N-Trivia
| Hemorrhoidectomy Posted: 22 Sep 2010 11:14 PM PDT 
 Definition
Excision of painful distended veins of the anus and rectum. Discussion Hemorrhoids are classified as internal or external, depending on their location. Hemorrhoids are generally associated with local anal problems such as anal ulcers and fistulas, or they may accompany pregnancy. Anesthesia may be regional, local, or general. Position Lithotomy, modified lateral (Sims), or jack knife. Skin Preparation The buttocks is taped apart with wide adhesive tape on each side of the anus, attaching the other end to the table frame. Only a minimal prep is usually performed. Packs/ Drapes - Laparotomy pack (jackknife or lateral sims position)
- Lithotomy pack (lithotomy position)
Instrumentation - Minor tray
- Rectal tray with dilators and rectractor
- Sigmoidoscopy instrument (optional)
Supplies/ Equipment - Stirrups
- Pillows or roll for positioning
- Suction
- Blades – (1) #10, (1) #15
- Minor basin set
- Needle counter
- Hemostatic agent
- Lubricant
- Pressure dressing
- Laser (optional)
Procedure Overview - Before beginning the surgical procedure, a sigmoidoscopy may be performed, followed by gentle dilation of the rectum.
- The hemorrhoid is grasped with a Penington, Allis, or Kocher clamp.
- The proximal portion of the hemorrhoid is excised by scalpel, cautery, or laser. Is the anus is stemotic, the distal internal sphincter may be incised.
- A mucous membrane flap and/ or skin flaps may be used to cover the denuded areas.
- Bleeders are controlled with ligature ties (3-0 Dexon/ chromic) or by cautery.
- Care is taken not to excise too much skin, anoderm, or mucous membrane and to avoid injury to the sphincter mechanism.
Perioperative Nursing Considerations - Be prepared to perform a sigmoidoscopy prior to the procedure.
- When electrosurgical unit is used, apply the ground pad after the patient has been placed in the lithotomy position.
- Protect the skin under the adhesive tape with tincture of benzoin.
- Should laser be used, all safety precautions must be in place prior to the patient's entry into the procedure room.
Related posts: - Anastomosis of Small Intestine (Small Bowel Resection)
- Pancreaticoduodenectomy (Whipple Procedure)
- Conduction Anesthesia
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| Pancreaticoduodenectomy (Whipple Procedure) Posted: 22 Sep 2010 07:04 PM PDT 
 Definition
- Removal of the head of the pancreas, the very proximal portion of the jejunum, the distal third of the stomach, and the distal half of the common bile duct, with reestablishment of continuity of the biliary, pancreatic, and gastrointestinal tracts.
Specific Technique Discussion - The procedure is usually performed for regional malignancy and benign, obstructive, or chronic pancreatitis.
Position - Supine, with arms extended on armboards
Incision Site - Transverse, midline, or paramedian incision
Packs/ Drapes - Laparotomy pack
- Transverse Lap sheet
- Four folded towels
Instrumentation - Major Lap tray
- Biliary instruments
- Intestinal tray
- Harrington retractors
- Hemoclip/ surgiclip
- Internal stapling instruments
Supplies/ Equipment - Basin set
- Blades – (2) #10, (1) #15
- Electrosurgical unit; suction
- Hemoclips/ surgiclips
- Dissector sponges
- Needle counter
- Internal staples
- Drains – for retractors: Penrose 1 inch.
- For drainage: HemoVac, Jackson Pratt, etc
- Sutures – surgeon's preference
- Solutions – saline, water
- Medications – Hemostatic agents, etc.
Procedure Overview - The abdomen is opened and explored; the operability of the findings is assessed.
- The distal portion of the stomach, extrahepatic biliary tract, head of the pancreas and entire duodenum are immobilized. (With a total pancreatectomy, a splenectomy and cholecystectomy with vagotomy may be indicated.) If the tumor has invaded the base of the mesocolon, portal vein, aorta, vena cave, or superior mesenteric vessels, this procedure is usually abandoned, and a lesser procedure (usually a bypass of the biliary tree and/ or stomach will be performed.
- The proximal end of the jejunum is anastomosed to the distal pancreas.
- The common bile duct is anastomosed to the jejunum with an end-to-side technique.
- The distal stomach is anastomosed to the jejunum (also end-to-side).
- Stapling instruments may be used to mobilize and transect multiple blood vessels and in transaction of the stomach and to perform the gastrojejunal anastomosis.
- Additionally, various plastic stents may be placed in the biliary or pancreatic anastomosis.
- The wound is irrigated, drains inserted and secured, and the abdomen is closed in layers.
Perioperative Nursing Considerations - Verify with the blood bank the number of available units.
- Accurate intake and output recording is essential for adequate replacement therapy.
- Instruments that have touched "dirty" areas must be isolated (no-touch technique).
- Scrub person should receive specimens in a basin.
- Have appropriate stents available, unopened.
Related posts: - Anastomosis of Small Intestine (Small Bowel Resection)
- Hemorrhoidectomy
- Throat Culture Procedure
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