Crafted Beauty Blog
Pearls of Cleaning and Sterilizing Surgical Instruments
Cleaning is the removal of foreign material (soil, organic material) from objects and is normally accomplished using water with detergents or enzymatic products (MaxiZyme, Metrizyme, Empower). Thorough cleaning is required before disinfection and sterilization.
Disinfection describes a process that eliminates pathogenic microorganisms, except bacterial spores, on inanimate objects.
Sterilization describes a process that destroys or eliminates all forms of microbial life.
Unlike sterilization, disinfection is not sporicidal.
The term germicide includes both antiseptics and disinfectants. Antiseptics are germicides applied to living tissue and skin; disinfectants are antimicrobials applied only to inanimate objects. In general, antiseptics are used only on the skin and not for surface disinfection, and disinfectants are not used for skin antisepsis because they can injure skin and other tissues.
The effective use of disinfectants is part of a multi-barrier strategy to prevent health-care–associated infections. Surfaces are considered noncritical items because they contact intact skin. Use of noncritical items or contact with noncritical surfaces carries little risk of causing an infection in patients or staff. Nonetheless, cleaning and disinfecting surfaces is common practice and should be routinely practiced.
Surgical instruments should be presoaked to prevent drying of blood, and to soften and remove blood/fat from the instruments. Cleaning may be done manually, by rubbing/scrubbing the soiled area with a brush to remove any blood, fat, or any other organic material from the surface, using water with detergents or enzymatic products, or mechanically, by using automatic cleaners such as ultrasonic cleaners, washer-de-contaminators, washer-disinfectors, and washer-sterilizers.
For instrument cleaning, a neutral or near-neutral pH detergent solution containing enzymes commonly is used because such solutions are active on blood/fat/carbohydrates providing good soil removal. Enzymatic cleaners are not disinfectants and as with all chemicals, enzymes must be rinsed from the equipment. Enzyme solutions should be used in accordance with manufacturer’s instructions, which include proper dilution of the enzymatic detergent and contact with equipment for the amount of time specified on the label.
Many disinfectants (alcohol, glutaraldehyde (Cydex), hydrogen peroxide) are used alone or in combinations.
Steam sterilization, moist heat in the form of saturated steam under pressure, is the most widely used and the most dependable method of surgical sterilization. Steam sterilization is nontoxic, inexpensive, rapidly microbicidal, sporicidal, and rapidly heats and penetrates fabrics. The basic principle of steam sterilization, as accomplished in an autoclave, is to expose each item to direct steam contact at the required temperature and pressure for the specified time.
There are four (4) parameters of steam sterilization: steam, pressure, temperature, and time. The ideal steam for sterilization is dry saturated steam and entrained water. Pressure serves as a means to obtain the high temperatures necessary to quickly kill microorganisms. Specific temperatures must be obtained to ensure the microbicidal activity. The two common steam-sterilizing temperatures are 121°C (250°F) and 132°C (270°F). These temperatures (and other high temperatures) must be maintained for a minimal time to kill microorganisms. At constant temperatures, sterilization times vary depending on the type of item (metal versus rubber, plastic), whether the item is wrapped or unwrapped, and the sterilizer type.
The two basic types of steam sterilizers (autoclaves) are the gravity displacement autoclave and the high-speed pre-vacuum sterilizer. Refer to the autoclave’s manual of operation for the type of steam sterilizer and the minimum cycle times for steam sterilization cycles.
Flash steam sterilization refers to sterilization of an unwrapped object and it depends on the type of sterilizer and the type of item (porous vs non-porous items). Although the wrapped method of sterilization is preferred, correctly performed flash sterilization is an effective process for the sterilization of critical medical devices.
Flash sterilization is a modification of conventional steam sterilization in which the flashed item is placed in an open tray to allow for rapid penetration of steam. It is not recommended as a routine sterilization method because of the lack of timely biological indicators to monitor performance, absence of protective packaging following sterilization, possibility for contamination of processed items during transportation to the operating rooms, and the sterilization cycle parameters (time, temperature, pressure) are minimal.
Flash sterilization is considered acceptable for processing cleaned patient-care items that cannot be packaged, sterilized, and stored before use. It also is used when there is insufficient time to sterilize an item by the preferred package method. Refer to the autoclave’s manual of operation for the type of steam sterilizer and the minimum cycle times for flash steam sterilization cycles.
Taking the time, putting the effort and following the appropriate guidelines of cleaning and sterilization will ensure the safety of all, patients and medical personnel.
Cleaning and sterilization of surgical instruments and disinfection of surfaces = Patient Safety! Connect with us at dravellanet.com.
Circles, Xs, Colors: The Surgical Map
Happy Thursday! It’s almost time to relax, enjoy the weekend and plan your next surgery. In previous blogs, I have talked about how and where to place incisions, how to take aesthetic photographs and the importance of planning. Today I start by saying: The planning of a surgery is critical in a liposuction surgery. Part of the planning is the pre-operative marking of the patient. I refer to markings as a surgical map. The areas to be treated should be marked accordingly using a permanent marker (I have tried various brands but Sharpies work best). I use specific anatomical landmarks to start drawing my map, use concentric circles to enclose the areas I will be working on, and finalize with Xs of different colors to emphasize the larger size of an area compared to its counterpart. Here is a video that shows you how I draw my surgical map.
Each surgical map belongs to and should de drawn by each cosmetic specialist. However you plan it and draw it, it’s entirely up to you. What’s important is the execution of the plan following a specific and well drawn surgical map.
Connect with us at dravellanet.com.
The Magic Wand: A Liposuction Cannula
Advances in instrumentation, techniques and devices have taken liposuction into a new era.
What is a liposuction cannula? What is it used for? Why is it important to understand the difference between a cannula and a needle? Why is it important to refer to a cannula as a cannula, specially during a surgery with a patient awake?
Pearls of history: The origin of liposuction can be traced to 1921 when Dujarrier used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimizing outcomes. In the 1960’s, Schrudde revived the practice using small stab incisions and sharp curettage with secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to a vacuum pump thus avoiding the complications of a sharp curette. The blunt cannula liposuction technique then became the global standard of care for liposuction. Liposuction is generally a safe procedure with reproducible outcome and just like any surgical procedure, it should be treated with the utmost care. (Illouz 2014)
Nomenclature of a liposuction cannula: A liposuction cannula is a blunt tip instrument used during a liposuction procedure. There is a wide variety of liposuction cannulas with different designs, sizes, lengths, and indication of use. Liposuction cannulas include: infiltration cannulas, suction or fat harvesting cannulas and injection or fat transfer cannulas.
An infiltration cannula is used during the initial tumescent anesthesia part of a liposuction surgery; it’s usually thin and with multiple openings at the tip allowing for the liquid tumescent anesthesia to be infiltrated by evenly spraying the solution into the tissue.
A suction or fat harvesting cannula is used to extract the fat from the tissue. There is a variety of designs, lengths and gauges and the choice of use will depend on several factors such as the end purpose of the surgery and the anatomical areas to be treated, among others. In other words, as an example, the cannula used for harvesting fat from the inner thighs to transfer to the face in a patient awake will be different from the cannula used for liposculpting with etching of a full abdomen in an awake patient.
An injection or fat transfer cannula is used to transfer fat after suctioning. These cannulas tend to have one opening at the tip and the length and gauge will depend on the area to be treated by fat. Other factors to consider in the selection of the appropriate fat transfer cannula are: the cannula used for fat harvesting, the anatomical area of the body from where the fat was extracted and the use of laser technology, among others.
The importance of understanding the difference between a cannula and a needle is based on patient safety and tissue preservation. A cannula is a blunt tip instrument which usually causes less damage to the tissue; a needle is usually a sharp, cutting tip instrument which is more aggressive to the integrity of the tissue. There is a learning curve for the use of a blunt cannula but with appropriate training and experience of use, one can acquire a high level of confidence in its use, contributing to the patient’s safety.
It is of critical importance for the cosmetic specialist to understand the type of instrument he/she is working with and to refer to it in the correct way. During surgery with an awake patient, it is not unusual for the patient to somewhat panic at the site of a long instrument and refer to it as a “huge needle”, but by quickly reassuring her/him that it is a cannula with a blunt tip and not a needle, the patient’s anxiety can quickly decrease, as safety and comfort will remain the cosmetic specialist’s priority. A liposuction cannula is a magic wand in the hands of the cosmetic specialist, an instrument designed and intended to cause minimal tissue damage maintaining patient safety, while providing the patient with beautiful and acceptable results that will make her/him feel more secure and beautiful with her/himself and increasing her/his self-esteem. Connect with us at dravellanet.com.
The Direction of the Cannula during Abdominal, Waist and Back Liposuction
As previously discussed in my blog “Pearls of Wisdom: Abdominal, Waist and Back Lipo Incisions”, the planning of a liposuction surgery, including the placement of incisions, is a critical step for it’s success. The placement of the incisions is part of the mapping of the surgery and will depend on the areas to be treated. These incisions are strategically placed so the direction of the cannula during surgery can reach and cover as much of the area to be treated as possible. The appropriate placement of the suction cannula in the fat layer and the direction of the cannula during suction, will ensure the most efficiency during the procedure.
A suction cannula is inserted into the adipose tissue at an angle to the skin, and once in the correct fat plane, it is advanced parallel to the surface of the skin. The movements are performed in parallel, in and out, along a straight line, using a “fanning or fan-shaped” pattern to aspirate the fat. This fat aspiration technique creates a number of tunnels in different directions that, once they collapse and the skin retracts, will give the body its new shape. The best results will be achieved by using multiple incision sites while overlapping adjacent fan-like tunnels with each movement in different directions.
Enclosed various images that show the direction of the cannula (pink arrows) from various incisions sites (green Xs) to treat the abdomen, waist and back areas.
Although this fat aspiration technique is a simple procedure with good and acceptable cosmetic results, it requires practice and experience; the more it is practiced, the more consistent better results can be achieved. Liposuction is a very tactile procedure, the more you do it, the better the results will be. Contact us at dravellanet.com for more information about our trainings.