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Surgical tips 2001.pdf

SURGERY TIPS

Nurse's Responsibility Before Breakfast: (Numbers 1 and 2 should be done first)
1.
Set out all the filled retrobulbar injections on the table in the screened-in area. They go to the retrobulbar area. (Kept overnight in refrig; prepared a day ahead). Fill alcohol containers (flat container [changed bi-weekly], forceps holder {small amount}, and small bottle with two 4x4's {changed daily}). Place Oertli cord, Oertli tips,
and cautery pencil in flat container (out of alcohol overnight). Need to soak for at least
30 min. The forceps is sterilized with the first instrument tray in dry heat sterilizer (DHS).

3.
ASAP, first instrument tray is placed in DHS by the "Cinderella" (the generator must be on, note sterilizer information to follow). After #1 tray is completed, put in second tray right after first is removed, pressing cycle I again. After #2 tray is sterilized, turn off and leave second tray in sterilizer until first cataract surgery is underway. (The "Cinderella” may do this, but she also may get busy with breakfast). 4. Draw up and set aside all the injections of antibiotics (one per patient (Kefzol) for sub-Tenon's injection) in TB syringe with 27 g. needle. If there is steroid injectable, this will also be added to about 0.5cc. Set up BSS Plus solution; (if 500 cc, one per day, if 250 cc, may require two). Set out gloves and drapes and check all electrical connections. Check trays (usually two at a time) for 'add-ons' for instrument trays. Get retrobulbars ready to be made up either now or during surgery (refrigerate).
Each Monday A.M. the ophthalmoscope needs to be recharged. Plug it in to the
outlet by the nurse's area. Reconnect with top and take to post-op that afternoon. Do
not
plug into the 220 outlet.
10.
If the trailer is cold, a hot water bottle is filled with a small amount of hot water,
wrapped in a layer of towel and carefully placed on operating microscope to warm oculars, preventing condensation at start of day. (Expel air in water bottle to make it less bulky, and not too much, or it will damage microscope / bend down.) 11. A heater (lower left cupboard, as entering trailer), is available if trailer is cold. Sterilizer must be off when heater used. It can be set up in the middle of the floor and
run while all are at breakfast, (DHS off) then put away again, once cool.
12. Restock the post op tray for afternoon post ops (done anytime during day).

Enjoy breakfast, keeping one eye on the time!


Detailed particulars for above (more information):
1.
Retrobulbar syringes and needles (per # of cases scheduled next day). Draw up the following in a 5cc syringe (over-extended), or 6 cc syringe: Xylocaine 4 cc with Wydase already mixed in Sensorcaine 1.5 cc **One Wydase is mixed with 1 cc Normal Saline and added to one large bottle of
Xylocaine. Label Xylocaine and date. Two or 3 bottles can be set up at one time. This
Xylocaine is then used with the Sensorcaine for the retrobulbars.
Change needles to (Adkinson) retrobulbar needles (blunt tip - if uncertain, check under
microscope). Place retrobulbars in plastic tub with packaged sterile 4x4's (2 per patient)
and refrigerate overnight. Retrieve used retrobulbar needles when last patient
enters
the trailer. The needles are cleaned, sterilized, and reused (4-5 needles are
placed in old syringe holders to be processed in pressure cooker). Also, small plastic
squares (5x5") are used under super pinkie, cut from the undamaged ends of drapes.
See that superpinkies are washed weekly with soap and water by Cinderella.
2.
Alcohol Containers: Forceps' holder is cleaned and sterilized daily in pressure cooker. Forceps' holder is placed with aluminum foil to cover and run in the pressure
cooker (empty) with all non-metal goods. The flat container is cleaned every 2 -3 days
(usually Wednesday and Friday). Hand off to the "Cinderella" during last procedure,
empty, and dry heat sterilize during last case (upside down covering lid). A new
sterilized small bottle containing (2) 4x4's is used every day. The 4x4's are used to wipe
down the tubing between cases with alcohol. Alcohol is obtained from the hospital and
empty bottles returned. Extra bottles are stored in reserve area in front.
3.
Instrument Trays - Dry Heat Sterilizer (DHS): First tray goes into DHS after generator is running. Press "on" button and wait until "888" changes to "- - -". Press
cycle one. Temperature should reach 375 F. (or 190 C. if Centigrade DHS used) and
then 6 minutes tick off and it buzzes. Remove tray and place on wire rack in trailer.
Place 2nd tray in DHS, press cycle one again. If wrong buttons punched or cycle
problem
, disconnect from extension plug, reconnect and start over with program. After
first two trays and through the day, the DHS must be pressed to off, otherwise it
runs with the tray out trying to sterilize the world!

4.
Injections: Given at the end of each surgery (syringe is placed on corner of mayo tray {shaking first to mix} at end of procedure). Draw up Kefzol (and steroid, if available) to 0.5 cc in TB syringes for each. (Kefzol is mixed with 5cc Saline and is stored in the refrigerator (crystallizes) -cover with alcohol wipe and foil). Set up 2 bottles at a time. 5. BSS Plus Irrigation and Aspiration (I&A): Add BSS Plus to bottle. Insert (lg.) white plastic end into additive and needle end into 500 cc bottle. Add .8 cc epinephrine to bottle, or .4 cc to 250 cc. Insert end of tubing into bottle without contamination (per demonstration by cross-over). Place clothes pin on folded corner of tubing package to keep rest of contents inside of sterile wrap, until handed off. Hang bottle from holder on ceiling of trailer. To hand off, peel back to allow doctor to grasp, keeping what is needed on the Mayo tray. Mark the dividing point of sterile and non-sterile with tape for identification of handling points. (Crossover will demonstrate). 6. Gloves, drapes and neyvus: Dr. or nurse will place Neyvus on patient, (1" below nose and 1" off of face). Open gloves for doctor to put on, then hand off drape, without
contaminating. Using two sterile q-tips, hold open patient's eye while doctor presses
drape in place. Help doctor gently move microscope in place and clip ends of drape to
curtain on each side of patient, high enough for the patient to breathe. If the left eye is
being done, make a "well" in the drape by clipping the side of the drape around the post
with a forceps. (We MUST use 1060's for left eyes, as 3M is no longer donating and
doctors have been using only 1061's and turning them
). Hand off mayo drape. Hold
metal tray while doctor places drape on top over your hand and sets it in place.
1060 -left eye (a well needed), we have a few drainage pouches
1061 -right eye (drainage pocket included),
1010 -Mayo tray drape
Small stainless steel trays : these vary from surgeon to surgeon a. Items set on: 10 or 12 cc syringe (depends on surgeon and method) Small Individual BSS irrigating bottle (may be refilled on tray) Microscope handles (sterilized in sets) Surgery pack, plus new items not included in pack because of non-avail- ability Pack includes: crescent and slit knives, wecks, 4-0, 7-0/8-0, and 10-0 suture, 2 cannulas, (2) 4x4's Viscoelastic (some doctors use one on more than one case by a sterile foil wrap being used as a barrier) If possible conserve/ 1 for two cases. ***Stay ahead by keeping 2 stainless steel trays filled on counter with add-ons
(per Dr. preferences) for procedures.

Important
: Do not allow your Cinderella to mass produce surgery packs.
There should only be a couple of packs on hand over what patient load is
expected for a given day. Some gals get carried away, and it makes for
too much product in circulation and waste (not all things used by particular
doctor rotating in) - the number of packs made in a day should be the
same as the number of patients done on a day (plus two in reserve), so
inventory not opened until needed. MONITOR THIS!
Hepatitis B cases (when known by history given by hospital), have been
done at end of surgery days. We have re-processed the goods (knives,
etc) from these cases and labeled them as Hep B packs (for this use).
Take extra handling precautions and supervise your Cinderella. We have
done our own soaking of metal instruments (get soak from hosp.-20
minutes) and then run the metals through the dry heat sterilizer at the end
of procedure, so there is an extra sterilization done of instruments.
Open items from metal tray (add-ons) and place (sterile technique) on instrument tray (once cooled). Use forceps to place the heavy items (to prevent instrument damage). Put small amount of NaCl in metal cup and place Oertli tip in it. Place cautery pen on top of tray to air dry. (Note: not all doctors are using the Oertli, so if not, eliminate all Oertli steps.) When Mayo tray is draped and in place, hold sterilizer tray for the doctor to pick out instruments along with all the add-ons from trays. Dr. arranges his tray, while nurse monitors to rescue recyclables that are tossed aside. When doctor has arranged tray, hand off Oertli cord with ring forceps, being careful not to drip on tray. Doctor will take it with 4x4's to dry it off and remove rubber bands (rubber bands are saved/reused, so rescue!). The sterile section of cord is placed on Mayo tray; nurse takes unsterile portion left, and clips it off field carefully. A rubber band marks sterile from unsterile.
Surgical Procedure: The nurse does not scrub in or wear gloves during cases.
The doctor does entire procedure alone, except when it requires assistance with
non-sterile items. (** Note: some Drs. use Chinese Dr. to help.)

The doctor scrubs at the sink. The water is turned on to set proper temperature and flow volume. Then electrical switch, which controls water pump,
is turned off (it is located to left of the sink on bench, under AC). The doctor can
now control water flow by using foot pedal on floor. When scrub is completed, the
nurse hands off towel and turns water pump on again. The water will run again
until faucets are turned off. Scrub brushes are saved in the wrapper (one day),
for another possible scrub. End of day, they are saved in an old (not new/good)
plastic bag and can be used for misc. jobs, or given to hospital.
Note: The water pump must be checked and turned off at the end of each
day, or if it is heard to be running when not in use, otherwise the pump will
burn out. Check for leaks if it continues to run.

Set out antibiotic ointment, shield, eye patch, and tape strips to be used at end of surgery. Nurse instills ointment and doctor or nurse applies the patch and shield. One tape for patch, and "fewer than more" for shield, as sticky residue is hard to remove from the patient's skin post op. Have Pilocarpine 2% or 4%, available for immediate use once IOL is in place during wound closing. Only if absolutely necessary (limited supply), I-chol (or another immediate miotic) may be needed, and should be available (sterile 3 cc syringe and 18 G needle placed on tray for doctor; nurse holds vial allowing doctor to access contents). **Also, tetracaine drops 0.5%, may be given topically in situations when the retrobulbar has not been as effective towards end of case. Assist doctor to cover microscope arm with sterile foil in AM and should contamination occur (as needed, ask Cinderella to make extra foils in packs). Help Dr. with cautery when needed. Turn on cautery and attach cautery cord to cautery pencil (held by doctor). Hold cord away from sterile field and doctor, allowing slack, but do not allow dangling on glove. (There are some portable cauteries in the event of a power outage, re-wrap in sterile foil for multiple use. Note location of extras in trailer.) Turn off cautery after each use. Turn on Oertli when requested. (Switch is on back, far right.) Press DIA then CAPS button. Doctor controls Oertli with foot pedal. When capsulotomy
complete, turn off machine. Be sure doctor cleans tip using microscope and
wecks, and have cord and tip handed off when completed. Remove tip without
twisting. Fold cord and place dental rubber band on ends making sure it lies very
flat. Cord and tip go in alcohol (check coverage and 30 minutes time) for next
case. Last case, be sure all things are out of alcohol.
Nurse turns on (and regulates) the BSS I&A solution at doctor's request. Tape marker distinguishes sterile from non-sterile area, and should be handled accordingly. Tubing is guided from bottle to surgical area by hangers lined up along microscope. Place upper (slack) tubing out of the way. When doctor completes I&A, nurse takes tubing, hangs it up by the tape divider, unwraps foil wrap, and wipes off end and places sterile needle cover on this end. Nurse wipes down tubing many times with a alcohol soaked 4x4, from tape marker to end. Carefully place end in a clothespin hanger so that between the tape and covered tip, nothing is touching and it can dangle to dry. Handle only end of tip (needle cover) and tape marker, keeping in-between 'sacred'. This will be demonstrated, but read this over to be familiar for it falling into place! Practice. If an AC IOL is used, a 'sheets glide' can be found in front bins.
Procedure for second patient (after draping):
Remove tubing from clothespin, first at the tape-marked end, and allow to dangle without it touching anything. Release end with needle cap, taking it into right hand. Then lift other end where tape marks end of sterile section. Place tube in sterile foil held open by doctor. Hold firmly, (but not so you pull off cap), so doctor can wrap foil around tubing and once done, pull off protecting cap, saving this so it can be re-sterilized. At end of case, tear off foil, wipe down as above again. (Foil wrap is sterilized with instruments in tray for doctor) A caliper is located with specialty instruments (sterile pouch). You will also find the Simcoe I&A, foil packs, surgery packs, q-tips, and other miscellaneous things not always needed. Sterilized items should be dated, and used in order. Let your Cinderella know when you use or need things, but please, please, do not allow her to make mass amounts of extra packs, just as needed/depleted. Sometimes the nucleus is given to the family in bottles supplied by hosp. Doctors can be reminded not to cut 4-0 silk (sta y suture), but instead it can be pulled through at end of procedure and then it can be cleaned/sterilized. Unused second halves of all other sutures can be resterilized in the packs, so keep track of them. They must be removed from the plastic holders, which melt in the pressure cooker. Special wraps are used. Doctors change gloves between patients/do not re-scrub. Gloves are put in a plastic bag hanging by the door and given to hospital (or gas sterilized if we are short of size needed) except Hepatitis B patient. Those should be destroyed. Record Keeping:
Patients treated by earlier teams may be seen or operated again by later teams, so all records should be in order in notebooks. We also see a number of
patients on succeeding years records are in Archive box. Cross reference #'s.
**** EACH TEAM (preferably) or if not done, the last team of the year should
bring any IOL slips as well as A -Scan calculation slips and send to GANSU, INC.
These keep track of the number of patients treated and all lenses utilized. All
lenses used on a patient should be listed on the A-Scan/IOL slips - WE DO
INVENTORY FROM THESE-
so if more than one procedure or lens was used,
write or put all stickers on this slip, so we know.
A number is assigned to each patient and is on A-Scan slips, our patient record and patient's IOL card. The numbering system helps for postop follow. Check carefully to be absolutely certain that patient coming into trailer for surgery is one corresponding to A - Scan slip taped to IOL box, and patient surgical sheet. A phonetic name is obtained during preop draping procedure. While the IOL is being checked, make certain that the sex, age, and eye coincide with expectations. Our patient surgical sheet is prepared the day ahead, while IOL measurements are done. Be certain to verify your patient! Complete the following tasks concerning IOL information: Put IOL stickers (if present) or write the information that is printed
on the lens container on the following:
1) A-Scan calculation slip taped to IOL box (inventory).
2) Patient's chart end of op note (for hosp. information).
3) Gansu patient's record (these records are archived and
are helpful with post op evaluations, or should a second eye
be done later).
4) Card from lens company, if present (we send back).
5) Patient's IOL card given to them (for presenting on later
visit), **don't forget to add pt number to this
Tape Gansu card (mission statement) and IOL card (for patient) to front of patient's chart. Include date and patient's number, i.e., 100-CON-01. If pt. does not get an IOL or a card is not included with IOL, complete a Gansu card made for this purpose. All patients receive a card with a pt. identification number.
First number is pt. order done that year, initials indicate Dr., last # is the year.
Charting:
On our sheet, during the surgery, chart any information that may be significant for post op, or, if seen by another doctor later. If doctor noted prior injuries or problems during surgery, he should tell you, but if nothing is said, please ask Dr. for something to include as short op note. Chart short note on the hospital chart (few will understand), but if there is difficulty, it should be included. IOL stickers or information should be as per 2 above. Hospital chart comes and goes with patient. Charting can be completed as soon as the IOL is in place. This is also when the next retrobulbar should be given (if no one has jumped the gun!).
End of day

Pull gloves, drapes and neyvus needed for each case (place in basket in If soiled, set out clean baby blanket for head wrap. Old ones can be included with the laundry for re-use (included with our laundry). 3. Shop for trailer supplies. A 'shopping list' sheet (yellow) is available listing supplies used in the trailer and is filled out during surgery schedule. Get ready for post-op clinic. Chart on the GANSU record, results of doctor's examination. Keep antibiotic/steroid in your pocket and be sure to
keep eyes on meds in tray. Things have come up missing, so be watchful,
and only YOU
control the giving. If the doctor checks eye pressures, remove
the 5.5 gram weight and remove post, clean with alcohol, allowing to dry before
next use (have two). To calculate the measurement, there is guide based on
weight used. Tricky assembly, but once learned, not difficult.
5.
File patient's record in large notebook. These are used in post-op and old ones filed by years Archives box. Two notebooks are needed for a summer and
patients return unexpectedly, so you may wish to keep both handy. *** If you see
a pt. from another year, or for another eye, please cross-reference (numbers)
on both patient sheets, so we can track both eyes and IOL's used (results).

6.
Set out TB syringes, BSS Plus and tubing, epinephrine and syringe, and retrobulbar syringes and needles for drawing up next A.M. 7. Be sure IOL's are pulled for next day and in order. Wipe off Mayo trays daily with alcohol, and clean the instrument trays and top and opening area of dry heat sterilizer. (Cinderella can do this). Check that trailer is in order, pump is off, lights off, all is locked up. Tidbits (Nurse):
Air conditioning cannot be turned on when dry heat sterilizer is running (the compressor of air conditioner surges when it is started, and will pop circuit breaker of generator). Once air conditioning is running it is not a problem to run sterilizer. It works best to turn on AC early in day before it gets too hot. The hospital will let you know if they need more (5x5) plastic sheets for retrobulbar area. These are cut from untouched sections of used (3M) drapes that have been cut off as procedures are finished - just have surgeon stand aside on a few cases and cut the third not soiled. Keep ahead on these and stock pile. Handle all instruments with care and encourage your Cinderella to do There are some eyeglasses available for pts who might need some, small pluses or minuses. The doctor can read from direct scope to give you a place to start with trying some of these. Take out only one pair at a time and keep it with wrapper - if once it gets separated, we don't know the measurements. Intraocular lenses opened but not used should be returned to GANSU, INC for accountability to the companies, and for re-sterilizing. DO NOT OPEN
IOL'S or PUT ON TRAY UNTIL THEY ARE READY TO BE INSERTED!

Be sure all patient's records are numbered correctly and that the number coincides with the patient chart, Gansu patient record, and the sheet on the IOL. Monitor lights and pump (off whenever leaving trailer). Monitor people coming in and going out, so as not to shake trailer. Slippers (not shoes) are to be worn in the trailer (bring a pair). Using stockings does not protect against stray needles, which may get dropped. No instruments or surgical supplies are to be given away under any
circumstances. Dr. Conrad is the only one who can authorize any of goods to be donated or given. We have inventoried all the box room, and often first team has already given a lot to the local hospital, so succeeding teams should defer to him. We get requests (IOL's etc), which should be answered by, "I'm sorry, but we cannot do that". We count on things being in place. We will give some knives away on our next visit to Lanzhou, if there is not too much to carry back. 12. Monitor surgeon to remove the microscope handles at end of each case. Support Person (Cinderella):
All supplies have been shipped from home, therefore, we try hard to conserve disposables, reusing some many times. Clean all cannulas, retrobulbar needles, plus any other goods you are advised are in short supply. Blow cannulas with syringes of air to get water out. Package according to cross-over technique demonstrated to you, and run through pressure cooker with packs. Crescents or other blades are carefully cleaned without hitting the
edges (swished through soap and rinse water), then air dried and capped for
re-sterilization. Protect the edges. These get "retired" by the physician when they
get dull, but if handled carefully, we get 7-8 uses per knife. Discard with sharps.
Clean & hand off cautery pencil (Valley Lab) to nurse ASAP for alcohol Instruments - Instruments are cleaned after each case. Work quickly.
Rinse in cold water to remove excess blood. Then hot water for soap wash,
where all crevices are cleaned with a toothbrush. (Watch a surgery (or ask) to
see which instruments need little washing, with minimal soil.) Always wear gloves
and be careful when handling. (When placing instruments in sterilizer, load trays
with the ends that open facing toward sterilizer handle, per demonstration.) After
each case
, instruments should be counted to be sure one didn't get thrown
in garbage (count twice at end of day!)
. ***Also, be sure everyone has all his
belongings, as instruments and a fanny pack ($$) have gotten into garbage,
never to be found again! Trash is gone through as soon as it is taken! Any
needing repair should be put aside for the Dr. to look at. If not able to be bent or
repaired on the spot, they should be bagged for nurse to bring home and shipped
to GANSU, INC for repair (a note included with the problem). Instrument trays
from last two cases are washed thoroughly, opening all hinges, and drying well.
The instruments are set up, covered, and are ready to be sterilized first thing in
the morning. The large ring forceps is placed on top of the tray to go in sterilizer
with first set, where the nurse can get easy access to pull out next morning. Wed.
Fri. during last case, the flat alcohol container needs to be sterilized.

Be sure retrobulbar needles have been retrieved from the hospital (last case) and microscope handles are wrapped and added to pressure cooker load. All dishes should be cleaned and stored. Counters, bed areas, the outside table and the trailer floor should be cleaned, along with the ledges of the trailer, and sweeping of the screen room. Garbage is combined and tied up after instrument count and placed outside. A.C. filter cleaned weekly. These things will need to be done while the surgeon and assistant are seeing the preop and post-op patients. Trailer ready for A.M., including hats and masks out for all. 7. Monitor/clean bathroom often and see that there is extra tp and clean towels. Wash 'superpinkies' at least weekly and hang to dry in box room. Mix with others outside and learn some Chinese or teach some English or come up to watch post op and mix with the families. Pressure cooker preparation: Takes 30-32 ounces of water. Put water from a
thermos (not the heavily chlorinated trailer water) in bottom of pressure cooker
below the floor grate. Place wrapped packages in metal bowls or around the
edges. Lock lid in place, being sure steam valve is on correctly (patent and free).
Turn gas burner on high. When steam valve rocks fully, turn gas down very
slowly
to place where a gentle but consistent rocking takes place (it reacts
slower than decrease in flame, so watch). Set timer for 35 minutes. When
completed, press release button until all steam has escaped then crack open lid
to air dry. Do not contaminate ring forceps container. The pressure cooker has
usually been run at the end of each day for things to be used next morning. Do
not put items inside of things, as they do not sterilize there fully. Set out to dry.
Please note: if the pressure cooker, for any reason, does not go through its
complete cycle in the usual time, i.e., gas tanks are low, flame goes out,
etc., re-add more water (if more than a few seconds have elapsed),
beginning again. If this is not done, the contents will be ruined and
meltdown occurs. This has happened! *********NEVER LEAVE THE
PRESSURE COOKER UNLESS YOU TAKE THE TIMER WITH YOU!!!!!!
Clean out the pressure cooker every couple of days to get rid of the
chemical build -up from the water.
There should be stainless steel cleaner.

Dry Heat Sterilizer: This is kept on the table just outside the trailer door, so that it
faces the door and is accessible from inside to place and remove the trays. Wipe this off
and out with clean damp cloth often to remove dust/dirt buildup.
Dry heat sterilization:
First tray goes into dry heat sterilizer after generator is running. Press the "on / off" button and wait until "888" changes to "- - -". Press
cycle one. Temperature must reach 375 (190 in centigrade machine) and heats
then for 6 minutes. Remove tray and place on wire rack in trailer. Place 2nd tray
in sterilizer. The tray has a slight "nose-down" position for placing in, and a
"tipped-up" position for removal. It is used for metal instruments or foil only - no
plastics, rubber of paper materials - because of high temp. When exiting trailer
to get tray, be sure doctor is not at a precarious point in the surgery. When
removing tray, press ON / OFF button again to stop unit or it will continue to run.
The tray is placed on cooling rack inside trailer. We have two sets of instruments,
one being cleaned and sterilized while other is being used. Two pieces of foil are
put at the bottom of trays to be used to cover tubing for next patient and to cover
arm of microscope where tubing has potential to hit. Handle the instruments with
care, as they are delicate. Bring home instruments needing repair!
Only the microscope, air conditioner and sterilizer can be used at one time,
otherwise the circuit breaker on the generator will pop.

Surgical Packs:
May be in any combination. Usually a pack is made up to accommodate each surgeon's needs. A standard cataract pack may include a capsulotomy needle (if Oertli not used), irrigating cannulas (2), 10-0, 7-0 and 4-0 sutures, wecks (5-7 per case) and 2- 4x4's, and slit and crescent knives. (If not all of contents available, just label packs the missing item(s), so new product can be added). Individual packs can be done up for excess products not needed for packs, and handed on when needed. Sterilizer paper in good condition can be reused over and over. Needles (unless in short supply) are put into the coffee can and burned at end of
each team's month. I&A’s and cannulas are cleaned and blown out to remove as
much water chemical as possible. Cannulas can be soaked in hot water to
loosen viscoelastic. These must be washed many times, or they will plug in the
pressure cooker. The nurse can help you with decisions on save vs. throw.

GENERAL: When all the supplies must be brought from home, we try very hard to
conserve, reusing items many times. Unused wecks can be done again, being
somewhat rigid, but useable. Second halves of sutures can be put in packs, and are
best handled when you feel patient (or outside in good lighting)! The 4-0 silk can be
reused, cleaning each time and put into packs. If not placed in packs, all likes can be
put together for re-sterilization together and then used as needed. This can be
demonstrated by the previous Cinderella or nurse. PLEASE, PLEASE, do not make up
too many packs ahead as directed by your nurse. Waste is the result from overage in
packs, as not all doctors use the same items, and too much product gets into
circulation.
Resource person (Outside helper):

Before breakfast the generator is taken out of storage and started up immediately so instruments can be started ASAP. The dry heat sterilizer is
brought to the trailer and placed on the table inside the screened area. Cords
must be connected right away.
Help patients in and out of trailer, keeping tent flap closed as much as possible for air conditioning and flies. Be gentle with flap closure, it has been fixed by Chinese methods. Assist patient with shoes (bend down in service) and hold on until family comes or patient gets his legs. Kindness is noticed. Water is filled and tested every day at end of surgery and cleaning up. Do not over-chlorinate! The electrical cords should be stored in the screen room up against the trailer. Check hot water heater gas light and refrigerator setting am and pm. Set up the cords for lasers, when they are needed, checking in at post op. Lock both the box and generator rooms at the end of each day. Also, do not allow people into our storage rooms, especially children. Monitor the 'NO SMOKING' around the trailer. Be aware of security - don't leave books, toys, or belongings around, as we have had shoes taken (person caught), toys and books missing. Never leave things out that are not monitored. Keep 'big' refrigerator filled with water and drinks, and cleaned out, (defrost toward the end of your tour). Mix any beverages your team needs, including milk and assist with mealtime needs. Keep track of propane tanks (filled), gas in generators, and battery Be available to deliver messages or get things, and keep those inside trailer aware of what's happening outside. Interesting events. Go up to the wards and visit with patients and their families. The most used sentence is, "only use a tiny bit of ointment, longer use is better than more at one time". Take lots of pictures, and take other people's cameras to do this, as others may be too involved with patients to notice. 12. Clean around trailer, sweeping and picking up after surgery day. Spray a couple times a week with bug spray at base of trailer to limit insects. We can buy or hospital can be asked to supply spray. We have ability to play music inside and out per Dr.'s preference (with a small CD player, if someone on your team personally brings one to use). 14. Monitor not too much noise or activity outside during surgery to bother the surgeons. Keep people away from surgical end, so as not to bump. 15. Keep both the box room and generator room cleaned and straightened up, so likes are with likes. Organize, monitor, and clean up and out.
A lot of the duties are shared, please be aware that the nurse and doctor may have a lot
of responsibility and anything the support persons can do to alleviate their stress is a
blessing. Also be aware that the translator has a great responsibility and may not be up
to always answe ring all of our questions or addressing all of our needs. They are there
to be witnesses to the people we seek to serve, as well as to the staff, who ask
questions about us, and not to minister to our needs all of the time.

Love the patients and their families. We come to show and be HIS love!

Source: http://www.gansuinc.org/Application%20Documents/SURGICAL%20TIPS%202001.pdf

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INTRODUCTION The evidence-based rationale formonotherapy in appropriate patientswith epilepsyTreatment of newly diagnosed epilepsy with aing an appropriate, safe, and effective treatmentsingle antiepileptic drug (AED) is now the favoredstrategy. For newly diagnosed partial seizures inapproach for seizure management. The emer-adults and adolescents, the American Academy ofAddress corres

Qse adv tg p138-143

QSE Adv TG p138-143 7/9/09 11:31 PM Page 138 Communication Objectives: – use expressions for minimising and the language of empathy and sympathy. – use vocabulary, phrases and idioms related to stress management. Educational Ss will address sources of stress and assess techniques for coping with stress. Objectives: Connected Topics: Grammar: Key Vocabular

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