SFA 273 - Fundamental Techniques

Credits: 3
Instructional Contact Hours: 4

1.    Discuss physiologic monitoring of patients undergoing surgery and the placement of monitoring devices.

A.    List the common types of noninvasive and invasive monitors used intra-operatively and discuss their potential complications.
B.    Discuss the SFA's responsibilities with regard to intra-operative patient monitoring.
C.    Define “vital signs”, explain why they are important, describe how they can be measured, and list their normal ranges in an adult.
D.    Define terms used to describe abnormalities in vital sign measurements.
E.    Explain the importance of monitoring urine output and body temperature and identify abnormalities that must be reported.
F.    Discuss CVP lines, PA catheters, end-tidal CO2 monitors, pulse oximeters, peripheral nerve stimulators, and special monitors specific to surgical specialties.
G.    Define terms related to hemodynamic monitoring.

2.    Demonstrate the preparation of a patient prior to surgery.

A.    Demonstrate an understanding of the preoperative assessment of the patient.
B.    Recognize the need for surgical intervention.
C.    Understand patient considerations when preparing the patient for surgery.
D.    Describe the proper attire for a patient entering the O.R. and explain the safety reasons for these rules.
E.    List the indications for bladder catheterization and discuss possible complications and appropriate actions.
F.    Describe the principles of performing urinary catheterization and be able to demonstrate proper technique.
G.    Discuss skills in positioning the patient for various surgical specialties, utilizing positioning devises and maintaining patient stability.  Must be aware of the fundamental principles of patient positioning and how to interpret the physiological effects of surgical positioning on the patient.
H.    Discuss pre-operative preps and indications for hair clipping.
I.    Describe and be able to demonstrate the correct method for various kinds of pre-operative wash preps, including the appropriate choice of antiseptic agent.
J.    List the basic principles of draping and be able to demonstrate standard draping procedures and variations.
K.    Discuss the correct placement, pressure settings, inflation time limits, and possible complications of a pneumatic tourniquet.

3.    Demonstrate understanding of methods of tissue handling and techniques of instrument use.

A.    Identify the indications, advantages and disadvantages for various types of abdominal incisions.
B.    List the general rules of gentle tissue handling and compare different methods of tissue dissection.
C.    Discuss the factors involved in the appropriate selection of instrumentation and the potential hazards from the improper use of instruments.
D.    Describe and demonstrate proper body mechanics when using various kinds of instruments.
E.    Compare various methods of tissue retraction.
F.    List the types of surgical lasers and the characteristics, common uses, and preparation and safe use of each.
G.    Discuss the surgical uses of ultrasound equipment.
H.    Discuss the role of the SA in secondary trocar placement, manipulation of tissue, and assisting the surgeon during MIS surgery
I.    Compare MIS and robotic surgery in regards to principles, terms and the role of the SA.
J.    Discuss navigational systems and troubleshooting in the operating room.

4.    Demonstrate methods of providing visualization of the operative site and of hemostasis.

A.    Discuss the various methods of wound visualization.
B.    Discuss the principles of selection and proper use of different kinds of sponging materials.
C.    Describe the proper use of suctioning equipment.
D.    Discuss the purposes and methods of intraoperative irrigation, and list the types, possible side effects and contraindications for various irrigation solutions.
E.    Discuss the different types of bleeding and the SFA’s role in achieving hemostasis.
F.    List and define terms relating to different ligating methods.
G.    Discuss the uses of operating microscopes and the role of the SFA.
H.    Review the principles and terms of electricity and the role of the SA in using ESU systems.
I.    Describe the application of various type of tourniquets.
J.    Identify circumstances and complications associated with tourniquet use. 

5.    Demonstrate appropriate methods of tissue approximation.

A.    List characteristics, common uses, and contraindications different types of suture materials.
B.    Discuss the principles and appropriate uses of the various types of suturing techniques.
C.    Demonstrate a clinically acceptable level of surgical knot-tying techniques.
D.    Discuss the uses of different types of surgical stapling appliances.
E.    Demonstrate a clinically acceptable level of suturing techniques. 

6.    Discuss actions that complete a surgical procedure.

A.    Describe the proper method for handling various types of surgical specimens and discuss the SFA’s role in the care of specimens.
B.    Discuss the purpose, proper usage, and potential complications of wound drainage.
C.    Compare the usage of different types of drainage systems. 
D.    Discuss and demonstrate the proper selection and application of wound dressings.
E.    Discuss the factors concerning the surgical procedure and the patient’s condition that affect the choice of dressing materials and technique of application.

7.    Demonstrate an understanding of methods of blood volume replacement.

A.    Discuss factors involved in blood transfusion compatibility and the techniques of blood compatibility testing.
B.    List the physiologic effects of massive blood transfusion.
C.    Compare the risks involved in using bank blood, directed donation, or autotransfusion.
D.    Describe various methods of pre-operative, intraoperative and post-operative procurement of autologous blood.

8.    Discuss human body thermoregulatory mechanisms and their considerations for surgery.

A.    Discuss the SFA’s responsibility for skin assessment and for reporting and documenting skin changes.
B.    Identify possible sources of intraoperative heat or cold injuries to tissue.
C.    List indications for systemic intraoperative warming and cooling, and discuss possible complications from the use of thermoregulatory devises.
D.    Explain how general anesthetic agents affect the normal thermoregulation mechanism.
E.    Discuss the indications and proper procedure for measuring intraoperative blood loss and urine output.

9.    Describe special considerations in selected types of surgical procedures.

A.    Discuss the principles and uses of various circulatory support devices.
B.    List the advantages, disadvantages, and relative contraindications for laparoscopic General surgery.
C.    List common types of endoscopic procedures performed in the various surgical specialties.
D.    Discuss the correct preparation and use of endoscopic and operative video equipment.
E.    Discuss the appropriate role of the SFA during endoscopic procedures.
F.    Discuss the SFA’s role during vascular surgery.
G.    Describe the proper preparation and use of biologic and synthetic vascular grafts and other surgical implantable devices
H.    Define terminology associated with bone fractures and dislocations, types of reduction and fixation, and bone healing.
I.    Compare and give examples of systems of orthopedic internal and external fixation devices and prosthetic equipment.
J.    Discuss the healing process of fractures, the problems of non-union, and the use of bone grafts and electrical stimulation.
K.  Demonstrate an understanding of the SFA role in robotic surgery.

10. Explain various methods of post-operative pain control.

A. Explain why it is difficult to differentiate whether a patient under Local anesthesia is feelingcpain or pressure, and discuss how the O.R. personnel can affect what the patient is experiencing.
B. Explain the “gate control” theory of pain, using the diagram provided in class, and relate acupuncture, TENS units and dorsal column stimulators to the “gate” concept.
C. Explain “descending” pain control physiology, relating serotonin, enkephalins and Substance P to the diagram provided in class.
D. List the physiologic responses to unrelieved pain in a post-operative patient.
E. Discuss the mechanism of action, advantages and risks of intrathecal or epidural narcotics.
F. Demonstrate the proper method of injecting a local anesthetic into the subcutaneous tissue when closing a wound.