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Samenvatting OK, Biopsies
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Samenvatting powerpoint OK, biopsies
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Zorg bij interventiesInterventionele procedures..................................................................................................................... 4
OK, puncties, biopsies, drainages en interventies .................................................................................. 4
1. OK ................................................................................................................................................ 4
1.1 Zone-indeling OK-complex: 3 zones .................................................................................... 5
1.1.1 sluiszone/niet-kritisch ................................................................................................. 5
1.1.2 Reine zone/semi-kritisch ............................................................................................. 6
1.1.3 De aseptische/kritische zone ....................................................................................... 6
1.2 Wanneer is een OK zaal in activiteit? .................................................................................. 7
1.3 Mobiliteit in OK.................................................................................................................... 7
1.4 Standaard voorzorgsmaatregelen OK ................................................................................. 7
1.4.1 Kledij en schoeisel ....................................................................................................... 7
1.4.2 Haarbedekking............................................................................................................. 8
1.4.3 Gelaatsbescherming .................................................................................................... 8
1.5 Preventiemaatregelen voor de OK ingreep ......................................................................... 9
1.6 Preventiemaatregelen tijdens de OK ingreep ................................................................... 10
1.6.1 Reinigen en ontsmetten ............................................................................................ 10
1.6.2 Afdekmateriaal .......................................................................................................... 10
1.6.3 Omgeving................................................................................................................... 10
1.7 Preventiemaatregelen na de OK ingreep .......................................................................... 11
1.7.1 Afvalverwijdering....................................................................................................... 11
1.7.1.1 Risicohoudend medisch afval ................................................................................ 11
1.7.1.2 Niet-risicohoudend medisch afval ......................................................................... 11
1.8 Operatieverslag ................................................................................................................. 11
2. Infectiepreventie ....................................................................................................................... 12
3. Punctiemateriaal ....................................................................................................................... 14
3.1 Afdekmateriaal .................................................................................................................. 14
3.1.1 Mogelijk materiaal op een steriele tafel (Angiografie Göttlicher Heiland) ............... 14
3.2 soorten handschoenen ...................................................................................................... 15
3.3 punctie instrumentarium .................................................................................................. 16
3.3.1 Grote indeling van een onderzoek ............................................................................ 16
3.3.1.1 Algemeen ............................................................................................................... 16
3.3.1.2 Een aanvraag omvat steeds................................................................................... 16
3.3.1.3 Algemene principes punctie/biopsie/drainage ..................................................... 16
3.3.1.4 Voorbereidingsfase puncties/biopsies/drainage – Verklarend gesprek ............... 16
3.3.1.5 Voorbereidingsfase puncties/biopties/drainage................................................... 19
3.3.1.6 uitvoeringsfase ...................................................................................................... 20
1
, 3.3.1.7 Nazorgfase ............................................................................................................. 20
3.3.1.8 verwerking van biopten ......................................................................................... 22
3.3.1.9 Weefselstaal voor AP............................................................................................. 22
3.4 Begrippen (Pinkhof, geneeskundig woordenboek, 1998) ................................................. 23
3.5 Rolverdeling arts/TMB....................................................................................................... 23
4. Puncties/biopsies/drainages ..................................................................................................... 23
4.1 Overzicht interventies ....................................................................................................... 23
4.2 Puncties ............................................................................................................................. 24
4.2.1 Doel puncties ............................................................................................................. 24
4.2.1.1 Diagnostische (proef-)punctie: (weinig/niet op MB)............................................. 24
4.2.1.2 Puncties om technisch onderzoeken mogelijk te maken: myelografie,
angiografie,… ......................................................................................................................... 24
4.2.1.3 Therapeutische punctie ......................................................................................... 24
4.3 Biopsies.............................................................................................................................. 24
4.3.1 Indicaties ................................................................................................................... 24
4.3.2 Soorten biopsies ........................................................................................................ 25
4.3.2.1 Naaldbiopsie → percutane biopsie ....................................................................... 25
4.3.2.2 Open biopsie.......................................................................................................... 25
4.3.2.3 Laparoscopische biopsie ........................................................................................ 25
4.3.3 Percutane vs chirurgische biopsie ............................................................................. 25
4.4 Drainage ............................................................................................................................ 25
4.4.1 Chirurgie .................................................................................................................... 25
4.4.2 Wonddrainage met redon ......................................................................................... 26
4.4.2.1 Indicaties................................................................................................................ 26
4.4.3 Thoraxdrainage.......................................................................................................... 26
4.4.4 Drainages onder echogeleiding ................................................................................. 26
4.4.4.1 (contra-) indicaties echogeleide drainages ........................................................... 27
4.4.5 CT-geleide percutane drainages ................................................................................ 27
5. Invasieve onderzoeken/behandelingen op MB (niet limitatieve lijst) ...................................... 28
5.1 MSK Contrast arthrografie ................................................................................................ 28
5.1.1 Algemeen................................................................................................................... 28
5.1.2 Algemene procedurele richtlijnen ............................................................................. 29
5.1.3 Arthrografie van de knie............................................................................................ 29
5.1.4 Arthrografie schouder ............................................................................................... 29
5.1.4.1 Procedure (beknopt) ............................................................................................. 29
5.1.4.2 Complicaties .......................................................................................................... 30
5.2 Harpoenplaatsing .............................................................................................................. 30
5.2.1 Uitvoering .................................................................................................................. 30
2
, 5.2.2 Harpoenplaatsing onder stereotaxie......................................................................... 30
5.2.3 Voorbereiding ............................................................................................................ 30
5.2.4 Uitvoering (beknopt) ................................................................................................. 31
5.2.5 Uitvoering punctie ..................................................................................................... 31
5.2.6 Nazorg........................................................................................................................ 31
5.3 Stereotactische biopsie borst met mammotoom ............................................................. 32
5.4 Prostaatbiopsie .................................................................................................................. 32
5.4.1 Procedure .................................................................................................................. 32
5.4.2 Contra-indicatie ......................................................................................................... 33
5.4.3 Complicatie ................................................................................................................ 33
5.5 Lumbaal punctie ................................................................................................................ 33
5.5.1 Contra-indicaties ....................................................................................................... 33
5.5.2 Liquorafname: ........................................................................................................... 33
5.5.3 Myelografie (radiculografie) ...................................................................................... 33
5.5.4 Oogfundus test .......................................................................................................... 34
5.5.5 Voorbereiding ............................................................................................................ 34
5.5.6 Uitvoeringsfase .......................................................................................................... 34
5.5.7 Bulging/protrusie/discus hernia ................................................................................ 35
5.5.8 Liquor ......................................................................................................................... 35
5.5.9 Indicaties ................................................................................................................... 35
5.5.10 Contra-indicaties myelo ............................................................................................ 36
3
, Interventionele procedures
OK, puncties, biopsies, drainages en interventies
1. OK
− Puncties, biopsies en drainages
→ in patiëntenkamer, dienst medische beeldvorming en OK
− De rol van de TMB in het ZH uitgebreid met beeldvorming op OK
− OK + Angiografiezaal
Eisen operatiekwartier
− Vlaams Agentschap Zorg & Gezondheid, zorginspectie
− Advies van de Hoge gezondheidsraad
− Eisenkader operatiekwartier, versie 2018
− KB 15 december 1978
OK ligging
Algemeen principe: alle OZ gegroepeerd in het OK
Uitzondering:
− Ingrepen op amb. Patiënten
− Spoedgevallen
− Verloskundige ingrepen
Inrichting van buiten het OK gelegen OZ → beantwoord maatstaven voor OK
OK is zodanig gelegen:
− Afgezonderd van algemene verkeerswegen van het ZH
− Korte en vlotte verbinding met spoedgevallendienst, IZ en sterilisatie
− Beveiligde toegang – enkel voor bevoegden
− Het OK dient niet als doorgang voor andere diensten en lokalen
− De OK-zone = beveiligde zone, enkel toegankelijk voor bevoegden (code/badge)
− Occasionele gebruikers worden begeleid
− Intern verkeer in het OK aan regels van aseptie voldaan
− Strikte scheiding: vuil en proper circuit (functioneel en/of architectonisch)
− Toegang reine en aseptische zones: geen persoonlijke bezittingen (boekentas, eten,…)
Uitzondering: laptop als werkinstrument, de draagtas niet.
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