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Higher nurse education




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BUKOVINIAN STATE Medical university

DEPARTMENT OF PATIENTS CARE AND

HIGHER NURSE EDUCATION

“APPROVED”


on the methodical conference of department

of patients’ care and higher

nurse education

“ ” ________ 200_ protocol N __

Chief of department, associate professor I.A. Plesh


METHODICAL INSTRUCTION

FOR SELF-PREPARATION OF STUDENTS

TO PRACTICAL CLASS №6


THE MAIN KINDS OF SUTURE MATERIAL. PECULIARITIES OF STERILIZATION AND STORAGE.

THE SURGICAL TECHNIQUES IN NURSE‘S WORK.

.


Discipline:

nursing in surgery

for 3nd year students

of medical faculty №4,

specialty "nurse business''


Methodical instruction was prepared by:

Assistant Riabyi S.I.


Chernivtsi - 2010

1. Topic: THE MAIN KINDS OF SUTURE MATERIAL. PECULIARITIES OF STERILIZATION AND STORAGE. THE SURGICAL TECHNIQUES IN NURSE‘S WORK.


^ 2. Duration of the class: 2 academic hour.

3. Study aim:

3.1. The student should know:

  • definition of an antisepsis;

  • classification of an antisepsis;

  • the mechanical methods of an antisepsis;

  • the physical methods of an antisepsis;

  • the chemical methods of an antisepsis;

  • the biological methods of an antisepsis;

  • the main requirements to the nurses hands;

  • the traditional methods of preoperative cleaning of the hands;

  • the modern methods of preoperative cleaning of the hands;

  • the methods of preoperative cleaning of an operative field.


^ 3.2. The student should be able:

  • to use modern mechanical, chemical and biological methods of an antisepsis;

  • to take care of the nurses hands;

  • to use the traditional and modern methods of preoperative cleaning of the hands;

  • to use the methods of preoperative cleaning of an operative field.


^ 3.3. The student should master practical skills:

  • preparation and using main chemical antiseptic solutions;

  • using different kinds of the dressing materials;

  • applying different kinds of drainages;

  • processing by Spasocucotsky-Cochergin;

  • processing by Chlorgexidin biglukonat (Gibitan);

  • processing by Pervomur;

  • preparation of the patiet‘s skin;

  • processing by Grossich - Philonchikoff.


·4. Advice for students:

Organization of work in the fastening bandaging one.

Bandaging, as a rule, takes place in one room, relatively small sizes. The area of bandaging on a 1 table must make 22 m2. Between that, in one room, except for bandaging, are executed before sterilization cleaning and disinfection instruments, here wash hands before and after bandaging doctors, trained nurses and students. In the same apartment immersion heaters are set for disinfection of instruments, closets for saving of different materials, instrumental closets, different necessary for work furnitures and equipments.

Usually bandaging are disposed on one corridor with chambers, but more comfortable to equip them in the eventual compartment of corridor, shut off by glass partition. A platform in which it is possible to put wheel-stretcher is thus created, closets for some articles of equipment, in a wall niche or in a separate closet to save facilities for cleaning up of bandaging.

Ceiling and walls of bandaging dye by an oily paint, but it is better, if walls face by a ceramic tile. A floor is to be covered by a ceramic tile. Ventilation must be wave-drawing with a double exchange for a 1 hour. All light must be subject to the moist cleaning up. In bandaging there must be two shells which place from sterile table a little rather and mark by inscriptions on a wall – “For washing of hands” , “For instruments” .

Fastening bandaging are used for bandaging running sore, and also puncture of abscesses and cavities, that contain a pus. Most fastening operative interferences, such how opening of abscess is, introduction of drainage to the pleura cavity at empiemi and others like that, are here executed. In the fastening bandaging patients are bandaged with intestinal and excrement noritsyami.

Support of cleanness and order in bandaging – it is an obligatory condition for implementation of rules of asepsis during bandaging. Work in bandaging, as well as in an operating block, is begun with the previous cleaning up. This measure sometimes takes quite a bit time, because bandaging is used by a duty personnel for the grant of urgent help to the patients, that are found in the separation. In evening and nightly time there can be a necessity in the change of the bandage wet through, introduction of tube, that fell out with wound and others like that. In bandaging for this purpose a “duty sterilization box” with bandaging material must be selected. After bandaging a duty personnel must do cleaning up, laying down the used instruments in a tank with solution of disinfection, and the bandages and bandage taken off, to collect muddy marbles and others like that in the special bucket with a lid, which is adjusted for collection of muddy material.

The current cleaning up is executed during bandaging. Near every bandaging table a pelvis or bucket for collection of the bandages and used in the process of bandaging material taken off stands necessarily. In intervals between bandaging a junior nurse translates maintenance of pelves in the special bucket with a lid, that after to take away him for incineration of muddy material. In bandaging are to be large to the pinch, which muddy bandages collect by.

After ending of bandaging the large cleaning up, similar to such cleaning up in an operating-room, is executed, and at the end of day the personnel of bandaging conducts the final cleaning up.

One time for a week in bandaging the general cleaning up similar to that is executed, that is executed in an operating block.

The important value in providing of cleanness and order in bandaging is had by clothes and conduct of people, healthy and patients, that` enter and work in bandaging. In bandaging enter in ordinary to the hospital clothes, that is in a dressing-gown and little cap, in which walk and work employees of surgical separation. Dressing-gowns and little caps are to be clean, on button up, sleeve are downed to the brushes or begun to swing, but so that with under them did not “look” the sleeve of lower shirt or blouse. To the personnel of bandaging it is better to use dressing-gowns, that are strung behind. Little caps must fully close a hair. All, who is included in bandaging, must put on sterile mask.

The trained nurses and junior nurses, that work in bandaging, change dressing-gowns every day, and floor to the dressing-gown dress aprons. Aprons daily disinfection, and at contamination during work are worn through a clean rag, moistened disinfection solution. Aprons must be dressed by doctors and students, that execute the fastening bandaging.

Like to the operating sisters of sister and junior nurse, that work in bandaging, must carefully toe the lines of the personal hygiene. Apodactilna work, that is not touching by fingers, is obligatory. All dirty jobs are needed to execute in working gloves or long tongs (for example, cleaning up from the floor of muddy serviette), to watch after the skin of hands, worry that there were no cracks, scratches.

For disinfection of air in bandaging ultraviolet lamps are applied. The ultraviolet irradiation of bandaging takes place according to the graph.

In the modern bandaging must be a place is selected for the before sterilisation cleaning of instruments, and in the festering bandaging – for previous disinfection. Usually near a shell with inscription “For instruments” a tank is disposed with a disinfection liquid, which all instruments, that was applied during fastening bandaging, are dipped in disinfection instruments, that were the use at bandaging of wounds, that granulate, are subject, and wounds with serous excretions, because there is no confidence in that these excretions are not contained by pathogenic microorganisms. As disinfection can be applied solution of pervomur, that stopped behind after treatment of hands, or a 6% solution of hydrogen peroxide from a 0,5% cleanser or 2,5% solution of chlorgexedin bigluconat, 0,2% solution of dezactin and others like that. These solutions have not a smell, and the stay in them of instruments during 30-60 does not lead minutes to corrosion of metal. For the before sterilisation cleaning it is necessary to have other tank which as well as a tank for disinfection is to be marked. Before sterilisation treatment of tool in bandaging is executed like to treatment of tool at a sterilization operating block.

The order of implementation of bandaging after the degree of aseptic consists in the following. Puncture of joints, soft fabrics and cistoc must be executed the first, then pleura puncture, as not always it is possible to foresee the character of maintenance which is found in a pleura cavity. Bandaging of fresh after operative wounds go farther; then removal of stitches and, on an end, bandaging of clean wounds, that granulate, gastrostom and others like that.

All bandaging of fastening wounds, exactly as well as puncture of abscess, washing of cavity of empiemi and others like that, and also bandaging of patients with fistula to the intestine are executed in the fastening bandaging In the fastening bandaging it is important out distribution of microorganisms outside the wound of patient. In communication with that above all things patients are bandaged with running sore, that heal over, then with considerable fastening excretions, and in the last turn – septic patients with intestinal fistula and others like that. Patients with an anaerobic infection need in the special measures.


Choice of facilities antiseptic depending on the variety of fastening-septic surgical pathology.

Surgeons in the work try to get a maximal effect antiseptic and, as a rule, apply a few types of antiseptic, and sometimes and all arsenal (mixed antiseptic). It relies on the variety of pathology and weight of its motion.


Examples of choice of facilities antiseptic at different pathological states

Pathological process

Facilities of antiseptic, that can be applied

mechanical

physical

chemical

biological

Clean wound




Drainage

OUVCH




Prophylactic antibioticotherapy

Contaminative wound (accidental)

Deleting of strange bodies.

Deleting of blood clots.

Deleting of necrotic fabrics and those, that potentially can grow stiff

Drainage.

Ultrasound

OuF-irradiation

Sorbenti

Osmotic facilities

Facilities for local application

Local and general antibioticotherapy Facilities of passive and active immunization against a stupor and hydrophobia at the bitten wounds

The Suppurative wound

Deleting of dead fabrics

Drainage.

Ultrasound.

OuF- irradiation

Sorbenti.

Osmotic facilities.

Laser irradiation


Facilities for local application.

Chemotherapy facilities.

Local and general antibiotics therapy.

Proteolitic enzymes.

Facilities of passive and active immunization against a stupor and hydrophobia at the bitten wounds

Fastening diseases of skin and hypodermic cellulose in a purulent-necrotic stage

Dissection of abscess.

Deleting of dead fabrics

Drainage.

Ultrasound.

OuF- irradiation.

Sorbenti.

Osmotic facilities.

Laser irradiation

Facilities for local application.

Chemotherapy facilities.

Local and general antibioticotherapy.

Proteolitic enzymes.

Facilities of passive and active immunization



^ Composition and preparation to application of some facilities antiseptic

Computation of component parts for preparation of working solution of pervomur (S-4)

Initial solution

Working solution

Pergidrol, ml

Ant acid, ml

Water, l

100%

85%

1,2%

2,4%

4,8%

17,1

6,9

8,1

To 2

To 1

0,5


For preparation of initial solution in a glass retort the proper quantity hydrogen peroxide is poured, and then add ant acid. Shake a retort up and put in the lower area of refrigerator on 1 – 1,5 hours, shaking up a retort each 20-30 min. Initial solution can be saved at a room temperature a 1 day. Working solution also suitable during a 1 day. Thus pervomour it is possible to prepare every 2 days.

Triple solution (Croupenin)

Composition:

Carbolic acid – 0,3%

Formaldehyde – 1,5%

Carbonate of sodium – 2%


Alcoholic solution Lugol

Composition:

Alcohol 96% - 100 ml

To potassium of iodide – 1 g

Clean iodine – 1 g


Water solution Lugol

Composition:

Distilled water - 100 ml

To potassium of iodine – 2 g

Clean iodine – 1 g


^ Organization of care of patient with an anaerobic infection

A patient with an anaerobic infection creates for surrounding him other patients and medical personal large danger. An anaerobic infection is characterized by the high level of contagious and, if not to apply prophylactic measures, can stagger other patients. Basic by distribution of anaerobic infection is contact, therefore popered all it is necessary to insulate a patient in a separate chamber and organize disinfection and sterilization of facilities of examination, crockery, instruments, and others like that, which contact by the given patient.

  1. In the induction centre a patient passes sanitary treatment.

  2. For washing of patient soap is applied in the shallow packing.

  3. Before hospitalization the bed, stand, floor, a pidcladne ship is processed by a 6% solution hydrogen peroxide with a 0,5% solution SMZ.

  4. Cleaning up of chamber is executed 2 times per a day with the use of a 6% solution hydrogen peroxide with a 0,5% solution SMZ.

  5. Facilities for cleaning up mark and sterilize in an autoclave after the 1st mode.

  6. The crockery of patient is released from tailings of meal, wet in a 2% solution of soda and boil hours during 1,5.

  7. A medical personnel before the entrance in a chamber is changed clothes in the special dressing-gowns and bahili, during the review of patient and bandaging use oilcloth aprons which are processed by a 6% solution hydrogen peroxide.

  8. Bandaging material is collected in specially selected bics, autoclave and annihilate.

  9. The linen worn and bed next to the skin is collected in cotton or polyethylene sacks, wet in a 2% solution of soda or cleanser, whereupon hours are boiled during 1,5.

  10. A mattress, pillow and blanket is added to chamber disinfection in the mode for microorganisms, that form spores.

  11. Dip the used tool in a 6% solution hydrogen peroxide with 0,5% SMZ on a 1 hour, then before sterilization preparation and sterilization is conducted.


Utilization of bandaging material muddy by fastening excretions.

Bandaging material, that was in touch with a patient at which a purulent-necrotic process takes place, is added to disinfection (wetting is applied in different chemical facilities antiseptic), the mode of the last relies on used for this mean. After disinfection the worked bandaging material is taken out and must be fire.


^ The order of carrying out of a general cleanings in the operational room

General cleaning is spent once a week and also urgently after operative interventions during which there was a pollution operational intestinal contents, by pus, after operative intervention at the patient with the purulent-necrotic process caused anaerobic by an infection. General cleaning is spent by a principle of final disinfection.

In the beginning of cleaning it is necessary to calculate quantity of a disinfectant solution which should be used. The area of operating room is usually known and specified in “the Log-book of carrying out of general cleanings” on a home page. The norm of charges on 1 м2 depends on a kind of a solution which will be applied. The most widespread norm is 150-200 ml on 1 м2 depending on a processable surface (it is covered by a tile, quality of a covering, is coated and so forth). It is necessary to consider chemical properties of a disinfection solution, its ability to cause corrosion of metals, to damage a paint, fabrics and so forth. During cleaning to observe safety rules at job with given solution, to use means of protection.

To carrying out of general cleaning most often apply:

  • Solution of peroxide of hydrogen of 3 % from 0,5 % of a washing-up liquid.

  • Solution of peroxide of hydrogen of 4 % from 0,5 % of a washing-up liquid.

  • Solution of peroxide of hydrogen of 6 % from 0,5 % of a washing-up liquid.

  • Solution chloramines 1 %.

From import solutions which can be used in Ukraine apply preparations on the basis of Aldehyde (Aerodesin, Bacillol plus, Deconex 50 AF), Chlorcept, Deconex, Solarcept and other means.


The sequence of cleaning consists in the following:

  • To release a processable surface from the subjects which are being on them (except for a bactericidal lamp) to remove from a wall a case, the equipment etc.

  • To irrigate walls, doors and windows by cleanser, beginning from above, on height not less than 2 meters.

  • To wipe a cloth moistened by cleanser the equipment, cases, the equipment, etc.

  • To irrigate by cleanser a floor, thus the charge solution should be at the rate of 200-250 ml on 1 м2.

  • In case of carrying out of disinfection by a method wiping, surfaces wipe with an interval of 15 minutes twice.

  • To include bactericidal lamps for 60 minutes.

  • To wipe all the processed surfaces a cloth moistened by water.

  • To include bactericidal lamps for 30 minutes.

  • To air a premise.


During carrying out of general cleaning bactericidal lamps also are disinfected, wiped. Glass of a bactericidal lamp is wiped 70 % by ethyl spirit; the screen of the equipment - a dry cloth, the case of armature is wiped by a cloth moistened in 3-6 % a solution of peroxide of hydrogen.

The solution of peroxide of hydrogen of 6 % from 0,5 % is used by a washing-up liquid in cases of presence (or suspicions on presence) the anaerobic microbe cells. At presence in air of a premise on subjects of fungi the solution of peroxide of hydrogen is applied to cleaning of 4 %. In other cases used a solution 3%.


^ Clothing of operational linen

After processing hands the operational sister of the first comes in operational where by means of orderly or other medical sister starts clothing a sterile dressing gown. The medical sister opens the box with sterile dressing gowns and, having chequed up on reaction of the indicator of sterility suitability of dressing gowns, takes out a dressing gown combined in the form of a roll, develops and puts on it. Orderly or other medical sister fastens behind an outset and a belt. Thus watch, that edges of a sterile dressing gown completely closed unsterile linen. Then from the second box or from disposable packing get sterile rubber gloves and dress them. Surgeons also put on independently, but the dressing gown them submits the operational sister, and sometimes and helps, supporting it for sleeves. On sleeves surgeons fasten outsets, but if it is necessary to hurry the operational sister help them with it. Behind and the belt fastens outsets orderly or other nurse. Gloves to the surgeon the operational sister submits so that last fast movement has entered a hand into a glove as it is possible more deeply. Then gloves usually process 96 % ethyl spirit to remove the rests of talc.


^ Method of preoperative processing of hands

Method by Spasocucotsky-Cochergin

In the beginning hands wash with soap under the crane hot water. Then in current of 6 minutes (2 times for 3 minutes) hands wash in two basins in 0,5 % a solution of ammonia by means of a napkin. Basins are burned spirit before instilling of a solution of ammonia. After washing hands in a solution of ammonia them wipe a sterile towel and wipe a napkin moistened in 96 % ethyl spirit. Then grease nail laying down 5 % spirit with a solution of iodine and dress gloves.


Processing by Chlorgexidin biglukonat (Gibitan)

20 % a solution of Chlorgexidin biglukonat are issued in glass bottles on 500 ml. Hands are processed 0,5 % spirit by a solution gibitan for what of 20 % Chlorgexidin biglukonat plants a solution in 70 % ethyl spirit in the ratio 1:40, that is on 500 ml of 70 % of ethanol add 12,5 ml of 20 % of a solution Chlorgexidin biglukonat.

Hands in the beginning wash with warm water with soap, then wipe their sterile towel then in current of 2-3 minutes wipe 0,5 % spirit a solution by Chlorgexidin biglukonat by means of a napkin. To put a solution it is necessary regularly, a finger behind a finger, watching to not pass any site of a skin of fingers, brushes and the bottom part of a forearm. Surfaces of a hand dry up after processing by an antiseptic.


Processing by Pervomur

Pervomur is a mix of peroxide of hydrogen, ant and underant acids at what last is formed during reaction between the two first components. A solution of Pervomur, initial and working (2,4 % and 4,8 % on underant acid), prepare, proceeding from the calculation presented in the table.


Calculation of components for manufacturing solutions of Pervomur

Initial solution

Working solution

Pergydrol, ml

Ant acid, ml

Water *, liters

100%

85%

2,4%

4,8%

17,1

34,2

85,5

171,0

6,9

13,8

34,5

69,0

8,1

16,2

40,5

81,0

До 1

До 2

До 5

До 10

0,5

1

2,5

5

* Water can be distilled, water, artesian and sea taken in the high sea or ocean. Concentration is presented in percentage of underant acid.

For preparation of an initial solution in a glass flask pour corresponding quantity of peroxide of hydrogen, and then add an ant acid. A flask is shacked and placed in a saucepan with cold water or in a refrigerator at 1-1,5 o'clock shaking a flask each 20-30 minutes. For this term in a solution the underant acid is formed. An initial solution it is possible to save 1 day at a room temperature. The working solution is suitable to use within 1 day. Hence, Pervomur it is necessary to prepare for each 2 day.

To processing hands apply a solution of Pervomur 2,4 % on a underant acid. For this purpose of 120 ml of a fresh initial solution add up to 4,880 ml of water. The initial solution of Pervomur, getting on a skin and mucous, can cause a burn; therefore at job with the concentrated solution of this preparation it is necessary to be cautious. The drops of the solution which has got on a skin, it is necessary to wash off immediately a lot of water. If the drop of a solution has got in an eye it is immediately necessary to wash out eye water, repeating this procedure repeatedly then it is necessary to address for the help to the oculist.

Processing of hands by Pervomur consists in the following: in the beginning hands wash with soap under flowing water within 1 minute without a brush; hands wipe dry a sterile towel; immerse hands in a solution of Pervomur up to elbow bends for 1 minute; hands wipe a sterile napkin or a towel; put on sterile gloves. In one basin can process hands up to 20 people.

To processing an operational field applies method by Grocih-Filonchicov which provides repeated processing an operational field of 5 % spirit a solution of iodine. As this solution can cause a burn of a skin, allergic reactions, dermatitis, is better use the preparations incorporated in group under the name iodofors (Iodinate, Iodopiron, Povidon-iodin, Betadin, Cutasept, etc.). The operational field can be processed by a solution diamond green (in particular at children), Chlorgexedin bigluconatis, Pervomur, etc.


^ 5. Study questions:

  1. definition of an antisepsis;

  2. classification of an antisepsis;

  3. the mechanical methods of an antisepsis;

  4. the physical methods of an antisepsis;

  5. the chemical methods of an antisepsis;

  6. the biological methods of an antisepsis;

  7. the main requirements to the nurses hands;

  8. preparation and using main chemical antiseptic solutions;

  9. using different kinds of the dressing materials;

  10. applying different kinds of drainages;

  11. processing by Spasocucotsky-Cochergin;

  12. processing by Chlorgexidin biglukonat (Gibitan);

  13. processing by Pervomur;

  14. preparation of the patiet‘s skin;

  15. processing by Grossych - Phylonchikoff.


6. The literature:

6.1. Basic :

  1. Textbook of basic nursing / Caroline Bunker Rosdahl. – J. B.Lippincott Company. Philadelphia. - 6th ed. –1995.– 1518 p.

  2. Fundamentals of nursing /Taylor Mary Carol, Mary Carol, Lillis Carol– J. B.Lippincott Company. Philadelphia. - 1989.– 1356 p.

6.2. Аdditional:

  1. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

  2. P. of Brown. Operating block. Operating brigade. – Kharkov, 1997. – with. 1-32.



Methodical instruction was prepared by

Assistant Riabyi S.I.


A review is positive, associate professor Chomko O.J.

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