HYGIENE OF TRANSPORTATION OF A SURGICAL PATIENT

Medical transportation is the transportation or carrying of a patient (injured) to the place of first aid or the performance of medical and diagnostic measures.

We do not dwell here on the issues of transportation of surgical patients at the prehospital stage.

In a hospital, a surgical patient has to be transported from the emergency room to the surgical department, from the surgical department to diagnostic rooms (departments) and back. In the surgical department, it becomes necessary to transport the patient from the ward to the dressing room, procedure room, operating room and from the dressing room, procedure room, operating room to the ward. There is no problem if the patient can walk and is not prescribed strict bed rest. Then he moves around the hospital on his own, if necessary, accompanied by junior and middle medical personnel. Patients who are assigned to strict bed rest, and patients in serious condition, are transported within the medical institution on a stretcher, gurney, wheelchair. The latter are stored in specially designated places (rooms) of the surgical department.

A stretcher with a patient can be carried by two or four people. They must go out of step so that the stretcher does not sway in time with the movement. When climbing the stairs, the patient must be carried head first, and when descending, feet forward, raising the foot end of the stretcher. This is done so that during transportation the patient does not occupy an unnatural position in which the head is lower than the legs and torso.

When using a gurney to transport a patient, medical staff must be proficient in the technique of transferring a patient: 1) from a bed to a gurney, 2) from a gurney to an operating or dressing table, 3) from an operating or dressing table to a gurney, 4) from a gurney to a bed.

The surgical department is equipped with so-called functional beds. This bed consists of four parts: head, two middle and foot. With the help of special devices, you can raise and lower individual parts of the bed, giving the patient the desired position. Most often, patients lie on their backs. After operations on the organs of the abdominal and thoracic cavities, the patient is given a semi-sitting position with the lower limbs bent at the knee joints. Less often, the patient after the operation lies in bed on his stomach or on his side.

Modern functional beds, as a rule, have wheels for easier movement. For short distances, if necessary, the patient can be transported directly on the bed.

A functional bed is approximately the same height as a standard stretcher, making it easier for patients to move from bed to stretcher. If the bed from which the patient must be shifted is lower than the standard wheelchair, it is advisable to use wheelchairs manufactured by modern industry with a variable bed height. Before shifting, it is necessary to lower the bed of such a wheelchair to the level of the height of the bed.

If the height of the bed and wheelchair are the same, it is advisable to use the following method of shifting the patient. The wheelchair is placed along the bed next to her. The head end of the wheelchair should be at the head end of the bed. The shifters (two or three people) are positioned so that the gurney is between them and the bed. When shifting together, one brings his hands under the head and chest of the patient, the other – under the lower back and lower limbs. When shifting three of us, one brings his hands under the head and the upper third of the chest, the second – under the lower third of the chest and under the lower back, the third – under the lower limbs. On command, the shifters lift the patient and move him to the stretcher.

If the beds in the ward are arranged so that the stretcher cannot be placed next to the bed and parallel to it, and also in cases where the stretcher is higher than the bed, you can use another method of shifting the patient. The wheelchair is placed perpendicular to the bed so that the foot end of the wheelchair is at the head end of the bed. The shifters (two or three) stand along the edge of the bed closest to the gurney and, using the techniques described above, lift the patient, turn him 90 ° and put him on the gurney.

When shifting a patient from a gurney to an operating or dressing table, it is also placed either parallel or perpendicular to the table. Usually the height of the wheelchair corresponds to the height of the table. In addition, the height of the latter, as a rule, can be adjusted. Therefore, the shifting method is more often used with the placement of the wheelchair parallel to the table. The staff is located along the table on the opposite side of the gurney. Hands are brought under the patient and, moving him towards himself, they put him on the table. You can put the wheelchair perpendicular to the table with the head end of the wheelchair to the foot end of the table. The patient is moved by two or three people from the wheelchair, turning 90 °, onto the table. Transferring a patient from a table to a gurney is usually carried out using the same techniques as when shifting from a bed to a gurney of the same height. The gurney is placed close to the table parallel to it. The shifters are arranged in such a way that the gurney is between them and the table where the patient lies. The patient is picked up under the head and torso and moved to a stretcher.

In the ward, the patient is transferred to the bed using one of the methods described above (with the wheelchair brought to the bed parallel to it or at an angle of 90 °). In the first case, the shifters are located along the free edge of the bed and move the patient from the wheelchair to themselves. In the second case, the patient is removed from the wheelchair and transferred to the bed with a 90° turn. In the intensive care unit, where the most seriously ill patients are transported, at least three people must transfer the patient from the gurney to the bed.

During transportation, it is necessary to constantly monitor the pulse rate, blood pressure, frequency and depth of breathing, the color of the skin, the state of consciousness of the patient, and exclude the possibility of injuring the patient.

Severely ill patients are often transported from the emergency room to the surgical room or from the operating room to the ward with an intravenous infusion system. Most often, the infusion is carried out in the veins of the upper limb. In order not to damage the wall of the vein during the movement of the limb, it must be immobilized with plywood or some other splint, for example, a ladder splint (Cramer splint). The infusion set must be supervised by a separate health worker during transport. He usually carries the infusate vial behind the patient, trying to avoid straining the tubes of the system.

When transporting a patient with an endotracheal tube, make sure that the latter is well fixed with an adhesive plaster or bandage to the patient’s head. In this case, the anesthesiologist supervises the transportation. He must have a portable ventilator at his disposal in case the patient stops breathing during transportation. If the transportation of a seriously ill patient or a patient after an operation that has just been performed under anesthesia requires the use of an elevator, medical workers need to be prepared for all sorts of accidents (unexpected stop of the elevator, etc.) that can be fatal for the patient. In the elevator, along with such patients, there should be an anesthesiologist who has everything necessary for resuscitation (a set of medicines, endotracheal tubes, a laryngoscope, a rotator expander, and a ventilator).

It is especially necessary to dwell on the transportation of patients with tubular drainages. Tubular drains are usually introduced during operations on the organs of the chest and abdominal cavities. The pleural cavity is most often drained in pneumothorax, hemopneumothorax, purulent pleurisy. Tubular drainages in the abdominal cavity are more often left after operations for peritonitis. During operations on the biliary system with the help of a tube, external drainage of the common bile duct is often performed. The main rule that must be observed when transporting a patient with drainage tubes is that the lumen of the latter must be necessarily blocked. This is usually achieved by placing clamps on the tubes. You can also bend the end of the tube and fix it in this position by tying the tube with a thread. Failure to comply with this rule can lead to contamination of the patient’s linen, gurney, floor of the surgical department with pus, blood, bile, and other biological fluids released through the drainage tubes, which is highly undesirable for hygienic reasons and carries the risk of spreading infection. If the drainage of the pleural cavity is not blocked, then air may be sucked into it, which brings direct harm to the patient and can negate the positive results achieved during his treatment. It is also necessary to carefully monitor that the drainage tubes do not stretch during the movement of the patient, do not fall under the patient’s body. It is extremely undesirable to accidentally remove the drains during transportation or during the transfer of the patient. So early removal of the tube from the common bile duct can lead to severe complications, sometimes requiring a second major operation.

Before transporting patients, the gurney is covered with a clean sheet or blanket. The sheet (duvet cover) is changed after each patient. The blanket is ventilated, and if contaminated with biological fluids, it is sent to a steam-formalin chamber for disinfection. At the entrance to the operating room, the wheels of the wheelchair are disinfected (double wiping with a solution of chloramine or another disinfectant) or wheelchairs with a removable stretcher are used.

After work, the gurney must be washed with a synthetic detergent and disinfected by wiping twice with a cloth moistened with a disinfectant solution.

CONTROL TESTS

1. Medical transportation is:

a) transportation of the patient to the place of first aid

b) transportation or carrying of the patient to the place of therapeutic measures

c) carrying the patient to the place of first aid or treatment

and diagnostic measures

d) transportation or carrying of the patient to the place of first aid or

performing therapeutic and diagnostic measures

e) transportation of the patient to the place of treatment

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

2. In the surgical department, the patient has to be transported:

a) in diagnostic rooms

b) in the dressing room

c) in the operating room

d) in the procedure room

d) all of the above are correct

Answer options: 1 a b, 2 b c d, 3 a d, 4 a c d, 5 e

3. Transportation of a surgical patient can be carried out:

a) on a stretcher

b) on a wheelchair

c) in a wheelchair

d) on a functional bed

d) all of the above are correct

Answer options: 1 a c d, 2 b c d, 3 a b d, 4 a b c, 5 e

4. How many people should carry a stretcher when transporting a patient?

a) 2 people.

b) 4 people.

c) 6 people.

d) 7 people.

e) 8 people.

Answer options: 1 a b, 2 c, 3 a c, 4 d, 5 e

5. When climbing stairs, the patient must be carried on a stretcher:

a) feet first

b) head first

c) in a horizontal position

d) with the head end of the stretcher lowered

e) no matter how to carry

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

6. What is a functional bed for?

a) to transport the patient

b) to reduce the patient’s pain

c) to give the patient a certain position

d) for the convenience of feeding the patient

e) for the prevention of postoperative purulent complications in a patient

Answer options: 1 a d, 2 b c, 3 av, 4 d e 5 a e

7. How many parts does a functional bed consist of?

a) from one

b) out of two

c) out of three

d) out of four

e) out of five

Answer options: 1 a, 2 b, 3 c, 4 d, 5 e

8. The most commonly used position of the patient on the functional bed

after operation:

a) on the side

b) on the back

c) on the stomach

d) with a raised foot end

e) “frog” position

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

9. Specify possible options for shifting a surgical patient in case of

its transportation within the medical institution:

a) from bed to operating table

b) from a wheelchair to a bed

c) from the operating table to the stretcher

d) from the wheelchair to the laboratory table

e) from the wheelchair to the operating table

Answer options: 1 b c e, 2 a c d e, 3 a b d e, 4 a b c e, 5 c d e

10. Transferring the patient from the bed to the wheelchair is carried out:

a) 2 people

b) 3 people

c) 4 people

d) 5 people

e) 6 people

Answer options: 1 a d, 2 a b, 3 d, 4 c d 5 c e

11. When shifting the patient from the wheelchair to the operating table, the staff

located:

a) along the wheelchair

b) at the ends of the wheelchair

c) between the table and the wheelchair

d) along the table

d) at the end of the table

Answer options: 1 a, 2 b, 3 c, 4 d, 5 e

12. When transferring a patient from a wheelchair to a bed, the staff is located:

a) along the wheelchair

b) between the bed and the gurney

c) along the bed

d) at the ends of the wheelchair

d) at the end of the bed

Answer options: 1 a, 2 b, 3 c, 4 d, 5 e

13. When transporting a surgical patient from the operating room

need to follow:

a) behind the patient’s mind

b) following the movement of the patient’s eyeballs

c) behind the swallowing movements of the patient

d) the patient’s pulse rate

e) for the work of the patient’s intestines

Answer options: 1 a b, 2 a d, 3 b c, 4 a c, 5 d e

14. The limb that is being infused into the vein during

transportation of a surgical patient, it is necessary:

a) lay on the stomach

b) hold on tight

c) bend at the elbow

d) immobilize with a splint

d) put aside

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

15. Tubular drains when transporting a surgical patient should be:

a) lifted up

b) lowered into a special container

c) blocked

d) connected to the suction

e) removed

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

16. Failure to comply with the rules for transporting surgical patients

with tubular drains can lead to:

a) to contamination of the wheelchair liquid released from the drains

b) to contamination of the patient’s linen released from the drains

c) to suction of air through the drainage introduced into the pleural cavity

d) to suction of air through the drainage introduced into the abdominal cavity

e) to accidental removal of drainage

Answer options: 1 a b c e, 2 a b d, 3 c d e, 4 a d e, 5 d e

17. When transporting a severe postoperative patient in an elevator

The anesthesiologist should have with him (name all that he should have):

a) a ventilator

b) mouth expander

c) a set of medicines

d) laryngoscope

e) endotracheal tubes

Answer options: 1 a b c, 2 a d e, 3 c d e, 4 b c d, 5 a b c d e

18. In the case of transporting a patient with an endotracheal tube, it must be:

a) delete

b) fix with adhesive tape

c) plug it with a special stopper

d) hem

d) hold hands

Answer options: 1 a, 2 b, 3 c, 4 d, 5 e

19. Before entering the operating room, the wheels of the wheelchair are wiped:

a) warm distilled water

b) alcohol

c) chloramine

d) halothane

e) chloroform

Answer options: 1 a, 2 b, 3 c, 4 d 5 e

20. The sheet that covers the gurney before transportation is changed:

a) after transportation of one patient

b) after transportation of two or three patients

c) at the end of the working day

d) three times a day

e) six times during the working day

Answer options: 1 a, 2 b, 3 c, 4 d, 5 e.

Chapter 11

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