4003ODP – Surgery Practice
VIVA VOCE QUESTIONS:
1. What is the purpose of the ‘Team Brief’?
Part of 5 steps to safer surgery, in addition to debrief by WHO. Takes place prior to each
surgery. It allows the perioperative team discuss the surgical and anaesthetic requirements for
each patient before the start of the list to ensure that any risks are managed effectively.
Working in compliance and the Team Brief is aimed at giving each member of the team a
complete shared picture of the planned procedures, it acts as an enabler for every team
member to speak up when they recognise a situation developing.
2. How would the patient’s skin integrity be assessed in the operating theatres?
Skin is assessed prior to surgery and post. This is recorded via the water low score which
determines which score they are at and what level. For example, 10= At Risk 20= High risk.
Also post-surgery, when the patient is transferred from the operating table using the pat slide,
the team checks for any areas of pressure sores, cuts, grazes, etc. Things to consider when
assessing skin, texture and colour, temperature, sensitivity. Also checked on the ward.
3. How is VTE managed in the operating theatre?
Venous thromboembolism is a condition in which a blood clot forms primarily in the
deep veins of the leg, groin, or arm, known as DVT (deep vein thrombosis). DVT is linked to PE
Pulmonary Embolism occurs when a blood clot (typically from a DVT in the leg) travels through
the bloodstream and becomes lodged in the arteries in the lungs, blocking blood flow.
VTE is managed using Intermittent Pneumatic Compression Devices (Flow Tron Boots) or TED
stockings, Thrombo-Embolus Deterrent.
Warfarin sodium
Clexane
4. What are the hazards associated with, and purpose of the application of a tourniquet?
Hazards: Local soft tissue damage: burns (occlusive drape is used around the tourniquet),
fitting is too tight or too loose. Necrosis (tissue death) and tourniquet pain.
After 2 hours if the surgery is still not complete tourniquet must be deflated & limb
reperfused for a minimum of 15 minutes before tourniquet is reinflated.
Purpose: A limb tourniquet with a timer alarm should be used.
Used to control bleeding, Creates bloodless field to improve surgical visibility.
, Bier's Block is the application of regional anaesthesia and is used to exsanguinate (drain blood)
the limb using a double tourniquet to isolate it from circulation. (Rarely used anymore, but
please mention as this is a competency in the PAD).
Upper limb – 200-250mmhg Lower limb – 300-350mmhg. Depending on patient BMI, higher
pressure would be used.
Application: Ensure patients skin is dry, choose correct shape and size, ensure selected
tourniquet has O-ring present (O-rings create a seal &
without one the tourniquet will not hold the right pressure). Protection applied to patient’s
skin, should cover the entire circumference of limb, and extend past borders of tourniquet.
The ends of the tourniquet bladder should overlap by 7-15cm. Consideration should be given
to ensure tourniquet is not too tight or too loose on limb (2 finger breaths underneath the
tourniquet will suffice). To prevent potential skin burns from skin preparation solution ensure
an occlusive drape is used around the tourniquet. Only deflate when the surgeon says it is
appropriate to do so.
5. What is the purpose of diathermy? (Student should define what diathermy is too and the
differences between monopolar and bipolar). High frequency alternating current which passes
through the body, helps to make precise incisions, minimizing/reduces blood loss, prevents
excessive bleeding by sealing off traumatized tissues. Diathermy produces variety of electrical
waveforms/settings Cut and Coag.
Cut uses low voltage electric current waveform which vaporises the tissues on contact.
Coag uses a higher voltage, and instead of tissue vaporization, a coagulation effect is
produced-blood changes from liquid to gel, potentially resulting in hemostasis.
Monopolar is where an active electrode is held by surgeon, creates a heating effect and the
current oscillates between surgeons electrode through patient’s body until it reaches the
electrode on the patients surgical site, back buttocks thigh stomach.
Bipolar: 2 active electrodes which is performed by a pair of forceps for sealing blood vessels.
Limited ability to cut and coagulate large bleeding areas. The only part of the patient included
in the circuit is that which is between the two electrodes, whereas Monopolar, current passes
through other tissues.
More ideal where tissues can be grasped more easily.
Spray coag (fulguration) which is good for haemostasis, produces sparking effect away from
the tissue.
Diathermy smoke consists of 95% steam and 5% cellular debris.
Consideration should be given to the patient with cardiac pacemakers, metal work.
