Fac|||l|es ard 3upp||es, 3creer|rg

ol Pal|erls ard Preparal|ors lor 3urgery

Crapler 1
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol
pal|erls ard preparal|ors lor surgery
1
Learn|ng 0bject|ves
-la|r a dela||ed r|slory lror lre c||erl requesl|rg ra|e
c|rcurc|s|or serv|ces
Perlorr a ra|e ger|la| exar|ral|or
L|sl corlra|rd|cal|ors lor ra|e c|rcurc|s|or
0escr|-e preoperal|ve preparal|ors lor adu|l ra|e
c|rcurc|s|or
L|sl equ|prerl ard supp||es requ|red lor slardard ra|e
c|rcurc|s|or
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 2
6:|pment and 8:pp||es
r operal|rg la-|e, Wr|cr car -e a:
!:rpose-b:||t operat|ng or r|ror procedures la-|e W|lr lac|||l|es
lor purp|rg up ard doWr accord|rg lo surgeor's re|grl, 0R
|xed-he|ght tab|e W|lr sleps (ard -r|c|s lo pul urder la-|e |egs
lo creale read-doWr pos|l|or)
we||-||l procedure roor
peral|rg lrealre r|ror procedures |arp or l|uorescerl
||grl|rg arrarged over lre operal|rg la-|e
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 3
6:|pment
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 1
6:|pment and 8:pp||es (cont.}
rslrurerl lray Wrapped
W|lr sler||e drape (1)
0|ssecl|rg lorceps (l|re|y
loolred)
rlery lorceps
(2 slra|grl, 2 curved)
Curved Velzer-aur's
sc|ssors (1)
3l|lcr sc|ssors (1)
Vayo's reed|e ro|der (1)
3porge ro|d|rg lorceps (1)
3ca|pe| |r|le rard|e ard -|ades
' drape (80 cr x 80 cr, W|lr
~5 cr ro|e)
0a|||pol lor arl|sepl|c so|ul|or
(e.g., pov|dore |od|re)
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 5
6:|pment and 8:pp||es (cont.}
Pov|dore |od|re (50 r| ol 10
so|ul|or)
P|a|r gauze sWa-s (10 x 10 cr, 15
p|eces)
Pelro|eur-je||y-|rpregraled gauze
(5 x 5 cr or 5 x 10 cr) ard sl|c||rg
p|asler
15 r| ol 1 p|a|r ||doca|re (W|lroul
ep|reprr|re) araeslrel|c so|ul|or
3yr|rge, 10 r| ard reed|es (s|rg|e-
use or slear sler|||za-|e)
rjecl|or reed|es (18- ard 21-gauge)
3ulure raler|a| (crror|c calgul or
v|cry|, 3-0 or 1-0 W|lr 3/8 c|rc|e
reverse-cull|rg reed|e)
0erl|ar v|o|el (5 r| or |ess) or sler||e
rar|er per
0|oves, ras|s, caps ard aprors
Cordors ard |rlorral|or raler|a|s
lor c||erls
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery
6:|pment a|ntenance
Crec|||sl lor raeroslal|c
arlery lorceps:
0o lre po|rls reel
accurale|y?
s lre gr|p or lre po|rls
Worr?
0oes lre ralcrel |oc|
secure|y or |s |l Worr?
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery Z
6:|pment a|ntenance (cont.}
Crec| ||sl lor surg|ca|
d|ssecl|or sc|ssors:
s lre cull|rg edge ol lre
-|ade srarp?
0o lre -|ades reel
secure|y?
s lre screW |oose?
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 8
6:|pment a|ntenance (cont.}
Crec|||sl lor reed|e
ro|ders:
0o lre po|rls reel
accurale|y?
s lre gr|p or lre po|rls
Worr?
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 9
6:|pment a|ntenance (cont.}
heck||st for d|ssect|on
forceps (tweezers}:
0o lre po|rls reel
accurale|y? (crossed
po|rls are a corror
pro-|er W|lr o|d Worr
|rslrurerls)
l loolred, are lre leelr
Worr?
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 10
8creen|ng the Ad:|t ||ent for :nder Loca|
Anaesthes|a |n the ||n|c
%re c|rcurc|s|or lear reeds lo ersure lral c||erls are:
|t lor surgery
e|| |nformed a-oul lre surgery
8:|tab|e for c|rc:mc|s|on :nder |oca| anaesthes|a |r lre c||r|c
f there |s any do:bt as to s:|tab|||ty, the c||ent sho:|d
be referred to the d|str|ct hosp|ta| or h|gher |eve| of
care.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 11
|story Tak|ng
hen tak|ng med|ca| h|story, en6:|re abo:t:
Currerl gerera| rea|lr
C||erl la||rg ary red|c|res
C||erl ras ary |roWr a||erg|es
lo red|c|res
l|slory ol raeropr|||a,
-|eed|rg d|sorders or araer|a
ry currerl ger|la| |rlecl|or,
u|cer or per||e d|scrarge
C||erl ras pro-|ers W|lr per||e
erecl|or or ary olrer corcerrs
a-oul sexua| lurcl|or
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 12
en|ta| xam|nat|on
Prys|ca| exam|nat|on of the pen|s srou|d |rc|ude:
#elracl|or ol lre lores||r lo |nspect the g|ans
rspecl|or ol the pos|t|on of the :r|nary open|ng (Wr|cr srou|d
-e rear lre l|p ol lre g|ars)
-serce ol scarr|rg or d|sease
Easy relracl|or ol lores||r ard a-serce ol |rl|arral|or or
rarroW|rg
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 13
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 11
Abso|:te ontra|nd|cat|ons to
||n|c-ased |rc:mc|s|on
Anatom|c abnorma||ty of the pen|s: For exarp|e, lre urelrra|
realus |s or lre urders|de ol lre per|s (rypospad|as) or or
lre upper s|de ol lre per|s (ep|spad|as). %re lores||r ray -e
reeded lor repa|r.
Crror|c paraph|mos|s: %re lores||r |s perrarerl|y relracled,
lr|c|ered ard sWo||er (reler pal|erl).
en|ta| :|cer d|sease: 3rou|d -e |rvesl|galed ard lrealed
-elore VC.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 15
Abso|:te ontra|nd|cat|ons to
||n|c-ased |rc:mc|s|on (cont.}
Urethra| d|scharge: srou|d -e |rvesl|galed ard lrealed
-elore VC
!en||e cancer: reler lo spec|a||sl
Crror|c d|sorders ol lre per|s ard lores||r e.g., f||ar|as|s:
reler lo spec|a||sl
|eed|ng d|sorder sucr as raeropr|||a (reler pal|erl lo a
r|grer |eve|)
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 1
Re|at|ve ontra|nd|cat|ons to
||n|c-ased |rc:mc|s|on
%re lo||oW|rg cord|l|ors re6:|re referra| lo lre spec|a||sl:
l|grl lores||r as a resu|l ol scar l|ssue (ph|mos|s)
8car t|ss:e al lre lreru|ur (corsequerce ol repealed lear|rg)
Exlers|ve pen||e warts: Per||e Warls car cause a |ol ol
-|eed|rg. (#eler pal|erl lo s|le Wrere d|alrerry |s ava||a-|e.)
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 1Z
Re|at|ve ontra|nd|cat|ons to
||n|c-ased |rc:mc|s|on (cont.}
%re lo||oW|rg cord|l|ors re6:|re referra| lo lre spec|a||sl:
a|an|t|s xerot|ca ob||terans (p|aque ol scar l|ssue exlerd|rg
orlo lre surlace ol lre g|ars ard |rvo|v|rg lre urelrra| realus
ard lores||r) (reler pal|erl)
8|ck|e ce|| d|sease
0ther abnorma||t|es ol lre ger|la||a, sucr as rydroce|e caus|rg
sWe|||rg (reler pal|erl)
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 18
nformed onsent for 8:rgery
%re c|rcurc|s|or lear srou|d ens:re that the c||ent has been
|nformed abo:t the r|sks and benef|ts ol ra|e c|rcurc|s|or,
us|rg everyday |oca| |arguage.
%re ora| |nformat|on srou|d -e -ac|ed up -y wr|tten
|nformat|on sheets |r lre |oca| |arguage.
%re c||erl srou|d -e a||oWed lo as| quesl|ors. le srou|d lrer
-e g|ver l|re lo rel|ecl -elore -e|rg as|ed lo s|gr lre
cerl|l|cale ol corserl. (3ee pperd|ces 1.2 ard 1.3 lor sarp|e
corserl lorrs.)
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 19
!reoperat|ve ash|ng and 8hav|ng
%re c||erl srou|d wash the gen|ta| area and the pen|s
w|th water and soap on the day of s:rgery. le srou|d
retract the foresk|n and wash :nder |t.
rred|ale|y pr|or lo lre operal|or, lre s||r |s lurlrer
c|eared W|lr pov|dore |od|re.
!:b|c ha|r shav|ng |s not recommended (damages sk|n
and promotes |nfect|on}.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 20
!reoperat|ve ash|ng and
8hav|ng (cont.}
%re advantages of N0T shav|ng:
3aves l|re ard razors
#educes lre rur-er ol srarps ard lre r|s| ol srarps |rjur|es
%re advantages of shav|ng are lral:
l avo|ds corlar|ral|or ol lre operal|or l|e|d
l |s eas|er lo l|x lre Wourd dress|rg lo lre s||r
l |s preferab|e to c||p |org pu-|c ra|r al rore or al lre c||r|c,
jusl -elore surgery.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 21
hen 8cr:bb|ng.
Pr|or lo scru--|rg, remove a||
jewe||ery ard ens:re na||s are
tr|mmed or f||ed
&se soap, a br:sh (or lre ra||s ard
l|rgerl|ps) ard r:nn|ng water lo
c|ear lrorougr|y arourd ard
urderrealr lre ra||s
3cru- rards ard arrs up lo lre
e|-oWs
lo|d up arrs lo a||oW Waler lo dr|p
oll your e|-oWs
%urr oll lre lap W|lr lre e|-oW
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 22
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 23

hat do we
|earn from
these
graph|cs?
After 8cr:bb|ng.
0ry hands w|th a ster||e towe| ard ra|e sure lre loWe|
does rol -ecore corlar|raled -y cor|rg |rlo corlacl W|lr
ror-sler||e surlaces.
o|d hands and forearms away from the body and
h|gher than the e|bows url|| lre sler||e goWr ard sler||e
g|oves rave -eer pul or.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 21
own|ng and |ov|ng
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 25
xerc|se 4.1: Recogn|t|on of |rc:mc|s|on
6:|pment
e prepared lo -e ass|gred lo a lear ol 1 or 5 peop|e.
Your lear W||| -e g|ver a -ag corla|r|rg equ|prerl. 3ore ol lr|s
equ|prerl |s requ|red ard sore N% requ|red lor slardard ra|e
c|rcurc|s|or.
wrer lre |rslruclor says 'go, your lear W||| rave 3 r|rules lo
se|ecl lre equ|prerl lral |s esserl|a| lo slardard ra|e c|rcurc|s|or.
Your lear W||| ga|r ore po|rl lor eacr esserl|a| p|ece ol equ|prerl
ard |ose ore po|rl lor eacr ror-esserl|a| p|ece ol equ|prerl
se|ecled.
%re lear W|lr lre V3% po|rls lral l|r|sres l|rsl |s lre W|rrer.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 2
xerc|se
wor| |rd|v|dua||y
#ev|eW:
pperd|x 1.1: 3arp|e c||erl record lorr lor adu|ls ard
ado|escerls
pperd|x 1.2: 3arp|e d|sposa-|e corsura-|es lor ore adu|l
ra|e c|rcurc|s|or
pperd|x 1.3: 0ela||ed aralory ol lre per|s
0ural|or: 30 r|rules
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 2Z
8:mmary
%re goa| ol assess|rg lre c||erl -elore c|rcurc|s|or |s lo
detect contra|nd|cat|ons ard cord|l|ors lral reed lrealrerl
or relerra|.
%re assessrerl |rc|udes h|story tak|ng, phys|ca|
exam|nat|on ard, occas|ora||y, |a-oralory lesl|rg.
%re surgeor srou|d adopt good asept|c techn|6:e.
Eacr c||r|c srou|d carry o:t a per|od|c rev|ew of s:rg|ca|
|nstr:ments for wear-o:t.
Crapler 1: Fac|||l|es ard 3upp||es, 3creer|rg ol pal|erls ard preparal|ors lor surgery 28