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Chapter 25
Minor Office Surgery
Today's Medical Assistant
2nd edition
2
INTRODUCTION TO MINOR OFFICE SURGERY
Surgery: Branch of medicine that deals with operative and manual procedures
for:
Correction of deformities and defects
Repair of injuries
Diagnosis and treatment of certain diseases
3
INTRODUCTION TO MINOR OFFICE SURGERY
Minor Office surgery: Surgical procedure that is restricted to:
The management of minor conditions
Does not require the use of general anesthesia
4
INTRODUCTION TO MINOR OFFICE SURGERY
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
5
INTRODUCTION TO MINOR OFFICE SURGERY
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
Life
Function of an organ
Body parts
6
INTRODUCTION TO MINOR OFFICE SURGERY
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
7
INTRODUCTION TO MINOR OFFICE SURGERY
Physician explains nature of surgical procedure and risks to patient
Offers to answer questions
8
INTRODUCTION TO MINOR OFFICE SURGERY
MA responsible for
Explaining patient preparation
Obtaining patient's signature on consent to treatment form
9
INTRODUCTION TO MINOR OFFICE SURGERY
Consent to Treatment Form
10
INTRODUCTION TO MINOR OFFICE SURGERY
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
11
INTRODUCTION TO MINOR OFFICE SURGERY
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
12
INTRODUCTION TO MINOR OFFICE SURGERY
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
13
INTRODUCTION TO MINOR OFFICE SURGERY
Remain with patient after surgery
Safety precaution
To explain postoperative instructions
Remove and properly care for used instruments/supplies
Clean the treatment room
14
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
15
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
16
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
17
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
18
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
19
SURGICAL ASEPSIS
Guidelines to Maintain 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
20
SURGICAL ASEPSIS
Guidelines to Maintain 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
21
SURGICAL ASEPSIS
Guidelines to Maintain 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
22
INSTRUMENTS USED IN MINOR OFFICE SURGERY
Most instruments are made of stainless steel
MA must know:
Names of instruments
Use
Proper care
23
INSTRUMENTS USED IN MINOR OFFICE SURGERY
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)
24
INSTRUMENTS USED IN MINOR OFFICE SURGERY
Part of an Instrument
25
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
26
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
27
SCALPELS
28
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
29
SCISSORS
Operating scissors
Straight delicate blades with sharp cutting edges
Used to cut through tissue
Blade tips available:
s/s
b/b
b/s
30
SCISSORS
Operating Scissors
31
SCISSORS
Suture scissors
Used to remove sutures
Hook on tip: for getting under suture
Blunt end: prevents puncturing of tissues
32
SCISSORS
Suture Scissors
33
SCISSORS
Bandage scissors
Inserted beneath a dressing or bandage to cut it for removal
Flat blunt prow: protects from puncturing patient's skin
34
SCISSORS
Bandage Scissors
35
SCISSORS
Dissecting scissors
Thick blades with a fine cutting edge
Used to divide tissue
Available with straight or curved blades
Both blades are blunt
36
SCISSORS
Dissecting Scissors
37
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
38
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
39
FORCEPS
Thumb forceps
Serrated tips
Used to pick up tissue or hold tissue between adjacent surfaces
40
FORCEPS
Thumb Forceps
41
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
42
FORCEPS
Tissue Forceps
43
FORCEPS
Splinter forceps
Sharp Point that are useful in removing foreign objects from the tissues
(splinters)
44
FORCEPS
Dressing forceps
Use:
Application and removal of dressings
To hold or grasp sterile gauze or sutures during MOS
Blunt ends with coarse cross-striations: for grasping
45
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
46
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
47
FORCEPS
Mosquito hemostatic forceps
Small, fine tips
Smaller and more delicate than standard (Kelly) hemostatic forceps
Use:
Hold delicate tissue
Clamp off smaller blood vessels
Standard hemostatic forceps: Used to grasp and compress larger blood
vessels
48
FORCEPS
Hemostatic Forceps
49
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
50
FORCEPS
Sponge Forceps
51
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
52
MISCELLANEOUS INSTRUMENTS
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
53
MISCELLANEOUS INSTRUMENTS
Retractors
Used to hold tissue aside
To improve exposure of operative area
54
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
55
CARE OF SURGICAL INSTRUMENTS
MA works with instruments when:
Setting up a sterile tray
Performing procedures (e.g., suture removal)
Cleaning up after MOS
Sanitizing and sterilizing instruments
56
CARE OF SURGICAL INSTRUMENTS
Guidelines
Handle instruments carefully
Dropping on floor or throwing into a basin: could damage them
57
CARE OF SURGICAL INSTRUMENTS
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
58
CARE OF SURGICAL INSTRUMENTS
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
59
CARE OF SURGICAL INSTRUMENTS
Guidelines
Always use instrument for intended purpose
Substituting instruments could damage an instrument
Sanitize and sterilize instruments using proper technique
60
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
61
COMMERCIALLY PREPARED STERILE PACKAGES
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
62
COMMERCIALLY PREPARED STERILE PACKAGES
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
63
COMMERCIALLY PREPARED STERILE PACKAGES
Opening a Peel-Apart Package
64
COMMERCIALLY PREPARED STERILE PACKAGES
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
65
COMMERCIALLY PREPARED STERILE PACKAGES
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
66
COMMERCIALLY PREPARED STERILE PACKAGES
Inside of peel-apart package can be used as sterile field
Open peel-apart package completely
Lay flat on a clean dry surface
67
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
68
WOUNDS
Closed wound: Injury to underlying tissues without break in skin surface
or mucous membrane (contusion)
69
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
70
WOUNDS
Contusion
71
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
72
WOUNDS
Open wounds: Break in skin surface or mucous membrane that exposes
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
73
WOUNDS
Laceration
74
WOUNDS
Open wounds: Break in skin surface or mucous membrane that exposes
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
75
WOUNDS
Puncture
76
WOUNDS
Open wounds: Break in skin surface or mucous membrane that exposes
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
77
WOUND HEALING
Skin: protective barrier for body; considered first line of defense
When skin is broken: easy for microorganisms to enter and cause infection
78
PHASE 1
Inflammatory Phase
Begins as soon as body is injured
79
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
80
PHASE 1
Phase 1: Inflammatory Phase
81
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
82
PHASE 1 Inflammatory process occurs
Four local signs of inflammation
Redness
Swelling
Pain
Warmth
Purpose of inflammation: to destroy invading microorganisms and remove
damaged tissue debris so proper healing can occur
83
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
84
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)
85
PHASE 2
Phase 2: Granulation Phase
86
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
87
PHASE 3
Phase 3: Maturation Phase
88
WOUND HEALING
Always inspect wound when providing wound care
Observe for
Signs of inflammation
Amount of healing
Chart in patient's record
89
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
90
WOUND DRAINAGE
Types of Exudates:
Serous exudate: consists of serum
Clear and watery
Example: fluid in blister from a burn
91
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
92
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
93
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
94
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
95
STERILE DRESSING CHANGE
Function of a sterile dressing
Protect the wound from contamination and trauma
Absorb drainage
Restrict motion
96
STERILE DRESSING CHANGE
Dressing material used (size, type, amount) depends on:
Size and location of wound
Amount of drainage
97
STERILE DRESSING CHANGE
Sterile gauze pads used in medical office
Come in a variety of sizes
2 x 2
3 x 3
4 x 4 (most frequently used)
Have tendency to stick to the wound
98
STERILE DRESSING CHANGE
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
99
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
uses.
12.Categorize suturing needles according to type of
point and shape.
Lesson 25.2
100
SUTURES
Used to
Close a surgical incision
Repair accidental wound
101
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
102
SUTURES
Purpose of sutures
Protect wound from contamination
Minimize amount of scar formation
Local anesthetic: to numb area before insertion of sutures
103
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
104
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
105
TYPES OF SUTURES
Absorbable sutures
Synthetic materials
Dexon
Vicryl – mainly used in hospital setting during surgery
106
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
107
TYPES OF SUTURES
Nonabsorbable Sutures
108
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
109
SUTURE SIZE AND PACKAGING
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)
110
SUTURE SIZE AND PACKAGING
Suture box
Holds individual packages of sutures
Stamped with an expiration date
Check before removing a suture package
111
SUTURE SIZE AND PACKAGING
Suture package
Outer peel-apart package
Sterile inner package
112
SUTURE SIZE AND PACKAGING
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
113
SUTURE SIZE AND PACKAGING
Type and size of suture used
Based on nature and location of tissue sutured
Physician's preference
114
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)
115
SUTURE NEEDLES
Cutting Needles
116
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
117
SUTURE NEEDLES
118
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)
119
SUTURE NEEDLES
120
INSERTION OF SUTURES
MA responsible for:
Suture tray setup
Assisting the physician
121
INSERTION OF SUTURES
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
122
INSERTION OF SUTURES
Transferring Sutures
123
SUTURE INSERTION SETUP
Items placed on side tray
Clean disposable gloves
Antiseptic solution
Surgical scrub brush
Antiseptic swabs
124
SUTURE INSERTION SETUP
Items placed on side tray
Sterile gloves
Local anesthetic
Alcohol wipe to cleanse vial
Tetanus toxoid with needle and syringe
125
SUTURE INSERTION SETUP
Suture Insertion Side Tray
126
SUTURE INSERTION SETUP
Items on sterile field
Fenestrated drape
Syringe and needle
Hemostatic forceps
Thumb forceps
127
SUTURE INSERTION SETUP
Items on sterile field
Tissue forceps
Dissecting scissors
Operating scissors
Needle holder
Sutures
Sterile 4 x 4 gauze
128
SUTURE INSERTION SETUP
Suture Insertion Sterile Field
129
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
130
POSTOPERATIVE INSTRUCTIONS: SUTURE
INSERTION
Keep dressing clean and dry
Contact medical office if infection occurs:
Excessive redness
Swelling
Discharge
Increase in pain
131
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
132
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
133
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
134
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
135
SURGICAL SKIN STAPLES
Inserted into skin with a special skin stapler
Reusable and disposable available
Holds cartridge with a prescribed number and size of staples
136
SURGICAL SKIN STAPLES
Physician inserts staples
Tissue is first approximated with tissue forceps
Stapler held over the site
Staple inserted into the skin
137
SURGICAL SKIN STAPLES
Are easily removed with a special staple remover
MA is usually responsible for removing staples
Written or verbal order must be given by physician
138
ADHESIVE SKIN CLOSURES
Approximate the edges of a laceration or incision
Consist of sterile, hypoallergenic tape
Available in a variety of widths and lengths
139
ADHESIVE SKIN CLOSURES
Brand names: Steri-Strip; Proxi-Strip
140
ADHESIVE SKIN CLOSURES
Used when not much tension exists on skin edges
Applied transversely across line of incision
To approximate edges of wound
141
ADHESIVE SKIN CLOSURES
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
142
ADHESIVE SKIN CLOSURES
143
ADHESIVE SKIN CLOSURES
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
144
ADHESIVE SKIN CLOSURES
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
145
ADHESIVE SKIN CLOSURES
What Would You Do? What Would You Not Do?
146
ADHESIVE SKIN CLOSURES
What Would You Do? What Would You Not Do?
147
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
148
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
149
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
150
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
151
TRAY SETUP
Covering Sterile Tray
152
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)
153
METHODS USED TO SET UP A STERILE TRAY
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)
154
METHODS USED TO SET UP A STERILE TRAY
155
METHODS USED TO SET UP A STERILE TRAY
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
air
Flip articles onto field from peel-apart packages
156
METHODS USED TO SET UP A STERILE TRAY
157
SIDE TABLE
Articles that are not sterile must not be placed on the sterile field
Set on an adjacent table or counter
158
SIDE TABLE
Examples:
Surgical scrub brush
Vial of local anesthetic
Physician's sterile gloves (outside of wrapper is not sterile)
159
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
160
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
161
SKIN PREPARATION
Cleansing the site
Cleanse with antiseptic solution
Example: Betadine Surgical scrub)
162
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
163
SKIN PREPARATION
Cleansing the Site
164
SKIN PREPARATION
Antiseptic application
Decreases the number of microorganisms
Betadine commonly used
165
SKIN PREPARATION
Fenestrated drape applied
Opening placed directly over operative site
Provides sterile area around operative site
Decreases contamination of the surgical wound
166
SKIN PREPARATION
Fenestrated Drape
167
LOCAL ANESTHETIC
Most frequently used:
Lidocaine hydrochloride (Xylocaine)
168
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
169
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
170
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
171
PREPARING THE ANESTHETIC
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
172
PREPARING THE ANESTHETIC
If MA draws up: needle and syringe placed on side table
If physician draws up: needle and syringe placed on sterile field
173
ASSISTING THE PHYSICIAN
Type of assisting required based on
Type of surgery
Physician's preference
174
ASSISTING THE PHYSICIAN
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)
175
ASSISTING THE PHYSICIAN
Handing Instrument
176
ASSISTING THE PHYSICIAN
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
177
ASSISTING THE PHYSICIAN
Holding Specimen Container
178
ASSISTING THE PHYSICIAN
Tissue specimen may be obtained and sent to the laboratory
Label specimen container
Using two unique identifiers – information that clearly identifies a specific
patient: patient’s name; patient’s date of birth
179
ASSISTING THE PHYSICIAN
Tissue specimen may be obtained and sent to the laboratory
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
180
ASSISTING THE PHYSICIAN
Biopsy Request Form
181
ASSISTING THE PHYSICIAN
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
182
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
183
SEBACEOUS CYST REMOVAL
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
184
SEBACEOUS CYST REMOVAL
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
185
SEBACEOUS CYST REMOVAL
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
186
SEBACEOUS CYST REMOVAL
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
187
SEBACEOUS CYST REMOVAL
Sebaceous Cyst Removal Sterile Tray
188
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
189
PROCEDURE: SEBACEOUS CYST REMOVAL
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
190
PROCEDURE: SEBACEOUS CYST REMOVAL
Sebaceous Cyst Removal
191
POSTOPERATIVE INSTRUCTIONS: SEBACEOUS
CYST REMOVAL
Keep dressing clean and dry
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
192
POSTOPERATIVE INSTRUCTIONS: SEBACEOUS
CYST REMOVAL
What Would You Do? What Would You Not Do?
193
POSTOPERATIVE INSTRUCTIONS: SEBACEOUS
CYST REMOVAL
What Would You Do? What Would You Not Do?
194
SURGICAL INCISION AND DRAINAGE OF
LOCALIZED INFECTIONS
Abscess: Collection of pus in a cavity surrounded by inflamed tissue
195
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
body
196
SURGICAL INCISION AND DRAINAGE OF
LOCALIZED INFECTIONS
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
197
PROCEDURE: INCISION AND DRAINAGE
Local anesthetic administered
Scalpel used to make incision
Allows pus to drain out
Using gauze to absorb drainage
198
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
199
POSTOPERATIVE INSTRUCTIONS: INCISION AND
DRAINAGE
Keep dressing clean and dry
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
drain
200
MOLE REMOVAL
Mole (also known as a nevus)
Small growth on skin
201
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
202
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)
203
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
204
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
205
MOLE REMOVAL
Skin Tags
206
MOLE REMOVAL
Most common types of moles
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
207
MOLE REMOVAL
Most common types of moles
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
208
MOLE REMOVAL
Dysplastic nevi:
Precancerous mole
Usually larger than normal moles
Irregular coloration and shape
209
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
210
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
211
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
212
MOLE REMOVAL
Melanoma
Characteristics of melanoma:
Asymmetrical: one-half of the mole is different from the other half
213
MOLE REMOVAL
Melanoma
Characteristics of melanoma:
Irregular border: the edges of the mole are notched, uneven, or blurred;
rather than round or distinct
214
MOLE REMOVAL
Melanoma
Characteristics of 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
215
MOLE REMOVAL
Melanoma
Characteristics of 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
216
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)
217
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
218
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
219
PROCEDURE: MOLE SHAVE EXCISION
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
220
PROCEDURE: MOLE SHAVE EXCISION
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
221
PROCEDURE: MOLE SHAVE EXCISION
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
222
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
223
PROCEDURE: SURGICAL MOLE EXCISION
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
224
PROCEDURE: SURGICAL MOLE EXCISION
Sterile dressing applied to operative site
Mole placed in a specimen container
Sent to laboratory for examination by a pathologist
225
POSTOPERATIVE INSTRUCTIONS: SHAVE
EXCISION AND SURGICAL EXCISION
Keep dressing clean and dry
Report signs that the wound is infected
Fever, increased pain, swelling, redness, warmth, or discharge
If sutures have been inserted
Notify medical office if they become loose or break
226
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)
Provide patient with written instructions on wound care
Instruct patient when to return for removal of sutures
227
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
228
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
229
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)
230
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
231
NEEDLE BIOPSY
Advantage
Sample of tissue can be obtained
That may otherwise require a surgical operation
232
PROCEDURE: NEEDLE BIOPSY
Performed under local anesthetic
Incision not required
Patient does not have discomfort of an operative recovery
233
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
234
POSTOPERATIVE INSTRUCTIONS: NEEDLE BIOPSY
Bruise typically occurs at the biopsy site
Gradually disappears within several weeks
Keep dressing clean and dry
235
POSTOPERATIVE INSTRUCTIONS: NEEDLE BIOPSY
Rest and avoid strenuous activity and heavy lifting
For 2 days following procedure
Report signs that wound is infected
Fever, increased pain, swelling, redness, warmth, or discharge
236
INGROWN TOENAIL REMOVAL
Occurs when toenail grows deeply into nail groove and penetrates
surrounding skin
Results in pain and discomfort
237
INGROWN TOENAIL REMOVAL
Caused by:
External pressure from tight shoes
Trauma
Improper nail trimming
Infection
238
INGROWN TOENAIL REMOVAL
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
239
INGROWN TOENAIL REMOVAL
Ingrown Toenail Packing
240
INGROWN TOENAIL REMOVAL
Severe cases cause:
Pain
Swelling
Redness
Drainage
241
INGROWN TOENAIL REMOVAL
Severe/recurring cases
Part of nail is surgically removed
Relieves pain by decreasing the nail pressure on soft tissues
242
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
243
PROCEDURE: INGROWN TOENAIL
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
244
PROCEDURE: INGROWN TOENAIL
245
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
246
POSTOPERATIVE INSTRUCTIONS: INGROWN
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
247
POSTOPERATIVE INSTRUCTIONS: INGROWN
TOENAIL
Provide patient with written instructions on wound care
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
248
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
249
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
250
COLPOSCOPY
Normal and Abnormal Cervix
251
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
252
COLPOSCOPY
Patient Preparation:
Do not douche
Do not use tampons, vaginal medications, spermicides
Do not have intercourse for 24 hours before procedure
253
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
254
PROCEDURE: COLPOSCOPY
Patient assisted into lithotomy position
Physician inserts vaginal speculum
255
PROCEDURE: COLPOSCOPY
Applicator moistened with saline used to wipe cervix:
Removes mucus film
Provides for better visualization of cervix
Colposcope focused on cervix
Physician inspects cervix
256
PROCEDURE: COLPOSCOPY
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
257
PROCEDURE: COLPOSCOPY
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
258
PROCEDURE: COLPOSCOPY
What Would You Do? What Would You Not Do?
259
PROCEDURE: COLPOSCOPY
What Would You Do? What Would You Not Do?
260
CERVICAL PUNCH BIOPSY
Performed in combination with colposcopy
To remove cervical tissue
For examination by a pathologist
261
CERVICAL PUNCH BIOPSY
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
262
CERVICAL PUNCH BIOPSY
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
263
CERVICAL PUNCH BIOPSY
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
264
CERVICAL PUNCH BIOPSY
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
265
PROCEDURE: CERVICAL PUNCH BIOPSY
Patient put in lithotomy position
266
PROCEDURE: CERVICAL PUNCH BIOPSY
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
267
PROCEDURE: CERVICAL PUNCH BIOPSY
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
268
PROCEDURE: CERVICAL PUNCH BIOPSY
Cervical biopsy punch forceps
Used to obtain several tissue specimens from abnormal epithelium
269
PROCEDURE: CERVICAL PUNCH BIOPSY
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
270
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
271
POSTOPERATIVE INSTRUCTIONS: CERVICAL
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
272
POSTOPERATIVE INSTRUCTIONS: CERVICAL
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
273
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)
274
CERVICAL CRYOSURGERY
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
275
CERVICAL CRYOSURGERY
Cryosurgery Unit
276
CERVICAL CRYOSURGERY
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
277
CERVICAL CRYOSURGERY
Following cryosurgery
Patient required to have Pap test every 3 to 6 months
For a period of time determined by physician
278
PROCEDURE: CERVICAL CRYOSURGERY
Patient placed in lithotomy position
Vaginal speculum is inserted
Cervix swabbed with acid-saline solution
Removes mucus and other contaminants
279
PROCEDURE: CERVICAL CRYOSURGERY
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
280
PROCEDURE: CERVICAL CRYOSURGERY
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
281
POSTOPERATIVE INSTRUCTIONS: CERVICAL
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
282
POSTOPERATIVE INSTRUCTIONS: CERVICAL
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
283
POSTOPERATIVE INSTRUCTIONS: CERVICAL
CRYOSURGERY
Contact office if any of the following occurs:
Bleeding that is heavier than normal menstrual bleeding
Foul-smelling vaginal discharge
Fever
Lower abdominal pain
Provide patient with written postoperative instructions
Schedule a return visit 6 weeks after procedure
To ensure that proper healing has occurred
284
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
285
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
off
Patient should keep area clean and dry until scab sloughs off
Two or more treatments may be required to remove lesion completely
286
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
287
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
288
GUIDELINES FOR APPLICATION
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
289
GUIDELINES FOR APPLICATION
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
290
GUIDELINES FOR APPLICATION
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
291
GUIDELINES FOR APPLICATION
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
292
GUIDELINES FOR APPLICATION
Circulation can be checked
Signs indicating bandage is too tight:
Coldness
Pallor
Numbness
Cyanosis of nail beds
Swelling
Pain
Tingling sensations
293
GUIDELINES FOR APPLICATION
Ask patient if bandage feels comfortable
If signs occur: loosen bandage immediately
If bandage roll is dropped:
Obtain a new bandage
Begin again
294
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
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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
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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
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TYPES OF BANDAGES
Elastic bandage: Made of woven cotton that contains elastic fibers
Be extremely careful when applying
Easy to apply too tightly: can impede circulation
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TYPES OF BANDAGES
Elastic bandage: Made of woven cotton that contains elastic fibers
Elastic adhesive bandages available
Have an adhesive backing to provide secure fit
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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)
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BANDAGE TURNS
Circular turn
Applied to body part of uniform width (toes, fingers, head)
Each turn completely overlaps the previous turn
Use
Two circular turns: used to anchor a bandage
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BANDAGE TURNS
Circular Turn
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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
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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
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BANDAGE TURNS
Spiral-Reverse Turn
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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
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BANDAGE TURNS
Figure-Eight Turn
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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
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BANDAGE TURNS
Recurrent turn
Used to bandage:
Tips of fingers or toes
Stump of an amputated extremity
Head
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BANDAGE TURNS
Recurrent Turn