Procedure Room

A clean procedure room with a table that elevates and an overhead surgical light that can be adjusted and focused gives the provider the best environment to carry out procedures. An adjustable and mobile mayo stand allows the most comfortable access to sterile trays and instruments during a procedure. Surgical instruments should be stored in sterile packs, ideally set up for specific procedures. Extra equipment may be in individual sterile packs and should be readily available. Check sterility date expiration for all packaged equipment.

Patients should be made comfortable for the procedure with use of an adjustable bed and pillows as needed. Open, supportive conversation with an empathetic approach encourages relaxation and reassurance before, during, and after the procedure. An assistant is helpful in setup and during the procedure and provides support for the patient during care. In children undergoing general surgery, a family-focused dialog and ongoing conversation were similar to using midazolam in reducing anxiety and speeding recovery (Kain et al., 2007).

Equipment

The most basic sterile pack for skin procedures contains a needle driver, Adson tissue forceps with teeth, iris or suture scissors, and a scalpel handle with blade. The instruments should comfortably fit the physician's hands.

There are three primary scalpel blade styles used in the outpatient setting. A #10 blade has a large, rounded cutting surface and may be used for longer, straight incisions on larger areas with thicker skin, such as the trunk or limbs. A #15 blade has a smaller, rounded cutting surface to allow more mobility and may be used on most skin procedures, particularly those with nonlinear incisions. A #11 blade has a pointed blade without a curve and is better used for paring superficial lesions, such as warts or calluses, or puncturing skin abscesses. The Adson forceps with teeth has one side with one tooth and the other side with two teeth. Less tissue trauma occurs using the single tooth on the external tissue while everting the skin edges or using a skin hook (Fig. 28-1).

Evert Skin Edges

Figure 28-1 Use of a skin hook to evert wound edge. This technique allows the operator to see the needle path, ensuring that the proper depth has been reached, and promotes eversion of the skin edges.

(From Lammers RL. Methods of wound closure. In Roberts JR, Hedges JR [eds]. Clinical Procedures in Emergency Medicine, 5th ed. Elsevier, Philadelphia, 2010.)

Figure 28-1 Use of a skin hook to evert wound edge. This technique allows the operator to see the needle path, ensuring that the proper depth has been reached, and promotes eversion of the skin edges.

(From Lammers RL. Methods of wound closure. In Roberts JR, Hedges JR [eds]. Clinical Procedures in Emergency Medicine, 5th ed. Elsevier, Philadelphia, 2010.)

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