granulation tissue (fragile,

shiny, bleeds easily)

PHASE 2

Phase 2: Granulation Phase

PHASE 3

Maturation Phase

Can last for up to 2 years

Collagen continues to be synthesized

Granulation tissue hardens to white scar tissue

Scar tissue is not true skin: does not contain nerves or have blood supply

PHASE 3

Phase 3: Maturation Phase

WOUND HEALING

Always inspect wound when providing wound care

Observe for

Signs of inflammation

Amount of healing

Chart in patient's record

WOUND DRAINAGE

Exudate (drainage): Material (fluid and cells) that has escaped from blood

vessel during inflammatory process

Inspect wound for drainage and chart in patient's record

WOUND DRAINAGE

Types of Exudates:

Serous exudate: consists of serum

Clear and watery

Example: fluid in blister from a burn

WOUND DRAINAGE

Types of Exudates:

Sanguineous exudate: red and consists of RBCs

Results when capillaries are damaged and blood escapes

Seen with open wounds

Color – bright red: fresh bleeding; dark red: older bleeding

WOUND DRAINAGE

Types of Exudates:

Purulent exudate: contains pus

Pus: consists of leukocytes, dead tissue debris, dead and living bacteria

Usually thick and has unpleasant odor

White in color: may acquire tinges of pink, green, or yellow (depending on

infecting organism)

Suppuration: Process of pus formation

WOUND DRAINAGE

Types of Exudates:

Mixed exudates

Serosanguineous exudate: clear and blood-tinged drainage

Purosanguineous exudate: pus and blood – often found in new wound

that is infected

STERILE DRESSING CHANGE

Surgical asepsis must be maintained when applying a dry sterile dressing

(DSD) to an open wound

Must prevent infection in clean wounds and decrease infection in infected

wounds

Function of a sterile dressing

Protect the wound from contamination and trauma

Absorb drainage

Restrict motion

Dressing material used (size, type, amount) depends on:

Size and location of wound

Amount of drainage

Sterile gauze pads used in medical office

Come in a variety of sizes

4 x 4 (most frequently used)

Have tendency to stick to the wound

Nonadherent pads

Surface impregnated with agents that prevent dressing from sticking to wound

Example: Telfa pads (shiny side placed next to skin)

Often used for burns

SUTURES

10.Explain the method used to measure the

diameter of suturing material.

11.Describe the two types of sutures (absorbable

and nonabsorbable), and give examples of their

12.Categorize suturing needles according to type of

point and shape.

Lesson 25.2

SUTURES

Used to

Close a surgical incision

Repair accidental wound

SUTURES

Purpose of sutures

Approximate (bring together) edges of wound with surgical stitches

Holds in place until proper healing occurs – so that wound can withstand

ordinary stress; no longer needs support from sutures

SUTURES

Purpose of sutures

Protect wound from contamination

Minimize amount of scar formation

Local anesthetic: to numb area before insertion of sutures

TYPES OF SUTURES

Absorbable sutures

Made from surgical gut or synthetic materials that are gradually digested and

absorbed by the body

Ranges from 7 days to several months after insertion depending on type of

tissue being sutured and size and type of absorbable suture

TYPES OF SUTURES

Absorbable sutures

Surgical gut: made from sheep or cow intestine (Surgigut)

Gradually digested by tissue enzymes and absorbed by body – 7–21 days

after insertion

Plain surgical gut: rapid absorption time

Chrome surgical gut: slower absorption time

TYPES OF SUTURES

Absorbable sutures

Synthetic materials

Vicryl – mainly used in hospital setting during surgery

TYPES OF SUTURES

Nonabsorbable sutures

Not absorbed by body

Sutures either remain in skin permanently or are removed

Used to suture skin

Frequently performed in medical office

Types: silk, nylon, polyester, polypropylene, polybutester, stainless steel,

surgical skin staples

TYPES OF SUTURES

Nonabsorbable Sutures

SUTURE SIZE AND PACKAGING

Measured by gauge: refers to diameter of the suture

Size ranges from numbers below 0 (pronounced "aught") to numbers

above 0

Size increases with numbers above 0 and decreases with numbers below 0

Example:

7-0: very fine sutures

5: heavy sutures

Nonabsorbable sutures with smaller gauge (5-0 to 6-0)

Leave less scaring

Used for delicate tissue (face, neck)

Nonabsorbable heavy sutures

Used for firmer tissue (chest, abdomen)

Suture box

Holds individual packages of sutures

Stamped with an expiration date

Check before removing a suture package

Suture package

Outer peel-apart package

Sterile inner package

Suture package

Labeled with

Type of suture material (e.g., surgical silk)

Size of suture (e.g., 4-0)

Length of suture (e.g., 18 inches)

Date of manufacture

Expiration date of the suture

Type and size of suture used

Based on nature and location of tissue sutured

Physician's preference

SUTURE NEEDLES

Type of point

Cutting needle: sharp point

Used for firm tissue (e.g., skin)

Noncutting needle: round point

Used for tissues that offer little resistance (e.g., intestines, muscle)

SUTURE NEEDLES

Cutting Needles

SUTURE NEEDLES

Shape of needle:

Curved needle: can dip in and out of tissue

Needle holder must be used

Straight needle: used when tissue can be displaced to permit needle to be

pushed and pulled through tissue

Does not require needle holder

SUTURE NEEDLES

Design of needle

Eyed needle: has eye through which suture is inserted

Swaged needle: suture and needle are one continuous unit. Advantages:

Suture does not slip off needle

Tissue trauma is reduced (only one strand of suture is pulled through tissue)

SUTURE NEEDLES

INSERTION OF SUTURES

MA responsible for:

Suture tray setup

Assisting the physician

Physician designates: size and type of suture and needle required

Sutures added to field by:

Flipping onto field

Placing on field with sterile gloved hand

Transferring Sutures

SUTURE INSERTION SETUP

Items placed on side tray

Clean disposable gloves

Antiseptic solution

Surgical scrub brush

Antiseptic swabs

Items placed on side tray

Sterile gloves

Local anesthetic

Alcohol wipe to cleanse vial

Tetanus toxoid with needle and syringe

Suture Insertion Side Tray

Items on sterile field

Fenestrated drape

Syringe and needle

Hemostatic forceps

Thumb forceps

Items on sterile field

Tissue forceps

Dissecting scissors

Operating scissors

Needle holder

Sutures

Sterile 4 x 4 gauze

Suture Insertion Sterile Field

PROCEDURE: SUTURE INSERTION

Numb area with local anesthetic

Physician inserts sutures to:

Close surgical incision

Repair an accidental wound

Sterile dressing may be applied to operative site

POSTOPERATIVE INSTRUCTIONS: SUTURE

INSERTION

Keep dressing clean and dry

Contact medical office if infection occurs:

Excessive redness

Swelling

Discharge

Increase in pain

POSTOPERATIVE INSTRUCTIONS: SUTURE

INSERTION

Notify office if sutures become loose or break

Provide patient with written instructions on wound care

Instruct patient when to return for removal of sutures

SUTURE REMOVAL

When wound healed: no longer needs support of sutures

Length of time sutures remain in place depends on

Location of the sutures

Amount of healing that must occur

SUTURE REMOVAL

Face and neck

Have a good blood supply: area heals more rapidly

Sutures usually removed in 3 to 5 days

Chest, arms, legs, hands, and feet

Sutures usually removed in 7 to 10 days

SURGICAL SKIN STAPLES

Fastest method for closing long skin incisions

Trauma to tissue is reduced

Tissue does not have to be handled very much during insertion

Consist of stainless steel

Inserted into skin with a special skin stapler

Reusable and disposable available

Holds cartridge with a prescribed number and size of staples

Physician inserts staples

Tissue is first approximated with tissue forceps

Stapler held over the site

Staple inserted into the skin

Are easily removed with a special staple remover

MA is usually responsible for removing staples

Written or verbal order must be given by physician

ADHESIVE SKIN CLOSURES

Approximate the edges of a laceration or incision

Consist of sterile, hypoallergenic tape

Available in a variety of widths and lengths

Brand names: Steri-Strip; Proxi-Strip

Used when not much tension exists on skin edges

Applied transversely across line of incision

To approximate edges of wound

Advantages

Sutures and local anesthetic are not needed

Can be easily applied and removed

Lower incidence of wound infection compared with sutures

Results in less scarring than sutures

Disadvantages:

Less precision in bringing wound edges together

Cannot be used where adhesive has difficulty adhering to skin

Areas that harbor moisture – palms of hands; soles of feet; axilla

Hairy areas – scalp; chest of male patient

MA is frequently responsible for applying and removing

5 to 10 days after application: closures may spontaneously lift off

If removal is required: MA should follow proper procedure

What Would You Do? What Would You Not Do?

MEDICAL OFFICE SURGICAL PROCEDURES

13.Explain the purpose of and procedure for

each of the following minor surgical

operations: sebaceous cyst removal,

incision and drainage of a localized infection,

mole removal, needle biopsy, ingrown toenail

removal, colposcopy, cervical punch biopsy,

and cryosurgery.

14.Explain the principles underlying each step

in the minor office surgery procedures.

Lesson 25.3

TRAY SETUP

MA must:

Know instruments/supplies for each setup

Know type of assistance required by physician

Be able to work quickly and efficiently

Be able to anticipate physician's needs

TRAY SETUP

Instruments/supplies are set on a sterile field

Many offices maintain index cards indicating

Instruments/supplies for each MOS

Skin preparation

Patient position

Physician's glove size

Type of suture material

Preoperative and postoperative instructions

TRAY SETUP

Tray can be set up before or after preparing patient's skin

Do not allow sterile setup to become contaminated:

If must turn away or leave the room:

Place sterile towel over tray

TRAY SETUP

Covering Sterile Tray

METHODS USED TO SET UP A STERILE TRAY

Prepackaged sterile setups

Commonly used

Setup wrapped in

Disposable sterilization paper

Muslin (prepared through autoclave sterilization)

Labeled according to use (e.g., suture pack)

Prepackaged sterile setups

Contains most of the instruments/supplies required for the MOS

Package opened on flat surface (e.g., Mayo tray)

Inside of wrapper used as sterile field

Add additional articles if needed (e.g., 4 x 4 gauze, sutures)

Place articles on a sterile field individually

Place sterile towel over a tray

To prevent contamination: handle towel by corners; do not fan towel through

Flip articles onto field from peel-apart packages

SIDE TABLE

Articles that are not sterile must not be placed on the sterile field

Set on an adjacent table or counter

SIDE TABLE

Examples:

Surgical scrub brush

Vial of local anesthetic

Physician's sterile gloves (outside of wrapper is not sterile)

SKIN PREPARATION

Skin contains an abundance of microorganisms

If microorganisms enter operative site: could cause wound infection

Operative site must be cleaned and prepared

Remove as many microorganisms as possible

Reduces risk of surgical wound contamination

SKIN PREPARATION

Shaving the site

Hair supports growth of microorganisms

Skin may need to be shaved around operative site

Disposable shave preparation trays are available

Pull skin taut to prevent nicks

When shaved, rinse and dry area thoroughly

SKIN PREPARATION

Cleansing the site

Cleanse with antiseptic solution

Example: Betadine Surgical scrub)

SKIN PREPARATION

Cleansing the site

Scrub site with surgical scrub brush

Use circular motion: moving from inside outward

Rinse using gauze pads saturated with water

Blot dry with sterile gauze

SKIN PREPARATION

Cleansing the Site

SKIN PREPARATION

Antiseptic application

Decreases the number of microorganisms

Betadine commonly used

SKIN PREPARATION

Fenestrated drape applied

Opening placed directly over operative site

Provides sterile area around operative site

Decreases contamination of the surgical wound

SKIN PREPARATION

Fenestrated Drape

LOCAL ANESTHETIC

Most frequently used:

Lidocaine hydrochloride (Xylocaine)

LOCAL ANESTHETIC

Local anesthetic injected around the operative site (infiltration)

Produces a loss of sensation

Prevents patient from feeling pain during surgery

When first injected:

Causes brief burning sensation

Begins working: 5 to 15 minutes

LOCAL ANESTHETIC

Duration of action: 1 to 3 hours

Local anesthetic containing epinephrine may be ordered

Epinephrine: Prolongs effect of anesthetic and decreases rate of systemic

absorption

By constricting blood vessel at the operative site

Physician informs MA of type, strength, and amount of anesthetic required

Example: 1 ml of Xylocaine 2.0% with epinephrine

PREPARING THE ANESTHETIC

Cleanse vial with alcohol wipe

Methods to draw anesthetic into syringe

Method 1: MA draws anesthetic up and hands it to physician, who has not yet

applied sterile gloves

Physician injects anesthetic and then applies sterile gloves

Methods to draw anesthetic into syringe

Method 2: Physician draws up with sterile gloved hands

Show label of vial to physician

Hold vial while physician withdraws medication – vial is medically aseptic

and cannot be touched by physician's sterile gloved hands

If MA draws up: needle and syringe placed on side table

If physician draws up: needle and syringe placed on sterile field

ASSISTING THE PHYSICIAN

Type of assisting required based on

Type of surgery

Physician's preference

MA may apply sterile gloves and assist directly

Hand instrument to physician:

In a firm, confident manner – so it does not slip out of physician's hand

In its functional position (position in which it is to be used)

Handing Instrument

Add instruments and supplies to sterile field as needed

Tissue specimen may be obtained and sent to the laboratory

Specimen must be placed in appropriate-sized container

Holding Specimen Container

Label specimen container

Using two unique identifiers – information that clearly identifies a specific

patient: patient’s name; patient’s date of birth

Label specimen container

Computerized bar code label

Handwriting information on label, which includes patient’s name, date of

birth, date and time of collection, medical assistant’s initials

Complete biopsy request form

Biopsy Request Form

Once minor office surgery is completed

Physician may instruct MA to place dry sterile dressing over site

Protects wound from contamination or injury

Absorbs drainage

MA responsible for assisting patient and cleaning the examination room

SEBACEOUS CYST REMOVAL

Sebaceous cyst: Thin, closed sac or capsule located just under surface of

the skin

Forms when outlet of gland becomes obstructed

Contains sebum (secretions from the sebaceous gland)

Causes swelling

Lining of cyst

Consists of stretched sebaceous gland

Usually white or yellow in appearance

Size: ranges from ¼ inch to 2 inches in diameter

Movable, dome-shaped mass with a smooth surface

Filled with a thick, fatty-white, cheesy material with a foul odor

Can occur anywhere on body except: palms of hands or soles of feet

Most frequently occur: scalp, face, ears, neck, back, genital area

Usually slow-growing, painless, and nontender

May disappear on its own

Usually does not require surgical removal

Unless it becomes infected

Infected cyst: painful, tender, red, swollen

May have a grayish-white, foul-smelling discharge

Difficult to remove

Physician usually drains cyst and allows it to heal

Excises cyst at a later time

Other reasons for removing:

Cosmetic concerns

Reduce discomfort from a cyst causing irritation

Example: cyst located in the armpit

Surgical excision

Involves complete removal of cyst wall and contents

Usually benign

Not usually biopsied unless there is an unusual appearance

Sebaceous Cyst Removal Sterile Tray

PROCEDURE: SEBACEOUS CYST REMOVAL

Local anesthetic used to numb area

Incision is made using either:

Single cut down center

Oval cut on both sides of cyst

Cyst is removed

Sutures are inserted to close the incision

(If cyst is biopsied) Cyst is placed in specimen container and sent to

laboratory

Sterile dressing applied

Sebaceous Cyst Removal

POSTOPERATIVE INSTRUCTIONS: SEBACEOUS

CYST REMOVAL

Report signs that wound is infected

Fever, increased pain, swelling, redness, warmth, discharge

Notify office if sutures become loose or break

Provide patient with instructions on wound care

Instruct patient when to return for suture removal

CYST REMOVAL

SURGICAL INCISION AND DRAINAGE OF

LOCALIZED INFECTIONS

Abscess: Collection of pus in a cavity surrounded by inflamed tissue

Caused by pathogen that invades tissues

Usually by way of break in the skin

Serves as defense mechanism to keep infection localized

By walling off microorganisms – prevents them from spreading through the

Furuncle (boil): Localized staphylococcal infection that originates deep

within a hair follicle

Produces pain and itching

Skin becomes red

Turns white and necrotic over the top

Surrounded by erythema and induration

PROCEDURE: INCISION AND DRAINAGE

Local anesthetic administered

Scalpel used to make incision

Allows pus to drain out

Using gauze to absorb drainage

PROCEDURE: INCISION AND DRAINAGE

Gauze packing and rubber Penrose drain inserted into wound

Keeps edges of tissues apart

Facilitates drainage of exudate – exudate contains pathogens (avoid

contact with exudate during MOS)

Sterile dressing applied

Absorbs drainage

POSTOPERATIVE INSTRUCTIONS: INCISION AND

DRAINAGE

Report signs of infection

Fever, increased pain, swelling, redness, warmth, or discharge

Provide written instructions on wound care

Instruct patient when to return for removal of gauze packing or Penrose

MOLE REMOVAL

Mole (also known as a nevus)

Small growth on skin

MOLE REMOVAL

Congenital nevi: Moles with which an individual is born

Acquired nevi: Moles that develop over time

Majority of moles: appear during the first 20 years of life

Moles can occur anywhere on skin

Normal: Between 10 and 40 moles on body

Usually concentrated on back, chest, and arms

Usually benign

MOLE REMOVAL

Characteristics of moles

Range from brown to nearly black in color

Can also be pinkish flesh color to dark blue or even black

Dark-colored moles: consist of melanocytes – melanocytes: produce the

pigment melanin (responsible for dark color of moles)

MOLE REMOVAL

Characteristics of moles

Shape is usually round or oval

May be smooth or rough

Size: usually smaller than a pencil eraser

Can range from barely visible to quite a large area

May form a raised area on the skin or may be flat

May sometimes have hairs growing out of them

MOLE REMOVAL

Most common types of moles

Skin tags (acrochordon)

Small, painless, benign growths

Project from the skin – from a small narrow stalk: peduncle

Flesh colored or slightly darker

Often appear in groups

MOLE REMOVAL

Skin Tags

MOLE REMOVAL

Skin tags (acrochordon)

Range from 1 mm to 5 mm in size

Occur most often during and after middle-age in: overweight adults; adult

diabetics

Most frequently found where skin creases – eyelids, neck, armpits, upper

chest, groin

Occasionally becomes irritated due to shaving; rubbing from clothing or

jewelry

MOLE REMOVAL

Flat mole: Any dark spot or irregularity in the skin

Raised mole

Extends above skin

Variety of colors

Runs deeper than flat moles

Most moles are benign

MOLE REMOVAL

Dysplastic nevi:

Precancerous mole

Usually larger than normal moles

Irregular coloration and shape

MOLE REMOVAL

Dysplastic nevi:

Center may be raised and darkened

More likely than ordinary moles

To develop into malignant melanoma

To determine if malignant

Biopsied

Removed and biopsied

MOLE REMOVAL

Melanoma

Very serious type of skin cancer

Can sometimes develop within a mole

Most apt to be found

Upper backs of men

Lower legs of women

MOLE REMOVAL

Melanoma

Excessive sun exposure increases risk of developing certain melanomas

Especially severe blistering sunburns early in life

If discovered early

May be possible to completely remove melanoma – reduce the spread of

skin cancer; if left untreated: can be fatal

MOLE REMOVAL

Melanoma

Characteristics of melanoma:

Asymmetrical: one-half of the mole is different from the other half

MOLE REMOVAL

Melanoma

Irregular border: the edges of the mole are notched, uneven, or blurred;

rather than round or distinct

MOLE REMOVAL

Melanoma

Color varies from one area of the mole to another – various shades of tan,

brown, and black (and sometimes white, red, or blue) are present

MOLE REMOVAL

Melanoma

Diameter is larger than ¼ inch (6 mm) – about the size of a pencil eraser

Other signs: mole is painful, tender, itches, bleeds, oozes, or has a scaly

appearance

MOLE REMOVAL

Purpose for removing moles:

Cosmetic

Reduce irritation and discomfort

Mole that is rubbing against clothing

Mole in the way when shaving

Precancerous (dysplastic nevus)

Cancerous (melanoma)

MOLE REMOVAL

Methods used for mole removal:

Shave excision

Surgical excision

Laser surgery

Method used depends on type of mole being removed (size, shape, color,

location)

Biopsy may be taken prior to removal

PROCEDURE: MOLE SHAVE EXCISION

Most commonly used to remove protruding moles

Can also be used to remove skin tags

Not used to remove dysplastic nevi

Might leave mole cells beneath the surface of the skin

Could cause mole to grow back again

Sutures not generally required

After numbing effect of anesthetic wears off

Area will be tender and sore

As healing occurs: scab forms

Falls off within 1 to 2 weeks (leaves a red mark)

As healing progresses

Flat white mark usually remains (same size as mole)

Over time: fades to a barely visible scar

Physician numbs area with a local anesthetic

Physician uses a scalpel to shave off protruding part of mole

Until area is flush with level of surrounding skin

Electrocautery instrument used to:

Destroy tissue below the surface of mole

Control bleeding

Topical antibiotic applied to area

Sterile dressing applied to operative site

Mole shavings may be placed in a specimen container

Sent to laboratory for examination by a pathologist

PROCEDURE: SURGICAL MOLE EXCISION

Often used when physician suspects a mole is precancerous or cancerous

Scalpel used to remove the entire mole

As well as a border or surrounding skin and tissue

Scar commonly forms after procedure

Fades over time

Physician numbs area with local anesthetic

Physician uses scalpel to cut oval border surrounding mole

Removes mole with tissue forceps

Electrocautery instrument used to control bleeding

Physician inserts sutures to close incision

Sterile dressing applied to operative site

Mole placed in a specimen container

Sent to laboratory for examination by a pathologist

POSTOPERATIVE INSTRUCTIONS: SHAVE

EXCISION AND SURGICAL EXCISION

Report signs that the wound is infected

If sutures have been inserted

Notify medical office if they become loose or break

POSTOPERATIVE INSTRUCTIONS: SHAVE

EXCISION AND SURGICAL EXCISION

To reduce scarring, protect the area from the UV rays of the sun

Stay out of the sun

Use a good sunscreen (SPF of 15 or higher)

Instruct patient when to return for removal of sutures

LASER MOLE SURGERY

Used to remove small or flat moles

That are brown or black in color

Laser beam of light

Evaporates mole tissue

Seals off blood vessels

Avoids need for sutures

Not used on raised moles, deep moles, large moles, dysplastic nevi

Laser light cannot penetrate deeply enough

LASER MOLE SURGERY

Laser reduces amount of tissue destruction in surrounding tissue

Minimizes scarring

Does not require a local anesthetic

No pain involved during the procedure

Patient feels only a mild tingling when laser pulses

Scab forms

Usually falls off within 1 to 2 weeks

Area is usually reddish

Takes several weeks before normal skin color returns

LASER MOLE SURGERY

May require repeated treatments (1–3)

Before mole is completely removed

MA should instruct patient to:

Keep area clean and dry

Protect from area UV rays of sun

Stay out of sun

Use a good sunscreen (SPF of 15 or higher)

NEEDLE BIOPSY

Biopsy: Removal and examination of tissue from the living body

Examined under a microscope

Most often performed to determine if tumor is malignant or benign

May also be used as a diagnostic aid for other conditions (e.g., infection)

Tissue from deep within the body is obtained

By insertion of a biopsy needle through skin

NEEDLE BIOPSY

Advantage

Sample of tissue can be obtained

That may otherwise require a surgical operation

PROCEDURE: NEEDLE BIOPSY

Performed under local anesthetic

Incision not required

Patient does not have discomfort of an operative recovery

PROCEDURE: NEEDLE BIOPSY

Tissue specimen placed in a container and sent to laboratory

Examined by a pathologist

Small dressing placed over puncture site

Protects site and promotes healing

After procedure:

Patient is observed for complications

POSTOPERATIVE INSTRUCTIONS: NEEDLE BIOPSY

Bruise typically occurs at the biopsy site

Gradually disappears within several weeks

POSTOPERATIVE INSTRUCTIONS: NEEDLE BIOPSY

Rest and avoid strenuous activity and heavy lifting

For 2 days following procedure

Report signs that wound is infected

INGROWN TOENAIL REMOVAL

Occurs when toenail grows deeply into nail groove and penetrates

surrounding skin

Results in pain and discomfort

Caused by:

External pressure from tight shoes

Trauma

Improper nail trimming

Infection

Protruding nail: acts as a foreign body

Usually results in secondary infection

Mild cases

Small piece of cotton packing inserted under toenail

Raises edge away from tissue of nail groove

Ingrown Toenail Packing

Severe cases cause:

Swelling

Redness

Drainage

Severe/recurring cases

Part of nail is surgically removed

Relieves pain by decreasing the nail pressure on soft tissues

PROCEDURE: INGROWN TOENAIL

Foot soaked in tepid antibacterial solution for 10 to 15 minutes

Softens nail plate

Decreases possibility of infection

Patient placed in reclining position with foot supported

Toe is shaved to remove hair

Hair acts as a contaminant

Antiseptic applied

Local anesthetic administered

Wedge of nail removed with surgical toenail scissors

Antibiotic ointment applied

Sterile gauze dressing or strip of surgical tape applied

Protects operative site

Promotes healing

POSTOPERATIVE INSTRUCTIONS: INGROWN

TOENAIL

Elevate foot for 24 hours following procedure

Keep area clean and dry

Cleanse toe daily with warm water and gently dry area

TOENAIL

Apply an antibiotic ointment daily

Until wound has completely healed

Wear loose-fitting shoes for 2 weeks following procedure

Avoid strenuous exercise for 2 weeks following procedure

Contact medical office if signs of infection occur

Increasing pain, redness, swelling, or drainage from toe

TOENAIL

Instruct patient in importance of wearing properly fitting shoes

Instruct patient in proper procedure for nail trimming

Cut nail straight across

With corners of nail protruding from end of toe

COLPOSCOPY

Colposcopy: Visual examination of the vagina and cervix with a

colposcope

Colposcope: Lighted instrument with a magnifying lens

Used to examine the vagina and cervix

COLPOSCOPY

Purpose

Examine vagina and cervix for abnormal tissue growth

When performed

After abnormal Pap test results

To evaluate vaginal or cervical lesion observed during a pelvic examination

COLPOSCOPY

Normal and Abnormal Cervix

COLPOSCOPY

Primary goal

Prevent cervical cancer

By detecting precancerous lesions early – then you can treat them

Procedure performed 1 week after end of menstrual period

Rationale: blood cells make it difficult to view cervix

COLPOSCOPY

Patient Preparation:

Do not douche

Do not use tampons, vaginal medications, spermicides

Do not have intercourse for 24 hours before procedure

COLPOSCOPY

Lens positioned 12 inches from opening of vagina

Magnifies tissue, which facilitates:

Inspection of cervical cells

Obtaining a biopsy specimen

Magnification of 6x to 15x generally used

PROCEDURE: COLPOSCOPY

Patient assisted into lithotomy position

Physician inserts vaginal speculum

Applicator moistened with saline used to wipe cervix:

Removes mucus film

Provides for better visualization of cervix

Colposcope focused on cervix

Physician inspects cervix

Cervix swabbed with acetic acid

Dissolves cervical mucus and other secretions

Causes abnormal tissue to turn white

Results in easier visualization of abnormal areas of the cervix

Cervical epithelium may be stained with Lugol's iodine solution

Healthy epithelium: absorbs iodine

Causes epithelium to stain dark brown color

Abnormal epithelium: unable to absorb iodine

If abnormal area is observed

Cervical biopsy specimen is obtained using punch biopsy forceps

CERVICAL PUNCH BIOPSY

Performed in combination with colposcopy

To remove cervical tissue

For examination by a pathologist

Purpose

Detect the presence of cervical dysplasia

Cervical dysplasia: An abnormal growth of cells on the surface of the

cervix that are precancerous: precancerous: Abnormal cells that have the

potential to develop into cancer in the future – can range from mild, to

moderate, to severe

Purpose

Detect the presence of cancer of the cervix

Diagnose polyps on the cervix

Diagnose genital warts

May indicate infection with human papillomavirus (HPV) – risk factor for

developing cervical cancer

Biopsy helps the physician determine type of abnormal tissue present

Can determine best form of treatment for patient’s condition

Frequently performed following abnormal Pap test results

Majority of abnormal Pap tests are not caused by cervical cancer

Usually caused by a vaginal infection

Performed 1 week after end of menstrual period

Cervix is least vascular: prevents inaccurate test results

Patient preparation (begin 2 days before examination)

Do not douche

Do not use vaginal creams, medications, or spermicides

Do not have intercourse for 24 hours before procedure

PROCEDURE: CERVICAL PUNCH BIOPSY

Patient put in lithotomy position

Anesthetic not needed

Cervix has few pain receptors

Patient experiences either:

No discomfort

Certain amount of discomfort

Ranging from mild to moderate in intensity

Patient may experience

Mild cramping and pinching as specimen is removed

Physician inserts vaginal speculum

Cervix is wiped with saline

Then swabbed with acetic acid

Physician may stain cervix with Lugol's solution

Colposcope is focused on cervix and inspected

Cervical biopsy punch forceps

Used to obtain several tissue specimens from abnormal epithelium

Patient may feel a pinching sensation and mild cramps

Each time a specimen is removed from the cervix

Specimen is placed in container and sent to laboratory

Examined by a pathologist

If bleeding occurs, controlled with:

Gauze packing

Hemostatic solution (Monsel’s solution)

Electrocautery

Patient given sanitary pad to absorb any discharge

POSTOPERATIVE INSTRUCTIONS: CERVICAL

PUNCH BIOPSY

Minimum amount of cramping and bleeding may follow procedure

Lasts up to 1 week

Contact office if bleeding lasts longer then 2 weeks

If Monsel’s solution is used to control bleeding

Thick, dark-colored vaginal discharge may occur following procedure

Lasts for several days

PUNCH BIOPSY

Do not douche, use tampons, or have intercourse

For 1 week following the procedure

Allows for proper healing of cervix

Contact office if any of the following occur:

Bleeding heavier than normal menstrual bleeding

Foul-smelling vaginal discharge

Fever, or lower abdominal pain

PUNCH BIOPSY

Provide patient with written postoperative instructions

Schedule appointment approximately 1 week following procedure to:

Make sure healing is taking place

Discuss biopsy results

CERVICAL CRYOSURGERY

Uses freezing temperatures to treat certain gynecological conditions

Most often performed

Treatment for cervical dysplasia

To destroy abnormal cervical cells that show changes that may lead to

cancer

Performed only after a colposcopy

Confirms presence of cervical dysplasia

Also used to treat chronic cervicitis (inflammation of the cervix)

Cryosurgery unit: consists of long metal cryoprobe attached to cooling-

agent tank

Cooling agents

Liquid nitrogen (used most often)

Compressed nitrogen gas

Cryoprobe: inserted into vagina

Placed firmly in contact with the abnormal area

Cryosurgery Unit

Cooling agents flow through cryoprobe: freezes tissue to –20oC

Causes abnormal cells to die and slough off

Cervical covering eventually is replaced with new, healthy epithelial tissue

Regeneration of cervical tissue: occurs 4 to 6 weeks after procedure

Following cryosurgery

Patient required to have Pap test every 3 to 6 months

For a period of time determined by physician

PROCEDURE: CERVICAL CRYOSURGERY

Patient placed in lithotomy position

Vaginal speculum is inserted

Cervix swabbed with acid-saline solution

Removes mucus and other contaminants

Metal probe inserted into vagina

Place firmly in contact with affected area

Cryosurgery unit turned on

Cooling agent flows through cryoprobe

Causes metal probe to freeze and destroy superficial abnormal cervical tissue

Probe is in contact with cervical area for approximately 3 minutes

Patient may experience pain resembling menstrual cramping

Cryoprobe removed for 3 to 5 minutes

Permits cervical temperature to return to normal temperature

Procedure is repeated for another 3 minutes

When completed

Assist patient as needed

Observe for signs of discomfort and vertigo

Patient is given sanitary pad to absorb discharge

CRYOSURGERY

Normal activities can be resumed the day following cryosurgery

On first postoperative day

Clear, watery vaginal discharge occurs

Lasts for 2 to 4 weeks

Caused by shedding of dead cervical tissue

Gradually diminishes as healing progresses

CRYOSURGERY

Use sanitary pads (rather than tampons)

To absorb the watery discharge

Do not douche, use tampons, or have intercourse

For 2 to 3 weeks following the procedure

Allows for proper healing of cervix

CRYOSURGERY

Contact office if any of the following occurs:

Bleeding that is heavier than normal menstrual bleeding

Foul-smelling vaginal discharge

Lower abdominal pain

Provide patient with written postoperative instructions

Schedule a return visit 6 weeks after procedure

To ensure that proper healing has occurred

SKIN LESIONS

Cryosurgery can be used to remove skin lesions (e.g., warts, skin tags)

Small amount of cooling agent is used

Liquid nitrogen: in small, pressurized canister with attached probe

SKIN LESIONS

Liquid nitrogen applied until lesion turns white (indicates freezing of

tissue has occurred)

Patient feels slight burning or stinging

Blister develops and dries to a scab in 7 to 10 days and eventually sloughs

Patient should keep area clean and dry until scab sloughs off

Two or more treatments may be required to remove lesion completely

BANDAGING

Bandage: Strip of woven material used to wrap or cover a part of the body

Function

Apply pressure to control bleeding

Protect wound from contamination

Hold a dressing in place

Protect, support, or immobilize an injured part of the body

GUIDELINES FOR APPLICATION

Apply bandage so that it feels comfortable to patient

Fasten securely with metal clips or adhesive tape

Observe medical asepsis

Area should be clean and dry

Do not apply bandage directly over open wound

Apply sterile dressing first to prevent contamination of the wound

Bandage should extend 2 inches beyond edge of dressing

To prevent irritation: do not allow skin of two body parts to touch

Insert piece of gauze between body parts (e.g., between fingers)

Pad joints and prominent parts of bones

Prevents bandage from rubbing the skin and causing irritation

Bandage body part in its normal position with joints slightly flexed

Avoids muscle strain

Apply bandage from distal to proximal part of the body

Aids in venous return to heart

Ask patient if bandage feels comfortable

Should fit snugly so it will not fall off

Not too tightly: impedes circulation

If possible: leave fingers and toes exposed

Circulation can be checked

Signs indicating bandage is too tight:

Coldness

Pallor

Numbness

Cyanosis of nail beds

Swelling

Tingling sensations

Ask patient if bandage feels comfortable

If signs occur: loosen bandage immediately

If bandage roll is dropped:

Obtain a new bandage

Begin again

TYPES OF BANDAGES

Roller bandage: Long strip of soft material wound on itself to form a roll

Ranges from ½ to 6 inches wide, and from 2 to 5 yards long

Width used depends on part being bandaged

Usually made of sterile gauze

TYPES OF BANDAGES

Roller bandage: Long strip of soft material wound on itself to form a roll

Advantages:

Porous and lightweight

Molds easily to body part

Inexpensive

Easily disposed of

Disadvantage: gauze may slip and fray easily

TYPES OF BANDAGES

Kling gauze: special type of gauze that stretches

Allows it to cling: molds and conforms better

Elastic bandage: Made of woven cotton that contains elastic fibers

Common brand name: Ace bandage

Expensive, but can be washed and used again

TYPES OF BANDAGES

Be extremely careful when applying

Easy to apply too tightly: can impede circulation

TYPES OF BANDAGES

Elastic adhesive bandages available

Have an adhesive backing to provide secure fit

BANDAGE TURNS

Five basic turns: can be used alone or in combination

Type of turn used depends on

Body part to be bandaged

What the bandage is being used for (support, immobilization, or holding a

dressing in place)

BANDAGE TURNS

Circular turn

Applied to body part of uniform width (toes, fingers, head)

Each turn completely overlaps the previous turn

Two circular turns: used to anchor a bandage

BANDAGE TURNS

Circular Turn

BANDAGE TURNS

Spiral turn

Applied to body part of uniform circumference (fingers, arms, legs)

Each turn is carried upward at a slight angle and overlaps previous turn by

one-half to two-thirds the width of the bandage

BANDAGE TURNS

Spiral-reverse turn

Used for a body part that varies in width (forearm, lower leg)

Reversing the spiral turn allows for smoother fit and prevents gapping

Thumb is used to make the reverse halfway through each spiral turn

Bandage directed downward and folded on itself

Each turn overlaps the previous by two-thirds the width of the bandage

BANDAGE TURNS

Spiral-Reverse Turn

BANDAGE TURNS

Figure-Eight turn

Used to hold dressing in place or to support and immobilize an injured joint

Consists of slanting turns that alternately ascend and descend around the part

and cross over one another in the middle

Each turn overlaps previous turn by two-thirds the width of the bandage

BANDAGE TURNS

Figure-Eight Turn

BANDAGE TURNS

Recurrent turn

Bandage anchored by using two circular turns and then passed back and forth

over tip of the part to be bandaged

Each turn overlaps previous turn by two-thirds the width of the bandage

BANDAGE TURNS

Recurrent turn

Used to bandage:

Tips of fingers or toes

Stump of an amputated extremity

BANDAGE TURNS

Recurrent Turn

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