| Textbooks |
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| Of course, you should read
the recommended texts for Surg200, including Lawrence,
but here are some places previous students have found helpful information: |
- Surgical
Recall (Blackbourne)
- Case
Files in Surgery (Toy)
- NMS
Casebook (Jarell)
- Surgery
Pretest (Geller and Nitzberg)
- Appleton
& Lange Surgery Review (Wapnick)
- The
Mont Reid Surgical Handbook (Univ. of Cincinnati Residents)
- Surgical
Review: An Integrated Basic And Clinical Science Study Guide,
2nd Edition (Kaiser)
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| Operating Room Etiquette |
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- Wear clean scrubs with a white coat in the halls.
- White coats are not permitted inside the operating room.
- Your hair must always be covered while in the operating room suite (hats are just inside the doors to the main OR).
- Masks must be worn at all times once the instruments have been opened.
- If you plan to scrub in for a case, eye protection is required (combined face masks and eye shields are available outside each OR).
- Be prepared to help out if asked to do so, but never take or use an instrument without being directed – not only does this make things more difficult for the surgeons, but it exposes you to the risk of needlesticks, etc.
- To scrub, first wash both hands and wet your arms up to just above your elbows. At HUP, we use a water-aided, brushless scrub, so you first clean under your fingernails with the nail picks provided above the scrub sinks. Then, squeeze a palm-sized portion of the scrub soap into one hand, and swirl the fingertips of your other hand in the soap. Then, switch hands and repeat the motion. Wash both arms up to just above the elbows and rinse without touching anything with your hands. Repeat the process, stopping just below the elbows this time, kick the sink off and keep your hands up (above the level of your elbows) at all times. Do NOT dry your hands. Open the door to the OR with your body, and wait for the scrub nurse/tech to hand you a towel. Dry your hands/arms, and put the towel down without touching anything, and wait for your gown. Once you have your gown on, the circulating nurse will tie it up, and you can work your hands out the cuffs without touching the gown with bare hands. The scrub nurse/tech will hold out one glove (usually the right glove), and you can put your hand into it. Then, help him/her to spread out the second glove, and put that one on as well. It is best to always wear two pairs of gloves in the OR, and you may be asked to put the second pair on yourself once you are sterile.
- Remember, nothing below your waist or above the level of your shoulders is sterile, nor is your back, so be careful not to touch any of those places, and be aware of your position so that you do not brush against anyone or anything else, as this would contaminate someone or something, requiring someone to rescrub, or a table/mayo stand to be changed. The safest place for your hands is on the patient, or folded on your chest!
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| Commonly
Used Surgical Instruments |
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| Kelly
(curved and straight) |
Kocher Forceps |
Curved
Mayo Scissors |
Straight
Mayo Scissors |
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| Metzenbaum
Scissors (Metz) |
Adson
Forceps |
Debakey
Forceps |
Russian
Forceps |
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| Right
Angle Forceps |
Mosquito
Forceps
(curved and straight) |
Needle-Holder |
Balfour |
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| Rake |
Richardson
Retractor |
Army-Navy
Retractor(s) |
Deaver
Retractor |
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| Malleable |
Sweetheart
Retractor |
Bladder
Blade Retractor |
Wheatlander
- 'Wheatie'
(self-retaining retractor) |
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| Yankauer
Suction |
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| Drains
and IV Access |
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Jackson-Pratt
Drain |
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The Jackson-Pratt Drain ("JP")
is a closed suction device that is made of two parts. The bulb
("grenade") is a soft plastic container with two openings
at the top in order to facilitate the creation of a vacuum after
the drain tubing has bee inserted. The drainage tube is soft
and has a long flat surface with multiple small holes which
can be trimmed to fit the desired drainage area. The JP drain
is used in situations where there is risk of fluid accumulation
post operatively (bowel anastomosis, neck surgery, etc.) |
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Nasogastric
Salem Sump |
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Commonly known as an NG tube. The system
is a sump (“suction pump”) which allows for air
and liquids to be injected and then sucked out by vacuum which
prevents the system from becoming permanently attached to the
wall of the stomach.
The NG is used in situations where the stomach need to be decompressed
or emptied. Common uses include: Patients with small bowel obstructions,
upper or lower GI bleeds, gastroparesis and situation where
there is an aspiration risk. |
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Dobhoff Nasogastric
Tubes |
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The Dobhoff is used to provide fluid
and food to patients who are unable to swallow but have an otherwise
functional GI tract. Dobhoffs are inserted into the nose for
final placement in the stomach. |
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Port-A-Cath |
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Port-A-Caths are vascular access devices
used in patients who require frequent vascular access (chemotherapy
or blood transfusions). Port-A-Caths consist of two parts: a
long piece of tubing that is inserted into a large vein, (usually
the subclavain), and a reservoir that is placed just underneath
the skin. The reservoir has a permeable membrane where needles
can be inserted. |
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Hickman Catheter |
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A hickman catheter is a vascular access
device. It is tunneled underneath the skin from the lateral
chest to where it inserts in to the jugular vein and into the
SVC. Uses are similar to that of the Port-A-Cath where frequent
vascular access is necessary (chemotherapy, blood transfusion
or blood analysis). |
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PICC |
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A PICC (Peripherally Inserted
Central Catheter) is a vascular access device where catheter
tubing is run through a medium size peripheral vein into a larger
central vein (SVC). Uses include chemotherapy delivery, TPN
delivery or extended antibiotic delivery. |
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Red Rubber
Catheter |
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The Red Rubber Catheter is most often
used to access the urethra of patients in order void urine (“straight
cath”). It can also be used in a variety of situations
to drain small collections of fluid most anywhere. Due to its
flexible and versatile nature it can be improvised for non-draining
purposes (eg. anchoring NG tubes in place). |
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Pig Tail Catheters |
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This drain is usually inserted over a
straight needle by Interventional Radiology. When the needle
is removed it curls into its prescribed shape. It is often used
to percutaneously drain abscesses or to treat small pneumothoraces |
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Pediatric
Feeding Tube |
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Used for enteral feeding of pediatric
patients. This tube can be advanced beyond the pylorus for duodenal
or jejunal feeds. This tube is inserted nasally. |
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Percutaneous
Gastrostomy Tube |
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The Percutaneous Gastrostomy Tube or
PEG (Percutaneous Endoscopic Gastrostomy) tube is a solution
for a patient who cannot swallow or has no appetite but has
a functional GI tract. This tube is placed in the OR under endoscopic
guidance. The tube is placed in the wall of the stomach and
the aperture is pulled through the skin of the abdomen where
it can be accessed. |
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Penrose Drain |
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The Penrose drain is the workhorse of
surgical drains. It is an open drainage system that allows fluid
to passively drain. It is most often used in open surgical wounds
that require drainage for closure. However, due to the floppy
and maneuverable nature of the penrose it is often used in the
OR and as a make-shift anything. |
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