Assisting with Minor Surgery C A S E S T U D Y Peter Smith is a 73-year-old male with a history of mild depression. He arrives at the clinic holding a bloody towel over his left forearm. He is taken immediately back to the treatment area. He states that he cut himself with a large knife while cutting a pineapple. You take his vital signs while waiting for the physician. You notice the blood is leaking through the towel. You need to control the bleeding. You put on PPE, most importantly gloves, and apply a large dressing over the area, holding firm pressure. The physician arrives, examines the patient, and determines that the patient will need sutures. While you are preparing Mr. Smith for his wound repair procedure, he tells you that he recently started swimming for exercise and is going to the Bahamas for a snorkeling trip in 2 weeks. He wants to know if this will ruin his trip. L E A R N I N G O U T C O M E S After completing Chapter 44, you will be able to: 1. 44.1Define the medical assistant’s role in minor surgical procedures. 2. 44.2Describe surgical procedures performed in an office setting. 3. 44.3Identify the instruments used in minor surgery and describe their functions. 4. 44.4Describe the procedures for medical and sterile asepsis in minor surgery. 5. 44.5Summarize the medical assistant’s duties in preoperative procedures. 6. 44.6Describe the medical assistant’s duties during an operative procedure. 7. 44.7Implement the medical assistant’s duties in the postoperative period. K E Y T E R M S 1. abscess 2. anesthesia 3. anesthetic 4. approximate 5. cryosurgery 6. debridement 7. electrocauterization 8. formalin 9. incision 10. inflammatory phase 11. intraoperative 12. laceration 13. ligature 14. maturation phase 15. needle biopsy 16. postoperative 17. preoperative 18. 19. 20. 21. 22. proliferation phase puncture wound sterile field suture swaged needle 0. Introduction 1. Minor surgical procedures are frequently performed in ambulatory care settings and office practices. Assisting with minor surgery requires a variety of duties and skills. As a medical assistant, you must be knowledgeable of the types of procedures performed where you are employed. You need to know how to prepare the patient for surgery, assist the practitioner during surgery, and care for the patient after surgery. Because all types of surgery require surgical asepsis, a working knowledge of this technique is mandatory. 2. The Medical Assistant’s Role in Minor Surgery 3. Medical assistants play an important role in all aspects of minor surgical procedures. You will perform administrative tasks prior to the patient’s surgery, including completing forms for insurance and obtaining signed informed consent from the patient. You will explain basic aspects of the surgical procedure and answer the patient’s questions. Informing the doctor of all current prescription and over-the-counter (OTC) medications that the patient is currently taking is also an administrative task. Finally, you will make sure the patient knows how to follow the appropriate presurgical instructions. 4. In addition to presurgical administrative tasks, you also will perform many tasks directly related to the surgical procedure. You will make sure the surgical room is clean, neat, and properly lit. You will see that all the equipment, instruments, and supplies the doctor will use are clean, disinfected or sterilized, and properly arranged. You also may function as an unsterile assistant, ensuring the safety and comfort of the patient during the procedure and performing other duties. At other times, you may directly assist with the surgical procedure in a sterile capacity. 5. Following the surgical procedure, you will help dress the wound and perform other postoperative patient care, making sure the patient is not experiencing ill effects from the surgery or local anesthetic. You will educate the patient about wound care and proper procedures to follow after surgery and make sure the patient has safe transportation home. You also will clean the room and prepare it for the next patient. Surgery in the Physician’s Office Minor surgical procedures are those that can be safely performed in the physician’s office or clinic without general anesthesia. Anesthesiais a loss of sensation, particularly the feeling of pain. An anesthetic is a medication that causes anesthesia. A general anesthetic affects the entire body, whereas a local anesthetic affects only a particular area. Minor surgical procedures typically involve the use of a local anesthetic in the form of an injection or a cream applied to the skin. Minor surgery is performed for many reasons, whether it be to diagnose an illness or repair an injury. Other procedures may be elective, or optional. Removal of a wart, skin tag (a small outgrowth of skin, occurring frequently on the neck as people get older), or other small growth for cosmetic reasons is an elective procedure. Some of the common minor surgical procedures you may assist the doctor with include the following: • Repair of a laceration • Irrigation and cleaning of a puncture wound • Wound debridement • Removal of foreign bodies • Removal of small growths • Removal of a nail or part of a nail • Drainage of an abscess • Collection of a biopsy specimen • Cryosurgery • Laser surgery • Electrocauterization Common Surgical Procedures Many surgical procedures are routinely performed in a doctor’s office. You may perform some of these procedures on your own. For example, you may change dressings for surgical wounds, and under a doctor’s orders, you may remove sutures (commonly called stitches) or staples after wounds have healed. Any procedure that requires an incision (a surgical wound made by cutting into body tissue) must be performed by a doctor. Draining an Abscess An abscess is a collection of pus (white blood cells [WBCs], bacteria, and dead skin cells) that forms as a result of infection. A protective lining can form around an abscess and prevent it from healing. In such a case, the physician may make an incision in the lining of the abscess. This procedure is known as an incision and drainage (I&D). The physician may allow the abscess to drain on its own or insert a drainage tube. Obtaining a Biopsy Specimen A biopsy specimen is a small amount of tissue removed from the body for examination under a microscope. Most biopsies involve cutting the tissue. For a needle biopsy, the doctor uses a needle and syringe to aspirate (withdraw by suction) fluid or tissue cells. (The procedure in the Assisting in Other Medical Specialties chapter describes how to assist with a needle biopsy.) All specimens must be placed in a preservative, most commonly a 10% formalin solution (a dilute solution of formaldehyde), to prevent changes in the tissue.