FIG. 3.1 Surgical department layouts. A, Central corridor, racetrack style. B, Central corridor, hotel style. C, Central core, peripheral corridor style. (From Phillips N: Berry & Kohn’s operating room technique, ed 13, St Louis, 2017, Elsevier.)
Specifications
• Humidity is maintained at 20% to 60%. (A humidity reading higher than 60% is conducive to the development of static electricity; a reading lower than 20% means that spark transmission is likely.) These standards were established as an aid to preventing fire in the operating room. Controlling humidity also limits microbial growth in the OR, prevents electrostatic discharge (ESD), and ensures the comfort of the OR team. Over time, these concerns have eased somewhat with the development and use of nonflammable anesthetic gases, improved ventilation systems, and the development of flame- and ESD-retardant materials for use in the manufacture of sterile drapes and gowns.
• Temperature is maintained at 68° to 73° F in most cases but is kept higher for pediatric, trauma, and immunosuppressed patients.
• Laminar air flow with unidirectional positive pressure is used in some hospitals to prevent microbes from leaving the OR or entering the surgical suite.
• There’s one suction outlet for the surgical team and one for anesthesia.
• Gas outlets are color-coded for safety and ease of use:
• Blue: nitrous oxide
• Black: nitrogen
• Green: oxygen
• Gray: carbon dioxide
• Yellow: compressed air
• Furniture includes:
• Operating table
• Back table
• Mayo stand
• Ring stand
• Kick buckets
• OR lights
Decontamination Room
Gross decontamination (removal of visible debris) is performed in this utility area, which is located in the semi-restricted area. The decontamination room holds specimens awaiting transport to the laboratory and is where instrumentation is washed before immediate-use steam sterilization for return to the sterile field.
Surgical Instrumentation
Electrosurgical Equipment
Not all surgery is accomplished with the use of scalpels, forceps, clamps, and needles alone. These days, much of it requires electronic equipment whose use you must be familiar with.
Before we move on to the various types of electronic surgical equipment and their purposes, let’s quickly review some pertinent electrical terms and their definitions (Table 3.2).
Electrocautery
Monopolar Cautery
Monopoloar cautery (Fig. 3.4) is the most commonly used type of electrocautery.
• Offers coagulation, cut, and blend modes
• Powered by a generator (a.k.a. Bovie machine, monopolar power unit)
• Performed with the use of a sterile active electrode (cautery pencil)
• Nonsterile dispersive electrode attached to patient to disperse current and prevent injury
Bipolar Cautery
Another type of electrocautery is bipolar cautery (Fig. 3.5).
• Powered by a generator or other power
• Performed with the use of an active electrode and (sterile) bipolar forceps
• Current passes through tissue grasped within the forceps, then returns to the generator through the tip of the forceps (Fig. 3.4)
Other Electrocautery Devices
• Argon beam. Argon, an inert gas, is incapable of combustion but permits passage of electrical current. A special argon beam grounding pad is required for the patient.
• Harmonic scalpel. This device uses ultrasonic energy to cut and coagulate tissue. No grounding pad is needed.
• CUSA (Cavitron Ultrasonic Surgical Aspirator). This patented device uses ultrasonic energy to emulsify and aspirate tissue. No grounding pad is needed.
Electrocautery Safety Tips
• Apply the grounding pad to a large fleshy area that is clean and dry (e.g., the thigh).
• Never place a grounding pad on a bony area or prominence or over a metal prosthesis.
• Never let skin prep solutions or other liquids pool around a grounding pad.
• Ensure that the grounding pad is placed in full contact with skin—no wrinkling or tunneling.
• Place the grounding pad as close to the surgical site as possible.
TABLE 3.2
| Term | Definition |
| Electricity | Free electrons flowing from one atom to another |
| Alternating current (AC) | Electrons flowing back and forth along a single pathway |
| Direct current (DC) | A current that flows in one direction, from negative to positive |
| Electron | A negatively charged particle that orbits an atom |
| Neutron | A neutral atom |
| Proton | A positively charged atom |
| Free electron | An electron that is not bound to an atom, ion, or molecule and can move freely; the basis of electricity and magnetism |
| Insulator | A material that inhibits the flow of electrical current |
| Volt | Electrical potential |
| Current | Flow of electrical charge, measured in amperes (amps) |
| Power | The rate at which work is done |
| Load | Device that requires electricity to perform |
| Switch | Device used to open or close a current |
FIG. 3.4 Monopolar current path. (From Phillips N: Berry & Kohn’s operating room technique, ed 13, St Louis, 2017, Elsevier.)
FIG. 3.5 Bipolar current path. No patient return electrode is used. (From Phillips N: Berry & Kohn’s operating room technique, ed 13, St Louis, 2017, Elsevier.)
• Keep flammable anesthetics away from electrocautery electrodes.
• Give prep solutions adequate time to dry before beginning electrocautery.
• Keep a smoke evacuator with HEPA filter ready for use on the cautery plume.
• Never reuse a grounding pad.
• Never silence the alarms on the electrosurgical circuit.
Lasers
The name laser is an acronym for Light Amplification by Stimulated Emission of Radiation. You will encounter several types of lasers in the operating room.
CO2 Laser
• Most frequently used laser, often in endoscopic procedures
• Uses CO2 gas to transmit a beam that cuts and coagulates tissue
• Cannot be transmitted through fluids
ND:YAG Laser
• Laser of choice for endoscopic gastrointestinal procedures
• Uses contact delivery system
• Fiber beam absorbed by darker-pigmented tissue
• Can be transmitted through fluids
Excimer Laser
• Commonly used in radial keratoplasty (RK) and stenotic artery plaque destruction
• Uses gases and halogens as the medium
Holmium:YAG Laser
• Commonly used in arthroscopic procedures and RK
• Employs a pulsed beam
Laser Safety
• A warning sign (Fig. 3.6) should be placed every door of every room in which lasers are in use.
• All personnel in the room with a laser must use protective eyewear.
• The surgical technician in the scrub role should maintain a basin or pitcher of sterile water on field for fire prevention.
FIG. 3.6 Laser warning sign. (From Rothrock JC: Alexander’s care of the patient in surgery, ed 15, St Louis, 2015, Mosby.)
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