Acute appendicitis in the emergency room. Open surgical technique for new professionals.
Appendicitis is very common, and it is the first cause of emergency surgery that reaches the hospitalization units. It is estimated that 5% of the population can suffer from this disease. The highest incidence occurs between 8 and 30 years of age.
In the preoperative period, the role of the circulating nurse is essential. It is the one that transmits a feeling of calm and confidence, acts without haste, and is also understanding and kind to a patient who arrives with anxiety, fear, and fear of the unknown.
María del Carmen León Bravo. DUE of the Emergency Operating Room of the Reina Sofía Hospital in Córdoba.
Pilar Torres Roldan Transit. DUE of the CCV Operating Room of the Reina Sofía Hospital in Córdoba.
Inmaculada Herrera Torres. DUE of the Reina Sofía Hospital in Córdoba.
María del Carmen León Bravo. Emergency operating room, ground floor. Reina Sofia Hospital. Adv. Menéndez Pedal s / n. CP 14.004, Córdoba.
Bibliographic search in the most important databases: guide, PubMed, Cochrane plus, and specialized books on general surgery instruments.
Appendectomy is the removal of the cecal appendix, which is a small elongated and narrow bag at the end of the cecum through an Mc Burney incision, in a supine position, which is performed in patients with a clinical picture of appendicitis, which is the inflammation of the cecal appendix.
Confirmed appendicitis ends in appendectomy (removal by surgical means).
DEVELOPMENT OF THE SURGERY:
The patient needs to know what is going to happen in order to have more control over the situation around him.
The patient is monitored, and a peripheral line is channeled to infuse Ringer or physiological serum. The anesthesia is general. We need to isolate the airway; for this, we will prepare an endotracheal tube, face mask, Goeddel, laryngoscope (all of the appropriate sizes).
The medication needed for anesthesia is a pain reliever, a hypnotic, and a muscle relaxant.
The patient is monitored with blood pressure, ECG, and pulse oximetry.
POSITION AND PREPARATION OF THE PATIENT:
The patient’s position is supine with arms outstretched at a right angle.
Protect the support areas on the surgical table (popliteal fossa, heels)
The surgical field preparation is with chlorhexidine solution.
Standard surgical equipment
PREPARING THE INSTRUMENT TABLE
We begin to place the instruments in the part of the table closest to the instrumentalist and from right to left:
A large # 4 scalpel.
A straight Mayo scissors.
A curved Mayo scissor.
Two dissecting forceps with teeth.
Two dissecting forceps without teeth.
Four Kocher tweezers.
And in the most distal part, also from right to left.
Two Allison’s forceps (Allis).
Two Duval triangle clamps.
Two Mass Separators (Rousse).
Two Carabeef spacers.
A Gosse separator.
Four field claws (Crabs).
Gauze compresses cloths.
An electric scalpel.
A vacuum cleaner.
SURGICAL TECHNIQUE DESCRIPTION:
After the circulating nurse has prepared the surgical field with chlorhexidine, the surgical field is delimited with two interceptions, two surgical drapes, and an open sheet: a field bag, electric scalpel, and an aspirator.
The skin incision is then made (Mc Burney). The nurse gives the surgeon a scalpel handle No. 4 with a blade No. 21, two white compresses, and two dissection pieces with teeth.
The surgeon performs hemostasis of bleeding points with the electric scalpel and toothless dissecting forceps. Make an aponeurosis incision of the greater oblique muscle with curved Mayo scissors and roux retractors.
He then performed a blunt dissection of the muscle fibers of the greater oblique and opening of the peritoneum with curved Mayo scissors, dissecting forceps without teeth, two cries, Carabeef retractors, and Roux retractors.
The next step is the protection of the surgical edges with two pads. And a small surgical ring to protect the abdominal wall (optional).
The cecum is located with ring forceps or by hand, toothless dissecting forceps, and Roux retractors.
The cecal appendix is located and extracted with allis forceps and toothless dissecting forceps. The appendicular artery and the meso are clamped, ligated, and cut with two dissectors, Crile forceps, and a 2/0 very ligation (Novosti).
The appendix is cut with scalpel # 4 with blade # 23 and straight Mayo scissors to cut suture threads.
Next, the tobacco bag is made around the base where the appendix has been cut and invaginates the appendicular stump with 3/0 vicarly (noosing) with a cylindrical needle Vaseline, dissection forceps without teeth, a Crile forceps, and scissors de Mayo straight to cut thread.
The abdominal cavity is checked and washed if necessary, using an aspirator; for this purpose, a ring clamp, compress, warm physiological saline, and the aforementioned aspirator are used.
If there is a lot of contamination or peritonitis, change gloves.
The gauze and compresses are counted.
The next step is to suture the peritoneum with dissection forceps without teeth, Kocher with teeth, needle holder with vicarly No. 0 cylindrical, and straight scissors.
The aponeurosis is then sutured with vicarly # 1 with a cylindrical needle.
The subcutaneous cellular tissue is checked, washed with warm saline solution, and sutured with sail Quick no. 2/0 or 0.
It is finished by suturing the skin with a stapler and forceps with teeth: wound cleaning and dressing.
The circulating nurse will correctly identify the samples and request for the corresponding studies.
Given the evidence of the need for prior training in specialized services such as the Operating Room service, we consider that training is always enriching both at a personal and service level, thereby increasing the quality of nursing care, benefiting the patient and the same staff.
This article will serve as a tool to consult new professionals and to carry out professional and surgical work successfully.