ENDOSCOPY. TERMINAL OBJECTIVE n State the duties and responsibilities of the scrub and circulator...
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Transcript of ENDOSCOPY. TERMINAL OBJECTIVE n State the duties and responsibilities of the scrub and circulator...
ENDOSCOPY
TERMINAL OBJECTIVE
State the duties and responsibilities of the scrub and circulator technologist during endoscopic surgery.
ENABLING OBJECTIVES State the purpose of endoscopic
surgery List the advantages and disadvantages
of endoscopic versus open surgery List the functions of:
An endoscope, camera, fiber optic light cord, suction/irrigator, video system components
ENABLING OBJECTIVES State the recommended practices
for the care and handling of endoscopic instruments and equipment
Connect a real or simulated camera, light cord, and insufflation tubing to a real or simulated video system
ENABLING OBJECTIVES State the function of a verres
needle and selected trocars/cannulas.
Prepare a verres needle and selected trocars with cannulas for use in a laparoscopic procedure
ENABLING OBJECTIVES
State the cannula sites for selected endoscopic procedures
List selected endoscopic instruments and state their function and uses
ENABLING OBJECTIVES List disinfection/sterilization
methods for selected endoscopic instruments and equipment
Demonstrate cleaning techniques for selected endoscopic instruments and equipment
ENABLING OBJECTIVES State the pathology leading to
the surgical intervention for selected endoscopic procedures.
State the major steps involved in selected endoscopic procedures.
PURPOSE Visual examination of:
Interior of a body cavityAbdomen
Hollow organsUterus, bladder
StructuresKnee, joint
ADVANTAGES VS. DISADVANTAGES
ADVANTAGES Minimal invasion required for
confirming a diagnosis Small incisions Decreased:
Trauma Postop pain Hospital stay Recovery time
DISADVANTAGES
Additional training required for surgeons
Purchase and maintenance of expensive equipment/instrumentation
FUNCTIONS OF EQUIPMENT
ENDOSCOPE
Lensed instruments used for viewing internal anatomical structures through natural body orifices or a tiny incision
Types varies in diameter and length based on specific patients and procedures
TYPES Rigid Non-flexible Optical capability
for the for operator Direct
0 degree
RIGIDAngled- -30,70,120 degreeExamples:-Cystoscopes-Laparoscopes-Hysteroscopes
TYPES Flexible
Panoramic view Mostly GI and respiratory tracts
BronchoscopeColonoscopeCholeducoscope
Have working channels that permit the use of biopsy forceps & laser fibers
CLASSIFICATIONS DIAGNOSTIC:
Used for observation only No operating channels
Laparoscope
CLASSIFICATIONS Operative:
Channel allows irrigating, suctioning, inserting, and connecting other instruments.Bronchoscope
3.8.3
CAMERA UNIT Camera head
Most important component of the video system
Head Cable
On/off
Cable Port
CABLE
Connects camera head to control unit
CAMERA CONTROL UNIT(IMAGE PROCESSOR)
Adjusts color and light intensity Transmits the image to a video
monitor, recorder, hard copy picture, or all three
CAMERA CONTROL UNIT(IMAGE PROCESSOR) White balance-most important!
Common cause for color distortion-not setting the white balance
Must focus camera on white field prior to set balance prior to procedure
COUPLERS (Adapters) Optical coupling devices ysed to
connect cameras to various endoscopes
CAMERA UNIT Enables image received by the
scope to be transmitted to the monitor
Zoom feature allows the image to be enlarged without moving the scope
CAMERA UNIT The tech may be required to
operate the camera Must have good spatial
orientation Steady hand Ability to concentrate for long
periods
FIBEROPTIC LIGHT CORD Comprised of hundreds of glass
fibers that transmit light
FIBEROPTIC LIGHT CORD
Light cords-NEVER in contact with drapes for prolonged periods of time Cause drape to burn Should be turned off when not in
use, or placed on a moist towel Connects to light source
LIGHT SOURCE Provides illumination essential for
visualization Halogen
Used for office and hospital applications
Xenon More expensive, lasts longer Better for smaller diameter scopes
LIGHT SOURCE Halide bulbs
Shorter life span (about 250 hrs) Less expensive Bulbs are easier to handle
Rheostat Used for regulating flow of current
from the electrical system
SUCTION/IRRIGATOR Simultaneously suctions and irrigates
body cavities Used
Through irrigating channelsirrigating systems inserted into
• Operating ports• Cannula• Operative endoscopes
SUCTION/IRRIGATOR Fluid can be introduced: Manually through an endoscope
Syringe/Stopcock attached to irrigation tubing
Irrigation pump powered by: CO2 Electricity
Provides large quantities of fluids
SUCTION/IRRIGATOR Gravity
Manually force through distal tubing
Pressure bag to increase flow
VIDEO SYSTEM COMPONENTS
Monitors (2) Used for educational training One on each side of OR bed
Should match the resolution quality of the camera
Second monitor is called slave monitor
VIDEO PRINTER
VIDEO SYSTEM COMPONENTS
Video Printer Utilized for teaching purposes Documentation for patients
VIDEO SYSTEM COMPONENTS
VCR Procedural documentation is
needed Teaching purposes
STORAGE SYSTEM•Houses multiple components
•All components must be securely fastened
INSUFFLATOR Provides CO2 for pneumoperitoneum
Non-toxic, highly soluble in blood rapidly absorbed from the peritoneal cavity
Flow and volume monitored by circulator and surgeon
12-18 mmHg pressure9 liters/ minute
INSUFFLATOR Should include a two-way
disposable hydrophobic filter to protect patient from chromium particles and colonization of organisms
INSUFFLATOR
CARE AND HANDLING
FUNCTIONS VERRES NEEDLE,TROCARS
AND CANNULAS Verres Needle Long insufflation needle is inserted
into the abdomen to introduce CO2 into the peritoneal cavity, creating pnemoperitoneum
VERRES NEEDLE
VERRES NEEDLE Allows visualization of abdominal
(or thoracic) structures Prevents injury to internal
structures during surgery
VERRES NEEDLE Spring-loaded needle has an outer
sharp hollow cannula with an inner blunt retractable stylet with a two-way stopcock at base for control of gas flow
SCOPE GUIDED TROCAR
CANNULA/TROCAR
REUSABLE TROCAR
10MM HASSON TROCAR
CANNULAS/TROCARS Provides a mechanism for inserting
and removing INSTRUMENTATION ENDOSCOPES
May be disposable or reusable
CANNULAS/TROCARS Cannula or sheath is inserted into
operative site by using trocar and obturator
Once port of entry has been made, trocar is removed, cannula is left in place
CANNULAS/TROCARS Variety of sizes to accommodate
diameter of instrumentation May have spring-loaded end
guards that cover sharp tip and protect internal structures after penetration
CANNULA SITES
LAPAROSCOPIC APPENDECTOMY
Periumbilical Port
Suprapubic Area
Left Lower Quadrant
LAPAROSCOPIC CHOLECYSTECTOMY
X
10/11mmSupraumbilical Port
X
10mm Trocar Subxyphoid
X X
5MMLATERAL
5MMLATERAL
ARTHROSCOPY OF THE KNEE
INSTRUMENTATION
INSTRUMENTATION Designed for use in surgical sites
and/or procedures The instrument length, design of
the working end, and design of the hand control vary according to needs of the procedure
INSTRUMENTATION Reusable or disposable May have monopolar and bipolar
capabilities
CLAMPING INSTRUMENTS
Used to grasp and hold tissue or other materials
Babcock Allis clamp Kelly clamp Alligator clamp
CAUTERY
MORE INSTRUMENTATION
DISSECTORS Used to cut, divide, or separate tissue Used for blunt or sharp dissection Scissors
Straight Curved (hook scissors)
Balloon dissectors Blunt dissection or creation of a
space i.e. Lap Hernia
STERILIZATION METHODS
ETO (ETHYLENE OXIDE)
Used for heat-sensitive items Endoscopes Lightcords
12 hr. cycles take instrumentation out of use for extended periods
STEAM Used for most endoscopic
accessory instruments EXCEPT Endoscopes, light cords,
cameras Damages fiberoptic cables
STERIS (PERACETIC ACID-35%)
Used for heat-sensitive items Uses low temperature and 30
minute cycle time
CIDEX (2% GLUTARALDEHYDE) Disinfects only
High level Item is completely immersed and
lumens filled with solution for 20 minutes Must be well rinsed in sterile,
distilled water before use on patient
STERILIZATION METHODS Documentation of endoscopic
instrumentation sterilization recorded in a permanent log Sterile processing department Any clinic or OR suite that
processes their own
CLEANING TECHNIQUES
LEAK TESTING Identifies damaged endoscopes Requires maintenance
Contaminates can enter interstitial space increasing chance of infection
CYTOLOGY BRUSHES Single use cytology brushes are
disposable Reusable brushes must be cleaned
and sterilized
CAMERAS Remove debris carefully from lens Never touch the lens with fingertips
or anything Never use any substance with
alcohol since it may dissolve cement
INSTRUMENTS/TROCARS May have disposable or
replaceable tips or reusable shafts or handles that may need to be removed
STORING INSTRUMENTS Place endoscopes and all parts
disassembled in well padded perforated tray
Terminal sterilization is preferred
PROCEDURES
DIAGNOSTIC LAPAROSCOPY
Endoscopic visualization of the peritoneal cavity through the anterior abd wall after the establishment of a pnemoperitoneum
Used to investigate and DX the causes of abd bleeding, pelvic masses, abd pelvic pain, infertillity and other diseases and disorders
ARTHROSCOPIC Endoscopic visualization of the
interior of a joint through an arthroscope
Used to diagnose cartilaginous, ligamentous, synovial and bony surface defects and for TX of meniscal, articular cartilage and ligamentous defects in the knee
REVIEW & SUMMARY
ENDOSCOPYQuestions?THE END