1.2.cartefinal Engleza

PRACTICAL GUIDE
OF SURGICAL
SEMIOLOGY
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CONTENTS
First day in the surgery service

Organizing the surgery service
Asepsis
Antisepsis
Evaluating the surgical patient
Preoperative preparation
Postoperative care
Cardio-pulmonary resuscitation
Hemostasis
Blood transfusions
Injections
Vascular probe
Punctures
EXIT
CLIC CU MAUS-UL PESTE FIECARE TITLU
Incisions
Surgical suture
Surgical drainage
Bandage
Bandaging
Digestive probes
Preparing the colon
Enema
Vesical probing
Attending the stomies
The surgical instrument
Bibliography
Instructions of use
THE FIRST DAY IN THE SURGICAL SERVICE
A significant status change

Preparation
The contact with the teachers
Behavior rules in the surgery theatre
CONTENTS
A SIGNIFICANT STATUS CHANGE

The 3rd year as a student at the Faculty of General Medicine represents the
beginning of the clinical training activity, therefore the direct contact with the
patient.
It is very important to remember that the study materials, rather impersonal, that
characterize the first two academic years (mainly focused on the preclinical
subjects), will be replaced by pathology, and not by people. The patient must not
be considered as an object of study, but as a human being in suffering who will
share the signs and symptoms of his disease, so that you learn to recognize it
anytime you see it in your future practice.
During the internships, you will come into contact not only with the patients, but
with different categories of personnel involved in the medical activity, and your
presence must not be considered a barrier in the deployment of this activity.
Surgery represents the last redoubt of the therapeutic possibilities of a disease.
When the conservatory treatment failed or it is not indicated, the only chance
given to the patient refers to the surgical intervention. When the surgical
resources are exceeded, in the majority of cases, death occurs in the nearest
future. Therefore, remember that the surgical patient is rather special, he came
to you after a longer or shorter journey in other services or in emergency
conditions with immediate vital risk. As a result, the patient is a fine observer
and even judge of your behavior.
BACK
PREPARATION
Aspect
Clean aspect the negligent beard or haircut creates
a very bad impression since the beginning;
decent clothing (a too short skirt or a dirty pair of
jeans will significantly distance you from the image of
future doctor);
The shoes must not be dirty with mud, dust etc.
White, clean gown, without spots (or you risk to be
mistaken with the cleaning personnel);
Devices (compulsory) : tensiometer and stethoscope.
Internship copybook, writing tools (compulsory)
BACK
BEHAVIOUR RULES IN THE SURGERY

THEATRE
These rules complete the duties and obligations that the students have in an educational institution.
General rules
-At the beginning of the internship course the students will be present in the theatre where they were distributed, NOT on the hallways, dressing
rooms, etc.
-The noisy discussions in the presence of patients, no matter the subject, are prohibited;
-It is prohibited to wait on the patients bed; the bed is the only privacy oasis that the patient has, therefore respect it as such!
-It is prohibited to consume coffee, sodas, tobacco, snacks etc. in the theatre;
-At the end of the internship, washing the hands is compulsory;
Special rules regarding patiens
-The patients may ask you questions related to their disease (explorations, evolution, prognosis), but it is better to avoid the answer in an elegant
manner (Ex. You
You should ask the doctor attending you);
-Do not discuss the disease of a patient in his presence, especially when it is very serious (cancer), unless the group assistant is present as
moderator;
-Do not refuse the patients who require a qualified maneuver (pulse, taking the blood pressure);
-It is prohibited the immixture in the therapeutic scheme or comments related to the presence of the respective patient, if the group assistant is
not present;
-Address the patients using the name Dumneavoastr
Dumneavoastr (You) (it is prohibited to use names such as mamaie
mamaie (granny),
(granny), tataie(grandpa)
tataie(grandpa),,
moule(old
moule(old man) etc.
etc.
Recommendations related to the medical personnel
-Besides the group assistant and the other doctors you will come into contact with, in the respective theatre you will also interact with the medical
personnel (registered nurses) and the auxiliary personnel (nurses).
-The registered nurses from the surgery service are overqualified and are very experienced in attending the patients, experience that a part of you
will not acquire very soon. Respect them to be respected. Moreover, they can answer very many questions regarding the caring of the surgical
patient, especially during the shifts when the teacher is more preoccupied with the medical problems specific to the emergency service. You have
the chance that, by modestly approaching a nurse, to make more maneuvers from the III year schedule (injections, enemas, perfusion mounting,
transfusions etc.) than other colleagues. A maneuver that you carried out by yourself is never forgotten.
-And in the end, remember that a fully-trained physician must know anytime to do the work of the registered nurse. Maybe in the future you will
have to guide the first steps of a recently graduated nurse.
BACK
ORGANIZING THE SURGICAL

SERVICE
General organization
Clinic I - II Surgery Sf.
Spiridon Hospital Iai
CONTENTS
GENERAL ORGANIZATION
The ambulatory
The in-patient unit
The operating theatre
The sterilizing unit
BACK
THE AMBULATORY
It is an integrating part of each service, ensuring the medical care without the patient's
hospitalization.
At this level the medical specialty examination is performed, the diagnosis is established
(including by paraclinical explorations), the appropriate therapy is indicated and applied
*in simple cases), and in the most difficult cases the hospitalization is programmed and
even the surgical intervention, afterwards this service taking over the post-operatory
directly observed therapy of patients.
The ambulatory must be organized in such a manner as to cover all these activities,
therefore it must comprise: the examination room, the room of small interventions and a
registration-archive.
The examination room must be equipped with a couch, a gynecological table, a source of
light, a carriage for the medical equipment , sanitary materials and cupboards for them.
The operating room from the ambulatory must have the same equipment with that of the
operating theatre (operating table, scialitic lamp, instrument table, anesthesia apparatus,
medical Aspirator, electrical bistoury) and to accomplish the same architectural conditions,
of heating, illumination and ventilation as the latter.
The Archive must comprise the medical documents of each patient who was examined,
investigated and tested at the ambulatory level, for a correct directly observed therapy
even if the medical file of each patient is archived by the family physician
The doctors who work in the ambulatory should also work in the in-patient unit. They would
have a program in the in-patient unit and a periodical one in the ambulatory. Thus, they
can examine their patients, establish the diagnosis, schedule for hospitalization and
surgery and send to directly-observed therapy after surgery.
BACK
THE IN-PATIENT UNIT
BACK
In all the classical manuals, the patient rooms are described from the
point of view of architectonic and equipment characteristics.
We must mention that, although this data remains valid, we must
respect other principles as well, and namely those regarding the
comfort and privacy of the patient. Thus, the rooms of 1-2 beds are
preferable, and in the case of large rooms, their boxing. The rooms will
be equipped, besides the bed, with bed table, table and chair,
installations for the medical fluids: and other facilities (bathroom,
telephone, radio, television).
In these conditions, the existence of dining halls, or bandage rooms is
no longer necessary. These, especially the bandage rooms are
necessary for carrying out some intervention maneuvers or particular
explorations.
Reducing the number of stationary beds can be compensated by their
rational use and the fast flow of patients.
For the good collaboration of the two sectors of the surgical service
the ambulatory and the in-patient unit- they must have the same
superior medical personnel.
The in-patient unit must be seen as an accommodation space (hotel)
of high quality, where the patients must benefit from the best
THE OPERATING THEATRE

Particular element in the surgical service, the operating theatre must be
organized and equipped to correspond to the principles of asepsis and
antisepsis, complexity and efficiency of the activities that are carried out
at this level. The operating theatre supposes a complex organization and
functionality which allow the carryout of the most diverse and complex
surgical interventions, with the maximum safety and efficacy. According to
the number of operating theatres, multiple plans of construction of the
operating theatres are described.
It must comprise rooms with special destination: operating rooms, rooms
for waking up the doctors, filter room, room for inducing the anesthesia
and waking up the patients, room for depositing the instruments and
sterile and used materials; they must have special illumination, ventilation
installations, and medical flows; circuits for the evacuation of the used
sanitary materials (waste) and means of communication. At the level of
the operating theatre, the access is limited and restrictive in order to
reduce to the minimum the contamination risks.
THE OPERATING
THEATRE
The filter room
The surgery preparation room
The operating room
The induction and wakeup room
The room for preparing the surgical
instruments
Depositing rooms
BACK TO
Click with the mouse over the underlined titles
GENERAL
ORGANIZATION
The filter room

It is the first room in the medical
personnel circuit where they dress up in
special clothes, for the operating theatre.
It may have the role of rest room
between the surgeries.
The doctors preparation

room
It is provided with multiple sinks with special
taps that allow the use without manual
touch. For touching the hands antiseptics
are used (soap, betadine, chlorhexidin).
Then, in the same room or in another one,
the next step is putting on the gown and the
sterile gloves. In particular situations
(transplant surgery, osteo-articular surgery
etc.) special equipment is used.
The operating room
Architectural conditions: insulation, dimensions, construction materials, illumination installations, ventilation, heating and communication equipment,
circuits of the personnel and patients, possibilities of cleaning and maintenance;
Equipped with furniture and devices: operating table, surgical lamps, anesthetics and monitoring apparatuses, tables for instruments; Aspirator, electrical
bistoury, cupboards/shelves for instruments sanitary materials and anesthetics;
The operating room must not communicate directly with the exterior, it must have dimensions so that to allow the placement of the furniture, apparatus,
and of the presence of the operating team, anesthetic doctors and afferent medical personnel;
The presence of other persons in the operating room is prohibited. The interested persons (residents, students) can watch the operatory act from a
special balcony or through a television system with closed circuit;
The construction materials used for the operating room (as of the entire operating theatre) must allow a cleaning and disinfection as easy and correct as
possible;
The artificial illuminating installation will support the lack of natural light.
The artificial heating and ventilation will be achieved through air conditioning system that ensure temperatures of 20-22 C and a humidity of 40-60 % ,
thus preventing the contamination of the air from the operating room.
The communications between the different departments of the operating theatre and with the exterior are ensured by phone, interphone and different
signaling systems.
The cleaning and disinfection of the operating room must be achieved daily and in accordance with the asepsis and antisepsis rules provided in the
operating theatre documents,
The access and evacuation circuits in the operating theatre and in the operating room are different for the patients and the medical personnel. They
must be strictly respected. Thus, in the operating room, only the operative team already trained, the personnel of the room (one-two registered nurses
and a nurse), the anesthetic team must be present.
The patient is brought into the operating room after having been put to sleep in the induction room.
The surgical instruments, the medical and anesthetic materials are prepared in the operating room or in its proximity, easily accessible. After use, they
will follow a separated circuit towards the sterilization unit or towards the crematory.
Out of prudence, the medical materials offered to the operating team and the used ones will be registered.
The operating table is special, multi-articulate, allowing different positions of the patient according to the necessities of the operating act.
Due to some accessories, it facilitates the operating gestures. It must allow the carryout of some intraoperative radiological explorations.
The table of instruments allows the preparation and display of the instruments necessary for the operating act.
The source of light (scialitic lamps, lights) of different models must ensure a good light in the operating field and be easy to operate according to the
necessities of the surgical act.
The anesthesia apparatus and the monitors will ensure the anesthesia and the monitoring of the vital functional parameters of the patient during the
anesthesia and for resuscitation gestures,
For the operatory gestures, the aspiration apparatuses and electrical bistoury are necessary.
The modern operating rooms ensure, through centralized installations, both the oxygen admission and aspiration.
The induction and wakeup

room
It is the first room in the patients circuit, where
they are administered the anesthetic induction
(and then they are transported into the operating
room), and when there is no separate room, they
are woken up through anesthesia. For these, the
room is equipped with a special bed for intensive
care, anesthesia apparatus and medical flows.
In the modern hospitals, the patient is taken from
the room to his bed (provided with wheels) and
transported with this bed to the induction room.
The room for the preparation

of surgical equipment
It is equipped with sinks or lavatories for

the mechanical and chemical cleaning of
the equipment, with boilers for them, with
tables and shelves for the boxes of
medical equipment.
The depositing rooms

They are destined for the surgical
equipment and the reserve medical
materials necessary for the surgical
interventions.
THE STERILIZING
UNIT
Absolutely compulsory, even in the current conditions when more and more
disposable equipment and medical materials are used, this component of the
medical service can exist whether as an independent unit within the hospital, or
as a component of the operating theatre.
It must comprise rooms for the preparation of medical materials and equipment
for sterilization (if they do not exist in the operating theatre); rooms with
sterilizing apparatus (autoclaves, drying chambers, installation of vapor
production) and rooms (with cupboards and shelves) for depositing the sterile
equipment and materials.
Such a sterilizing unit must have a reception for the receipt and issuance of
sterile materials, so that the access into the unit space is allowed only for the
persons who work at this level.
The constructive characteristics (construction materials and especially finishing
materials) and the equipment must be identical with those from the operating
theatre.
BACK
DEFINITION
A general principle that consists in the systematic avoiding of the
contamination of surgical wounds and secondary infection of
burns and wounds
It includes methods and rules that prevent the wound
contamination and infection
These rules and methods address all the possible vectors of the
microbial germs to the surgery wounds, equipment, textile
materials, hands, clothes, syringes, probes, medicines, air from
the operating room etc.)
Methods : sterilization, disinfection of live tissues
The rules generally refer to the behavior of the personnel that
handles the sterile materials: surgeons, registered nurses from the
operating theatre or bandage rooms, the students involved in the
therapeutic act or just the watchers.
CLICK WITH THE MOUSE ON THE UNDERLINED WORDS
CONTENTS
STERILIZATION
DEFINITION
The totality of methods through which the

complete and total destruction of
microbial particles, both of the stagnant
forms and of the sporulated ones is
achieved
It can be achieved through physical and
chemical means
STERILIZATION
PHYSICAL MEANS
HEAT
ULTRAVIOLET RADIATIONS
IONIZING RADIATIONS
ULTRASOUNDS
FILTRATION
BACK
STERILIZATION THROUGH HEAT
STERILIZATION THROUGH DRY

HEAT
STERILIZATION THROUGH HUMID
HEAT
BACK
STERILIZATION
THROUGH DRY HEAT
BUCKLING
INCINERATION
HOT AIR OVEN
CLICK WITH THE MOUSE ON EACH TITLE
BUCKLING
The passage through flame of the metallic or
glass objects in view of sterilizing them
Sterilizing the phials before aspirating their
contents into the syringe, test tubes, metallic
handles (microbiology)
Disadvantage the fast degradation of metallic
instruments, especially the cutting ones
INCINERA TION
The complete destruction by burning of
the waste with biological risk
It is applied in the crematories found in
all the hospitals
THE HOT AIR STOVE
Device
Sterilization parameters
Check
Indications
Advantages
Disadvantages
THE HOT AIR STOVE
DEVICE
Synonym: Poupinel (improper)

PHOTO
Conceived as a metallic cupboard with double
walls and thermally insulated from the exterior
The door is provided with safety systems that
do not allow the building-up of the electrical
circuits when it is open
Components: source of heat (electrical), safety
systems, thermometer, recorders (show how
much time the sterilizing temperature was
maintained), system of temperature
uniformization in the precincts
THE HOT AIR STOVE

STERILIZATION PARAMETERS
160 C for 1h
170 C for 40
180 C for 20
In our country: 180 C for 30-40
THE HOT AIR STOVE

CHECKING THE STERILIZATION
Classical thermal tests: caramelizing of

paper or cotton cellulose
Modern: thermocouples with temperature
recording
THE HOT AIR STOVE

INDICATIONS
Objects of thermo-resistant glass

Metallic instruments (the cutting
instruments must have a protected cut)
Powders
THE HOT AIR STOVE

ADVANTAGES
Dried instruments at the end of the

sterilization
The instruments are in boxes or other
closed packages
They do not require other handling
before use
THE HOT AIR STOVE

DISADVANTAGES
The long sterilization duration

Long cooling time before use (about 1 hour)
Cannot be used for textile, plastic, rubber
materials
It modifies the properties of the metallic
instruments (annealing) and favors its fast
degradation (corrosion, breakage)
THE AMBULATORY OF SF.

SPIRIDON hospital
The emergency unit of SF.

SPIRIDON Hospital
The in-patient unit of CLINIC I II

SURGERY
Anesthesia and Intensive Care

SEC TION
OPERATING THEATRE
FILTER ROOM
OPERATING ROOM
Anesthesia apparatus
Scialitic lamp
Medical flows inlets (Aspirator, oxygen,

electricity)
Cautery
Ultraviolet lamp
Aspirator
Operating table
Aspirator
Operating room
OTHER EQUIPMENTS
Apparatus for intraoperatory

radiological examination
Turn
For the minimally invasive surgery
Table for instruments
THE
STERILIZATION
HUMID
It is the THROUGH
most efficient sterilization
method
The firstHEAT
form of sterilization through humid
heat was boiling, but it does not create

sufficiently high temperatures in order to
destroy the bacteria spores
The AUTOCLAVE= the device through which
the sterilization through humid heat is made, by
obtaining sufficiently high temperatures and
pressures that destroy all the pathogen agents
THE AUTOCLAVE
Device
Sterilization parameters
Check
Indications
Advantages
Disadvantages
BACK
THE AUTOCLAVE
DEVICE
With the help of a vacuum air pump, the air from the autoclave is
evacuated, which is resistant to pressure and is closed air-proof
achieving an thermal insulation from the environment
Through an admission pump, water vapors are introduced under
pressure, which will lift to the surface allowing the evacuation in
successive stages of the air that descends in the inferior part of
the autoclave
After obtaining the vacuum, the vapor admission is continued until
the obtaining od the set sterilizing parameters
The time, pressure and temperature of sterilization are variable
according to the type of the autoclave and the sterilized materials
(quantity, quality and their dimensions)
At the end of the sterilization, the vacuum air pump will evacuate
the water vapors from the autoclave, introducing a jet of filtered
cold air, with role of drying the sterilized material
The carriage for introducing and removing the materials from the autoclave
Entry into the sterilization

On the right door the non-sterile materials are introduced
Through the left door, the sterile materials are issued
Shelf for depositing the boxes with

medical materials
Recording on the paper the date, h

and sterilization parameters
AUTOCLAVE
Regulation buttons of temperature and pressure
The Autoclave
Removing the material from the autoclave

after sterilization
Depositing the sterile

material
TH AUTOCLAVE
STERILIZATION PARAMETERS
24 hours validity
Pressure
temperature
1 atm
120C
2 atm
136C
3 atm
144C
THE AUTOCLAVE
CHECK
Physical methods: test band

Biological tests
Electrotechnical methods: recording on
thermocouples the temperature variation
for the sterilization duration
Tests for checking the

sterilization
THE AUTOCLAVE
INDICATIONS
Textile material (fields, masks, gowns,

compresses, tampons, suture yarns, etc.)
Thermoresistant glass objects
Metallic instruments (the cutting
instruments must have the cut protected
with smooth material)
Sterile medicines
Sterile water
THE AUTOCLAVE
ADVANTAGES
It allows the sterilization of the entire surgical

material
The reduced degradation of the smooth
sterilized materials
Reduced sterilization time
The material resulted from sterilization is dry
and pre-packed therefore easy to handle
Reduced costs
Contains the source of vapors as well
Does not require special installation conditions
THE AUTOCLAVE
DISADVANTAGES
Technical breakdowns
Rapid degradation of the corrosive
metallic instruments
THE STERILIZATION WITH

ULTRAVIOLET RADIATIONS
These radiations act at the level of nucleic acids
= bactericide and bacteriostatic effect
It is necessary to previously wash the surfaces to
sterilize (the UV radiations have small
penetration power)
Indications: the sterilization of the air from the
operating and bandage rooms, the sterilization of
work surfaces
ATTENTION: They are harmful for the people
Protection of teguments and eyes
S TERILIZATION THROUGH
IONIZING RADIATIONS
(GAMMA)
DEVICE: container with pre-packed material on
which a radiation of 2.5 up to 5 Mrad (Celsius
137 or Cobalt 60) is projected
CHECK : measuring the radiation level
INDICATIONS: any medical material
ADVANTAGES: large quantities of pre-packed
material is sterilized, reduced costs under
continuous functioning conditions
Disadvantages: the irradiation, formation of
toxic compounds with ethylenoxide
Used only in the industrial environment
THE ULTRASOUND
STERILIZATION
The high-frequency ultrasounds in liquid
medium cavitation phenomenon
mechanical rupture of the cellular
membrane of microorganisms
Indications: especially for the sterilization
of the dental equipment
STERILIZATION THROUGH
FILTRATION
In bacteriology, for the sterilization of

culture mediums
The sterilization of some medicines
The sterilization of the air from the
operating rooms
THE STERILIZATION
CHEMICAL MEANS
THE STERILIZATION WITH FORMALDEHYDE VAPO

RS
THE STERILIZATION WITH ETHYLENOXIDE VAPOR
S
THE STERILIZATION BY IMMERSION
THE STERILIZATION
WITH
FORMALDELHYDE
DEVICE: special container where a depression of 50 mmHg is
achieved for 10 minutes which evacuates the air, followed by the
VAPORS
introduction of water vapors at 90C vegetative bacteria.
Cyclically, at 90 seconds, formaline vapors are introduced, that

destroy the sporulated forms.
STERILIZATION PARAMETERS:
Sterilization, 90 minutes
Washing stage of the formaldehyde with cold water vapors,
12 minutes
Drying stage, 8 minutes
CHECK: biological, physical tests
INDICATIONS: thermosensitive materials (more and more rarely
used)
THE STERILIZATION
WITH ETHYLENOXIDE
VAPORS
Device
Check
Indications
Advantages
Disadvantages
THE STERILIZATION
WITH ETHYLENOXIDE
The ethylenoxide requires depositing in metallic
containers at
VAPORS
small pressure because it boils at the temperature of 10.7 C
DEVICE
It is used in the following combinations : 10% ethylenoxide +

90% carbon dioxide or 12% ethylenoxide + 88% fluorocarbon
The container is hermetically closed, the ethylenoxide vapors
or the gas mixture are introduced, the substances having a
variable action time according to the producer (10 minutes up
to a few hours). The ventilation of the room where the
sterilizer is found follows, for 15 minutes and afterwards the
depositing of sterilized materials in a container that allows
their ventilation for 3-6 hours.
The ethylenoxide is combined with the nucleoid acids of
bacteria, determining a denaturation of the proteins through
an alkylation process that has as a result the destruction of
microbes
THE STERILIZATION
WITH ETHYLENOXIDE
VAPORS
CHECK
Chemical methods: of torsion, of color

Biological methods
THE STERILIZATION
WITH ETHYLENOXIDE
VAPORS
Plastic materials
INDICATIONS
Thermally fragile materials: catheters,
endoscopes, cystoscopes, plastic tubes,
aspiration probes, Blakemore probes,
ophthalmological instruments, arterial
grafts
Wood, paper
The industrial or hospital use
THE STERILIZATION
WITH ETHYLENOXIDE
VAPORS
It allows the sterilization and use of

ADVANTAGES
some
thermolabile medical instruments and
materials
The sterilized objects are pre-packed
THE STERILIZATION
WITH ETHYLENOXIDE
VAPORS
The gas is irritating for the eyes and

the
DISADVANTAGES
respiratory ways producing cephalalgea,
nausea, vomiting, dizziness to those who come
into direct contact (medical personnel, patient)
It requires a good ventilation
The sterilized materials through gamma
radiations cannot be resterilized through
ethylenoxide vapors because of the
appearance of some toxic products
THE STERILIZATION
THROUGH
Used in hospitals or dispensaries IMMERSION
DEVICE: the instruments are immersed for a minimum period of
DEVICE: the instruments are immersed for a minimum period of

time into the substances that have the property to destroy the
microbes chemically
The Glutaraldehyde 2%: in 10-15 minutes it destroys the vegetative
forms of the bacteria and their spores after 10 hours (the
tuberculosis bacilli in 20 minutes)
The peracetic acid: action time of minimum 10 minutes, it is
corrosive for the copper
INDICATIONSI: optical, laparoscopic, endoscopic instruments
ADVANTAGES
Does not require special installations
It is fast
DISADVANTAGES:
THE RESULTED MATERIAL IS WET
IT requires cleaning with sterile water, the glutaraldehyde being
PHOTO
toxic and irritating
Container for the

sterilization through
immersion
THE
OF
DISINFECTION
LIVE TISSUES
THE SURGEONS HANDS

THE PATIENTS SKIN
THE DISINFECTION OF
LIVING TISSUES
THE SURGEONS HANDS
The liquid soap, solution of chlorhexidine soap or

povidone iodine are used
Liquid soap: washing for 5 minutes up to the
superior third part of the forearm, the following 5
minutes up to the half of the forearm and other 5
minutes only the surgeons hands
Soap with chlorhexidine or povidone iodine: the
same stages each lasting only 2-3 minutes
The immersion of the surgeons hands into the
germicide solution for a few minutes (some
countries)
In the end the embrocation of hands with
concentrated alcohol or iodine tincture
THE DISINFECTION OF
LIVING TISSUES
SURGEONS HANDS
The sponge with antiseptic substance
Antiseptic solution
Sandglass
Taps with
sterile water
for
disinfecting
the
surgeons
THE DISINFECTION OF
LIVING TISSUES
THE PATIENTS SKIN
The area subject to the incision and broadly, the

teguments around it, will be prepared
Solution: iodine tincture, povidone iodine,
chlorhexidine
The three times embrocation of the surgical
drapes, the first 2 stages being followed by drying
with sterile compresses and in the end the drying
of the tegument is expected, that ensures a
sufficient action time
The transparent self-adhesive drapes applied on
the skin prepared as mentioned previously, the
incision being made through the drape, increasing
the asepsis safety
VIDEO
STERILIZATION
RULES
R
ULES FOR THE STERILIZATION OF THE O
PERATING ROOM
RULES FOR THE PREPARATION OF THE STE
RILIZATION MATERIALS
RULES FOR THE

STERILIZATION OF
THE
OPERATING
Preventing the post-operatory infections
ROOM
requires the carryout of the surgical intervention
in
an environment as appropriate as possible from
the point of view of the asepsis
In the operating theatre there must be septic and
aseptic operating rooms. Generally nowadays
there is a room for emergencies where the septic
surgical interventions are usually performed
The sterilization of the operating room supposes:
preparing the surfaces (operating table, floor,
walls or ceiling) and preparing the air
STERILIZING THE
OPERATING ROOM
PREPARING THE SURFACES
Washing the surfaces three times with water and detergents

Removing the dust from the equipment (cloths with
antistatic properties will be used)
The hermetic closing of the room
Formolization (formaldehyde vapors 4 g formalin/m
surface) at least 7 hours
Ventilation 2 hours before the beginning of the surgical
program
Removing the dust
Neutralizing the formalin with ammoniac solution
The materials necessary for the surgeries will be brought in
the morning
It is compulsory to respect the circuits in the operating
theatre
STERILIZING THE
OPERATING ROOM
PREPARING THE AIR
The air must enter the room from the superior side
and be evacuated through the inferior side. The
admission inlet is in the center of the room, above
the table, without blowing the air directly onto the
patient. The evacuation will be made through the
lateral sides
The air circulated through the operating rooms
requires a special filtering process both at the
entry and at the exit of the operating room. There
are high-performance apparatuses that can even
obtain sterile air
STERILIZING THE
OPERATING ROOM
PREPARING THE AIR
The ultraviolet lamp that will lead to a sterilization of the

surfaces and air is also used
It is used outside the operating program
It is placed at 150 cm from the walls and at 300 cm in
front of the other, facing the wall
The control of sterilization in the operating room is
made with bacteriological tests (Petri boxes placed
open for 30 minutes in the corners of the operating
room after which we will monitor the colonies that will
grow, their type and number being related to a national
standard
PREPARING THE MATERIAL

FOR STERILIZATION
THE TEXTILE MATERIAL

THE METALLIC EQUIPMENT
RUBBER GLOVES
PLASTIC EQUIPMENT
BRUSHES AND LOOFAHS

FOR STERILIZATION
TEXTILE MATERIAL
Washing
Ironing
Folding according to
the standard
technique
Positioning into
metallic containers or
packed individually in
paper
Autoclaving

FOR STERILIZATION
METALLIC EQUIPMENT
Washing with hot water

Boiling
Diluted Perhydrol solution that
precipitates the organic materials
from the equipment surface
Washing
Wiping
Drying
Dressing the sharp and cutting
materials into textile material
Positioning the equipment into
metallic containers
Autoclaving

FOR STERILIZATION
RUBBER GLOVES
Meticulous washing
Drying
Applying French chalk
Introducing gloves of textile material
into the interior
Autoclaving or ethylenoxide vapors

FOR STERILIZATION
PLASTIC OR RUBBER INSTRUMENTS
Washing with detergents

Disinfectant
It is packed in casseroles, wire baskets
or individually

FOR STERILIZATION
BRUSHES AND LOOFHAS
Used by the surgeon for disinfecting the

hands
They are cleaned, individually packed
and sterilized in metallic boxes
EVALUATING THE
SURGICAL PATIENT
Although the surgery, in itself, can

be MINOR for the surgical team,
for the patient it is always MAJOR
EVALUATING THE
SURGICAL PATIENT
THE EMERGENCY SURGERY

THE ELECTIVE - COLD REASON
SURGERY
THE ONE-DAY SURGERY
THE PRE-OPERATORY EVALUATION
CONTENTS
EVALUATING THE SURGICAL

PATIENT
Surgical emergency
THE EMERGENCY SURGERY
On-duty room
Death
Cardiorespiratory resuscitation
AIC
Successful resuscitation
Continuing the resuscitation
In-patient unit
Stabilization
Investigations
Preparation for surgery
Investigations
Preparation for surgery
Operating room
Morgue

PATIENT
ELECTIVE SURGERY
Surgical disorder
Usual investigations
Surgical and anestheological consultation
Hospitalization
Additional investigations
Specific preparation
Staff
Staff
Operating room

PATIENT
THE ONE-DAY SURGERY
Motivation:
Financial: the high cost of hospitalization,
consume of expensive medical materials
Personal: the patients desire to be in the
family environment and not in the hospital,
the socio-professional reintegration as soon
as possible
Medical: patients with a good medical
education

PATIENT
THE ONE-DAY SURGERY
Completely investigated patient
Hospitalization in the morning of the surgery

Local preparation
Premedication
Operating room
Post-operatory monitoring for a
few hours
Hospital
release
In-house monitoring
PRE-OPERATORY
EVALUATION
Any hospitalized patient will have an observation sheet that
needs to be completed after a complete clinical examination
Appropriate paraclinical explorations are necessary,
corresponding to each case, the assessment of all the
associated disorders, establishing the anesthetic risk and
Choosing the therapeutic behavior (the operatory moment,
the type of anesthesia and the type of surgical intervention
that the patient will be submitted to)
It would be very useful that the family doctor has a medical
file for each patient, file that the attending physician must
have access to, at hospitalization
THE PREOPERATORY
EVALUATION
OBSERVATION SHEET
The Observation Sheet (OS) is a medical-legal document that must

reflect an image as exact and complete as possible of the patients
state at hospitalization, of his evolution during hospitalization, data
as complete as possible that lead to the correct disease diagnosis.
According to the evolution mentioned in the observation sheet, the
therapeutic indications will also be made, and the hospital release
recommendations as well
The OS must offer exact data related to the patients identification
The OS represents a medical-legal document that can defend or
accuse the doctor in the case of a judicial confrontation with one of
the patients
It is an useful document in the scientific research (retrospective
studies etc.)
Probably, in our country as well, there will be detailed file for each
patient, with all the services that he goes through during his
lifetime, these files having a much bigger scientific value, allowing a
better evaluation of the patient and establishing a correct therapy
THE PRE-OPERATORY
EVALUATION
OBSERVATION SHEET
The components of the observation sheets :

GENERAL DATA
DIAGNOSIS
ANAMNESIS
THE GENERAL PHYSICAL EXAMINATION
PARACLINICAL EXPLORATIONS
THE SURGICAL INTERVENTION
TREATMENT AND EVOLUTION
EPICRISIS
TEMPERATURE SHEET
THE PRE-OPERATORY
EVALUATION
GENERAL DATA
Comprise:
Identification data: surname, first name, sex,
date of birth, age, address, telephone number,
job
Hospitalization place: hospital, clinic
Hospitalization period: date of hospitalization,
date of hospital release
Allergic to.
Blood group and Rh
THE PRE-OPERATORY
EVALUATION
DIAGNOS IS
The diagnosis has three stages :

Diagnosis at hospitalization
Diagnosis at 72 hours
Diagnosis at hospital discharge: it must comprise the
diagnosis of the basic disease, the evolution stage, the
clinical form, complications
Secondary diagnosis: the diagnosis of all the associated
diseases
Diagnosis in case of death:
a. The direct cause of death
b. Initial pathology
c. Associated disorders
d. Associated morbid states
THE PRE-OPERATORY
EVALUATION
ANAMNESIS
It must be performed in such a manner as to obtain the patients trust to
tell us the most detailed information
Reasons for hospitalization: all the objective and subjective problems that
the patient speaks of will be enumerated
Physiological personal antecedents: they are important especially in the
case of women, providing information regarding the first menstruation, the
date of the last menstruation, the number of pregnancies, the number of
births, and abortions (spontaneous, therapeutic or at request), the state of
fetuses at birth, the lactation
Pathological personal antecedents: you will have to obtain data from the
patient regarding any disorder he suffered from previously (allergies,
infections, surgical interventions, degenerative diseases, neoplasias)
Family history antecedents: they present a special importance especially
in the case of transmittable diseases or with generic predisposition (atopy,
neoplasia, metabolic diseases, infections)
Life conditions, customs and work: the dwelling place (important in the
case of a family in which a member has a transmittable disease
tuberculosis), alimentary habits the predisposition towards certain
pathologies- obesity), smoking (the number of cigarettes a day and the
period since when they have been smoking), the alcohol consume (grams
of alcohol 100% expressed per day or weeks), drugs, birth control pills, or
the working place (toxic environment, allergic, carcinogenic substances,
intense physical effort)
PREOPERATORY
EVALUATION
HISTORY
It must be as detailed as possible, indicate the date of the

disorder beginning, the manner in which it started (acute,
insidious), the symptomatology present at the beginning
and the symptomatology evolution until the present. In
addition, it must be mentioned if during this time interval
the patient was examined by a physician or if he performed
certain investigations, what are their results , what
treatment he followed and which are the modifications from
the last period of time that determined hospitalization.
A correct anamnesis leads to a presumptive diagnosis that
will orient the patients physical examination and the
subsequent paraclinical explorations.
PREOPERATORY
EVALUATION
THE GENERAL PHYSICAL EXAMINATION
It requires an examination room that offers privacy to the patient

It is performed with the patient in clino-orthostatism and during
walking
It must be performed comparatively with the contralateral organ
or segment
It comprises:
1. Inspection
2. Palpation
3. Percussion
4. Listening
Means of performing:
ON APPARATUSES AND SYSTEMS
ON BODY SEGMENTS
LOCAL EXAMINATION
CLICK WITH THE MOUSE ON THE UNDERLINED TITLES
PREOPERATORY EVALUATION
THE GENERAL PHYSICAL
EXAMINATION

The general state
Tegument and mucuses
Subcutaneous cellular test
Lymphatic-ganglionic system
Muscular system
Osteoarticular system
Respiratory apparatus
Cardiovascular apparatus
Digestive apparatus and annexed glands
Genital-urinary apparatus
Nervous system, sense organs and endocrine glands
PREOPERATORY
EVALUATION
GENERAL PHYSICAL EXAMINATION

GENERAL STATE
Can be : serious, influenced, good
The patients aspect : scarred patient, tormented with
pain peritonitis
Attitude: Paralysis, opisthotonus tetanus, supporting
the traumatized limb with the healthy one
Facies: hypocratic (pale, with dark circles, pointed
nose, prominent cheek) peritonitis
Walking: ataxic tabetic lesions
Nutrition state: disassimilation, normal weight , obesity
(IMC=Gx100/T)
Conscious state: cooperant, temporo-spatially oriented,
somnolent, obnubilated, coma
PREOPERATORY
EVALUATION
GENERAL PHYSICAL EXAMINATION ON APPARATUSES

AN SYSTEMS
Teguments and mucuses

Color: cianosis chronic cardiac insufficiency,
bronchopenumopathies, pale - hemorrhages,
anemia, yellow icterus
Postoperatory scars: normally scarred wound,
keloid scar
Elasticity: idle abdominal cutaneous ply
dehydration
Mucuses: jugal mucus with roasted aspect
dehydration
Lesions: petechia, ecchymoses, coagulation
disorders, excoriations aggression, traumatism ,
PREOPERATORY
EVALUATION

AN SYSTEMS
SUBCUTANEOUS CELLULAR TISSUE

It mentions the nutrition degree
The coetaneous fold will be measured on the
antero-lateral side of the abdomen and thorax
normal about 2 cm.
PREOPERATORY
EVALUATION
GENERAL PHYSICAL EXAMINATION ON APPARATUSES AN

SYSTEMS
THE LYMPHATIC- GANGLIONIC SYSTEM

The superficial ganglionic system
The presence of adenopathies must be mentioned :
localization, consistency, mobility, presence of pain,
spontaneously or at palpation, the moment of the
appearance and their evolution
Examined regions : occipitals, retro-auricular,
submandibular, cheek, laterocervical, supraclavicular,
axillary, epitrochlear, inguinal
The lymphatic system : localized or generalized edema
cardiac insufficiency, renal insufficiency, hypoproteinemia
Superficial venous system: circulation - periumbilical
venous superficial gorgon vascularly decompensated
hepatic cirrhosis
PREOPERATORY
EVALUATION

AN SYSTEMS
THE MUSCULAR SYSTEM
Tonus: hypotonic, normotonic, hypertonic

The musculature development
Carrying out the movements:
normokinetically
PREOPERATIVE
EVALUATION

ON APPARATUSES AN D SYSTEMS
OSTEO-ARTICULAR SYSTEM
Bone deformities: rachitic rosary rickets

Continuity of bone reliefs: discontinuity
accompanied by crepitations fractures
Active and passive articular mobility: immobile,
partial mobility, normal mobility, hyperlax
articulation
PREOPERATIVE EVALUATION
THE RESPIRATORY APPARATUS

Thorax conformation : normal, rickets sequels,
emphysematous thorax
Amplitude of breathing movements : draw, pathological
whistling
Dyspnea: inspiratory , expiratory, mixed
Transmission of vocal vibrations : it can be perceived by
palpating the thorax when the patient says 33
Percussion: normal sonority, sub-dullness or dullness
pleurisy, pneumonia, hypersonority pneumothorax
Ascultation: crepitating rales pneumonia, subcrepitanting
bronchopneumonia, sibilant bronchial asthma, sonorous
rhonous chronic nicotine addiction
PREOPERATIVE
EVALUATION

CARDIOVASCULAR APPARATUS
The anamnesis may show effort dyspnea, nocturnal dyspnea, prestern um
pain due to effort
Color of teguments, mucuses, extremities: cyanoses in chronic cardiac
insufficiency
Palpation
Apexian shock: normal left 5th intercostal space medioclavicular line
Peripheral pulse: temporal artery, carotid artery, radial artery, femoral
artery, popliteal artery , dorsal artery of foot
Ascultation: cardiac noises, rhythm, central frequency
Ascultation of the carotid, femoral arteries, abdominal aorta, renal
artery
Percussion: cardiac dullness (rarely used nowadays)
Measurement of arterial pressure : clino- and orthostatism
PREOPERATIVE
EVALUATION

THE DIGESTIVE APPARATUS AND THE ANNEX GLANDS

Anamnesis: appetite, weight loss, nausea, vomiting, pain, bowel transit
Examination: mouth cavity, coordination of abdomen movements with
breathing, existence of scars or other tegument lesions, (bruises,
hematomas, scratching lesions, abrasions)
Palpation
Superficial: cutaneous hyperesthesia: peritonitis
Deep: palpation of liver and spleen, tumors, uterus
Percussion: hepatic dullness, hypersonority occlusion
Ascultation: absence of hydro-air noises occlusion, sulphides
tumors
Rectal palpation compulsory at any examination : perianal
teguments (perianal fistula, moles, external hemorrhoids), tonus of
anal sphincter (hypo-, normo- hypertonic), shape, limits and
consistency of the prostate, suppleness of the rectal wall, existence
or absence of feaces, of fresh blood or melena or other tumoral
lesions
PREOPERATIVE
EVALUATION

THE GENITO-URINARY SYSTEM

Anamnesis: urination frequency, symptomatology associated to
the urination (pain, smarting pain, interrupted jet), urine color,
diuresis (amount of urine in 24 hours), existence of nycturia
prostate adenoma, enuresis
Examination: lumbar regions (postoperative scars, deformations
renal tumor), conformation of external genital organs
Palpation: urethral points, lumbar area
Percussion: positive Giordano maneuver vivid pain at the
percussion of lumbuses acute suffering
Digital vaginal examination and vaginal examination with valves:
inspection, palpation
PREOPERATIVE
EVALUATION

NERVOUS SYSTEM, SENSE ORGANS AND ENDOCRINE

GLANDS
State of consciousness: cooperative, time-space oriented,
drowsy, obnubilated, coma
Reflexes: osteotendinous, cutaneous, pupillary, reaction to
pain
The examination of the spine is important for a
rachianesthesia
The exam of the anterior cervical region for the thyroid
gland
Comparative examination of breasts is compulsory
Sense organs: hearing, sight (myopia, hypermetropia),
balance
PREOPERATIVE
EVALUATION
ON BODY SEGMENTS
A more cursive and elegant method to examine
the patient than the classic examination ON
APPARATUSES AN SYSTEMS
Modalities of perfomance
Sitting down
Clinostatism
Orthostatism
PREOPERATIVE
EVALUATION
GENERAL PHYSICAL EXAMINATION ON BODY

SEGMENTS
SITTING DOWN
Chephalic extremity : teguments, conjunctiva
mucous, implantation of exoskeletons,
ganglions, photomotor reflex, sinus points
(frontal and maxillary), mouth cavity (mucous,
dentition, dentures, tonsils), thyroid gland
Thorax: respiratory apparatus, heart
ascultation, exploration of mammary gland,
adenopathies (axillary, supraclavicular), spine
Lumbuses: urogenital apparatus, examination
of lumbar spine
PREOPERATIVE
EVALUATION
GENERAL PHYSICAL EXAMINATION ON BODY SEGMENTS
CLINOSTATISM
Thorax: cardiovascular apparatus
Abdomen: digestive apparatus, week
abdominal points, inguinal region
Lumbar region: palpation of renal lodges,
urethral points
Limbs: inspection, passive and active mobility,
osteotendinous reflexes, pulse and peripheral
sensitivity
Rectal and vaginal palpation
PREOPERATIVE
EVALUATION
GENERAL PHYSICAL EXAMINATION ON BODY

SEGMENTS
ORTHOSTATISM
Balance
Gait
Varices
Hernial regions
PREOPERATIVE
EVALUATION
LOCAL EXAM
It is very important, providing data about

the affected region, apparatus
It includes anamnesis, examination,
palpation, percussion, ascultation
The characteristics of the lesions must be
described: number, shape, dimensions,
limits, surface, consistency, sensitivity,
mobility
PREOPERATIVE
EVALUATION
PARACLINIC EXPLORATIONS
For the patient who needs surgery it is

better for the paraclinical investigations
to be performed in ambulatory. If it is not
possible then they will be performed as
soon as possible after being hospitalized
Routine explorations
Special explorations
PREOPERATIVE
EVALUATION
ROUTINE EXPLORATIONS
Biological
Hemoleucogram (hemoglobin, hematocrit, trombocyes,
leukocytes, leukocyte formula)
Glycaemia, urea, creatinine
Coagulation tests (bleeding time, coagulation time, prothrombin
time, fibirin degradation products)
Hepatic tests, total proteins
RBW (syphillis), viral serology for AIDS and hepatitis
Urine test, urine elimination in 24h
Imagistic and functional
Chest X-Ray (radiography)
Simple abdominal radiography
Abdominal echography
EKG
PREOPERATIVE
EVALUATION
SPECIAL EXPLORATIONS
They have to be as targeted as possible and to offer a complete and clear
image of each patient
Biological:
Ionogram: Na+, K+, Cl -, alkaline reserve
Hepatic tests: hepatocytolisis syndrome (TGP, TGO, GGT, alkaline
phosphatasis, iron content in blood), hepatoprive syndrome
(fibrinogen, total lipids, cholesterol), serum proteins electrophoresis,
biliary function, (total direct and indirect bilirubin)
Amylasaemia, amylasuria
Hemocultures, urocultures
Imagistic and functional:
Echocardiography, respiratory tests, eso-gastro-duodenal
radiography with contrast substance, irigography, fistulography,
cavitatography, CT, IRM, scintigram, endoscopy, biopsy puncture,
diagnostic laparoscopy
SURGICAL INTERVENTION
To write down:
Number of the operatory protocol
Operatory diagnosis
Operation description
Type of anesthesia
Operatory team
TREATMENT AND EVOLUTION

To write down every day the medicines administered,
the dose (g/day), dose fractioning, the way of
administration (oral pills, intramuscular, intravenous
perfusion, etc.)
The evolution has to include: temperature, pulse, blood
pressure, general condition, postoperative evolution
(bandage and wound aspect, drainage, resumption of
bowel transit, resumption of feeding), diuresis
For the surgical treatment one should establish: the
operatory indication, preoperative preparation,
operatory risk and anesthesia, operatory time,
postoperative treatment, discharge
EPICRISIS
It is a summary of the entire observation sheet
and it must include:
Discharge reasons
Explorations performed and their results
(medicated and surgical) Treatments taken
Evolution
Recommendations and discharge
TEMPERATURE SHEET
It represents a complete description of the
patients condition and evolution
To be written down daily :
Body temperature
Pulse
Blood pressure
Diuresis
Amount of drained fluids
Digestive aspiration
Administered medication
DEFINI TION
It is the method that uses a series of physical
or chemical means in order to destroy the
saprophyte or pathogen agents, to combat the
infection after it has been identified
PURPOSE AND PRINCIPLES
INDICATIONS
CONTRAINDICATIONS
ANTISEPTICS
CLICK WITH THE MOUSE ON EACH UNDERLINED TITLE
CONTENT
PURPOSE AND
PRINCIPLES
The purpose of the antiseptics is to destroy the
infectious agents from the wounds or teguments
Operation mode: they dissolve the bacterial
membrane or modify the macromolecules at this level
determining the destruction of the microorganism
Types of antiseptics:
Cytophilactic: they respect the integrity of the
organism cells
Cytotoxic: they destroy the organism cells
PURPOSE AND
PRINCIPLES
THE IDEAL ANTISEPTIC:

1. Hydrosoluble
2. Non toxic and non irritant for live tissue
3. Broad bacterial spectrum
4. Bacteriostatic and bactericidal action
5. To be biochemical stable
6. Not to produce toxic compounds after
metabolization
7. The bactericidal effect should not depend on the
presentation shape
8. Bactericidal effect in presence of organism fluids
9. Cheap
INDICATIONS
To make aseptic the skin around the wounds

To make aseptic the wound destroying the bacteria
To make aseptic the patients skin (operative field)
before the surgical intervention
To wash and make aseptic the surgeons hands
To sanitize the instruments
To sanitize the surfaces in the operation room
To sanitize the sanitary installations
CONTRAINDICATION
S
The use of alcoholized, irritant or toxic substances in the wound (alcohol
denatures the proteins and determines the appearance of a protei c film which
favors the development of infection by preventing the antiseptic substances
from getting into the wound)
Only use substances indicated at the level of the mucuses (nasopharyngeal
mucous, oral mucosa, ocular mucous membrane) because they can be
absorbed in the systemic circulation resulting in intoxications or anaphylactic
shock
Vaginal lavages, enemas will only be perfo rmed with recommended
substances having the risk of irritations or ulcerations at this level
There will not be used to sterilize the instruments substances that only destroy
the vegetative forms of bacteria without destroying the bacterial spores, too
The patients with atopy need special attention when choosing the antiseptic
agent to be used (e.g.: allergic to iodine)
The iodine antiseptics shall not be used for the new-born child and the little
child (great capacity of iodine absorption )
ANTISEPTICS
CLASSIC
MODERN
CLASSIC
ANTISEPTICS
Antiseptics with alcohol contents

Antiseptics which liberate chlorine
Antiseptics which liberate oxygen
Compounds of heavy metals
Potassium permanganate
ANTISEPTICS WITH
ALCOHOL CONTENTS
EHTYL ALCOHOL 70:
Indications: to make aseptic the tegument

Advantages: osmotic power, penetrating the deep layers of the
epidermis and in the sebaceous glands
Disadvantages: diminished action when applied on wet teguments
TINCTURE OF IODINE
Indications: to make aseptic the tegument
Better penetration than simple alcohol
Composition: iodine 10g, potassium iodide 4g, alcohol 90 136g
Advantages : it indicates the region made aseptic by the yellow color
Disadvantages : toxic if older than 6 days because it produces iodine
derivates, irritant for the areas covered with hair (axilla, scrotum), it
does not apply on wounds
Other products: ANCOHOL IODATE, GAS IODATE, EHTER IODATE
SULPHURIC ETHER: to make aseptic the (peritoneal, articular)
serous membranes
GOMENOL: rhynopharyngeal and urological infections
PHOTO
ANTISEPTICS WITH
ALCOHOL CONTENTS
Ethyl alchool 70
Products based on iodine
ANTISEPTICS WHICH
LIBERATE CHLORINE
They have bactericidal action by liberating chlorine
as it is produced
DAKINS SOLUTION (SODIUM HYPOCHLORITE):
chemical scalpel of all sphaceluses and pus
To be administered in intermittent or continuous
irrigations
It dissolves and eliminates sphacelus es, clots
and pus
CHLORAMINE B SOLUTION 0.2-2%
More powerful action than Darkins solution
Local applications, continuous or intermittent PHOTO
irrigation, local baths
ANTISEPTICS WHICH
LIBERATE CHLORINE
Chloramine tablets
Chloramine solution
ANTISEPTICS WHICH
LIBERATE OXYGEN
There are substances which rapidly liberate a large quantity of oxygen
or after a while, a constant quantity but with a smaller volume
They determine the formation of hydrogen peroxide resulting in the
destruction of microorganisms
OXYGEN
Cytophilactic, hemostatic antiseptics
It melts and eliminates sphaceluses
OXYGENATED WATER
Cytophilactic, hemostatic solution
By effervescence it can eliminate foreign bodies from the wound
Disadvantages: it lyses the catgut, it delays the wound
cicatrization
BORIC ACID
It gradually liberates oxygen
Form of existence :
Crystals: wounds infected with pyocyanic bacillus
Solution 1-4% as antiphlogistic in ophthalmology and
dermatology
COMPOUNDS OF HEAVY METALS

Mercury salts : MERCURY
OXYCIANIDE for mucous lavage,
MERCURY BICHLORIDE
(SUBLIMATE) for making
teguments aseptic
SILVER NITRATE: for making the
wounds aseptic, cauterizing action
on granulated wounds and
epithelizing action on atone
wounds. The solutions are widely
used in dermatology
COLARGOL 1%,
PROTARGOL 2%
Less and less used
POTASSIUM
PERMANGANATE
POTASSIUM PERMANGANATE
SOLUTION 2-4%
Cytophilactic antiseptic
The only one in the group of colorant
substances that is still used
Indications: washing anfractuous wounds
with sphaceluses, cavities and ducts
(urethra, bladder), disinfecting baths
MODERN
ANTISEPTIC
Antiseptics based on phenols and derivaS
tes
Quaternary ammonium compounds
Biguanide antiseptics
Hypochlorites and dichloroisocyanurates
Iodides and iodoforms
ANTISEPTICS BASED
ON PHENOLS AND
DERIVATES
PHENOL: it is not used anymore because it is
PHENOL: it is not used anymore because it is

corrosive and irritant for the respiratory ducts
PRINTOL: disinfectant for surfaces
CLEARSOL: detergent for cleaning surfaces
HEXACLOROFEN
Combined with soap it is used to make
aseptic the surgeons hands
Disadvantages: toxic, cutaneous lesions
QUATERNARY
AMMONIUM
COMPOUNDS
Cytophilactic antiseptics but also having
detergent action contributing by the foam they

produce to eliminate the cellular remainders
and foreign bodies
CETAVLON, BROMOCET, CETAZOLINA,
CETRIMIDE BP, SAVLON
Indication: to clean wounds, burns, surface
disinfection (depending on the concentration of
the solutions)
BIGUANIDE
ANTISEPTICS
CHLORHEXIDINE
Indications: used to make aseptic the surgeons hands,
wounds, emergency disinfection of medical termolable
instruments (chlorhexidine 10% + alcohol 70 - 10 minutes)
Advantages: it can be diluted at the desired concentration, it is
not allergenic
Disavantages: it is not active on tuberculous bacilli, spores
and some viruses, it cannot be combined with soap
One of the most used antiseptics in surgery
BENZALKONIUM CHLORIDE
Bactericidal effect
Indications: to clean wounds, bladder, to make aseptic the
surgeons hands
Advantages: slightly irritant for skin
HYPOCLORITES AND
DICHLOROISOCYANURATE
S
Antiseptics active on bacteria and spores,

funguses, viruses
Rapid action
Form of presentation: concentrated solutions
(when used they need to be diluted)
Indications: to sterilize the instruments, to
disinfect surfaces
Disadvantages: unpleasant smell, irritant,
corrosive for metallic instruments
IODIDES AND
IODOFORM (POVIDONE IODIDE) IODOFORMS
It liberates active iodine, it destroys funguses, bacteria
and their spores
Form of presentation: yellow crystals with strong smell,
solutions of various concentrations or associated with
detergents to increase the cleaning effect, spray
Indications: to clean wounds, for the preoperative
preparation of the patients tegument, lavage of natural
cavities and ducts, iodoform gauze, stomatology
Advantages: it doesnt need alcohol to be dissolved, it is
not irritant for skin and mucuses, it doesnt stain the
cloths it touches, it can be easily removed by washing it
The most often used antiseptic
VIDEO
PHOTO
IODIDES AND
IODOFORMS
DEFINI TION
All gestures and maneuvers used in
order to prepare the patient for a surgical
intervention
INDICATIONS
CONTRAINDICATIONS
STAGES
CLICK WITH THE MOUSE ON EACH UNDERLINED TITLE
CONTENT
PURPOSE AND
PRINCIPLES
The purpose of the preoperative preparation is to prepare the patient

for the surgical intervention
The patient has to be informed on the pathology he suffers from, on
the possible therapy (a few data concerning the intervention), the
risks and the benefits of the treatment, possible mutilations or
infirmities, on the possible changes of the postoperative life style
One also has to provide information on the immediate and later
prognosis of the disease (Romanian legislation does not stipulate
what the patient should know, so generally in practice the patients
questions are answered and the non expressed desire not to be given
too many details)
The physical preparation of the patient is another stage of the
preoperative preparation, and it intends to bring the patient to a
physical condition which is good enough to support the surgical
intervention as easily as possible
The preparation has to be done step by step, the patient has to be in
a condition as good as possible at the moment of the intervention
Any patient will have to give his/her written agreement for the
investigations and therapy he/she is going to benefit from
INDICA TIONS
Any surgical intervention carries some
risks, that is why it is necessary for any
patient that is going to undergo a surgical
intervention to receive psychological and
physical preparation specific to the
pathology and surgery he/she will
undergo
CONTRAINDICA TIONS
They are not absolute, concerning especially the
patients who need emergency surgery, when there is
no time for ideal psychological or physical preparation,
this being done as it goes depending on the general
condition of the patient
In case the patient is unconscious, they have to talk to
the patients family about his/her condition
The written agreement for the surgery has to be
urgently obtained from the patient or his/her relatives in
case he/she is unconscious
PREOPERATIVE
PREPARATION
PSYCHOLOGICAL PREPARATION
PHYSICAL PREPARATION
OPERATION TIME
CLICK WITH THE MOUSE ON THE TITLE
PSYCHOLOGICAL
PRE PARATION
It will be done by the attending physician (the physician who will perform the
surgical intervention)
The patients information has to be very objective, informing him/her both on
the risks and benefits without trying to convince the patient to get operated
The decision to benefit from the surgical treatment is entirely up to the
patient, who will decide himself/herself for his/her life
In order to help the patient take a decision on the surgical act the patient is
recommended to consult another doctor, to have access to a second
opinion
The psychological preparation also has to inform the patient on the changes
that may appear after the surgery. So there may appear some mutilations
(iliac anus), infirmities (thigh amputation) which latter may need prosthesis,
transitory or definitive loss of sexual potency or metabolic or psychic
disorders (interventions on the endocrine glands)
A topic difficult to approach is the severe prognosis, the situation varying
from patient to patient. Some people insist on being informed on the
evolution and prognosis, whereas some other patients are not interested in
this aspect. It is recommended to answer according to the patients desire
to know more or less about the pathology he/she suffers from
PHYSICAL
PREPARATION
It includes:
GENERAL PREPARATION
SYSTEMIC PREPARATION
LOCAL PREPARATION
PREVENTION OF POSTOPERATIVE
COMPLICATIONS
Hydroelectrolytic and acido-basic
GENERAL PREPARATION
balance
Nutritional preparation
PHYSICAL PRE PARATION

HYDROELECTROLYTIC AND ACIDO-BASIC BALANCE
GENERAL PREPARATION
The hydroelectrolytic balance has two aspects: filling the vascular bed and the
electrolytic balance
The filling of the vascular bed is monitored with the blood pressure in clino and
orthostantism, diuresis measurement, as well as of central venous pressure
Depending on these constant values the hydric balance of the organism will be
calculated (input and losses) and one should try to correct the unbalance using
different solutions (physiological serum, Ringer solution, glucose 5% or 10% to
which one may add various chlorides in case of dehydration or macromolecules in
case of hemorrhage). The solutions used should be normotonic, the hypertonic
ones having limited indications (patients with severe brain disorders). Refilling the
vascular bed is performed gradually during the preoperative period having the role
to prevent the drops of blood pressure or even vascular collapse and exitus during
the surgical intervention
The electrolytic and acido-basic unbalance needs to be balanced according to the
ionogram and the blood pH. In case the kidney function is affected the preoperative
dialysis may be useful that will reestablish the electrolytic and acido-basic balance
In case of hemorrhages with great losses of blood it is necessary to restore not
only the circulating volume but also to restore the hemoglobin quantity which may
ensure an appropriate transport of oxygen in the tissues (the surgical ceiling
when one may proceed in safety conditions is of 10gHg/100ml blood)
GENERAL PREPARATION
NUTRITIONAL PREPARATION
It represents an important aspect of the preoperative
preparation because a denutrited patient cannot
epithelize and its immune system will be deficient, not
being able to defend itself against infections
It is recommended that whenever possible the patients
postoperative nutritional state should be the best
possible. In emergency situations when the patients
life depends upon the surgical intervention, the
nutritional recovery will be done after the operation
The nutritional recovery can be carried out in two ways:
parenteral route and enteral route
GENERAL PREPARATION
NUTRITIONAL PREPARATION PARENTERAL

ROUTE
It uses glucose solutions, special nutritive
solutions for parenteral administration (they are
very expensive)
It is recommended to the cases with minor
nutritional deficit
It can also be used for patients with diabetes
using as energetic support the glucose dabbed
with insulin
GENERAL PREPARATION
NUTRITIONAL PREPARATION ENTERAL

ROUTE
There are used hypercaloric substances
(Fresubin)
It can be used when the digestive tube is
functional, allowing the absorption and
digestion of food principles, if not the
parenteral route may used
It needs the evaluation and support of all

apparatuses and systems:
Cardiovascular apparatus
Respiratory apparatus
Renal function
Hepatic function
Neurological
HISTORY
>70 years
5p
IMA the last 6 months
10p
CARDIOVASCULAR APPARATUS
The score for establishing the risk
of postoperative cardiac morbidity
or mortality (table).
Maximum score is 53 points.
A score over 28 points
determines postponing the surgical intervention
Other risk factors: smoking, diabetes, blood
pressure, hyperlipaemia, unstable angina pectoris,
rhythm disorders, valvulopathies
CLINICAL EXAM
Gallop S3 or distension of jugular vein
11p
Significant aortic stenosis
3p
EKG
Premature atrial systoles or nonsinus rhythms
7p
>5 premature ventricular systoles / minute
7p
SURGERY
Emergency
4p
Intraperitoneal or intrathoraric or aortic
3p
RESPIRATORY APPARATUS
It is useful for the patients with preexisting pulmonary
diseases, for old, obese, sick patients who will need
extended immobilization
There will be used bronchodilators, targeted antibiotherapy
Respiratory gymnastics is recommended especially to the
patients who are going to undergo a surgical intervention to
the upper abdominal level or thorax. It involves ample
respirations, deep inspiration followed by expulsion of the
inspired air into a water bottle by means of a perfusor tube,
tapotement with efficient coughing to eliminate secretions
Smoking is forbidden at least a week before surgery
(smokers have a state of chronic hypoxia)
RENAL FUNCTION
The renal function which was affected after the surgery
results in a more difficult elimination of drugs
(anesthetics, nephrotoxic antibiotics), needing and
adjustment of the doses used
For patients who have diseases of the lower urinary tract,
in case of complicate surgeries, at the genital or rectal
level, it is recommended to put a catheter in the bladder
on the operating table after the patient was asleep. The
catheter will be kept till the spontaneous resumption of
mictions
PHYSICAL
PREPARATION
HEPATIC FUNCTION
The disorders of the hepatic function manifest
themselves by blood coagulation disorders,
nutrition disorders which will determine
deficient cicatrization as well as metaboli zation
disorders of various substances with hepatic
elimination
It is necessary to assess hepatic excretion,
hepatic cytolysis, protein synthesis,
coagulation samples, etc.
Risk factors: denutrition, ascites, bilirubin >3mg
%ml, albumin < 3mg%ml
NEUROLOGICAL
It is important to identify the neurological
pathology that may be aggravated by the
anesthesia
The patients with motor deficiency have
a higher risk of postoperative
complications
LOCAL PREPARATION
Local preparation: on the morning of the surgical intervention,

the region where the tegument will be incised will be epilated,
and then it will be made aseptic with alcohol iodate
Stomach preparation: in case o duodenal stenoses the lavage
and the aspiration through a naso-gastric tube are
recommended to empty the stomach of food remainders and
secretions
Colon preparation: will be carried out for all patients who will
undergo surgical intervention by means of two enemas (the
evening before surgery and one on the morning before
surgery). The patients who will undergo colon surgery need
more laborious preparation which may ensure the complete
discharge of the digestive tube of food residues. Thus the day
before surgery the patient will have a hydric diet, he/she will be
administered 4 sachets of Fortrans followed by 2 enemas (one
in the evening and the second one on the morning before
surgery)
PREVENTION OF POSTOPERAT IVE COMPLICATIONS
Preoperative preparation plays an

important role in preventing
postoperative complications
The most frequent postoperative
complications are: infections,
thrombembolisms and
organic insufficiency
INFECTIONS
They determine a difficult postoperative recovery delaying the cicatrization, extending the
convalescence or even with the appearance of septicemia .
They may be prevented with a correct preoperative preparation depending on the surgery
that is going to be performed (skin, colon preparation, etc.)
Risk factors: old age, obesity, malnutrition, neoplastic problems, diabetes mellitus and its
complications, corticosteroid or immunosuppressor treatment, other infections,
radiotherapy, adrenocortical insufficiency
Necessary preparations: restoring nutritional status, balancing diabetes (glycaemia below
1,2g%ml), treatment of concomitant infections, solving the adrenocortical insufficiency,
prophylaxis with antibiotics, shaving the operating region on the morning of the surgery , etc
Indications for antibioprophylaxis:
Neck and head surgery with opening the upper air ways
Esophagus surgery (except for the hiatal hernia
Gastro-duodenal surgery except for uncontrolled hyperacidity
Surgery of biliary tract for patients with acute cholecystis, over 70 years old who need
choledocotomy
Bowel resections
Gangrenous acute appendicitis or peritonitis
Gynecological surgery
Prosthetic surgery for different organs: heart, hip, knee, valves, vessels
PREVENTION OF POSTOPERATTIVE COMPLICATIONS
THROMBEMBOLISM
The risk of appearance of thromboembolisms
increases: if the duration of the intervention
exceeds one hour, obesity, blood
hypercoagulability, antecedent of vascular
thrombosis, pelvic surgery, treatment with oral
contraceptive pills
Prevention: elastic bandages on the lower limbs
to ensure higher return pressure, precocious
postoperative mobilization, prophylaxis with
anticoagulant medicines (normocoagulant dose)
ORGANIC INSUFFICIENCY
Respiratory apparatus: pneumonias, broncho-pneumonias,
respiratory insufficiency, respiratory distress syndrome
Heart system: rhythm disorders, cardiac insufficiency,
myocardial infarction
Hepatic function: coagulation disorders, hepatic
insufficiency
Urinary system: acute renal insufficiency
Neurological system: coma
The correct PREOPERATIVE EVALUATION allows
identifying the risk factors for these possible complications
and at the same time preventing their appearance by
measures specific to each system
SURGERY TIME
Programming the surgery time

differs from elective surgery to
emergency surgery
SURGERY TIME
ELECTIVE SURGERY
The choice of surgery time is very important in elective

surgery
Its choice depends on the patient, surgeon and
anesthetist
The patient has to be prepared having a good general
physical and mental condition, good enough to be able to
undergo the surgery and the postoperative evolution and
recovery which should be as fast as possible
As to the surgeon, it is necessary for him/her to go
through all the stages of the preoperative preparation
and to establish the surgical technique
These requirements are also necessary for the
anesthetist
SURGERY TIME
EMERGENCY SURGERY
Depending on the seriousness of the situation the

preoperative preparation may be skipped (massive
hemorrhages) or it may be partially replaced in the
preoperative room and continued postoperative ly
(bowel occlusions)
So there may be:
Immediate emergencies
Emergencies postponed for the immediate
following period 24 hours
Emergencies postponed for later up to 7 days
POSTOPERATIVE
CARE
DEFINITIONS
CONTENT
DEFINI TION
It varies depending on the anesthesia type: local, rahianesthesia,
general
Postoperative periods:
Immediate (post-anesthesia): the patient recovers
consciousness and the vital functions are stable
Intermediate: it takes from the complete recovery after
anesthesia till the discharge from hospital
Belated (convalescence): starts on discharge when the patient
has stable vital functions and a cicatrized wound and
continues at home
The postoperative care involves the clinical and paraclinical
monitoring of the patient
Monitoring represents observation, registration and detection by
clinical observation or paraclinical methods of the patients state
PURPOSE AND
PRINCIPLES
Monitoring is carried out in order to detect any
change of the patients state to a possible
complication as well as to a favorable
evolution, and also in order to take the
necessary compensatory or support measures
for rapid healing
The most important principle is careful and
complete monitoring of the patients state
which will allow adopting the necessary
measures for a favorable evolution
CLINIC AL
MONITORI NG
It starts on the operating table and continues until the
patients discharge
It will be carried out following a certain schedule which will
allow the temporary distribution of the clinical parameters
during the day
Parameters watched: state of consciousness, facies,
tongue, tegument and mucous color, cutaneous fold,
breathing frequency and amplitude, frequency of central
and peripheral pulse, blood pressure, diuresis in 24 hours,
operatory wound aspect, drainages (flow rate, aspect),
functioning of venous catheters, patients mobilization,
resumption of bowel transit for gas and feaces
PARACLINIC AL
MONITORI NG
Definition: it represents a series of measures
intended to watch the patients condition
Indications:
It is useful because a surgical patient carries
a risk of complications of different gravity,
which have to be prevented
The unconscious patients, who cannot
describe the changes that come up in their
evolution, need special monitoring
PARACLINIC AL
MONITORI NG
Contraindications: any patient has to be
monitored, the only contraindication being
represented by the economic criterion (very
expensive costs)
Necessary materials: various devices and
apparatuses are necessary in order to
measure body weight, temperature, blood
pressure, breathing frequency and amplitude,
quantity of ingested fluids, blood tests,
(ionogram, blood ph), electrocardiogram,
sfigmogram, etc.
PARACLINIC AL
MONITORI NG
The patient lies on the bed in a position as close to
the anatomic one as possible, he/she has to take off
his/her clothes so that the access to any anatomic
region may be easy
All sensors and necessary catheters have to be
monitored
Standard monitoring includes: measurement of
blood pressure, body temperature, breathing
frequency, diuresis and state of consciousness
Special monitoring vary depending on the patients
pathology
STANDARD
PARACLINIC AL
MONITORI NG
BLOOD PRESSURE
Normal values: systolic 90-160mmHg, diastolic 6090mmHg
Technique: manually with tensiometer and stethoscope or by
means of an electric apparatus
PULSE
Normal values: 60-80 beats / minute
Technique: manually by direct palpation or with the
sfigmometer sensor; to be measured for 30 seconds
minimum, simultaneously with heart auscultation
Tachycardia = pulse > 100 beats / minute
Bradycardia = pulse < 60 beats / minute
STANDARD
PARACLINIC AL
MONITORI NG
BODY TEMPERATURE
Normal values: 36-37C
The most accurate is intrarectal measurement of body
temperature
The most used method is to measure temperature in
the axillary region
BREATHING FREQUENCY
Normal values: 10-16/minute
Technique: direct count or nasal sensor
Tachypnea = over 20 respirations/minute
Bradypnea = below 8 respirations/minute
STANDARD
PARACLINIC AL
MONITORI NG
DIURESIS
Normal flow rate 1ml/kg/h
Technique: to be measured the amount of urine
gathered in a gradated recipient which is connected to
the urinary probe
Oliguria = below 400 ml/24h
Anuria = below 200ml/24h
STATE OF CONSCIOUSNESS
PARACLINIC AL
MONITORI NG
SPECIAL MONITORING
Cardiocirculatory disorders: central venous pressure,

medium pressure in the pulmonary artery, pressure at
the extremity of the pulmonary capillaries, plasma
osmolarity, hemoglobin and hematocrit values, oxygen
saturation of arterial blood
Respiratory function: lip color, psychomotory agitation,
capnometry, amount of oxygen and carbon dioxide in
blood, value of alkaline reserve and serum lactates
Renal function: value of urea and serum creatinin, urea
and blood osmolarity, creatinin clearance, ionogram
To see if the tissues function correctly you need an
evaluation of how oxygen is used in the tissues, and
this process needs complex equipment
The instruments used to monitor the patient have to be taken care of

compliant to the following requirements:
All materials used shall be sterile, for single-use only
The orotracheal intubation probe shall be aspired and changed
regularly
The vascular catheters shall be kept permeable by washing them with
heparin
The digestive aspiration probe shall be aspired and washed regularly
and if necessary repositioned or changed
The urinary probe shall be regularly washed with antiseptic solutions
The patient needs to be ensured local and general rigorous hygiene to
prevent complications (decubitus escharres, etc.)
The patients nutrition shall be carried out depending on the patients
condition: parenterally or orally
CARDIO- PULMONA R Y
RESUSCITATION
DEFINITION, PURPOSE, PRINCIPLES
INDICATIONS
CONTRAINDICATIONS
NECESSARY MATERIALS
TECHNIQUE
POSTRESUSCITATION CARE
INCIDENTS, ACCIDENTS, COMPLICATIONS
CONTENT
DEFINITION,
PURPOSE,
They represent all therapeutic measures
to be applied in emergency, in
PRINCIPLES
cardiac arrest, in order to recover the vital functions
The cardiac arrest diagnosis has to be established quickly and the
resuscitation maneuvers have to be performed within very short time from
the beginning of the cardiac arrest and they also have to performed fast in
order to prevent the appearance of irreversible damage of the organs (6
minutes after the beginning of the cardiac arrest the neurons suffer
damage, any resuscitation method becoming useless)
The maneuvers have to be correctly performed in order to be efficient
Diagnosis
Cardiac arrest: lack of heart beats, lack of peripheral pulse, lack of
carotid pulse, low blood pressure
Pulmonary arrest: disappearance of respiratory movements,
peripheral cyanosis, mydriasis, lack consciousness, drop of sphincter
tonus
Mnemotechnical formulas: ABCDEFGHI, HELP ME
INDICATIONS
Arrest of cardiac and respiratory function:
Ventricular fibrillation
Cardiac asystole
Apnea of central origin
Obstructions of upper airway
Posttraumatic
CONTRAINDICATION
S
Cardiopulmonary resuscitation is
contraindicated only when it is useless:
More than 7 minutes from the beginning of
the cardiac arrest (relative contraindication)
Unrecoverable patient
Biological death (they are maintained in this
state for organ donation)
Multiple organic failure
NECESSARY
MATERIALS
Oxygen mask
Oxygen pump
PHOTO
Guedel pipe
Larhyngoscope
Intubation cannula
Defibrillator
EKG monitor
Flexules for venous catheters
Equipment for venous denudation
Syringes, needles
Drugs for emergencies
OXYGEN MASKS
OXYGEN PUMP (AMBU)
GUEDEL PIPE
LARHYNGOSCOPE
OROTRACHEAL
INTUBATION CANNULA
TECHNIQUE
The patient will be removed from the action of the
nocuous factors (place of accident, etc.)
The patient will be lain on the back
The reanimator or reanimators should be at the
same level with the patient, if there is only one
savior this one will place himself/herself on the left,
if there are two, the one who will perform cardiac
resuscitation will stay on the left and the one who
will perform artificial respiration will stay on the right
INTERNAL CARDIAC MASSAGE
DEFIBRILLATION
TECHNIQUE
Deconstruction of upper airway

Keeping it free: Guedel pipe, anterior mandible dislocation
Pinch the patients nostrils with the fingers of the right hand and give two full
breaths. The rhythm is of 12 breaths per minute
External cardiac massage has to be performed in the lower 1/3 of the sternum
with the right hand positioned on the left hand so that the fingers of the left
hand may not touch the thorax (this position offers maximum pressure on
minimum thoracic surface). The depression of the thorax shall be done on 4
cm minimum. The rhythm is of 80-90 compressions per minute
Efficiency may be followed by the appearance of the peripheral pulse after the
sternum compressions, the extremities regain color again, disappearance of
mydriasis
For the new born child and little child the resuscitation will be performed with
three fingers
The resuscitation will continue after the appearance of spontaneous pulse
because there the risk that the cardiac arrest may start again due to hypoxia
In case the resuscitation maneuvers are inefficient, they will be interrupted
when they become useless (reappearance of clinical signs of hypoxia, fixity of
mydriasis)
Reanimator No. Breath no.
Compression
no.
30
INTERN AL
CARDIAC
MASSAGE
Incision in the left 4th intercostal
space
Take the heart in the right hand with the
left ventricle in the palm and squeeze it
with a frequency of 80-90 per minute
At the same time perform artificial
respiration
DEFIBRIL LATION
Start external cardiac massage simultaneously
with the artificial respiration
If the patient does not respond to the resuscitation,
continue with the stimulation of cardiac activity
using electric shocks produced by the defibrillator
(150-400 W/sec)
Electric stimulation may be repeated, and at the
same time efficient medication has to be
administered compliant to the resuscitation
protocols (adrenalin, atropine, dopamine,
lidocaine, sodium bicarbonate, calcium blockers,
antiarrhythmic agents, etc.)
ABCDEFGHI
A (airways): permeable respiratory air tract
B (breath): artificial respiration
C (circulation): restoring circulatory function
D (drugs): drug administration
E (EKG): monitoring the cardiac function by EKG
F (fibrillation): electric defibrillator
G: establishing the diagnosis that determined the
cardiac arrest
H: neuropsychic therapy
I (intensive care): intensive care service
HELP ME
(BEJAN)
H: head hyperextension
E: clearing upper airway (foreign bodies,
secretions)
L: anterior luxation of the jaw
P: nose pinching, mouth-to-mouth resuscitation
M
External cardiac massage
E
POST
RESUSCITATION
CARE
The patient will still be kept under medical
supervision because there is the risk that the

cardiac arrest may start again or of appearance
of complications
Administer oxygen
Correct hydro-electrolytic and acido-basic
unbalances
Do not administer glucose (risk of
hyperglycemia and damage of nervous function)
INCIDENT S ,
ACCIDENT S ,
COMPLICA
TIONS
Respiratory function: tongue swallowing, loss of
insufflated air near the mask or through the nostrils,

rupture of pulmonary parenchyma leading to the
appearance of pneumothorax due to the insufflation of a
too large amount of air
Cardiac function:
External cardiac massage: rib and sternum fractures
which may induce secondary lesions (lung,
pericardium, liver lesions)
Internal cardiac massage: myocardial ischemia, heart
rupture, disinsertion of large vessels
Defibrillation: tegument burns, ventricular fibrillation
BLOOD TRANSFUSION
INDICATIONS
CONTRAINDICATIONS
NECESSARY MATERIALS
BLOOD GROUP DETERMINATION
DIRECT COMPATIBILITY TEST
TECHNIQUE
CARE
CLIC WITH THE MOUSE ON THE UNDERLINED TITLES
CONTENTS
DEFINITION,
PURPOSE,
PRINCIPLES
Definition: it is a method
used to
introduce blood, erythrocytes or plasma
in the patients cardiocirculatory system
Transfusion has as a purpose to correct
the patients blood deficits (volume,
erythrocytes, plasma factors)
Principle: perfect compatibility between
the doner and the receiver is compulsory
INDICATIONS
Great losses of blood volume (massive
hemorrhages)
Increase of oxygen transport (serious
anaemias)
Deficit of coagulation factors (hemophilia)
CONTRAINDICATION
S
Arterial hypertension, right ventricular
decompensation (heart surcharge)
Pulmonary diseases: pneumonias,
bronchopneumonias (acute pulmonary
edema)
Thrombophlebitis, venous thromboses
(embolisms)
NECESSARY
MATERIALS
Transfusion substance: blood, plasma, erythrocyte
PHOTO
mass, cryoprecipitates (factor 8, factor 12)
Heating device for the perfusion substance
Perfusor which is provided with a philter for possible
microclots
Needle for venous puncture
Garrot
Cotton tampon and 70 alcohol
Gloves
Adhesive bandages
BLOOD GROUP
DETERMINATION
On a glass strip put a drop of anti-A
serum and anti-B serum
Each of them will be mixed with a drop of
the patients blood
Wait for a few minutes and the results will
be interpreted on the microscope
compliant to the table
Serum O A
B
AB
anti-A
lyse
lyse
lyse
anti-B
lyse
BLOOD GROUP
DETERMINATION
Rh DETERMINATION
Use a kit of anti-D serums

Use the same technique on the strip
The presence of D antigen on the red
blood cells determines the Rh+ group
Serum Rh+ Rh
anti-D lyse -
DIRECT
COMPATIBILITY TEST
Put on a glass strip a drop of the
patients blood (receiver) in direct contact
with a drop of the donated blood
If there is no agglutination, then the two
types of blood are compatible and the
transfusion may be made
TECHNIQUE
The patient will be informed on the transfusion technique,
benefits and disadvantages and its agreement has to be
obtained
The patient will be placed in a comfortable position,
preferably in dorsal decubitus
The product to be transfused will be brought to the
transfusion service and the direct compatibility test will me
made
Find a new vein into which the preparation will be
administered
The administration rhythm is of 50 drops/min 15 minutes (to
observe possible adverse reactions), then 60-80
drops/minute. For emergencies a unit (500 ml) may be
administered in 10 minutes.
INCIDENTS,
ACCIDENTS,
COMPLICATIONS
Precocious hemolytic reaction: cephalea, fever, shiver, lumbar
pain, tachycardia, hypotension, respiratory problems,
hematuria
Late hemolytic reaction: unexplainable icterus, decrease of
hemoglobin
Fever shiver. If the temperature increases by more than one
degree Celsius the transfusion will be stopped
Allergic reaction: urticaria, pruritus, rash, wheezing, fever,
shiver
Bacterial contamination of transfused blood
Immune reactions (pulmonary edema, excessive bleeding),
hypothermia, hyperpotassemia, hypocalcemia, acidose,
thrombophlebitis, embolisms, transmission of certain
diseases (hepatitis B, C, AIDS, cytomegalovirus, syphilis, etc.)
CARE
The flask label will be stuck in the patients observation
sheet
15 minutes after starting the perfusion the vital signs will be
monitored (pulse, tension, breathing frequency) as well as
the existence of possible adverse reactions
At that moment if there are no incidents the transfusion
rhythm will be increased
The patient will be checked every 30 minutes
At the end of the transfusion the vital signs will be checked
again and the diuresis, and they will be written down in the
observation sheet
The catheter will be cleaned with physiological serum
The packages will be returned to the transfusion service
INJECTIONS
INJECTION ADVANTAGES
INDICATIONS
CONTRAINDICATIONS
NECESSARY MATERIALS
STANDARD TECHNIQUE
INJECTION TYPES
CARE
CLIC WITH THE MOUSE ON EACH TITLE
CONTENT
DEFINI TION ,
PURPOSE ,
PRINCIP
Definition: it is a method
used to LES
introduce in the body different medicated
substances
Purpose: therapeutic, diagnosis
Principle: active principles are introduced
in the organism, by means of needles
with lumen, and are resorbed in the blood
that circulates through that region
INJECTION
A D VANTAGES
The absorption speed of active principles is
well controlled
They avoid hepatic metabolization
The administered dose is not influenced by
digestive absorption (accelerate transit, etc.)
It allows administrating medicines to
uncooperative or unconscious patients
They avoid the digestive tube: there can be
administered medicines that irritate or are not
absorbed in the digestive tube
INDICA TIONS
Seriously ill patients, for exact dose control
Patients who need a shock dose by rapid
absorption (intravenously)
Controlled-release preparations which cannot
be given as tablets
Patients with digestive intolerance
Unconscious patients
Diagnosis purpose (intravenous urography)
Local anaesthesia
CONTRAINDICA TION
S
Hemophilia
Anticoagulant treatment
Tetanus
Induction from general anesthesia
NECE S SAR Y
MATERIAL S
Active substance PHOTO
Needle
Luer tapers
Cotton tampons with
solution for making
the tegument aseptic
Garrot
Sterile gloves
PERFUSION SOLUTIONS
PERFUSION SOLUTIONS
INJECTION TYPES
INTRADERMIC INJECTIONS
SUBCUTANEOUS INJECTIONS
INTRAMUSCULAR INJECTIONS
INTRAVENOUS INJECTIONS
INTRA-ARTERIAL INJECTIONS
STANDARD
TE
C
HNI
QUE
The patient will be informed on the manoeuvre to be performed, obtaining
his agreement
The patient will be placed in a comfortable position depending on the
injection type to be administered
The vial or ampoule containing the active substance will be opened, the
vial neck will be sterilize by singing it with a flame and then the content will
be aspired in the taper
The needle used to aspire the substance will be changed with another
sterile needle in order to perform the injection
If necessary, apply the garrot
Make aseptic the region where the injection has to be made by rubbing it
with an alcohol tampon
Take off the protecting cap from the needle, puncture the skin and the
other anatomic structures till the plane where you want to get to
Slightly aspire into the taper to see if the position is correct (vein dark
red, artery crimson, muscle no blood)
Inject the active substance compliant to the indications
Take out the needle and the taper with a firm movement
Massage the injection place to perform the hemostasis
The waste will be deposited in recipients specific to each of them
INTRADERMIC
INJECTION
Make the tegument aseptic
The needle with the tip upwards will be
introduced in the superficial tegument until the
needle orifice disappears under the tegument
Inject the substance from the tape
At the injection place there appears a tegument
deformation as an orange skin
Indications: intradermic reactions
Injection region: anterior side of the forearm
VIDEO
INTRADERMIC
INJECTION
TO CONTINUE THE VIDEO CLICK WITH THE MOUSE ON THE IMAGE
SUBCUTAN EOUS
INJEC TION
Make the tegument aseptic
Create with the left hand between the thumb
and the forefinger a cutaneous fold
The needle will be introduced parallel to the
tegument, in the axis of the fold without
penetrating the muscle
Indications: slow absorption drugs
Injection region: external side of the forearm or
thigh
VIDEO
SUBCUTAN EOUS
INJEC TION
INTRAMUSCULAR
INJECTION
Make the region aseptic
With the needle perpendicular to the tegument,
puncture the skin with a firm movement and push the
needle in the muscle
Slightly aspire in the taper (there mustnt be any blood)
Inject all the contents of the taper
With a fast movement take out the needle and the taper
Massage the region
Indications: most medicated substances (oily
substances will only be administered intramuscularly)
Injection region: upper-external quadrant of the buttock,
deltoid muscle, quadriceps muscle
VIDEO
INTRAMUSCULAR
INJECTION
Picture 036.avi
INTRAVENO US
INJECTION
Apply the garrot to determine vein dilation and to make it

visible
The needle will be positioned on the vein to be punctured,
being pushed in the direction of the
blood flow
Puncture the vein
Aspire in the taper the venous blood
Inject the contents of the tapper
Extract the needle from the vein
Perform the hemostasis by compressing the vein for a few
minutes with a cotton tampon imbibed with alcohol
Indications: when the fast absorption of active principles is
useful, administerer perfusion solutions
Injection region: veins of upper limb (elbow plica, forearm,
hand)
VIDEO
INTRAVENO US
INJECTION
INTRAARTERIAL
INJEC TIONS
Detect with the forefinger and the medius of the left hand the
artery pulsations
Puncture the skin with the needle perpendicularly on the
artery
Aspire in the taper creating lower pressure, and push the
needle until red blood appears inside the taper
Inject the contents
Extract the needle firmly
Compress for a few minutes on the injection place with a
cotton tampon imbibed with alcohol
Indications: local anesthesia, chemotherapy
Injection region: radial artery, femoral artery
VIDEO
RADIAL ARTERY
PUNCTURE
INCIDENT S ,
ACCIDENT S ,
COMPLICA TIONS
Local hematoma
Vessel rupture
Tegument, vascular necrosis
Allergic reactions
Subcutaneous nodules
Embolisms
CARE
Generally, they dont require special care
A sterile bandage has to be applied on
the puncture place
In case of intravesel injections
hemostasis will be performed by
compression for a few minutes with a
cotton tampon imbibed with alcohol
INCI SIONS
INDICATIONS
CONTRAINDICATIONS
NECESSARY MATERIALS
TECHNIQUE
CARE
CLIC WITH THE MOUSE ON EACH TITLE
CONTENT
DEFINI TION ,
PURPOSE ,
PRINCIP LES
Definition: they mean cutting tissues with a cutting object

Purpose: they make access to a certain anatomic structure, pathologic collection or for
exploration
Principles:
The asepsis and antisepsis requirements have to be complied with
Knowing the region anatomy
Anaesthesia has to be performed
The incision dimensions have to be adapted to the purpose
The incision orientation has to take into account local innervation so that cicatrization may
take place without any complications
The incision direction has to follow the force lines on the skin, this way avoiding faulty
cicatrizations
The incision will be performed with a single movement, it has to be regulated and rectilinear
The incision will be made plane after plane, for deeper planes the incision being shorter
thus allowing better closing the wound at the end of the intervention
Point out the important structures and avoid cutting them
For collections the incisions have to be performed in the maximum fluctuation point and
their length adapted to the collection length
INDICATIONS
Opening purulent infections
Excisions of tegument formation or lesion
Creating an approach for a certain abdominal
or thoracic organ
Retouch of bad incisions
Clearing incisions to bring near the margins of
the wound
Opening the capsule to get deep into the
viscera
CONTRAINDICATION
Hemo
philia
S
Tetanus
Induction in general anesthesia
NECESSARY
MATERIALS
Sterile soft material
Materials for
anesthesia
Scalpel
Scisors
Saw
Knife
SCALPEL BLADE
ELECTROCAUTERY
TECHNIQUE
The patient will be explained the technique obtaining its written agreement
for the surgery
The patient will be placed in a comfortable position to point out the best way
possible the region where the incision is going to be made
The preparation of the operative field will be done compliant to the
description in the chapter preoperative preparation
The surgeon will stay on the patients right side (except for the interventions
in the gynaecological field, pelvic region or left limbs) and its help will stay in
front of the operator, on the patients left side
(Local, general, rahianesthesia, etc) anesthesia will be performed
The skin will be kept under tension with the forefinger and medius of the left
hand, on the same direction but from the other end of the incision
The incision will be started with the scalpel perpendicularly to the skin, in an
almost vertical position, then it will be oriented to about 30
The incision will be made in a single movement
To the lower angle of the incision the scalpel will be brought again to an
almost vertical position as to the skin
Each anatomic plane will be cut in a single movement
The incision will cut plane after plane till the desired depth
VIDEO 1
VIDEO 2
VIDEO 3
CROSS INCI SION FOR AN

ANT H RACOID ABCESS IN THE NAPE
REGION
SCALP INCI SION FOR THE

EXCISION OF A SEBACEOUS CYST
INCIDENTS,
ACCIDENTS,
COMPLICATIONS
Hemorrhage due to vessel cutting

Hematomas
Nerve damage by intercepting its path
Damage of internal organs
Wound infection
Eventration
Evisceration
CARE
Daily sterile bandage
Lavage with antiseptic solutions
COLON
PREPARATION
INDICATIONS
CONTRAINDICATIONS
NECESSARY MATERIALS
TECHNIQUE
CONTENT
DEFINITION,
PURPOSE,
Definition: mechanicalPRINCIPLES
and biological
preparation of the colon in order to be explored

or for surgery
Purpose: discharging of feaces from the colon,
decreasing the degree of contamination of the
peritoneal cavity during the surgical
intervention
Principles: it is necessary to eliminate the
feaces as completely as possible
INDICATIONS
Explorations: rectoscopy, colonoscopy,
barium anema, edoluminal ultrasound of
the colon
Determining colon motility
Surgical interventions on various
segments of the large intestine
CONTRAINDICATION
Relative: patients influenced state doesS
not allow rigorous preparation
Absolute: surgical emergencies,
diseases with risk of colon perforation
NECESSARY
MATERIALES
Purgative drugs
Necessary materials
for perfoming anema
TECHNIQUE
Diet without residues (milk, yoghourt, cheese, soup) 2 days before the
surgery until 0 time of surgery day, from that moment on suppressing
the administration of any food or fluid
Medication
Manitol
The first day the patient will ingest 250 ml of Manitol and 3 liters
of fluids minimum
The second day the patient will be administered 250 ml of
Manitol oral pills and 3 liters of fluids minimum . The evening
before and on the morning of the surgery an enema will be
performed
Third day surgery
Fortrans: at 2 p.m. The day before surgery, there will be
administered a sachet of Fortrans dissolved in a litre of water which
will be drunk in about one hour. Four sachets of Fortrans will be
administered. The evening before and on the morning of the
surgery an enema will be performed
Enema: the evening before and on the morning of the surgery
an enema will be performed
At present we dont administer any antibiotics after the surgery (they
cause dismicrobisms)
ENEMA VIDEO
ENEMA
NECESSARY MATERIALS
INDICATIONS
CONTRAINDICATIONS
TECHNIQUE
TECHNICAL VARIANTS
CLIC WITH THE MOUSE OF EACH TITLE
CONTENT
DEFINITION
It is a maneuver used to introduce in the

anal canal at the level of the lower
digestive tube various substances
intended for discharge, diagnosis or
therapy
PURPOSE,
PRINCIPLES
Discharge: by introducing the fluids in the

rectum and colon in the lower part this
produces the distention of the digestive tract
that will determine the simulation of the
peristalsis, also soaking the feaces to
determine defecation
Diagnosis: by means of enema one may
introduce radiopaque substances which allow
showing the lesions in the colon, its motility
and caliber
Therapeutical: it consists in introducing various
active substances especially when other ways
of administration are inaccessible
NECESSARY
MATERIALS
PHOTO
Gloves
Single-use sterile cannula
Lubricant PHOTO
Irrigator PHOTO
The substance to be introduced
Basin
Protection oilcloth
PHOTO
NECESSARY MATERIALS
Irrigator with the

substance
to be administered
Irrigator
Rectal cannula
NECESSARY MATERIALS
Non sterile gloves
Lubricant
INDICATIONS
Colon discharge for persons with constipation, old
people, cachectic people, etc.
Preoperative preparation of the colon and rectum
Enema before a surgery with general anesthesia (it
prevents defecation due to the relaxation of the anal
sphyncter)
Barium enema for diagnosis
Medicated enemas (in digestive intolerance)
Hydrating enema (to be administered in a low rate drop
by drop)
Anesthetic enemas
CONTRAINDICATION
S
Suspicion of colon perforation

The pathology that makes the bowel wall thinner and
it induces perforation risk (bowel infarction, colitis,
ulcero-hemorrhagic rectocolitis)
Low tumor that may be damaged by this maneuver
(rectorragia may appear)
In case of barium enemas for low tumors the valve
phenomenon may appear due to the passage of the
tumor substance and its retention due to water
absorption which forms barium sulphate stones which
are difficult to eliminate
In diagnosis uncertainty, the barium enema may
determine a change of the clinical image which may
delay the therapeutic indication and aggravate the
general state
TECHNIQUE
The technique will be explained to the patient, especially the fact
that the substance introduced has to be kept in the colon for at
least 15 minutes. The patient will lie on the back or on one side
The oilcloth is put under the patients pelvis
Put on the gloves, take the lubricated cannula and attach it to the
irigator
Let some fluid drip to eliminate the air inside the tube
Introduce the cannula in the patients anus, about 8 cm being
cranially and posteriorly oriented
Slowly introduce the fluid from the irigator (it prevents the sudden
distention of the rectal ampulla and the activation of the defecation
reflex)
Slowly take out the cannula from the anus, following the opposite
direction as when it was introduced
Perform local perianal cleaning
Clean the place where the enema has been performed
VIDEO
BACK TO THE TECHNIQUE

FOR COLON PREPRATION
TECHNICAL
VARIANTS
High enema: a long flexible cannula is used,

the initial position being in lateral decubitus,
and then in dorsal decubitus and right lateral
decubitus
Medicated enema: will be performed slowly 2040 drops/minute. A Nelaton probe can be used,
which is thinner and shorter
Enema for patients with colostom or fecal
incontinence: insert a Foley probe, and inflate
the little balloon in the anal sphincter, this way
ensuring good continence
I NCIDENTS , ACCIDENT S ,
COMPLICATIONS
Disconfort to the patient
Rectal perforation: it needs immediate
diagnose, followed by the emergency
reparatory surgical treatment
SURGICAL
DRAINAGE
DEFINITION, PURPOSE, PRINCIPILES
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
NURSING CARE
CONTENT
DEFINI TION ,
PURPOSE ,
Definition: it represents the evacuation PRINCIPLES
of pus collections from an
abscess cavity
Purpose: therapeutic (the evacuation of the pus collection),

postoperative observation on postoperative clinical evolution
(facilitates the recognition of bleedings, digestive fistulas, etc.)
Principles:
Drainage tube must be positioned in the lowest part of the cavity
Dimensions (length, diameter, material) must be adjusted to the
purpose of the drainage and to the characteristics of the
evacuated cavity
The path of the drainage tube must be as short as possible and
should avoid the intestinal loop
The drainage tube will be exteriorized by counter incision
The drainage tube will be attached to the skin by suture
The drainage tube will be connected to a collecting container
RECOMMENDATION
S
Pus collections
Peritonitis
Interventions with septic stage
Difficult, incomplete haemostases
Interventions with laborious starts
Fistulas, continuity solutions at the level of
cavity organs
Purulent pleurisies
Pneumothorax, hemothorax
CONTRAINDICATION
S
Are relative
In case of interventions that need
prostheses or explants that imply a risk
of septic contamination by means of the
drainage tube
REQUIRED
MATERIALS
PHOTO
Plastic or silicon tubes
Drainage external catheters and liners
PHOTO
Multiple hole tubes
Medical wigs
PHOTO
Collecting systems
Drainage tubes of various dimensions
The Kehr tube (T-tube)
Multiple hole tube
The Redon bottle for aspirative draining
THE TECHNIQUE
The patient will be informed regarding the
procedure and his /hers written agreement will be
obtained
The drainage tube will be positioned in the lowest
part of the cavity
The tube will be exteriorized through the cavity wall
by counter incision if the wound can be sutured per
primam
The drainage tube will be attached by suture
A sterile bandage will be applied
The drainage tube will be connected to a collecting
container
VIDEO
PHOTO
INCIDEN TS , ACCIDENT S ,
COMPLICA TIONS
Incorrect positioning of the drainage tube
Obstruction of the drainage tube
Infection
Bleeding
Incorrect adjustment of the collecting
container
Exteriorization of the drainage tube
NURSING CARE
Daily sterile bandaging
Observing the quantity and the aspect of the
drainage content
Cleaning the cavities with the help of aseptic
solutions
Reinstating vacuum pressure in case of aspirative
drainages
Evacuation of the collecting containers
Removing the obstructing factors from the
drainage tube by using antiseptic solutions
APPLYING IODOFORM ON A
SUPPURATIVE WOUND
TO REVIEW PRESS CLICK WITH THE MOUSE ON THE IMAGE
ATTENDING THE
STOMIES
REQUIRED MATERIALS
STANDARD TECHNIQUE
DIFFERENT STOMA TYPES
CONTENT
D EFINITION ,
PURPOSE ,
Stoma = a constructed PRINCIP
opening to theLES
exterior of a cavity organ

The stoma allows the alimentation or the
evacuation of some cavity organs
Purpose: attending the stomies should
guarantee their correct functioning
Principles: the tolerance of the patient to
the stoma care products must be tested
DIFFERENT
STOMA TYPES
GASTROSTOMY
JEJUNOSTOMY
ILEOSTOMY
COLOSTOMY
CUTANEOUS URETEROSTOMY
REQUIRED
MATERIALS
Self-adhesive collecting bags
Plastic disk (that will cover the stoma
allowing the accumulation of the
collecting pus)
Adhesive gel
Probes, tubules
Sterile dressing/cloth
STANDARD
TECHNIQUE
The tissues around the stoma will be cleaned
using warm water, preferably without soup
We wait until the skin is dry
The self-adhesive collecting beg that has been
previously adjusted according to the
dimensions of the stoma will be attached
In case the bag will be evacuated it is better to
have it cleaned first with a syringe filled in with
50 ml of warm water
GASTROSTOM Y
Indications: high gastric obstacle that impedes
the normal feeding (pharyngeal, esophageal
neoplasm, etc.)
Changing the bandage daily until the wound is
healed
The probe permeability must be tested by using
special substances
When not used, the probe lumen will be sealed
with a plastic stopper
PHOTO
GASTROSTOM Y PROBES
PEZZER PROBE (prepacked and sterilized)
FOLEY PROBE
(in fact a urinary probe that can be also used for
gastrostomy, if needed)
JEJUNOST O M Y
Recommended for : non-resectable
gastric tumor, thus the stomach is being
saved for a future operation
Are more easy to be maintained because
for their carrying out a probe is used by
means of which the food will be provided
COLOSTOM Y
It will remain opened for 2 days postoperative and the sutures will be
suppressed 7 days after the surgery
The colon transit will be reestablished in
2 days from the surgery
The colostomy care has to be done on a
daily basis
In the beginning, the patient is not
aware when defecating, but later on, a
process of gaining awareness takes
place that will finally allow a perfect
conscious control of the external
sphincter
The colostoma patients need
psychotherapy in order to benefit of a
more rapid social and professional
reintegration
PHOTO
VIDEO
Colostomy bags
DETACHING THE BAG THAT

NEEDS TO BE REPLACED
CLEANING THE PERFORMED

COLOSTOMY
TO VIEW AGAIN CLICK WITH THE MOUSE ON THE IMAGE
PREPARING THE NEW COLOSTOMY BAG
THE COLOSTOMY BAG IS

CALIBRATED/ADJUSTED AND
ATTACHED
ILEOSTOM Y
Purpose: to evacuate
Recommendations: terminal (after performing
proctocolectomy upon various indications, after
right colon resections with contraindication for
ileotransverse anastomosis in the first stage ) or
lateral (neglected occlusions of right colic or
iliac artery)
Attending to the stoma in this case means
applying the same principles as in colostomy;
only that more attention should be given to
digestive losses and to a good hydroelectrolitical, acid-base and volemia levels
ASEPSIS OF THE LIVING

TISSUES
RUBBING SURGEONS HANDS
THE PERITONIAL DRAINAGE AFTER

A CLASSICAL CHOLECYSTECTOMY
THE BANDAGE
INDICATIONS
CONTRAINDICATIONS
THE BANDAGING ROOM
REQUIRED MATERIALS
TECHNIQUE
BANDAGE TYPES
CONTENT
DEFINITION,
PURPOSE,
PRINCIPLES
Definition: it represents the medical procedure by
means of which a wound is asepticized or

antisepticized
Purpose: it protects and helps the healing of the wound
Principles: it needs
to be sterile
to be absorbent
to ensure protection from the environment,
preventing the contamination of the wound
to not stick to the wound
to not produce pain
INDICATIONS
Surgical incisions
Accidental wounds
Burns
Varicose leg ulcers
CONTRAINDICATION
S
The facial injuries are usually left unbandaged
THE BANDAGING ROOM
Closet for
drugs and medical
instrument storage
Medical instrument
carriage
REQUIRED
MATERIALS
Soft sterile cloth: compresses, swabs, cotton

wool, medical wigs, cotton buffers
Antiseptic solutions (see the chapter regarding
Asepsis and Antisepsis)
Surgical sterile instruments: Koher forceps,
Pean forceps, anatomic forceps, medical
scissors, scoop, scalpel, probe, director, suture
needles, sutures, drainage tubes
Special materials for securing the bandage:
band aids, dressings, surgical nets, adhesive
solutions
PHOTO
REQUIRED MATERIALS
Sterile dressing cases
Soft sterile non-fabric

gauze case
Pre-packaged sterile dressing case
Sterilized surgical instrument case
REQUIRED MATERIALS
Antiseptic solutions
Ointment
Cotton wool
Sterile and
non-sterile gloves
BANDAGING
TECHNIQUE
The patient will be informed regarding the medical maneuver after
and he/she will be placed in a comfortable position so that the person
taking care of the bandaging will have optimal work conditions
Before applying or changing the bandage the medical personnel must
have the hands clean
The wound surrounding tissues will be cleaned and disinfected with
tincture of iodine
The wound will be disinfected, examined and treated
The wound will be covered with soft sterile cloth according to the
characteristics of the injury
The bandage will be secured with dressing, band aids, etc.
The evolution of the wound, the eventual drainages performed , etc.
will be noted in the patients observation sheet
The secretory wounds need an absorbent bandage with cotton buffer
and a thick cotton wool layer
The wounds presenting local congestive manifestations need wet
bandages impregnated with chloramine or alcohol, then covered with
absorbent cotton buffer
The suppurative wounds need drainage and a proper medical care
BANDAGE TYPES
THE DRY BANDAGE

THE WET BANDAGE
THE COMPRESSION BANDAGE
THE OCLUSSIVE BANDAGE
THE GREASY BANDAGE
THE BANDAGE OF SUPPURATIVE
WOUNDS
BANDAGE TYPES
DRY BANDAGE
Recommended for :
cleaning nonsecretory wounds
It is the most
commonly used
bandage for wounds
It is made out if
gauze padded
compresses and
cotton wool
PHOTO
GAUZE SWABS COVERED WITH AN

IMPERMEABLE MATERIAL ON ONE SIDE (BLUE )
VIDEO
PRE-WARPPED AND STERILIZED MATERIALS FOR DRY

BANDAGE
BANDAGE TYPES
DRY BANDAGE
BANDAGE TYPES
WET BANDAGE
Recommended for:
inflamed non-secretory
wounds
It has antiphlogistic effect
It should be used on short
periods of time due to the
fact that it can be irritant
It is made out of a
moistured compresses
impregnated with antiseptic
solution covered up in the
end by a dry dressing
Another word used for this
type of bandage is
cataplasm
BANDAGE TYPES
COMPRESSION BANDAGE
Recommended for: bleeding injuries, residual

cavities
It has hemostatic role and the role of flattening
the residual cavities
It is made out of large pieces of gauze and
cotton wool
It needs to be more firmly attached so that to
keep the respective area compressed without
affecting the local blood circulation
It can be used no more than 7 days
BANDAGE TYPES
OCLUSSIVE BANDAGE
Recommended for : bone

injuries and wounds (open
fractures, etc.)
It is made out of a plaster
bandage that can be shaped
around the injured area.
For granting access to the
wound an opening will be
cut into the plaster bandage
Plaster bandage
Dressing made up of smooth

cloth in order to protect the tissue
under the plaster bandage
BANDAGE TYPES
GREASY BANDAGE
Recommended for: burns, surrounding

tissues of hole fistulas
This type of bandage is made out of
gauze compresses impregnated with
Vaseline or Lanolin but it can also be
directly conditioned by the manufacturer
It has antalgic and antiphlogistic effect
BANDAGE TYPES
SUPPURATIVE WOUND BANDAGE
The surrounded tissues will be bandaged

with alcohol
The wound needs to be cleaned with
antiseptic solutions, usually in
sequences: first using oxygenated water
Dakin (cloramine) drying
betadine or equivalent solutions
powder antiseptics (optional) medical
wicking
VIDEO
TYPES OF DRESSINGS
THE DRESSING OF THE SUPPURATIVE WOUNDS
THE XI PH O- U MBILICAL INCISION
VASCULAR
CATHETERIZATION
THE IDEAL CATHETER
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
STANDARD THECNIQUE
NURSING CARE
CONTENT
DEFINI TION ,
PURPOSE ,
PRINC PLES
Definition: it represents the technique by which

various catheters can be introduced into the
vascular lumen (catheters are thin plastic
tubes)
Purpose: therapeutic (medical substances are
introduced into the body), diagnostic, access
for different organs (heart, limbs, etc.)
Principles: it is a sterile maneuver that must
serve the purpose above
IDEAL CATHETER
Should be thin
Should not be irritant
Should not determine the platelet aggregation
in its exterior and interior
Should be long enough and wide enough to
serve its purpose
Should be radiopaque
Some catheters have more lumens
INDICATIONS
Hydro- electrolytic balance
In emergency for introducing rapid action
drugs
Parental nutrition
Determining the central venous pressure,
the pulmonary pressure and intracavitary
cardiac pressure
Interventional radiology
Diagnostic purpose
THE CATHETERIZATION OF
THE RADIAL ARTHERY
CONTRAINDICA T I ON
S
Haemophilia
Tetanus
Induction from general anesthesia
REQUIRED MATERIALS
Syringe and needle
Xyline
Sterile gauze compress
Sterile gloves
(needle) Holder and
needle with suture
Medical tray containing:
syringe, thick needle,
guide wire, catheter,
fixing support
CENTRAL VENOUS CATHETER TRAY
THE STANDARD
TECHNIQUE
The patient will be informed about the medical procedure he/she will go through
and his/hers written agreement will be obtained
The patient will be placed in a comfortable position
The skin area where the puncture will be made is disinfected
The sterile gloves are put on
The local anesthesia is performed
The vein will be punctured according to the technique described in the chapter
About punctures
5-6 ml of blood will be aspirated into the syringe
The syringe will be detached and the guide wire will be introduced through the
lumen of the needle with the patient in voluntary apnea
The needle will be removed
The catheter will be introduced along the guide wire, then the guide wire will be
withdrawn until it reaches the distal end of the catheter
Both the guide wire and the catheter will be introduced until reaching the desired
position after which the guide wire will be removed
The blood will be aspirated into the syringe to check the position of the catheter
The catheter will be connected to a perfusion with Normoton or heparin serum
The catheter will be secured to the skin with sutures
In the end a sterile bandage is applied
ARTERIAL
CATHETERIZATION
VENOUS
CATHETERIZATION
SELDINGER TECHNIQUE FOR

INTERNAL JUGULAR VEIN
CATHETERIZATION
VENOUS CATHETER
JUGULAR INSERTION
INCIDENT S , ACCIDENT S ,
COMPLICA TIONS
When installing: insertion of the catheter,
catheterized blood vessel perforations ,
artery puncture, pneumothorax,
chylothorax, gas embolism,
hemomediastinum, arrhythmias
In use: infection, phlebitis
At the suppression: breaking the catheter
MAINTENANCE
It requires maintaining the permeability of the
catheter which is achieved by maintaining a
continuous flow or by washing the catheter with
heparinized saline after stopping the perfusion
Any maneuver that will be done must be sterile
The perfusor will be changed in maximum 24
hours
DIGESTIVE
PROBING
DEFINITION, PURPOSE AND PRINCIPLES

INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE

TYPES OF DIGESTIVE PROBING
CONTENT
DEFINITION,
PURPOSE,
PRINCIPLES
Definition: it represents the medical maneuver through
which various probes are introduced through the

digestive proximal tract for various purposes
Purpose: collection of digestive secretions (gastric,
duodenal, biliary, pancreatic), qualitative and quantitative
biochemical measurement (pH meters, cytology,
microbiology), gastrointestinal manometry, tract
evacuation, cavity washing (gastric lavage), enteral
nutrition
Principles:
The principles of asepsis and antisepsis must be
respected
A proper probe is to be used
INDICATIONS
Gastric hypo- or hyperacidity evaluation
Determination of PH digestive secretions
Gastrointestinal manometry
Gastric stasis - evacuation, gastric
lavage
Pre-surgery preparation of the stomach
CONTRAINDICA TIONS
The digestive probes are being gradually
replaced by modern technique
Traumas, malformations, obstacles that
do not allow passage of the probe
REQUIRED MATERIALS
Einhorn digestive probes
Probes with radiopaque
marks
Syringes
Test tube
Stimulation drugs
Antidote solutions
Containers
Gloves
TECHNIQUE
The patient will be informed about the maneuver, his
cooperation is important during the digestive probing
The patient will be placed in the sitting position, lateral or
dorsal decubitus
The probe is introduced through the nose into the throat,
then the patient will be asked, while normally breathing, to
do swallowing movements, and in that moment the probe is
gently pushed up into the esophagus and stomach.
Eventually, a local anesthetic to the pharyngeal mucosa can
be done.
If you want to reach up into the duodenum, the patient is
placed in lateral decubitus for 30-60 minutes, while the
probe will be spontaneously progressing into the duodenum
INCIDENT S ,
ACCIDENT S ,
COMPLICA TIONS
Discomfort to the patient (agitation, coughing,

vomiting)
Exteriorization of the probe through the mouth
Penetration of the probe into the upper airway
Tracheobronchial aspiration syndrome
Bleeding
Esophagus or stomach perforation
Probe blockage with food debris
Decubitus lesions of the gastric mucosa
DIGESTIVE
PROBING
Digestive probing types
GASTRIC LAVAGE
DIGESTIVE SUCTION
ENTERAL NUTRITION THROUGH
DIGESTIVE PROBE
GASTRIC LAVAGE
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
GASTRIC LAVAGE
DEFINITION, PURPOSE, PRINIPLES
Definition: the maneuver by which the

stomach is emptied and cleaned
Purpose: discharge of toxic substances,
pre-surgery preparation
Principles: for intoxication lavages
specific antidote should be used
GASTRIC LAVAGE
INDICA TIONS
Accidental or voluntary ingestion of

corrosive substances, toxic drugs
Preparation for endoscopies, pre-surgery
radio-imaging explorations
Upper digestive bleeding: cold serum
lavage
GASTRIC LAVAGE
CONTRAINDICA TIONS
Ingestion of caustic substances

Esophageal varices
GASTRIC LAVAGE
REQUIRED MATERIALS
Gloves
Faucher Probe (photo)
Funnel
Lavage fluid, antidote
Medicines
Container for collecting
the evacuated digestive
content
GASTRIC LAVAGE
TECHNIQUE
The patient will be informed about the maneuver, his cooperation

is important during the gastric lavage
The patient will be placed in the sitting position or right lateral
decubitus
The Faucher probe will be inserted through the patients mouth,
up to the pharynx, asking the patient to swallow
The probe will slowly progress into the stomach, no more than 4560 cm
The funnel will be adjusted to the probe
The lavage fluid will be poured through the funnel placed to the
chest level, slightly raising it up to the head
Then the funnel will be descended below the abdomen, while
evacuating the gastric fluid
The operation will be repeated until the evacuated fluid is clean
The probe will be gently extracted to prevent its evacuation into
the respiratory tree
GASTRIC LAVAGE
INCIDENT S , ACCIDENT S , COMPLICA TIONS
Discomfort to the patient (agitation,

coughing, vomiting)
Penetration of the probe into the upper
airways
Tracheobronchial aspiration syndrome
Bleeding
Septic mediastinal complications
GASTROINTESTINAL
SUCTION

INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
GASTROINTESTINAL
SUCTION
Definition: it is the maneuver by which the

excessive gastric fluid is evacuated
Purpose: the evacuation of gastric,
excessive duodenal or jejunal fluids in order
to avoid the digestive stasis
Principles: the principles of aseptis and
antisepsis must be respected, a proper
hydro-electrolytic balance must be ensured
GASTROINTESTINAL
SUCTION
INDICA TIONS
Acute dilatation of the stomach

High digestive stenosis
Intestinal occlusions
Acute pancreatitis
Gastrointestinal perforation
Post-surgery until the resumption of intestinal transit for
gases
Dynamic Ileus
Conservative treatment (Taylor method for perforated
ulcer)
Pre-surgery preparation
GASTROINTESTINAL
SUCTION
REQUIRED MATERIALS
Gloves
Radiopaque probes
Graded collecting containers
GASTROINTESTINAL
SUCTION
TECHNIQUE
The patient will be informed about the maneuver, his

cooperation is important during the digestive probing
The patient will be placed in the sitting position or right
lateral decubitus
The tube will be inserted through the patients mouth, up to
the pharynx, asking the patient to swallow
The tube will slowly progress into the stomach, no more
than 45-60 cm
In case of postoperative suction the tube will always be
placed upstream of the digestive suture during surgery
In case of biliary pathology the tube can be placed
endoscopically in the ducts
The volume and the aspect of the sucked digestive fluid will
be daily noted in the patients observation sheet
GASTROINTESTINAL
SUCTION

vomiting)
Penetration of the tube into the upper airways
Aspiration syndrome
Bleeding
Probe blockage with food debris
Decubitus lesions of the digestive mucosa
ENTERAL FEEDING THROUGH

THE DIGESTIVE PROBE

INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE
Definition: introducing specially prepared food

by means of probes directly into the proximal
digestive tract
Purpose: ensuring the necessary intake of
nutrients for the patient
Principles: it is necessary to ensure the patient
a balanced nutrition which determine that
his/hers alimentation and digestion is as closed
to the natural as possible
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE
Patients who cannot be fed
spontaneously
INDICATIONS
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE
CONTRAINDICA TIONS
High gastrointestinal obstacles

Incoercible vomiting
Digestive fistulas
Inflammatory digestive disorders
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE
REQUIRED MATERIALS
Gloves
Radiopaque tubes with single or multiple lumen
Containers
Connection tubing
Dosing pumps
Nutrient preparations that are to be
administered according to specific nutritional
deficiencies of each patient
PHOTO
NUTRITIENT SOLUTION TO BE
ADMINISTRA TED THROUGH DIGESTIVE
PROBES
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE
TECHNIQUE
The patient will be informed about the maneuver, his cooperation

is important during the digestive probing
The patient will be placed in the sitting position or dorsal
decubitus Fowler type
The tube will be inserted through the patients mouth, into the
pharynx while the patient will be asked to swallow
The tube will progress slowly into the stomach, up to 45-60 cm
The positioning of the probe will be made radiologically,
endoscopically or intraoperatively (always downstream of the
anastomosis)
The probe will be connected through the connection system to
the nutrient bag
The administration can be done in bolus" or continuously, the
pace being set by the patient's the digestive tolerance
A caloric intake of 3000 cal / day is necessary
ENTERAL FEEDING
THROUGH
THE DIGESTIVE PROBE

vomiting)
Penetration of the probe into the upper airways
Aspiration syndrome
Bleeding
Dyspepsia
Gastroesophageal reflux, regurgitation, nausea
PERITONEAL DRAINAGE
ASEPTISATION
OF THE LIVING TISSUES
PATIENTS SKIN
HEMOSTASIS

INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
INCIDENTS, ACCIDENTS,
COMPLICATIONS
CONTENT
DEFINITION,
PURPOSE,
PRINCIPLES
Definition: the maneuver through which

the bleeding is stopped
Purpose: stopping blood from flowing
from the vascular bed
Principles: hemostasis can be done
spontaneously (physiological
mechanisms of the body) or surgically by
physical and chemical methods
INDICA TIONS
Any bleeding that does not stop by
spontaneous hemostasis
CONTRAINDICA TIO
NS
Pathological situations in which surgery
may be delayed in the hope of a
spontaneous hemostasis (e.g. upper
gastrointestinal bleeding that under
conservative treatment may stop
spontaneously)
REQUIRED
MATERIALS
Temporary hemostasis: tourniquet, soft
tissue for the compression of damaged
vessels
Final hemostasis: common instruments for
surgery, hemostatic forceps, atraumatic
needles to restore vessel continuity
In case of hemostasis mechanism disorders
blood derivatives are required (see Chap.
Transfusions), hemostatic substances, etc.
TE CHNIQUE
TEMPORARY HEMOSTASIS
FINAL HEMOSTASIS
TE CHNIQUE
Definition: it represents the method by which

the bleeding is temporarily stopped
Purpose: avoids blood loss until final
HEMOSTASIS can be done
Temporary hemostasis is represented by the
vascular compression that is made by/through :
TOURNIQUET
POWERFUL COMPRESSION
TECHNIQUE
TOURNIQUET
If there is no tourniquet it can be improvised using a cord, a
belt, a scarf
Indications: limbs
By applying it the vascular walls are crushed and bleeding
stops
It is very important to attach a note where the date and exact
time of tourniquet application are recorded . If the transport
takes longer than 15-30 minutes, the tourniquet will be
opened for a few seconds to restore the blood flow to the
affected limb
In case of a jet bleeding with red blood, the bleeding has
arterial origin, and the tourniquet will be applied proximally to
the lesion, to the concerned member
In case of a continuous jet bleeding with dark red blood, the
bleeding has venous origin, and the tourniquet will be
applied distally to the lesion, to the tip of the concerned limb
TE CHNIQUE
POWERFUL COMPRESSION
Indications: head, neck, thorax, abdomen
It can be done by the strong compression of the injured
vessel against a skeletal plan, or by compression
bandage
The compressive bandage is made with sterile
compresses, the bandage is large enough to make the
injured blood vessel cooperate. Over sterile compresses
a crumpled of folded compresses or a roll of infancy
can be added, followed by a tight enswathement of the
area by circular infancy turns, with hemostatic role
TE CHNIQUE
Definition: it represents the surgical maneuvers

through which final hemostasis is obtained into
the blood vessel
During surgery it can be performed:
TEMPORARY HEMOSTASIS: it enables a
postponement of the final hemostasis in a
propitious moment
FINAL HEMOSTASIS
TE CHNIQUE
Forcipression
The tourniquet
Loops
Balloon probes: Foley, Fogarthy
Compressive bandage
Swabbing
TE CHNIQUE
TEMPORARY HEMOSTASIS FORCIPRES SION
Definition: catching the end of the injured blood

vessel between the arms of a hemostatic
forceps
Indications: small diameter vessels
It can cause final hemostasis by spontaneous
hemostasis into the blood vessel or it may
require a subsequent final hemostasis
technique
TE CHNIQUE
TEMPORARY HEMOSTASIS TOURNIQUET
Definition: a loop suture will be passed around

the blood vessel, then both ends of the loop
suture are passed through a plastic tube that
by tightening will causes the compression
effect of the blood vessel
Advantages: does not harm the blood vessel,
easy to apply, when suppressed it allows the
reestablishment of the blood circulation in the
blood vessel
TECHNIQUE
TEMPORARY HEMOSTASIS THE LOOPS
Definition: a loop of cotton will go around the

blood vessel, determining a lifting position by
forceps traction or fixation, temporarily
stopping the bleeding
Indications: vascular surgery in the
reconstruction of damaged blood vessels
TECHNIQUE
TEMPORARY HEMOSTASIS BALOON PROBES
Definition: the balloon probe is inserted through

the injured end of the blood vessel, which by
inflation causes lumen obstruction with
temporary bleeding stop
Indications: vascular surgery
Advantages: it is an atraumatic technique
TECHNIQUE
TEMPORARY HEMOSTASIS PLUGGING ,

COMPRESSION BANDAGE
Definition: compression of the blood vessel

with a tissue, a sufficient time to allow
spontaneous hemostasis
Indications: small diameter vessels, diffuse
bleeding
TECHNIQUE
FINAL HEMOSTASIS
Ligature
Electrocoagulation
Embolization
Cushioning
Mass suture
Hemostatic substances
TECHNIQUE
FINAL HEMOSTASIS - LIGATURE

Definition: applying a loop suture by knotting in the blood vessel that will
determine HEMOSTASIS
Required materials: absorbable or non absorbable sutures, metal clips,
rubber rings
Technique: a hemostatic forceps will be applied to the damaged vessel
and the forceps will be adapted to the size and length of the blood
vessel and to the depth that the vessel is located, the tip of the forceps
being beyond the vessel by 1-2mm. Forceps should be applied only on
the blood vessel without catching other structures nearby. The suture
will be passed around the forceps and the vessel, with a forceps, then
the loop will be tied with at least three nodes (raise, fix, ensure). After
the first node the operator will open the forceps, and now the assistant
will tighten the node perfectly. After checking hemostasis the loop is cut
to 3-4 mm from the node.
If necessary several ligatures may be applied on the same blood vessel
a few millimeters away from each other or a supported ligature may be
applied.
VIDEO
TECHNIQUE
FINAL HEMOSTASIS - LIGATUR E
TECHNIQUE
FINAL HEMOSTASIS - ELECTROCOAGULA TION
Definition: is the method

by which hemostasis is
produced using
electricity
Principles: changing the
intensity-voltage ratio it
can produce currents
that burn the cells that
come into contact with
the electrical scalpel
causing bleeding stop in
the small blood vessels
VIDEO
TECHNIQUE
TECHNIQUE
TECHNIQUE
FINAL HEMOSTASIS - EMBOLIZA TION
Definition: it means introducing coagulant

substances in the injured blood vessel
Indications: interventional endoscopy
Coagulant substances: absolute alcohol,
polidocanol, adrenaline
TECHNIQUE
FINAL HEMOSTASIS THE CUSHIONING
Definition: it is a method of achieving

hemostasis by suture, bringing side by
side, in close contact "raw surfaces. This
creates a high pressure cavity that will
determine hemostasis
Indications: hemostasis in the gallbladder
bed after cholecystectomy
TECHNIQUE
FINAL HEMOSTASIS MASS SUTURE
Definition: passing sutures in "x" around

the damaged vessel, and by tightening the
loop creating pressure in the blood vessel
that will lead to stopping the bleeding
Indications: diffuse bleeding where the
damaged vessel cannot be identified or it
is very small and brittle, other hemostasis
techniques not being possible
TECHNIQUE
FINAL HEMOSTASIS ORGANIC SUBSTANCES
Definition: obtain hemostasis by

applying organic substances on
the surface where you want to
stop bleeding
These products have in their
composition certain substances
(fibrin, organic glues) that
stimulate and encourage
hemostasis
Products: fibrin powder,
Gelaspon, Tisucol, TachoComb
INCIDENT S ,
ACCIDENT S ,
COMPLICA TIONS
Incidents, accidents:
Ligature slipping of the blood vessel
Pulling out the blood vessel during tying
Crushing the blood vessel between the
forceps arms when its dimensions are not
adapted to the vessel size
Local hematoma
Complications: necrosis, massive bleeding,
hypovolemic shock
PUNCTURES
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
STANDARD TECHNIQUE
PUNCTURES TYPES
CONTENT
DEFINITION, PURPOSE,
PRINCIPLES
Definition: it represents the manoeuvre
through which an organ, cavity or tissue
is entered with a needle or trocar
Purpose: disposal, treatment, diagnosis,
biopsy
Principles: the punctures tract should be
as short as possible, the manoeuvre must
be aseptic
INDICATIONS
Pneumothorax
Paracentesis
Pneumoperitoneum
Pancreatic pseudocyst
Abscess
Biopsy
Seldinger puncture
CONTRAINDICATIONS
Haemophilia
Treatment with anticoagulants
Tetanus
Induction of general anaesthesia
REQUIRED MATERIALS
Iodine alcohol, soft
material, sterile gloves
Syringe with needle,
lidocaine
Puncture
needle,
trocar and syringe
Fittings and containers
for collection
Fluids for lavage
STANDARD TECHNIQUE
Patients information on the procedure and obtaining his written
consent
A comfortable position will be further on chosen, with removal of the
clothing from the examined region
Sterile gloves will be used during the examination
The region to be punctured will be sanitized
Local anaesthesia will be further on performed
The clinically or imagistically spotted region will be punctured with the
needle attached to the syringe
The collections content will be drawn and stored in special containers
according to the test that is to be performed
For therapeutic puncture, the desired substance will be injected
The needle is firmly removed
The region will undergo massage with a alcohol swab
Sterile dressing
Rest for 30 minutes
TYPES OF PUNCTURES
THORACIC PUNCTURE (THORACENTESIS)
PERICARDIAL PUNCTURE
ABDOMINAL PUNCTURE (PARACENTESIS)
SUPRAPUBIC PUNCTURE
LUMBAR PUNCTURE
STERNAL PUNCTURE
BIOPSY - PUNCTURE
CLICK USING THE MOUSE ON EACH TITLE
THORACIC PUNCTURE
(THORACENTESIS)
Purpose: disposal, treatment, biopsy

Patients position: leaned forward, seated on a chair facing the chairs back or semi-seated
when dealing with a patient difficult to mobilize
Punctures place:
Intercostal space III posterior axillary line for the disposal of pneumothorax
Intercostal space VI posterior axillary line for the disposal of fluid
In full dullness to percussion
Sanitization of the region, sterile gloves will be used during examination
One ampoule of Mialgin will be administered 15 minutes prior to the puncture
Local anaesthesia
The needle or the trocar will be positioned perpendicularly to the skin, grazing the top edge
of the lower coast
Skin is penetrated and at first and after that all layers of the chest wall until one can feel a
slight resistance to the needle when passing through the pleura
Then, one will go forward one centimetre more; after this, the collection will begin
The needle is firmly removed, sterile dressing
INCIDENTS, ACCIDENTS, COMPLICATIONS: paroxysms of cough, pneumothorax,
pleural shock, acute pulmonary oedema, tear of the puncture needle
IMAGE
THORACIC PUNCTURE
(THORACENTESIS)
PERICARDIAL
PUNCTURE
Purpose: disposal
Patients position and punctures place:
Seated: intercostal space V at 6 cm from the left edge of the stern
Supine position: top of the xiphoid appendix
Morphine should be administered
Local anaesthesia
The needle attached to the syringe will be positioned perpendicularly to the skin
Under moderate aspiration, one goes forward with the needle until fluid enters in
the syringe (this is when one knows the pericardial cavity has been reached)
The desired quantity of fluid will be sampled
The puncture needle is firmly removed the region will undergo massage
Sterile dressing
Bed rest for the patient
INCIDENTS, ACCIDENTS, COMPLICATIONS: bleeding, restlessness, irregular
heartbeats
ABDOMINAL PUNCTURE
(PARACENTESIS)
Purpose: disposal (for ascites, no more than 5 litres per session will be disposed),
diagnosis
Patients position: supine position
Punctures place: midway between the umbilicus and the left anterior-superior iliac
spine, 2 cm under umbilicus
IMAGES
Local anaesthesia
The needle will be positioned perpendicularly to the skin, penetrating all the layers of
the abdominal wall (there will be two resistant layers aponeurosis and transversalis
fascia
The peritoneal fluid will be drawn and stored in the indicated containers or the needle
will be coupled to an external drainage system
Peritoneal lavage: to the puncture needle, with the help of a blood infusion pump, a
bottle of physiological serum will be placed to at least one meter above the bed.
Once emptied, the bottle will be placed at the level of the bed, thus allowing the
leaking of the fluid from the peritoneal cavity into the bottle
The puncture needle is firmly removed, sterile dressing
Bed rest for the patient
INCIDENTS, ACCIDENTS, COMPLICATIONS: puncture of an intestinal loop,
gastrointestinal bleeding or vascular collapse in the event of sudden decompression
of the abdomen
ABDOMINAL PUNCTURE
(PARACENTESIS)
Abdominal punctures place
Veress needle
SUPRAPUBIC PUNCTURE
Purpose: disposal, collection of urine for urinalysis

Sanitization of the region, sterile gloves will be used during
examination
Punctures place: suprapubic region
The needle attached to the syringe will be positioned perpendicularly
to the skin, under moderate aspiration, until urine appears in the
syringe
The desired quantity of urine will be disposed
The bladder is washed with antiseptic solutions, which will be later on
disposed
Sterile dressing
INCIDENTS, ACCIDENTS, COMPLICATIONS: bleeding from the
bladder wall, infection
LUMBAR PUNCTURE
Purpose: diagnosis, treatment

Patients position:
Lateral decubitus, squat
IMAGE
Seated, the column is curved in front, the hands are placed on opposite shoulders
Punctures place: L2, below the vertebra
Sanitization of the region
It will pinpoint the spinous apophysis of the lumbar vertebra, left thumb
The needle will be positioned perpendicularly to the skin, grazing the spinous apophysis,
until feeling an increased strength has been overcome and the entrance is entirely void of
obstructions
The needles tenaculum is removed
2-3 drops of Cerebro-Spinal Fluid are obtained
2-3 ml of Cerebro-Spinal Fluid are sampled or the desired substance is injected with a
sterile syringe
The region will undergo massage with a alcohol swab
Sterile dressing
Bed rest for the patient during the whole day
INCIDENTS, ACCIDENTS, COMPLICATIONS: headache, bleeding, infection
LUMBAR PUNCTURE
STERNAL PUNCTURE
Purpose: diagnosis
Mialgin or Morphine is administered
Punctures place: stern
Local anaesthesia will be performed
With the Malarme trocar, placed perpendicularly on the stern, one goes
forward until feeling the entrance is entirely void of obstructions
The tenaculum is removed and with a sterile syringe are sampled 4 ml
of haematogenous medulla
The trocar is sampled
Sanitization of the region with alcohol
Sterile dressing
INCIDENTS, ACCIDENTS, COMPLICATIONS: infection, stern fracture
BIOPSY - PUNCTURE
Purpose: diagnosis
Patients position: one will choose the most comfortable
position for the patient, depending on where the region or

organ to be punctured is found
Punctures place: varies depending on localization

(adenopathies, liver, tumours)
Sanitization of the region, sterile gloves will be used during
examination
The puncture technique described above will be carried out
The sampled product will be placed in containers and sent as
soon as possible to the histopathology laboratory
INCIDENTS, ACCIDENTS, COMPLICATIONS: bleeding,
infection
VIDEO
Biopsy needle
BIOPSY - PUNCTURE
MAMMARY TUMOR
IN ORDER TO SEE AGAIN THE CLIP, CLICK USING THE MOUSE ON THE IMAGE
SURGICAL SUTURE
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
MEDICAL CARE
CONTENTS
DEFINITION,
PURPOSE,
PRINCIPLES
Definition: it represents the closeness and solidarity of the margins of a

wound (skin, organ, digestive tube, etc.) by sewing them with a needle
and a thread
Purpose: restoration of the anatomical continuity of the structure involved
or of two different structures when surgery requires so
Principles:
It is a sterile manoeuvre
Local hemostasis must be perfect
The edges to be sutured must have an adequate vascularization
The suture begins with the deepest chain to the surface
For the hollow organs, the suture must be tight and not stenosed. In
order to comply with this rule, if necessary, one can perform more
sutures
The knots of the suture must not be made to close in order to avoid
ischemia; nor should they be too large, untight
A suture may be primary or secondary
INDICATIONS
Restoring the continuity of the incised or
broken structures
Fixing some mobile structures to other mobile
or fix structures
Fixing of prosthesis (prostheses, grafts, etc.)
Fixing the drain tubes, probes
CONTRAINDICATIONS
Infected wounds
Old septic high-risk wounds
Purulent incised collections
Suture of viscera in peritonitis
Poorly vascularised structures
REQUIRED MATERIALS
Sterile gloves
Soft sterile material
SEE ANTISEPTICS
Antiseptic solutions
Suture needles
FOTO
Suture threads
Metal staples
Needle holder
Anatomic clamp with or without teeth
Scissors
REQUIRED MATERIALS
REQUIRED MATERIALS
REQUIRED MATERIALS
NEEDLES
Disposable needles (atraumatic) or re sterilizable (always traumatic, are rarely

ever used)
Straight or curved needles
Triangular needles (skin, fascia), oval or
round needles (intestines, organs, etc.)
REQUIRED MATERIALS
SUTURE THREADS
Natural (flax, cotton, silk, catgut) or synthetic

(nylon, dacron) threads
Reabsorbable (resorption between 14 days
and 6 months) or non-reabsorbable threads
In terms of thicknesses, they vary
depending on the structure that is to be
sutured
They must be flexible
They must be resistant
TECHNIQUE
Patients information on the procedure and
obtaining his written consent
Preoperative preparation of the suture place
(waxing, sanitization, disposal and cleaning of
hollow viscera)
Preparation of the structures to be sutured:
identification and tracking of anatomical
elements, perfect hemostasis, adequate
vascularization, removal of the fat from the
level of the suture
TECHNIQUE
INTERRUPTED SUTURE
CONTINUOUS SUTURE
METAL STAPLES SUTURE
TECHNIQUE
INTERRUPTED SUTURE
SIMPLE INTERRUPTED SUTURE

HORIZONTAL MATTRESS SUTURE
VERTICAL MATTRESS SUTURE
TECHNIQUE
INTERRUPTED SUTURE
The needle will pass approximately 1 cm away

from the wounds edge penetrating all deep
levels up to about 1.2 cm of the incision line
The same trajectory will be followed on the
opposite lip of the wound
The node will not fall on the wound but on one
of the places of entry or exit of the needle
VIDEO
TECHNIQUE
INTERRUPTED SUTURE
PERITONEUM-APONEUROTIC SUTURE
TECHNIQUE
INTERRUPTED SUTURE
CUTANEOUS SUTURE
TECHNIQUE
INTERRUPTED SUTURE
HORIZONTAL MATTRESS SUTURE LEXER
The same indications as for the simple

suture will be followed, only that one will
also return with the needle pointing at 0.5
cm from the needles place of exist
The node will be done on the wound
where the suturing was begun; in the
end, two parallel threads will appear
joined by a node
TECHNIQUE
INTERRUPTED SUTURE
A simple point will be made; it will

continue with a U-shape turn at 3 mm
from the wound, the needle passing
through the epidermis
The node will be made on the wounds
part where the suture was started
It provides a very good approach
VIDEO
TECHNIQUE
INTERRUPTED SUTURE
TECHNIQUE
CONTINUOUS SUTURE
The suture begins with a simple point; then, the

needle will pass like for the interrupted suture,
this meaning that the node is no longer made
after each pass of the needle, the thread being
held in tension until the end of the suture when
it is finally tied
It can determine asymmetries of the wound
Types of continuous suture: interrupted, BlairDonatti, intra-dermal
TECHNIQUE
METAL STAPLES SUTURE
Separate points
The
mechanical
suture of the hollow
viscera (it is fast,
tight and provides a
very good approach)
COMPLICATIONS
Breaking of the suture threads
The wound gets opened by the sectioning of the
sutured structures
Seroma
Hematoma, bleedings
Infection
Eventrations
Eviscerations
Thread granuloma
Vicious scar
MEDICAL CARE
Daily dressing in the first two days, then as
needed
The threads will be removed in 4-14 days from
the suture, depending on local factors
(vascularization, etc..) and general factors
(cachexia, malignancy, etc.) - 4 days for scalp
and neck, 7-10 days for thorax and abdomen,
12 days for limbs
Clips will be removed 4 days postoperatively
BANDAGING
(DRESSING OF A WOUND)

REQUIRED MATERIALS
TECHNIQUE
CONTENTS
DEFINITION, PURPOSE,
PRINCIPLES
Definition: it represents the method through which the body is
covered or fixed with gauze or elastic rollers
Purpose: fixing the bandage
Principles:
Not to cause pain, not to be too tight or too wide
To cover well the region, protecting and isolating the wound
To achieve a better fixing of the bandage
To allow mobilization of the dressed segment
The roller is unfolded from left to right
The fixing of the dressing is made at distance from the wound
in order not to cause pain
At the level of the limbs, the bandage will be made from distal
to proximal
REQUIRED MATERIALS
Gauze roller of varying lengths and
widths
Elastic roller
Adhesive strip of fixation
Nets
Staples
REQUIRED MATERIALS
Types of rollers
Plaster roller
Elastic roller and fixing staple
REQUIRED MATERIALS
FIXING MATERIALS
Adhesive strip
Fixing staple
Galifix
Elastic net
TECHNIQUE
Dressing will start with 1-3 circular fixing laps
The roller will be unfolded with the right hand and fixed
with the left hand
Bandaging will continue according to the region
involved
Bandaging will end with 1-2 circular laps
Bandaging is fixed with adhesive stripes or safety pins
placed away from the wound
Bandaging will be removed by cuts with scissors made
in a part outside the wound
TECHNIQUE
GENERAL TECHNIQUES
BANDAGING ACCORDING TO TOPOGRAPHICAL REGIONS
GENERAL TECHNIQUES
CIRCULAR BANDAGING
SPIRAL BANDAGING
FAN BANDAGING
SPICA BANDAGING
IMAGE-OF-EIGHT BANDAGING
RECURRENT FOLD BANDAGING
TECHNIQUE
CIRCULAR BANDAGING
INDICATIONS: neck, arm, fist

Circular laps will be put one over another
Advantages: easy to make
Disadvantages: it rolls up, gets tighten
becoming uncomfortable
TECHNIQUE
SPIRAL BANDAGING
INDICATIONS: limbs, thorax

The bandaging begins with 1-2 circular
fixing laps, continues with partially
overlapped oblique circular laps and ends
with 1-2 circular laps
Advantages: it covers important surfaces
Disadvantages: the distal part of each lap
is large
TECHNIQUE
FAN BANDAGING
INDICATIONS: elbow, knee

The bandaging begins with 1-2 circular laps,
continues with spiral laps in the thickness of
the joint space where 1-2 circular laps are
followed by as many spiral laps as
necessary, ending with 1-2 circular laps
Advantages: it fixes the bandaging at the
level of the joint
TECHNIQUE
SPICA BANDAGING
INDICATIONS: shoulder, hip

laps at the level of the thorax or abdomen,
continues at the level of the joint with 8shape laps partially overlapped and ends
Advantages: it provides a good fixing of
the bandaging
TECHNIQUE
INDICATIONS: hand, ankle

laps distal to the joint, continues with 8shape laps partially overlapped and ends
proximally with 1-2 circular laps
TECHNIQUE
RECURRENT FOLD BANDAGING
INDICATIONS: head, amputation stump

PHOTO
2 rollers are to be used
With one roller, are done 1-2 circular laps in the
fronto-occipital region; with the other roller, the
bandage passes from anterior to posterior and
vice versa (folded roller); each passing of the
roller is fixed with the first roller by a circular lap
until the whole surface is covered. The bandage
ends by getting fixed due to 1-2 circular laps
BANDAGING
ACCORDING TO
TOPOGRAPHICAL
REGIONS
AT THE LEVEL OF THE HEAD
AT THE LEVEL OF THE NECK

AT THE LEVEL OF THE THORAX
AT THE LEVEL OF THE ABDOMEN
AT THE LEVEL OF THE PERINEUM
AT THE LEVEL OF THE LIMBS
TECHNIQUE
AT THE LEVEL OF THE HEAD
Types of bandages
CAPELINE
MONOCLE, BINOCLE
NASAL SLING AND CHIN BANDAGE
TECHNIQUE
AT THE LEVEL OF THE HEAD-CAPELINE
With one roller, are done 1-2 circular laps

in the fronto-occipital region; with the other
roller, the bandage passes from anterior to
posterior and vice versa (folded roller);
each passing of the roller is fixed with the
first roller by a circular lap until the whole
surface is covered. The bandage ends by
getting fixed due to 1-2 circular laps
TECHNIQUE
CAPELINE
TECHNIQUE
AT THE LEVEL OF THE HEAD-MONOCLE, BINOCLE
INDICATIONS:
ophthalmology
With one roller, are done
1-2 circular laps in the
fronto-occipital
region;
then, are done oblique
laps in the temporo-subauricular uni or bilateral
region, fixed by 1-2 circular
laps. The bandaging ends
MONOCLE
BINOCLE
TECHNIQUE
AT THE LEVEL OF THE HEAD-NASAL SLING AND CHIN

BANDAGE (FOUR-TAILED BANDAGE)
A roller of approximately
80 cm length will be split
in
both
extremities,
leaving in the middle 6-8
cm
not
split.
The
extremities are crossed
over each other and
behind the ear, being
knotted at the blackhead
and calvaria
SLING
FOUR-TAILED
BANDAGE
TECHNIQUE
AT THE LEVEL OF THE NECK
ANTERIOR SPICA OF
THE NECK
POSTERIOR SPICA OF
THE NECK
These
are
complex
bandages
They apply the 8-shape
bandaging technique as
well as the circular
bandaging
POSTERIOR SPICA OF THE NECK
TECHNIQUE
AT THE LEVEL OF THE THORAX
Types of bandages:
VELPEAU BANDAGE
BREAST SPICA
TECHNIQUE
VELPEAU BANDAGE
INDICATIONS: orthopedic injuries of the

shoulder, humerus
Circular chest laps will be done,
alternating with oblique laps that fix the
upper limb to the thorax, as well as
vertical laps over the shoulder and
forearm, the hand being free
TECHNIQUE
BREAST SPICA
INDICATIONS:
mastectomy
2-3 circular laps will
be done on the thorax
under the normal
breast, then oblique
laps
over
the
shoulder, altering with
circular chest laps
VIDEO
TECHNIQUE
BREAST SPICA
TECHNIQUE
AT THE LEVEL OF THE ABDOMEN
It is difficult to be made and lacks

functionality
Other types of fixing the bandage are
preferred, especially adhesive strips
One used dressing type is the loose
bandage
VIDEO
TECHNIQUE
AT THE LEVEL OF THE ABDOMEN-LOOSE BANDAGE
TECHNIQUE
AT THE LEVEL OF THE PERINEUM
DRESSING OF A TSHAPE WOUND

Two rollers are to be
used for this bandage,
one going circular
abdominal, and the
other antero-posterior
covering the genitals,
being fixed due to
abdominal
circular
laps
TECHNIQUE
AT THE LEVEL OF THE LIMBS
SPICA BANDAGING: shoulder, hip, fingers

FAN BANDAGING: elbow, knee
IMAGE-OF-EIGHT BANDAGING : hand, ankle
CIRCULAR BANDAGING: arm, fist
TECHNIQUE
SPICA OF THE SHOULDER, HIP
TECHNIQUE
SPICA OF THE FOREFINGER
TECHNIQUE
FAN BANDAGING OF THE ELBOW, KNEE
TECHNIQUE
HAND
ANKLE
TECHNIQUE
IMAGE-OF-EIGHT BANDAGING-HAND
TECHNIQUE
IMAGE-OF-EIGHT BANDAGING-ANKLE
TECHNIQUE
CIRCULAR BANDAGING
TECHNIQUE
STUMP THIGH
Elastic stocking
Fixing bandage with an elastic net
URINARY CATHETERIZATION
DEFINITION, PRINCIPLES
PURPOSE
INDICATIONS
CONTRAINDICATIONS
REQUIRED MATERIALS
TECHNIQUE
MEDICAL CARE
CONTENTS
DEFINITION,
PRINCIPLES
Definition: it represents a method through
which the communication between the
external environment and bladder is
achieved
Principle: it is an aseptic method
Purpose
Disposal:
Monitoring: in hydro-electrolytic unstable
patients, during the postoperative immediate
phase (loss evaluation)
Therapy : acute retention of urine (urgency)
Exploration: a radio-opaque substance is
inserted allowing to obtain information on the
bladders form, shape, size
Therapy: antibiotics (urinary tract infections),
chemotherapy (cancer)
INDICATIONS
Acute retention of urine
Prostate stenosis (for disposal purpose
and simultaneously accomplishes a
dilatation of the urethra)
Urethral stenosis
Administration of radio-opaque substances
Administration of drugs (antibiotics,
chemotherapeutic)
CONTRAINDICATION
S
The major urethral structure when are
created false paths or the urethral
rupture due to the catheters insertion
REQUIRED MATERIALS
Oilcloth
Sterile gloves
Sterile solution for sanitization
Nelaton probe (women), Thyeman
(balloon), Pezzer
Lubrication gel
Collecting bag
Kidney tray, basin
(men)
Foley
TECHNIQUE
The oilcloth is placed under the patient, together with a basin or a
kidney tray
The patient is in supine position, with the hips flexed on the legs
and knees apart
Gloves must be used for now on. Left hand will be used for the local
toilet (penis glans for men, vulvar region for women); the right hand
will be used for handling the catheter, the glove being kept sterile
After doing the toilet with the left hand, the glans is opened or the
vulvar lips are kept apart; after this, a lavage with abundant
antiseptic solutions will be made
The physician will keep the peak of the catheter while the distal end
will be attached to the collecting bag by the nurse
The lubricant will be poured in the catheter's peak and in the penis
urinary meatus
TECHNIQUE FOR THE MALE
TECHNIQUE FOR THE FEMALE
CLICK USING THE MOUSE ON THE UNDERLINED TITLES
TECHNIQUE FOR THE

MALE
The penis glans is localized

The penis is oriented to zenith
The catheter is gently inserted
When the peak reaches the prostate, the penis
be directed caudally, parallel to the bed
The catheters insertion continues until reaching
bladder (the urine appears in the urinary tube)
The balloon fills with physiological serum
The catheter is withdrawn until it stops (at
bladder opening of the urethra)
VIDEO
Local toilet
will
the
the
TECHNIQUE FOR THE

MALE
TECHNIQUE FOR THE

FEMALE
The catheter is inserted into the urinary meatus
The catheter is slowly and progressively inserted
The catheter is inserted approximately 10-15 cm (the
female urethra is short and right)
The balloon fills with physiological serum
The catheter is withdrawn until it stops (at the
bladder opening of the urethra)
Local toilet
VIDEO
TECHNIQUE FOR THE

FEMALE
COMPLICATIONS
The false path" is the most common complication that can lead to rupture
of the urethra. It requires the urgent attention of the urology department
The balloons filling in the urethra causes the dilatation of the urethra, which
can be accompanied by bleeding or rupture. In order to avoid this accident,
first the catheter will be entirely inserted and only after that the balloon will
inflate
Bleeding ex vacuo" occurs due to sudden emptying of the bladder that
causes the rupture of the blood vessel in the bladder mucosa
If it is necessary to evacuate a large amount of urine, then this will be
gradually made, evacuating small amounts of urine alternating for few
minutes with the catheters plucking
Urinary infection
The blocking of the catheter with clots, flakes, precipitates requires washing
with antiseptic and anti-obstruction solutions
MEDICAL CARE
Purpose: the sterility of the bladder and
of the disposed urine must be maintained
The catheter will be changed in 7 days
time in aseptic conditions
The collecting bag must be changed or
emptied in aseptic conditions
Local hygiene
SURGICAL
INSTRUMENTS
CONTENTS
TYPES OF
INSTRUMENTS
INSTRUMENTS TO SECTION TISSUES
INSTRUMENTS OF EXPLORATION
INSTRUMENTS TO GRASP AND MANIPULATE
TISSUES
INSTRUMENTS OF HEMOSTASIS
INSTRUMENTS OF REMOVAL
INSTRUMENTS OF SUTURE
INSTRUMENTS OF FIXATION
INSTRUMENTE FOR LAPAROSCOPY
INSTRUMENTS TO
SECTION TISSUES
Removable and disposable blade scalpel

Electric scalpel
Ultrasonic scalpel
Laser scalpel
Curved and straight scissors
Amputation knife
Osteotomes
Chisel
Blade-type, Gigli, electrical, pneumatic saws
INSTRUMENTS TO
SECTION TISSUES
Electric scalpel
Hand grip scalpel
Scissors
Scalpel blades
INSTRUMENTS TO
SECTION TISSUES
Saw
Costotome
Chisel
Bone cutter
INSTRUMENTS TO
SECTION TISSUES
Amputation knife
Gigli saw
INSTRUMENTS OF
EXPLORATION
Channelled catheter
Button stiletto Olive-tipped explorer
Histometer
INSTRUMENTS TO GRASP
AND MANIPULATE
TISSUES
Anatomic clamp with or without teeth

Surgical clamps
Heart-shape clamps
Babckok clamp
Mice teeth-shape clamp Chaput
Coprostatic straight and curved clamps
Anastomotic clamps - Line-Thomas
L-shape clamps
AND MANIPULATE
TISSUES
Anatomic clamps with teeth (surgical clamps)
Anatomic clamps without teeth
AND MANIPULATE
TISSUES
Heart-shape clamp
Babckok clamp
AND MANIPULATE
TISSUES
Coprostatic clamps
L-shape clamp
INSTRUMENTS OF
HEMOSTASIS
Curved and straight Pan clamps

Curved and straight Kocher clamps
Mosquito clamps
Halsted clamps
Guyon clamps
Satinski clamps
Bulldog-type clamps - Dieffenbach
INSTRUMENTS OF
HEMOSTASIS
Kocher clamps
Pan clamps
Satinski clamps
INSTRUMENTS OF
HEMOSTASIS
Buldog-type clamps - Dieffenbach
INSTRUMENTS OF
REMOVAL
Farabeuf spreader
Valves
Auto-static spreaders: Gosset, Dartigues,
Finochetto, Collin
Anal dilators
Vaginal speculum
INSTRUMENTS OF
REMOVAL
Finochetto spreader
Farabeuf spreaders
Volkman spreader
Valves
INSTRUMENTS OF
REMOVAL
Gosset spreader
Dartigues spreader
INSTRUMENTS OF
REMOVAL
Vaginal speculum
Anal dilator
INSTRUMENTS OF
SUTURE
Round and triangular, straight or curved
Hagedorn needles
Atraumatic needles
Metal staples
Mathieu Needle holder
Hegar Needle holder
Rechargeable or disposable staplers
INSTRUMENTS OF
SUTURE
Mathieu Needle holder
Hegar Needle holder

Mechanical suture clamp
INSTRUMENTS OF
SUTURE
Round-head needle
Reverdin needle
Triangular-head needle
INSTRUMENTS OF
SUTURE
Metal staples
Fixing adhesive strips
INSTRUMENTS OF FIXATION
(racks)
INSTRUMENTE FOR
LAPAROSCOPY
Clamps
Trocar
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
BIBLIOGRAPH
Y
Acalovschi I.: Manopere si tehnici de terapie intensiva.

intensiva. Ed. Dacia, Cluj-Napoca, 1989
Angelescu N.: Elemente de propedeutica chirurgicala.
chirurgicala. Ed. Medicala, Bucharest, 1981
Angelescu M.: Pregatirea preoperatorie a bolnavului chirurgical. In Patologie chirurgicala editorship N. Angelescu. Ed. Medicala,
Bucharest, 2001, 421-428
Bancu E.V.: Semiologie chirurgicala. In Tratat de patologie chirurgicala vol. I editorship E. Proca. Ed. Medicala, Bucharest, 1989
Bancu S.: Riscul operator. In Patologie chirurgicala editorship N. Angelescu. Ed. Medicala, Bucharest, 2001, 419-420
Bercea O.: Bolnavul chirurgical cu tara respiratorie. In Tratat de patologie chirurgicala vol. II editorship E. Proca. Ed. Medicala,
Bucharest, 1998
Bevan P.G., Donovan I.A.: Hand book of general surgery.
surgery. Blackwell Scientific Publications, Oxford, 1992
Burcos T.: ASEPSIS si antisepsia. In Patologie chirurgicala editorship N. Angelescu. Ed. Medicala, Bucharest, 2001, 461-474
Caloghera C.: Chirurgia de urgenta.
urgenta. Ed. Antib, Timisoara, 1993
Cardan E.: Bolnavul chirurgical cu tara digestiva, metabolica si endocrina. In Tratat de patologie chirurgicala vol. II editorship E.
Proca. Ed. Medicala, Bucharest, 1998
Costea I.: Elemente de mica chirurgie.
chirurgie. Ed. Apollonia, Iasi, 1999
Dragomirescu C.: Manual de chirurgie pentru studentii facultatilor de stomatologie.
stomatologie. Ed. Didactica si Pedagogica, Bucharest, 1998
Detrie P.: Petite chirurgie. Soins. Conduite a tenir et investigations,
investigations, 4-me
4-me edition, Masson, Paris, 1991
Dolinescu C.: Indreptar de activitati practice n clinica chirurgicala.
chirurgicala. Litografia IMF Iasi, 1982
Dunn CD, Ranglison N.: Chirurgie-diagnosis si tratament. Ghid de ngrijire a bolnavului chirurgical.
chirurgical. Ed. Medicala, Bucharest,
1995
Georgescu S.O., Lazescu D.: Primii pasi n chirurgie.
chirurgie. Ed. Kolos, Iasi, 2003
Mandache F.: Propedeutica si semiologie clinica chirurgicala. Ed. Didactica si Pedagogica, Bucharest, 1976
Mircea N., Leoveanu A.: Tehnici de anestezie si analgezie spinala.
spinala. Ed. Academiei, Bucharest, 1989
Mircea N.: Monitorizregion n chirurgie si terapie intensiva. In Patologie chirurgicala editorship N. Angelescu. Ed. Medicala,
Bucharest, 2001, 327-348
Mircea N.: Anestezia. In Patologie chirurgicala editorship N. Angelescu. Ed. Medicala, Bucharest, 2001, 371-418
Mozes C.: TECHNIQUE MEDICAL CAREi bolnavului.
bolnavului. Ed. Medicala, Bucharest, 1978
Onisei O.: Bolnavul chirurgical-elemente de diagnosis chirurgical.
chirurgical. Ed. Helicon, Timisoara, 1997
Tefler ABM: General patient management. Brit Ind Bull 1988;44(2): 235-246
Ticmeanu F.: MEDICAL CARE postoperatorii generale si specifice. In Patologie chirurgicala editorship N. Angelescu. Ed.
Medicala, Bucharest, 2001, 429-444
Turai L.: Mica chirurgie fiziopatologica.
fiziopatologica. Ed. Medicala, Bucharest, 1970
Way W.L.: Current surgical diagnosis and treatment.
treatment. Printice-Hall International Inc, 1988
CONTENTS
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PRACTICAL GUIDE

First day in the surgery service

CLIC CU MAUS-UL PESTE FIECARE TITLU

THE FIRST DAY IN THE SURGICAL SERVICE

A significant status change

A SIGNIFICANT STATUS CHANGE

BEHAVIOUR RULES IN THE SURGERY

ORGANIZING THE SURGICAL

THE IN-PATIENT UNIT

THE OPERATING THEATRE

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The filter room

The doctors preparation

The operating room

The induction and wakeup

The room for the preparation

It is equipped with sinks or lavatories for

The depositing rooms

The totality of methods through which the

STERILIZATION THROUGH HEAT

STERILIZATION THROUGH DRY

CLICK WITH THE MOUSE ON EACH TITLE

THE HOT AIR STOVE

THE HOT AIR STOVE

Synonym: Poupinel (improper)

THE HOT AIR STOVE

THE HOT AIR STOVE

Classical thermal tests: caramelizing of

THE HOT AIR STOVE

Objects of thermo-resistant glass

THE HOT AIR STOVE

Dried instruments at the end of the

THE HOT AIR STOVE

The long sterilization duration

THE AMBULATORY OF SF.

The emergency unit of SF.

The in-patient unit of CLINIC I II

Anesthesia and Intensive Care

Medical flows inlets (Aspirator, oxygen,

Apparatus for intraoperatory

Table for instruments

heat was boiling, but it does not create

CLICK WITH THE MOUSE ON EACH TITLE

Entry into the sterilization

Shelf for depositing the boxes with

Recording on the paper the date, h

Removing the material from the autoclave

Depositing the sterile

Physical methods: test band

Tests for checking the

Textile material (fields, masks, gowns,

It allows the sterilization of the entire surgical

THE STERILIZATION WITH

In bacteriology, for the sterilization of

THE STERILIZATION WITH FORMALDEHYDE VAPO

Cyclically, at 90 seconds, formaline vapors are introduced, that

It is used in the following combinations : 10% ethylenoxide +

Chemical methods: of torsion, of color

It allows the sterilization and use of

The gas is irritating for the eyes and

DEVICE: the instruments are immersed for a minimum period of

Container for the