WE ARE GOING TO BE VIDEOTAPING.
AS YOU CAN SEE WE'VE GOT LIGHTS AND WE'RE KIND OF BECOMING A LITTLE BIT MORE OF A PRODUCTION AROUND HERE.
ISN'T THIS WILD.
WE ARE TRYING TO MAKE DVD'S. WE TOLD YOU ABOUT THAT
AND SO WE ARE GETTING THOSE READY TO GO AND LIGHTING WAS KIND OF AN ISSUE
WHEN WE WENT TO CUT AND THEY WERE DARK AND SO
THE VIDEO TAPES WE DON'T LIKE TO REDO. WE WANT TO JUST DO THEM.
THEY ARE WHAT THEY ARE, AND MAKE THE DVD'S.
SO THAT MEANS IF YOU COME IN LATE WE WANT YOU TO NOT CROSS IN FRONT OF THE CAMERA
BECAUSE THIS IS THE REAL THING AND WE WANT TO DO AS MINIMAL OF EDITING AS POSSIBLE
SO IF YOU COULD HELP US OUT WITH THAT.
SO EVERYONE THAT COMES EARLY AND ON TIME IF YOU KIND OF START OUT AT THIS END
AND LEAVE LATE SEATS OVER HERE FOR OTHER PEOPLE, THAT WOULD BE REALLY HELPFUL.
THE OTHER THING WE REALLY NEED YOU TO DO THIS SEMESTER
AND BE REALLY CONSCIOUS OF IS TURN YOUR CELL PHONES OFF AND YOUR PAGERS.
THAT WON'T SOUND GOOD ON VIDEO TAPES AND WE HAVE A BIGGER THAN JUST US PROJECT.
WE WANT TO DISSEMINATE THEM AND WE HAVE A LARGER AUDIENCE THAT HAVE REQUESTED THE DVD'S,
SO THAT WILL HELP US A LOT IF YOU WOULD DO THAT.
WE ARE GOING TO DO ABOUT FOUR SKILLS TODAY AND ONE IS PASS-FAIL
AND THREE SKILLS. AND THEY ARE VERY SIMPLE.
WE START OUT AS USUAL HAND WASHING AND THIS TIME WE ARE GOING TO DO A TWO MINUTE SCRUB.
SO IN YOUR SKILLS KIT I GAVE YOU TWO BRUSHES THIS SEMESTER.
ONE BRUSH TO PRACTICE WITH AND ONE TO BRING BACK FOR WHEN YOU DO YOUR SKILLS.
AND THAT REMINDS ME. ON THE BACK OF YOUR MODULES -- LET'S TURN TO PAGE
SO YOU CAN SEE WHAT I AM TALKING ABOUT.
ON PAGE 11 IT SAYS WHAT SKILLS WE'RE GOING TO PERFORM, NUMBER F,
AND THEN ON G IT SAYS SUPPLIES REQUIRED FOR PERFORMANCE.
THOSE ARE SUPPLIES THAT YOU HAVE IN YOUR SKILLS KIT.
YOU HAVE TO BRING THOSE.
AND IF YOU DON'T BRING YOUR SUPPLIES FROM YOUR SKILLS KIT, THEN IT'S AN UNEXCUSED LATE.
YOU HAVE TO HAVE THEM, I DON'T HAVE ENOUGH SUPPLIES FOR EVERYBODY
AND I CAN'T SELL YOU MINE BECAUSE I DON'T EVEN KNOW THE PRICE COS I BUY IN BULK.
SO YOU HAVE TO BRING YOUR OWN STUFF.
SO MAKE SURE YOU CHECK THAT LIST.
YOU'RE GOING TO HAVE THESE COOL LITTLE BAGS.
THEY ARE BLUE AND RED AND THEY ARE NOT BAD LOOKING AT ALL.
SO YOU CAN CARRY THAT AND THAT WAY ARE ALWAYS SAFE AND YOU HAVE ALL YOUR STUFF,
BUT IF YOU CAN'T DEAL WITH THAT,
JUST STICK IN WHAT YOU NEED AND BRING JUST THE SUPPLIES THAT YOU NEED EACH WEEK,
BUT MAKE SURE YOU HAVE THEM.
ALRIGHT, I AM GOING TO MOVE BACK TO THE BACK SINK, SO KIND OF SHIFT AROUND AND WE WILL DO OUR LITTLE...
OKAY. WE ARE GOING TO DO A TWO MINUTE SCRUB
AND WHERE YOU'RE GOING TO USE THIS TWO MINUTE SCRUB ARE IN CLEAN AREAS
PARTICULARLY IN THE NEW-BORN NURSERY THEY MAKE YOU SCRUB
AND SOME OF YOUR ICU'S THEY MAKE YOU SCRUB
AND SOME OF YOUR CANCER UNITS THEY MAKE YOU SCRUB.
WHERE IMMUNE SYSTEMS ARE LOW AND YOU NEED TO DO MORE THAN JUST YOUR LITTLE 10 SECOND HANDWASH.
SO WHAT I AM TEACHING YOU IS NOT A SURGICAL SCRUB BECAUSE THAT'S A FIVE MINUTE SCRUB.
THAT THEY WILL TEACH YOU IN SURGICAL.
SO YOU CAN'T DO THIS LITTLE TWO MINUTE SCRUB AND RUN IN AND ASSIST WITH SURGERY.
BUT IT IS BASICALLY THE SAME TECHNIQUE THEY WILL TEACH YOU IN SURGERY,
JUST LONGER THAN WHAT WE'RE GOING TO DO.
TWO MINUTES IS WHAT'S ADEQUATE.
WHEN YOU DO SOME OF YOUR READING, YOU'RE GOING TO SEE IN THE READING
THAT IT SAYS THEY'VE APPROVED THE ALCOHOL RUBS FOR A SURGERY.
AND THAT IS TRUE, BUT WHAT I DID IS CALL SOME OF THE SURGERY CENTERS HERE IN TOWN
TO SEE WHAT THE PRACTICE IS WITHIN THE COMMUNITY
AS FAR AS USING ALCOHOL VERSUS SCRUB BRUSH IN THOSE AREAS.
AND WHAT THEY'RE DOING, THE AORN, WHICH IS THE ASSOCIATION OF OPERATING ROOM NURSES
DOES NOT APPROVE THE ALCOHOL RUB OR RECOMMEND THE ALCOHOL RUBS AS THE ONLY CLEANSER.
THEY ARE STILL RECOMMENDING A FIVE MINUTE SCRUB AND THEN THE ALCOHOL GELS BETWEEN SCRUBS,
SO THAT YOU'RE GETTING THE ANTI-BACTERIAL, BUT THEY WANT THAT FRICTION
AND THEY WANT THE SCRUB AS WELL.
SO WHAT THEY ARE USING IS THE BETADINE SCRUB OR HIBICLEN SCRUB IF YOU'RE ALLERGIC TO IT
AT LEAST AT FRESNO AND A COUPLE OF THE OTHER INSTITUTIONS ARE USING CHLORHEXIDINE,
INSTEAD OF THE BETADINE.
BUT STILL USING THE BRUSH AND STILL SCRUBBING FOR THE ALLOTTED AMOUNT OF TIME.
JUST BECAUSE IT'S CHEAP I GAVE YOU BETADINE SCRUB BRUSHES AND HOPEFULLY THERE IS NO ISSUE,
BUT IF THERE IS I DO HAVE SOME PLAIN ONES, THEN WE CAN DO.
SO, BUT IT WILL GET THE JOB DONE.
BETADINE, STAINS AS YOU KNOW,
SO I WOULDN'T BE PRACTICING THIS AT HOME IN YOUR BEST OUTFIT
OR ANYTHING BECAUSE IF IT SPLASHES, OOH, WHAT A MESS.
ALRIGHT, YOU'RE GOING TO HAVE A LITTLE SCRUB BRUSH LIKE THIS
AND THE TECHNIQUE IS VERY SIMILAR TO A PLAIN HAND WASH
IN THAT YOU'RE GOING TO STAND AWAY FROM THE SINK.
YOU'RE GOING TO MAKE SURE YOUR PAPER TOWELS ARE READY AND HAVE ALL YOUR SUPPLIES TOGETHER.
MAKE SURE YOU HAVE A TRASH CAN AVAILABLE
BECAUSE YOU DON'T WANT TO BE PULLING THAT OUT WITH YOUR ALREADY CLEAN HANDS.
IF YOU FORGET, GRAB SOMETHING TO BE A BARRIER TO REACH IN FOR YOUR TRASH
OR JUST THROW 'EM ON THE COUNTER UNTIL YOU CAN GET TO WHAT YOU NEED AS FAR AS DISPOSAL.
ALRIGHT, SO I AM GOING TO GET MY WATER RUNNING.
OPEN UP MY BETADINE SCRUB BRUSH
AND INSIDE IS NOT AN ORANGE STICK BUT A FINGERNAIL FILE TO GET THAT KIND OF THING DONE.
SO WHAT I WANT TO DO IS I WANT TO WET MY HANDS
AND I AM GOING TO LEAVE MY HANDS THIS TIME WITH FINGERTIPS POINTED UP.
BECAUSE I AM GOING TO CLEAN ALL THE WAY TO ELBOW,
AND SO YOU DON'T WANT DRIPPING DOWN FROM YOUR ELBOW, DIRT,
YOU WANT IT DRIPPING TO YOUR ELBOW.
SO YOU WANT WHAT'S CLEANEST TO BE DRIPPING TO WHAT'S DIRTIEST.
THE FIRST THING I WANT TO DO IS I WANT TO CLEAN UNDERNEATH ALL MY FINGERNAILS WITH THIS,
EVEN THOUGH THEY DON'T APPEAR TO BE VERY DIRTY.
MY FINGERNAILS AS YOU CAN SEE ARE NOT MY NICE TIPS AS OF LAST SEMESTER.
NATURAL NAIL IS STILL RECOMMENDED.
THEY WON'T LET YOU IN THE SURGERY WITH THE ACRYLIC, FAKE NAILS OR FINGERNAIL POLISH.
IT HAS TO GO. YOU HAVE TO HAVE NATURAL NAILS.
I LIKE TO POKE MINE, JUST TO GET IT ALL GOING HERE.
ONCE YOU HAVE YOUR FINGERNAILS DONE,
YOU WANT TO TAKE YOUR SCRUB BRUSH, SQUEEZE IT. IT'S WET.
AND YOU WANT TO TAKE YOUR FINGERNAILS --
WE ARE GOING TO START FROM FINGERTIPS DOWN
AND WE ARE GOING TO DO 15 BRUSHES ACROSS YOUR FINGERNAILS.
SO 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.
I DIDN'T GET MY THUMBS VERY GOOD,
SO I AM GOING TO TAKE IT OVER AND I AM GOING TO SCRUB MY THUMB OUT.
SO I DID ALL OF THEM AT THE SAME TIME AS FAR AS MY FOUR FINGERS.
SO I JUST COULDN'T GET MY THUMB. I DIDN'T FEEL IT GOING IN HERE.
SO I AM GOING TO DO THAT AND SWITCH AND DO THESE.
YOU DO BOTH HANDS EQUALLY.
YOU DON'T DO ONE TO ELBOW AND THEN TAKE THAT DIRTY SCRUB BRUSH
AND GO BACK TO YOUR FINGERTIPS AND COME ON DOWN.
ALRIGHT, WHEN YOU'RE DOING YOUR HANDS WHAT YOU WANT TO DO IS
YOU WANT TO CONSIDER YOUR HANDS OR YOUR FINGERS --
I'M GOING TO TURN THAT OFF JUST SO YOU CAN HEAR BETTER.
AS FOUR SURFACES.
THE BACKSIDE IS ONE SURFACE.
THIS SIDE IS ONE SURFACE.
THE PALM OF YOUR HAND IS ONE SURFACE AND THE INSIDE OF YOUR FINGER IS ONE SURFACE.
EACH SURFACE OF YOUR FINGER MUST BE SCRUBBED 10 TIMES.
OKAY. SO EACH WHITE COUNTS AS ONE. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
AND THEN YOU KEEP GOING. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 AND YOU SCRUB ALONG.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 AND SO FORTH.
YOU JUST KEEP GOING.
YOU WANT TO MAKE SURE WHEN YOU HAVE GONE BETWEEN YOUR FINGERS --
I'M JUST GOING TO BETWEEN ALL OF THEM AND THEN HIT MY PALMS HERE.
THAT YOU GET DOWN INTO THE WEBBING.
YOU DON'T WANT TO MISS THE WEBS OF YOUR FINGERS.
IT WAS INTERESTING, YESTERDAY, I DID MY SCRUB WITH MY GLO GERM
AND I MISSED THE WEBBING BETWEEN ONE FINGER.
I MEAN, YOU FEEL LIKE YOU'RE DOING EVERYTHING,
BUT YOU WANT TO MAKE SURE THAT YOU HAVE DONE IT.
SO I AM GETTING THE BACK SURFACE OF MY HAND AND THEN I AM GOING TO HIT MY HAND WITH THE 10,
HIT MY WEBBING WITH THE 10.
ISN'T THIS EXCITING?
AND MY PALM, 10.
AND THIS SIDE OF SURFACE ON MY HAND, 10.
SWITCH OVER TO MY OTHER HAND AND IT'S THE SAME THING.
MORE SURFACES.
SHOULD HAVE HAD SOMEONE TIME ME
TO SEE IF I AM GOING INTO THE 5 MINUTE OR STAYING INTO THE 2 MINUTE.
IT'S MESSY. I'M JUST PLOPPING BEDADINE ALL OVER THE PLACE OVER HERE.
SO, AGAIN I AM JUST TRYING TO STAND BACK AND AWAY SO I DON'T GET ANYTHING ON ME.
MY FINGERTIPS ARE PLUS 10.
YOU GOT TO GET THAT WATER WARMED UP.
MY BACK SURFACE, 10.
WEBBING. MY THUMB.
I WANT TO GET THOSE NAIL BEDS GOOD...AND THE BACK SIDE OF MY HAND.
ALRIGHT, NOW YOU'RE GOING TO HIT THE WRIST. SAME THING FOR SURFACES.
YOU CAN COME ON DOWN.
WE'RE NOT GOING TO GO ALL THE WAY TO THE ELBOWS, BUT JUST KIND OF MID-ARM.
AND I JUST NEED A LITTLE WATER HERE.
OKAY. I AM DONE.
YOU CAN TOSS IT IN THE SINK. YOU CAN TOSS IT OUT.
YOU'RE GOING TO RINSE FROM FINGERTIPS...DOWN.
AND I AM RUBBING TOGETHER HERE BECAUSE I CAN SEE YELLOW ON MY HANDS.
TRY NOT TO TOUCH ANYTHING BECAUSE IF YOU DO, YOU GOT TO DO IT OVER.
OKAY, SO SEE THE DRIP FROM THE ELBOWS.
GET YOUR PAPER TOWELS AS BEST AS YOU CAN
AND YOU CLEAN FROM FINGERTIPS DOWN, SO THAT YOU'RE NOT SCRUBBING UP.
MORE.
TO THE ELBOW AND YOU'RE DONE.
OKAY.
ANY QUESTIONS?
- THE WEBBING WE DO TEN TIMES.
- UH-HUH.
- YEAH. - OH, SO IT'S THE SIDES OF THE FINGERS, THE WEBBING.
- UH- HUH. YEAH.
I THINK I -- DID I HIT THEM ALL?
I DON'T KNOW. IT FELT LIKE I DID.
JUST KEEP GOING, EVERYTHING COUNTS, EVERY SURFACE COUNTS.
SO THINK OF IT, FOUR SURFACES.
OKAY.
YOU'LL LOVE THIS ONE.
OUR WHOLE FOCUS THIS TIME IS STERILITY
AND WE ARE NOT REALLY GOING TO -- WE ARE GOING TO DO ONE STERILE PROCEDURE,
BUT I WANT TO TEACH YOU THREE DIFFERENT KINDS OF STERILE FIELD SETUPS.
SO THAT YOU CAN BE TALKED THROUGH A STERILE PROCEDURE BY ONE OF YOUR PRECEPTORS.
WE CAN'T DO EVERYTHING FIRST WEEK. THEY WANT YOU TO KNOW EVERYTHING.
SO WE ARE GOING TO DO OUR STERILE TECHNIQUE
AND IF THEY WANT TO COACH YOU THROUGH SOME KIND OF PROCEDURE,
YOU'LL AT LEAST KNOW THE PRINCIPLES OF STERILITY
AND YOU WON'T CONTAMINATE ANY OF YOUR SETUPS, SO THAT WILL HELP YOU.
ALRIGHT, THE FIRST THING THAT I WANT YOU TO DO -- IT'S JUST PASS-FAIL.
I JUST WANT YOU TO KNOW THE APPROPRIATE TECHNIQUE FOR OPENING UP A STERILE KIT.
THERE IS A LOT OF PRE-PACKAGED STERILE KITS FOR DOING VARIOUS THINGS.
YOU'RE GOING TO SEE THAT YOU HAVE THE FOLEY CATHETER KIT, THE TRADE CARE KIT.
AND ALL THE SUPPLIES YOU NEED ARE IN THE KIT. IT'S WONDERFUL.
YOU JUST GRAB IT AND GO, RATHER THAN HAVING TO COLLECT ALL THESE VARIOUS ITEMS.
YOU NEED TO HANDLE THE THINGS INSIDE IT SO THAT THEY MAY MAINTAIN THEIR STERILITY.
WHENEVER YOU'RE WORKING IN A STERILE ENVIRONMENT,
YOU NEED TO MAKE SURE THAT THE WORKING AREA AND THE SURFACE THAT YOU'RE WORKING ON IS CLEAN.
SO MAKE SURE THAT THERE IS NO WETNESS THERE.
IF YOU NEED TO CLEAN IT OFF BECAUSE SOMEONE'S EATEN
AND YOU'RE CONCERNED ABOUT THAT,
THEN MAKE SURE THAT YOUR SURFACE IS CLEAN AND DRY.
BECAUSE IF WETNESS LEECHES UP THROUGH YOUR STERILE FIELD,
THEN THE FIELD IS CONSIDERED CONTAMINATED.
YOU CAN'T HAVE WET IN YOUR STERILE FIELD.
IN A KIT YOU HAVE AN OUTSIDE WRAPPER.
THIS IS A PLASTIC WRAPPER AND THAT PROTECTS IT.
MOST OF THE TIME, THEY HAVE A DATE ON IT FOR BEING STERILIZED
AND SO WANT TO MAKE SURE ABOUT THE DATE OF YOUR KIT.
ALL OF MINE ARE EXPIRED AS YOU CAN TELL.
JUST MAKE SURE YOU LOOK AND SEE WHAT THE DATE IS.
THIS ONE'S BEEN USED BEFORE, BUT ON YOUR KIT IT SAYS RIGHT HERE, GRASP.
YOU PEEL THE TOP PIECE OFF SO THAT IT OPENS UP. SO YOU HAVE AN OPEN KIT.
EVERYTHING INSIDE THIS KIT IS STERILE, SO WHEN I REACH IN WITH MY NON-STERILE HANDS
WHAT I TOUCHED IS NOT STERILE ANY MORE.
ALRIGHT, I AM GOING TO SET THIS DOWN.
I LOVE KITS BECAUSE YOU HAVE THIS AUTOMATIC LITTLE TRASH BAG, BUILT IN.
SO REMEMBER THAT. THAT'S THE ONE ITEM I TEND TO FORGET IF I HAVE TO GRAB A TRASH BAG.
BECAUSE I AM USED TO HAVING IT WITH MY KITS THAT I'M KIND OF SPOILT. SO I FORGET.
SO CUP THEM UP. THEY WILL SIT RIGHT UP FOR YOU
AND YOU'LL HAVE A TRASH BAG RIGHT READY FOR DRESSINGS AND THAT KIND OF THING.
ON YOUR KITS, YOU'LL NOTICE THAT THERE IS A TOP FLAP THAT'S THERE.
YOU WANT TO TURN YOUR KIT SO THAT THE FLAP IS AWAY FROM YOU.
SO THAT YOU, WHEN YOU OPEN IT UP,
AND YOU TAKE YOUR CONTAMINATED ARM ACROSS THE FIELD,
YOU'RE NOT CROSSING OVER WHAT'S GOING TO BE STERILE.
SO I AM GOING TO GRAB THE FLAP AND GO AWAY FROM ME
AND I AM CONSIDERED NON-STERILE OVER A STERILE.
BUT I STILL HAVE TWO FLAPS THAT ARE PROTECTING THE INSIDE INTEGRITY OF THIS PACKAGE,
SO NOW I AM GOING TO GRAB THESE OUTER FLAPS AND PULL THEM AWAY.
THEN I HAVE ONE LITTLE FLAP HERE THAT COMES TOWARDS ME.
THE LAST FLAP IS ALWAYS TOWARDS YOU.
THAT'S HOW YOU OPEN A KIT. EVERYTHING INSIDE THERE IS STERILE.
AND YOU'RE GOING TO HANDLE IT WITH STERILE GLOVES. OKAY, THAT'S HOW YOU OPEN A KIT.
JUST AS INSTRUCTION RELATED TO YOUR STERILE FIELDS,
THERE ARE SOME BASIC RULES ABOUT STERILE FIELDS.
YOU CAN TELL THAT MY STERILE FIELD ISN'T ON A STERILE TABLE.
SO WE NEED TO CONSIDER EVERYTHING THAT FALLS BELOW THE TABLE NON-STERILE
AND ONE INCH AROUND EVERYTHING ON THE TABLE AS NON-STERILE.
BECAUSE WE DON'T KNOW WHAT'S GETTING ON FROM THE EDGE OF THE TABLE
AND SO YOU WANT TO BE PROTECTED THERE.
SO ANYTHING THAT FALLS WITHIN THAT ONE INCH BORDER OF THE EDGE, YOU CAN'T USE AS STERILE.
IT'S CONSIDERED CLEAN.
ALRIGHT, ALL YOU HAVE TO DO FOR PARTICULAR DRILL IS OPEN THE KIT.
NOT TOO BAD, HUH?
OKAY.
YOU DON'T NEED IT AGAIN, DO YOU? THINK YOU GOT IT? OKAY.
SO IT WILL LOOK LIKE THIS FOR YOU.
OPEN AWAY, OPEN THERE, OPEN THERE.
OKAY, THAT'S IT. FOLD IT BACK UP FOR THE NEXT GUY.
I WANTED YOU TO HAVE A REALLY NICE FIRST WEEK.
YEAH?
- SO PASS-FAIL? - PASS-FAIL.
- IS THERE...
- NO, THAT'S ANOTHER ONE.
YEAH.
REAL FUN. IT SHOULD BE PASS-FAIL.
- THIRD ONE. - THIRD ONE.
HERE COMES 16 POINTS.
OKAY. THAT'S ONE STERILE FIELD, A PRE- PACKAGED KIT.
THEY ALSO MAKE PRE-PACKAGE KITS IN LINEN WRAP.
AND YOU SEE THOSE VERY OFTEN IN SURGERY.
A LINEN WRAP IS LIKE A TOWEL WRAP THAT'S PUT IN AN AUTOCLAVE.
IT HAS TAPE AROUND IT JUST TO HOLD IT
AND YOU KNOW THAT IT'S BEEN STERILIZED IF THE TAPE HAS BLACK STRIPES ON IT.
THAT MEANS IT'S GONE THROUGH THE AUTOCLAVE, IT'S BEEN ACTIVATED AND THE CONTENTS ARE STERILE.
HOWEVER, IT'S DIFFERENT THAN A PLASTIC CONTAINER,
THINGS CAN POKE THROUGH AND PERFORATE INTO THE LINEN, INTO CLOTH,
WHERE THEY CAN'T INTO PLASTIC. SO YOU HAVE TO PROTECT THEM.
IF THEY ARE DROPPED YOU HAVE TO DISCARD THEM.
IF THERE IS ANY WETNESS THAT'S GOTTEN ON THEM,
THEY ARE AUTOMATICALLY CONSIDERED CONTAMINATED
BECAUSE WE DON'T KNOW HOW DEEP THE WATER'S GONE
AND IF THEY ARE CONTAMINATED OR NOT, TO OUR STERILE SUPPLIES.
SO THEY ARE HANDLED A LITTLE BIT DIFFERENTLY.
THEY MUST STAY ABOVE WAIST AND SO FORTH.
I AM GOING TO TALK ABOUT SOME OF THOSE PRINCIPLES HERE IN A SECOND.
OKAY, THE NEXT THING WE ARE GOING TO DO IS STERILE GLOVING
AND WE ARE GOING TO SET UP A STERILE FIELD.
WE ARE GOING TO CREATE A STERILE FIELD WITH SOMETHING THAT IS NOT A PRE-PACKAGED KIT.
FOR EXAMPLE, IF SOMEONE NEEDS A DRESSING CHANGE
AND YOU NEED TO GATHER ALL KINDS OF WEIRD THINGS.
THAT MAYBE YOU HAVE TO PACK IT WITH THREE OR FOUR GAUZE
AND THEN YOU HAVE TO LAY OVER A COUPLE MORE DIFFERENT KINDS OF GAUZE
AND THEN A BIG, FAT, SURGICAL PAD AND ALL KINDS OF STUFF
AND YOU NEED IT TO ALL TO BE STERILE.
AND THAT'S NOT GOING TO COME IN A KIT, SO YOU'RE GOING HAVE TO GATHER IT UP.
SO HOW DO YOU SET UP A STERILE FIELD SO THAT THEY GET A STERILE DRESSING?
YOU'RE GOING TO HAVE IN YOUR KIT A STERILE DRAPE.
IN YOUR KITS -- I WANT YOU TO OPEN UP EVERYTHING AND PRACTICE WITH EVERYTHING.
TOUCH IT. WORK WITH IT.
THAT'S THE WHOLE IDEA, REALLY.
THIS WHOLE WEEK'S WORTH OF DRILLS YOU CAN PRACTICE AT HOME.
YOU HAVE EVERYTHING AND SO YOU CAN WORK WITH IT.
THEN WHAT YOU'LL DO IS YOU'LL JUST FOLD IT BACK UP AND PRETEND IT'S STERILE AGAIN.
SO, DRAMA CLASS, BUT AT LEAST YOU GET THE IDEA OF HOW IT WORKS.
OKAY, SO YOU'RE GOING TO GATHER UP A STERILE FIELD
AND THEN WHAT I AM GOING TO HAVE YOU DO IS PUT A FOUR BY FOUR ON THERE.
WE ARE ONLY GOING TO DO ONE THING, SO THAT YOU'RE LEARNING PRINCIPLE.
WE DON'T HAVE A DRESSING TO CHANGE IT THIS PARTICULAR WEEK.
AND THEN WE ARE GOING TO PUT ON STERILE GLOVES, REACH IN TO OUR STERILE FIELD
AND YOU'RE GOING TO HAND YOUR INSTRUCTOR A STERILE FOUR BY FOUR.
THAT'S HOW YOU PASS. YOU'LL SEE THAT THERE IS A LOT OF ASTERISKS ON THIS ONE.
THAT'S IT. IT MAYBE THE WHOLE THING BECAUSE IF AT ANY POINT IT'S CONTAMINATED
THEN IT'S NOT STERILE ANY MORE AND THAT'S THE WHOLE POINT.
ALRIGHT, JUST SET UP YOUR STERILE FIELDS.
BUT THE THING YOU GOT TO DO IS OPEN UP THE PACKAGE.
THERE IS A TOP OF THE PACKAGE -- WE TALKED A LITTLE BIT ABOUT THIS
WHEN YOU DID THE DRESSINGS BEFORE WHEN WE DID OUR NO-TOUCH TECHNIQUE.
WE ARE GOING TO OPEN IT UP THE SAME.
YOU WANT TO PEEL IT OPEN...
AND THEN STRETCH IT DOWN.
ALRIGHT, EVERYTHING INSIDE THAT PACKAGE IS STERILE.
SO THEORETICALLY, I HAVE A STERILE FIELD INSIDE MY PACKAGE.
SO IF YOU'RE NEEDING A LITTLE MORE SPACE
OR YOU JUST WANT TO PUT SOMETHING ON THERE, USE YOUR PACKAGE.
SOMETIMES, I DON'T NEED ALL THAT AND IT'S IN THE WAY AND I WILL TOSS IT OUT.
INSIDE THAT STERILE PACKAGE IS MY DRAPE
AND I AM LOOKING FOR AN EDGE WITH WHICH I CAN PICK THIS UP, BUT I CAN'T SEE IT.
IT'S ON THE OTHER SIDE, AND YOU PROBABLY CAN SEE IT.
SO I AM GOING TO CLOSE THIS, FLIP IT OVER AND THERE IT IS.
OKAY?
WHAT I WANT TO DO IS I WANT TO GRAB A CORNER OF THIS,
THE EDGE OF THE DRAPE BECAUSE WHAT'S THE RULE ABOUT A STERILE FIELD? WHAT'S CONTAMINATED?
- ONE INCH BORDER.
SO I CAN TOUCH A CORNER WITHIN THE ONE INCH BORDER.
SO I AM GOING TO REACH IN...
AND PULL WAY UP.
NOTICE I AM NOT DRAGGING ON HERE BECAUSE THEN WHAT IS IT?
CONTAMINATED.
SO SINCE IT'S DRAMA CLASS, WE'RE BACK ON HERE GOING OOPS.
OKAY, IT'S ALL STERILE.
I AM GOING TO GRAB FROM THE TOP KEEPING IT NICE AND HIGH ABOVE MY WAIST
AND IN MY SIGHT AND I AM GOING TO OPEN THIS THING UP.
RIGHT NOW I'M GOING TO OPEN UP --
THE NEW ONES ARE ALWAYS SO VERY STICKY.
I AM NOT HAVING VERY GOOD LUCK.
WELL, OKAY.
I HAVE A COUPLE OF OPTIONS HERE, IT'S NOT OPENING.
I KNOW THE RULE OF MY STERILE FIELD IS EVERYTHING THAT FALLS BELOW THE FIELD
I MEAN, BELOW THE TABLETOP IS CONTAMINATED, RIGHT?
SO I CAN SWEEP THIS OUT AND JUST LET IT FALL
AND I WILL DEAL WITH IT AND JUST HAVE A LITTLE SHORT FIELD,
OR I CAN ROTATE,
NOT TO BE OUTDONE BY A PIECE OF PAPER, AND GET THE CORNER.
SEE WHAT I AM DOING?
NOTHING IS EVER CONTAMINATED, SO I CAN ROTATE AROUND.
NOW, I NEED TO THROW THIS OUT LIKE THIS AND DROP IT DOWN LIKE THIS.
SO THAT THAT WHOLE SURFACE IS CONSIDERED STERILE AND I HAVE ONLY TOUCHED ONE INCH CORNERS.
WHAT WOULD HAPPEN IF I WENT LIKE THIS?
WHAT RULE HAVE I BROKEN?
- YOU'VE CROSSED OVER. - I HAVE CROSSED OVER.
SO WHEN YOU PULL UP. YOU THROW OUT AND DOWN, SO THAT YOU'RE NOT CROSSING OVER YOUR FIELD
BECAUSE YOU'RE CONTAMINATED.
OKAY, THERE IS ONE OTHER TECHNIQUE I WANT TO SHOW YOU BEFORE WE GO ON
AND IT'S JUST THE SIMPLE UNFOLD TECHNIQUE, WHICH WORKS JUST AS WELL.
BUT WE ARE GOING TO DO THE PULL UP TECHNIQUE.
YOU COULD PULL THIS AND UNFOLD THIS, RATHER THAN SWEEP IT.
BUT THE THING I DON'T LIKE ABOUT WHAT HAPPENS WHEN YOU UNFOLD
AND I DON'T KNOW IF YOU COULD APPRECIATE IT, BUT THIS EDGE TOUCHED DOWN
AND THEN THIS EDGE AND CAME BACK UP AND TOUCHED THE INSIDES.
SO WHAT'S CONSIDERED ONE INCH CONTAMINATED
ACTUALLY TOUCHED INTO WHAT'S SUPPOSED TO BE STERILE.
IT DIDN'T STAY FLAT.
SO WHEN I PULL UP I HAVE A BETTER CHANCE OF IT NEVER TOUCHING.
OKAY, MY FIELD IS DOWN.
I AM STILL NOT STERILE, RIGHT?
I AM JUST A HAND WASHED PERSON.
BUT I NEED TO GET MORE STERILE SUPPLIES ON THERE,
SO I AM GOING TO OPEN UP MY FOUR BY FOUR, JUST LIKE WE DID BEFORE.
PEEL IT APART.
NO. I DON'T LIKE HOW THAT OPENED BECAUSE IT RIPPED.
AND IT RIPPED THROUGH AND IT'S TOUCHING INTO MY GAUZE.
NO GOOD. ALWAYS BRING EXTRA WHEN WE ARE DOING STERILE TECHNIQUE.
THERE ARE EIGHT MILLION WAYS TO CONTAMINATE A STERILE FIELD OR STERILE SUPPLIES
AND YOU NEED TO BE PREPARED FOR THAT. IT HAPPENS. ALWAYS TAKE EXTRA.
SO I AM GOING TO RE-PEEL. AND SOMETIMES I KIND OF SHIMMY IT.
I THINK YOU SAW ME DO THAT AND I AM GOING TO PEEL IT APART AGAIN.
TRY NOT TO RIP THAT THING.
BEAUTIFUL.
OKAY, NOW I NEED TO GET THIS ON TO THAT FIELD WITHOUT CROSSING OVER OR CROSSING IN.
SO I AM GOING TO TOSS IN LIKE THIS, RATHER THAN LIKE THIS.
SEE THE DIFFERENCE?
BECAUSE IT GOES IN.
NOW INTERESTING THINGS HAPPEN WHEN YOU THROW FOUR BY FOURS ONTO FIELDS.
OH, LOTS OF INTERESTING THINGS HAPPEN.
BRING EXTRA.
THEY GO FLYING OR I AM STARTING TO RUN OUT OF SUPPLIES.
WHEN YOU DO IT -- I DON'T KNOW IF I CAN DO THIS IF I PLAN IT...
WHAT HAPPENS IF IT LANDS LIKE THAT?
NO GOOD. WHAT ARE YOU GOING TO DO WITH THAT ONE?
- LEAVE IT. - LEAVE IT.
BECAUSE WHAT IS THE TOP OF IT?
STERILE. JUST EXTENDS YOUR STERILE FIELD.
YOU JUST CAN'T USE THAT ONE FOR YOUR DRESSING
BECAUSE THE BOTTOM SURFACE IS CONTAMINATED, OKAY?
ALRIGHT, SO I HAVE MY STERILE FIELD, I HAVE MY ONE GAUZE THAT I NEED
AND IT WOULD BE SILLY TO SET UP A WHOLE FILED FOR ONE GAUZE
BECAUSE ALL YOU NEED TO DO IS OPEN A PACKAGE. BUT YOU GET THE IDEA.
YOU WOULD BE TOSSING ON ALL THE STUFF THAT YOU NEED FOR WHATEVER YOU'RE PLANNING TO DO.
OKAY.
IF I NEED TO MOVE THINGS, I CAN COME UNDERNEATH.
I CAN MOVE AROUND.
I CAN DO -- ABOUT THAT'S IT.
THERE IS NOT A LOT YOU CAN DO WITH THE STERILE FIELD IF YOU NEED TO MAKE AN ADJUSTMENT.
ALWAYS WORK FROM UNDERNEATH. ALWAYS WORK FROM AN EDGE OR GO TO THE OTHER SIDE.
DON'T REACH AROUND TO CHANGE THINGS.
IF IT GOT WET YOU WOULD HAVE TO REMOVE IT.
AND THE OTHER RULE ABOUT A STERILE FIELD IS THEY WANT IT TO BE ABOUT WAIST HIGH.
THEY DON'T WANT IT TO BE LOW -- THEY, WHOEVER WRITES THE STERILE FIELD RULES.
BELOW YOUR WAIST AND IT HAS TO STAY WITHIN YOUR SIGHT.
THIS IS NO LONGER STERILE.
COS SCOTTY COULD HAVE JUMPED UP AND THROWN SOMETHING ON THERE AND I DIDN'T KNOW.
BY THE SAME TOKEN MOST OF US DON'T SABOTAGE EACH OTHER'S FIELDS,
BUT THINGS CAN FALL OUT OF THE AIR VENTS AND YOU DON'T KNOW, UNLESS YOU'VE GOT AN EYE ON IT.
SO AND YOU DON'T HAVE TO BE LIKE THIS, BUT IT HAS TO BE LIKE THIS.
I MEAN WHEN YOU WORK, IT HAS TO BE IN YOUR PERIPHERY.
SO THAT YOU KNOW WHAT'S HAPPENING AND YOU CAN PROTECT THE INTEGRITY OF THAT FIELD.
RIGHT, BEFORE I CAN GET ANYTHING OUT OF THAT FIELD I NEED TO PUT ON STERILE GLOVES.
SO TO PUT ON STERILE GLOVES. I AM GOING TO OPEN THEM UP, JUST LIKE BEFORE.
DOESN'T MATTER IF THIS IS RIPPED.
CAN'T REALLY USE IT FOR A FIELD.
BECAUSE WHAT I AM LOOKING FOR IS THE INSIDE PACKAGE THAT NEEDS TO BE STERILE.
ALRIGHT, YOU'RE GOING TO GET THREE PAIRS OF STERILE GLOVES WHEN YOU BUY YOUR KITS.
YOU NEED TO KNOW YOUR SIZE FOR YOUR STERILE GLOVES.
THEY COME IN SIZES, NOT SMALL, MEDIUM AND LARGE.
THEY COME IN REAL SIZES LIKE SIX AND A HALF, SEVEN, SEVEN AND A HALF,
EIGHT, EIGHT AND A HALF, NINE. I WOULD RECOMMEND --
WE ARE GOING TO PUT SOME OUT FOR YOU TO TRY ON SO THAT YOU CAN GUESS YOUR SIZE.
DON'T TRY TO GET THE PERFECT SNUG FIT
BECAUSE YOU'RE GOING TO REUSING THESE GLOVES OVER AND OVER,
THROUGHOUT THIS SEMESTER FOR OUR DRAMA CLASS.
YOU'RE GOING TO PRACTICE AND THEN YOU'RE GOING TO USE THEM AGAIN.
YOU WANT THEM A LITTLE BIT BIGGER SO THAT YOU CAN GET THEM ON AND OFF.
YOUR HANDS ARE GOING TO GET SWEATY WHEN YOU'RE NERVOUS IN TESTING.
AND WHEN THEY ARE TOO TIGHT, OH, IT'S HORRIBLE.
LET ME HELP YOU WITH YOUR SIZES.
IF YOU NORMALLY WEAR SMALL GLOVES, THE NON-STERILE GLOVES
THAN YOU'RE GOING TO BE LOOKING AT SIZES SIX AND A HALF, SEVEN, MOST NORMALLY.
I WEAR A SNUG. I LIKE SMALL GLOVES AND SEVEN IS MY BEST SIZE.
SO SEVEN AND A HALF IS WHAT YOU SHOULD GET FOR TESTING.
GO UP A HALF A SIZE.
IF YOU'RE MEDIUM PERSON, YOU'RE GOING TO BE IN THE SEVEN AND A HALF, EIGHT.
IF YOU LIKE THE MEDIUM GLOVES, SO MAYBE YOU NEED TO GO TO THE EIGHT, EIGHT AND A HALVES.
AND IF YOU'RE A LARGE HAND, YOU'RE GOING TO BE THE EIGHT AND A HALVES POSSIBLY THE NINES.
AND WE ONLY HAVE NINES, SO YOU'RE OUT OF LUCK IF YOU NEED ANY BIGGER THAN THAT.
SO GO UP A LITTLE BIT MORE SO THAT THEY SLIDE ON.
ALRIGHT YOU HAVE YOUR LITTLE STERILE PACK HERE.
WE ARE GOING TO OPEN IT UP
AND INSIDE THE PACK IT TELLS YOU THAT YOU HAVE A LEFT HAND AND A RIGHT HAND.
YOU'RE GOING TO TAKE THE LITTLE FLAPS.
YOU'RE GOING TO GRAB THEM AND I HAVE TO BE CAREFUL NOT TO CONTAMINATE MY FIELD HERE,
SO I AM GOING TO GO LIKE THIS. I AM GOING TO OPEN AND PULL...
APART.
SO MY STERILE GLOVES ARE SITTING THERE, BUT I AM NOT STERILE.
WHEN YOU'RE PUTTING ON STERILE GLOVES,
YOU NEED TO HANDLE ONLY THE INSIDE OF THE GLOVE WITH YOUR NON-STERILE HANDS.
SO I AM GOING TO PICK UP THE FIRST GLOVE WITH MY NON-DOMINANT HAND,
SO THAT I CAN GLOVE MY DOMINANT HAND FIRST.
NOTICE THAT I AM PICKING IT UP BY THE CUFF.
THEY ARE CUFFED OVER SO THAT THE INSIDE NOW IS ON THE OUTSIDE.
I'M GOING TO TAKE MY HAND, SLIDE IT IN.
NOTICE WHERE MY HANDS ARE, ABOVE MY WAIST AND ABOUT 10 TO 12 INCHES AWAY FROM MY BODY,
UP AND OUT SO THERE IS NOTHING FOR ME TO TOUCH, TO GET CONTAMINATED
AND NOTHING TO INADVERTENTLY HIT ME.
IF YOU KEEP WORKING IN LIKE THIS,
YOU TOUCH THINGS AND YOU BRUSH YOUR UNIFORMS.
LIKE THIS, UP AND OUT.
ABOVE YOUR WAIST, UP ABOVE, GET IT AT EYE LEVEL.
I HAVE ONLY TOUCHED THIS INNER CUFF AND I CAN PULL IT EVEN DOWN A LITTLE BIT.
NOW THIS HAND IS STERILE, BUT I GOT TO GET A NON-STERILE HAND INTO IT.
HOW DO I DO THAT?
I AM GOING TO TAKE MY STERILE HAND AND SLIDE IT.
I CAN PICK UP THE GLOVE ANYWHERE.
I CAN TOUCH THE INSIDE WITH THIS HAND RIGHT NOW,
BUT I AM SLIDING MY HAND INTO THE CUFF,
SO THAT IT IS STILL PROTECTED AND STERILE
AND I AM GOING TO PUT MY NON-STERILE HAND INTO THIS.
WATCH YOUR THUMBS.
BE CAREFUL ABOUT GRABBING LIKE THIS BECAUSE YOU'LL HIT YOURSELF WITH YOUR THUMBS.
SO ONCE I HAVE GOT MY HAND IN THE CUFF, WELL, I PUT MY THUMB WAY OUT.
LOOK WHERE MY HANDS ARE.
HIGH. EYE LEVEL.
THEN -- OH, MY GOODNESS.
THEY ARE ALL WHACKY.
AND THAT HAPPENS, BUT AT THIS POINT NOW BOTH HANDS ARE STERILE,
SO I CAN READJUST HERE AND GET MYSELF SETTLED AND I CAN POP THEM.
IF THEY ARE KIND OF WADDED UP,
IF YOU'LL TAKE THEM AND POP THEM IN THE MIDDLE,
THE AIR WILL RELEASE THE WAD AROUND YOUR WRIST.
WHEN YOU'RE DOING A BEDSIDE TECHNIQUE
AND YOU'RE JUST USING YOUR HANDS TO INTRODUCE A DRESSING ONTO A CLIENT,
I DON'T WORRY A LOT ABOUT THE WAD AROUND MY WRIST
BECAUSE I DON'T WORK WITH MY WRISTS.
I WORK WITH MY HANDS.
SO DON'T FUSS WITH IT AND RISK TOUCHING YOUR WRIST WITH YOUR THUMB.
OKAY, I AM STERILE, HANDS ABOVE MY WAIST, AT LEAST 10 TO 12 INCHES.
IF I AM NOT DOING ANYTHING AND I AM WAITING FOR A MINUTE,
I HOLD MY HANDS TOGETHER ABOVE MY WAIST AND OUT,
SO THAT I DON'T TOUCH ANYTHING.
ONCE YOUR GLOVES ARE ON AND YOU KNOW YOU'RE STERILE,
YOU'RE GOING TO REACH IN TO YOUR STERILE FIELD
BECAUSE I AM STERILE NOW AND I CAN REACH IN.
YOU'RE GOING TO GET YOUR STERILE FOUR BY FOUR AND HAND IT TO THE INSTRUCTOR.
TA-DA. YOU'RE DONE.
OKAY, THERE IS ONE OTHER RULE ABOUT STERILE FIELDS THAT YOU NEED TO KNOW.
IF ANYONE TELLS YOU THAT YOU'VE CONTAMINATED, YOU HAVE CONTAMINATED.
EVEN IF YOU DON'T BELIEVE THAT YOU DID,
EVEN IF YOU DIDN'T FEEL YOURSELF TOUCH SOMETHING, YOU'RE CONTAMINATED.
IT'S THE RULE.
YOU CAN'T ARGUE.
YOU CAN'T CONTINUE ON.
YOU CAN'T.
WHEN I FIRST STARTED TEACHING I TOLD A STUDENT SHE CONTAMINATED
COS SHE REALLY HAD CONTAMINATED AND SHE LOOKED AT ME AND SAID, "NO I DIDN'T."
OH, SHE WAS MAD.
I SAID, "YES, YOU DID." "NO I DIDN'T."
I WILL TELL YOU RIGHT NOW, YOU DO THAT TO ME AND YOU'RE GETTING A ZERO.
SHOCKED ME THE FIRST TIME.
SECOND TIME GETS A ZERO.
AND HERE'S A REASON, ONE, IT'S VERY DISRESPECTFUL,
AND TWO, SHE BROKE ALL THE RULES OF STERILE TECHNIQUE.
WHAT ARE YOU GOING TO DO?
PAW THOSE CONTAMINATED HANDS INTO SOMEBODY AND TAKE CARE OF THEM.
YOU POOR EXCUSE FOR A NURSE.
IT'S WRONG. IT'S JUST WRONG.
NOW, I WANT YOU TO APPRECIATE AND UNDERSTAND.
YOU'VE PROPERLY WATCHED ER, HAVEN'T YOU? AND MEDICAL SHOWS?
AND YOU KNOW HOW THEY TREAT THE NEWBIE
AND THE INTERN WHEN THEY GO TO SURGERY
AND THEY JUST TELL THEM THEY'VE CONTAMINATED
WHEN THEY HAVEN'T CONTAMINATED BECAUSE THAT'S THE RULE.
YOU HAVE TO UNGLOVE AND START ALL OVER.
AND SO THEY DO IT TO JUST TAUNT THEM AND HAZE THEM OR WHATEVER.
CAN I TELL YOU, WE WON'T DO THAT TO YOU.
WE DON'T HAVE TIME.
WE DON'T WANT TO.
IF WE TELL YOU, YOU'VE CONTAMINATED, YOU HAVE.
YOU WON'T BELIEVE SOME OF THEM.
YOU DON'T EVEN KNOW HOW YOU CAN CONTAMINATE.
THERE ARE SO MANY WAYS.
SO NORMALLY WHEN YOU TEST, WE JUST LET YOU DO THE WHOLE THING AND WE NEVER SAY ANYTHING, RIGHT?
AND WE GRADE YOU AND WE TELL YOU WHAT WE'VE OBSERVED.
HOWEVER, WHEN YOU DO STERILE TECHNIQUE, AS SOON AS YOU CONTAMINATE,
WE WILL TAKE A BREATH AND WE WILL SEE IF YOU CAN CATCH YOURSELF,
BUT IF YOU DON'T WE WILL TELL YOU RIGHT AWAY THAT YOU'VE CONTAMINATED
BECAUSE WE NEED YOU TO MAKE THE RIGHT ADJUSTMENT.
WE NEED YOU TO SAY, "I'LL GET A NEW ONE. I'LL PUT ON NEW GLOVES OR WHATEVER."
IF YOU CONTAMINATE IN THE PROCESS OF PUTTING ON YOUR GLOVES,
THEN WE WILL HAVE YOU RE-GLOVE.
IF YOU PUT ON YOUR GLOVES PERFECTLY
AND YOU MAYBE BRUSH UP AGAINST THE BED OR YOU HIT YOUR OUTFIT OR SOMETHING
THEN WE WILL PROBABLY JUST HAVE YOU SAY, "I'VE PUT ON NEW GLOVES."
BECAUSE WE JUST NEED YOU TO DO THE RIGHT THING AT THE RIGHT TIME.
AND WE DON'T HAVE TIME FOR YOU TO RE-GLOVE 8 MILLION TIMES.
BUT WHATEVER WE NEED YOU TO DO, JUST DO IT TO GET IT RIGHT AS FAR AS THE SKILL GOES.
ALRIGHT, YOU'RE GOING TO NEED TO SAVE YOUR GLOVES, SO TAKE THEM OFF,
PUT THEM ALL BACK TOGETHER AND MAKE YOURSELF A NICE CUP, PUT THEM IN, FOLD THEM UP
AND VOILA! YOU GOT STERILE GLOVES AGAIN.
OKAY SO KEEP SAYING IT. SAME THING WITH THIS.
YOU WANT TO MAKE SURE TO SAVE YOUR PACKAGES.
REFOLD THESE LIKE YOU GOT THEM.
PUT THEM BACK IN, SAVE IT, VOILA, YOU'RE STERILE AGAIN.
ALRIGHT. ANY QUESTIONS ON THAT ONE?
OKAY, WE WANT YOU TO DO STERILE GLOVES AT THIS STATION AND AT THIS STATION THAT YOU GO TO,
THIS IS WHERE YOU'LL BE GRADED ON STERILE GLOVING,
THAT'S THE SHEATH THAT'S JUST STERILE GLOVING.
SO WE HAVE ONE OTHER STATION WHERE YOU'RE GOING TO DO ONE OTHER KIND OF STERILE FIELD
AND IT'S FOR YOUR CENTRAL LINE
AND IT'S WORKING WITH PACKAGES AND THE INSIDE OF THE PACKAGES ARE CONSIDERED STERILE
SO WHY WOULD YOU PUT UP ALL THAT FIELD FOR NO REASON WHEN YOU CAN JUST WORK OUT OF PACKAGES.
SO I LEFT MY GLOVES.
NOTICE THAT I HAVE A LOT OF EXTRA SUPPLIES
AND I ALWAYS TAKE AT LEAST TWO GLOVES WHENEVER I DO ANY PROCEDURE
BECAUSE AGAIN YOU DON'T KNOW.
SOME OF YOU'LL CONTAMINATE TWO OR THREE TIMES, SO AT THE END OF THE DRILL I WILL SAY,
"SO HOW MANY TIMES DID YOU CONTAMINATE?" AND YOU'LL GO, "THREE."
AND I AM JUST GO, THEN BRING THREE GLOVES WHEN YOU GO TO DO YOUR SKILLS.
YOU KNOW IT'S JUST TO MAKE YOU AWARE YOU NEED EXTRA BECAUSE THINGS HAPPEN.
DON'T EVER GO TO ANY SKILL WITHOUT MORE -- I MEAN, WITHOUT LESS THAN TWO, IT'S GOOD LUCK.
IF YOU TAKE TWO, YOU PROBABLY WON'T USE IT,
BUT IF YOU DON'T TAKE IT YOU'RE GOING TO NEED IT, I PROMISE.
OKAY, MOST OF THOSE I DON'T EVEN THINK THEY HAVE HIGH FIVE PROPERTIES.
WE TALKED BOUT WASHING HANDS -- I MEAN STERILE TECHNIQUE,
MOST OF THE TIME NEEDS A DOCTOR'S ORDER,
BUT YOU CAN INSTITUTE THAT WITHOUT A DOCTOR'S ORDER
BECAUSE YOU WANT IT TO BE A SPECIAL THING.
ON THIS PARTICULAR EXERCISE YOU'RE GOING TO CHANGING A CENTRAL LINE DRESSING.
WE'RE GOING TO TALK MORE ABOUT CENTRAL LINES WHEN WE DO IV THERAPY,
BUT A CENTRAL LINE IS AN IV THAT GOES IN TO THE HEART.
ITS THREADED INTO THE HEART CAVITY.
SO THE DRESSING HAS TO PROTECT THAT EXIT PORT SPOT FROM MIGRATING BACTERIA.
YOU HAVE TO HAVE AN INCLUSIVE DRESSING, SOMETHING THAT DOESN'T ALLOW BACTERIA TO GET INTO IT.
SO IT NEEDS TO BE STERILE AND MOST TYPICALLY WE DO A TRANSPARENT DRESSING
THAT LOOKS LIKE THIS. AND I'LL TRY TO GET HIM SITUATED HERE IN A SECOND.
SO YOU'RE GOING TO CHECK YOUR DOCTOR'S ORDER TO SEE WHAT KIND OF DRESSING THE DOCTOR WANTS.
THEY WILL EITHER HAVE YOU DO A TRANSPARENT DRESSING
OR THEY WILL HAVE YOU DO A GAUZE DRESSING.
EVERYONE IN THE VALLEY RIGHT NOW IS DOING TRANSPARENT DRESSING,
EXCEPT ONE OF THE CANCER PHYSICIAN'S
AND HE ABSOLUTELY WILL NOT LET YOU DO A GAUZE DRESSING.
IT WAS INTERESTING A STUDENT A FEW YEARS AGO HAD LEUKEMIA
AND SO SHE DROPPED OUT OF THE PROGRAM FOR A LITTLE WHILE
AND SHE HAD GONE THROUGH THE TREATMENT FOR LEUKEMIA AND THEN CAME BACK TO TALK TO ME.
AND SHE SAYS I JUST WANTED TO TELL YOU WHAT HAPPENED WITH MY CENTRAL LINES.
SHE HAD -- THEY PUT IN A HICKMAN.
AND HICKMAN IS A LINE THAT IS SURGICALLY IMPLANTED, IT STARTS HERE,
THERE'S AN ENTRANCE AND IT'S THREADED INTO THE HEART
AND THEN IT ACTUALLY GOES UNDERNEATH THE SKIN FOR A WHILE AND HAS AN EXIT PORT.
AND THE WHOLE POINT OF THAT IS THAT GERMS DON'T MIGRATE.
THEY ARE NOT ABLE TO GET TO THE HEART IF THEY GOT ALL THAT SKIN,
THEY GOT TO TRY TO PASS THROUGH IT,
AND THE IV LINE HAS A LITTLE MESH ON IT, AN ANTI BACTERIAL MESH
UNDERNEATH THE SKIN THAT TRAPS MIGRATING BACTERIA.
AND THE PURPOSE OF THESE CENTRAL LINES IS THAT THEY LAST FOR WEEKS AND MONTHS
AND FOR SOME YEARS DEPENDING ON WHAT KIND OF LINE THEY PUT IN.
SO SHE HAD HER LINE FOR A FEW WEEKS AND SHE HAD GONE HOME
AND SHE HAD BEEN DOING THE GAUZE DRESSING, THAT'S WHAT THEY HAD HER DO IN THE HOSPITAL
AND SHE HAD BEEN COVERING THAT EXIT SITE WITH GAUZE.
SHE WENT IN TO SEE A NURSE AT THE HOSPITAL TO DO A FOLLOW UP VISIT
AND THE NURSE GOES, "WHY ARE WE DOING GAUZE DRESSING? WE ALWAYS DO TRANSPARENT DRESSING."
AND SO SHE TOOK THE GAUZE OFF AND SHE PUT A TRANSPARENT DRESSING ON.
THE VERY NEXT DAY SHE SAID I STARTED HAVING PUS COMING OUT OF MY EXIT SITE
AND THEY HAD TO PULL THE LINE.
I LOST MY LINE. I WASN'T ABLE TO GET MY TREATMENT.
I HAD TO GET ANOTHER LINE AND SO FORTH.
AND THE PHYSICIAN WAS ABSOLUTELY LIVID.
HE SAYS, "I NEVER USE THE TRANSPARENT DRESSING. I USE ONLY USE GAUZE.
THAT'S THE REASON." AND YOU CAN APPRECIATE HIS FURY.
INTERESTING, AFTER SHE DID THAT I STARTED TRYING TO READ THE RESEARCH
AND FIND OUT BECAUSE IT'S COMMON PRACTICE TO USE THE TRANSPARENT DRESSING.
AND INTERESTINGLY SOME RESEARCH THAT WAS DONE LAST YEAR,
CAME OUT TO SAY THAT THEY HAD CULTURED
AND THEY HAD FOLLOWED THE CENTRAL LINES WITH BOTH THE GAUZE AND WITH THE TRANSPARENT
AND THERE WAS NO SIGNIFICANT DIFFERENCE IN INFECTION BETWEEN THE TWO.
SO MAYBE IT'S JUST HIS LUCK OF THE DRAW AND HIS EXPERIENCE,
BUT SO FAR RESEARCH HASN'T BORNE OUT THAT ONE IS BETTER THAN THE OTHER.
WE LIKE THE TRANSPARENT DRESSING BECAUSE WE CAN SEE THE SITE.
IF IT GOT INFECTED AND PUSY UNDERNEATH THAT GAUZE,
I WOULDN'T KNOW IT UNTIL THE NEXT CHANGE,
WHEREAS IF IT STARTED TO GET INFECTED WITH THE TRANSPARENT,
I WOULD PROBABLY PICK UP ON IT A LITTLE BIT SOONER BECAUSE YOU CAN SEE THROUGH IT.
IF YOU WERE LOOKING FOR SIGNS AND SYMPTOMS OF INFECTION, WHAT WOULD YOU SEE?
- REDNESS. - REDNESS.
NOT JUST REDNESS, THOUGH. THEY CAN GET SOME REDNESS AROUND THE SITE
BECAUSE IT'S THE NATURAL BODY RESPONSE TO TAKE THOSE WHITE CELLS TO SOMETHING THAT'S BEEN,
YOU KNOW, PUT INTO THE SKIN THAT IS NOT NATURAL.
SO ITS GOING TO BE A LITTLE RED AT THE SITE, BUT IF IT STARTS GETTING SWOLLEN,
AND HOT, AND FEVERISH IT MAYBE INFECTION.
WHAT ELSE?
I GAVE YOU THE CLUE.
WHAT HAPPENED TO THAT GIRL? PUS.
YOU'RE GOING TO SEE PUS.
THAT'S NOT GOOD. PUS IS NOT GOOD.
REMEMBER THAT, GREEN STUFF COMING OUT.
IT'S NOT GOOD.
MOST OF THE TIME THEY WILL PULL THE LINE WHEN THERE'S AN INFECTION.
I DID WORK IN A COUPLE OF CIRCUMSTANCES WHERE THEY TRIED TO SAVE THE LINE,
IT WAS REALLY CRITICAL THAT THE CLIENT RECEIVED TREATMENT
AND SO THEY TREATED HIM WITH ANTIBIOTICS TO SEE IF THEY COULD SAVE THE LINE.
BUT WE EVEN THEN THEY ENDED UP PULLING THE LINE OUT.
SO YOU WANT TO BE WATCHING VERY CAREFULLY FOR SIGNS OF INFECTION.
THERE IS ONE OTHER THING THAT HAPPENS UNDERNEATH THAT
AND WE ARE GOING TO CHECK IT WHEN WE TAKE THE DRESSING OFF.
WE'RE NOT ONLY GOING TO LOOK FOR INFECTION, BUT WE ARE GOING TO LOOK FOR WHAT WE CALL CREPITUS.
IV'S CAN LEAK INTO THE SKIN AND THEY CAN -- AIR OR FLUID CAN GET UNDERNEATH.
AND CREPITUS IS FLUID OR AIR THAT GETS UNDER THE SKIN,
SO THAT WHEN YOU PRESS ON THE SKIN YOU CAN FEEL THE SHIFT.
YOU CAN JUST FEEL IT. YOUR SKIN DOESN'T DO THAT.
AND SO YOU'RE LOOKING FOR ANY KIND OF...
ANY KIND OF THING THAT'S JUST WRONG, THAT'S NOT NORMAL AND SO YOU'RE LOOKING FOR THOSE.
ALRIGHT, WE'VE GOT OUR DOCTOR'S ORDER.
WE'RE GOING TO DO A TRANSPARENT DRESSING. WE'VE GATHERED UP OUR EQUIPMENT.
AND OUR EQUIPMENT IS GOING TO BE A LITTLE TRASH BAG TO PUT THE DRESSING IN.
I NEED SOMETHING TO CLEAN THIS SKIN WITH AND I AM GOING TO
AND YOU'RE GOING TO USE BETADINE SWABS AND ALCOHOL SWABS.
I WILL PROVIDE THOSE FOR YOU. I DIDN'T PUT THEM IN YOUR KITS.
I WANT TO SHOW YOU HOW TO OPEN UP THESE PACKS IF YOU CAN'T FIND THE SWAB STICKS.
WE NEED OUR TRANSPARENT DRESSING.
I NEED TAPE TO SECURE THE TUBING SO IT'S NOT FLOPPING ALL OVER.
AND I NEED MY STERILE GLOVES.
ALSO YOU WANT TO CONSIDER WEARING A MASK.
MOST OF YOUR HOSPITALS WITH CENTRAL LINES HAVE YOU PUT A MASK ON,
SO THAT YOU'RE NOT INTRODUCING BACTERIA
ONCE YOU HAVE TAKEN THAT DRESSING OFF INTO THE EXIT SITE.
SO I AM NOT GOING TO WEAR A MASK,
I AM GOING TO SAY IT BECAUSE YOU CAN'T HEAR ME TALK WHEN I HAVE IT ON.
ALRIGHT, I'VE GATHERED UP MY EQUIPMENT.
I HAVE WASHED MY HANDS.
I HAVE IDENTIFIED MY CLIENT, GOOD MORNING, I AM GOING TO...
I AM DIANE YOUR NURSE TODAY AND I AM GOING TO CHANGE YOUR CENTRAL LINE DRESSING.
SAM SPADE, GREAT.
I HAVE IDENTIFIED MY CLIENT AND I AM GOING TO PROVIDE PRIVACY
SO DON'T FORGET YOUR HIGH FIVE, GET BACK TO THAT.
IN MY PREP I'M GOING TO GO AHEAD AND GET A PIECE OF TAPE READY HERE TO SECURE.
I'M NOT GOING TO OPEN MY STUFF UP YET, BUT I AM GOING TO GET SOME NON-STERILE GLOVES SO THAT I CAN REMOVE THE DRESSING.
WHEN I REMOVE THE DRESSING I AM GOING TO DO ALL THE STUFF I ALREADY TALKED TO YOU ABOUT.
I AM GOING TO LOOK FOR SIGNS AND SYMPTOMS OF INFECTION AND I AM GOING TO LOOK FOR CREPITUS
TO MAKE SURE THERE IS NO DRAINAGE...
REDNESS, FEVER, PAIN.
PAIN IS SOMETIMES THE SYMPTOM OF INFECTION. IT'S HURTING THEM AND IT SHOULDN'T HURT THEM.
ALRIGHT, I AM GOING TO...
WILL YOU SIT UP, MR. SPADE? I AM GOING TO UNDO YOUR GOWN HERE,
SO I CAN GET TO YOUR LITTLE DRESSING.
THE NURSE THAT PUT THIS ON DIDN'T A DATE, TIME.
I DON'T KNOW HOW LONG THIS DRESSING'S BEEN ON
AND IF I DON'T KNOW I AM GOING TO CHANGE IT UNLESS HE SAYS,
"OH, SHE PUT THEM ON THIS MORNING AND THEN THE DRESSING LABEL GOT WADDED UP, SHE FORGOT.
THEN I WOULD CHECK THE CHART OR SOMETHING AND SEE, RATHER THAN JUST RIP IT OFF.
THESE DRESSINGS ARE GOOD FOR THREE DAYS,
UNLESS THEY'VE FALLEN OFF. WHEREAS GAUZE HAS TO BE CHANGED EVERYDAY.
AND THAT'S THE DIFFERENCE BETWEEN THE TWO.
SO I AM LOOKING FOR SIGNS AND SYMPTOMS OF INFECTION.
I AM GOING TO PRESS HERE AND SEE IF I FEEL ANY CREPITUS. EVERYTHING LOOKS OKAY.
I AM GOING TO GO AHEAD AND TAKE THIS DRESSING OFF.
YOU REMEMBER WITH YOUR TRANSPARENT DRESSING
THAT IF YOU STRETCH IT WILL RELEASE ITSELF,
BUT IF THEY TAPED ALONG THE EDGES IT KEEPS IT FROM STRETCHING.
SO I AM GOING TO PULL UP FROM THE EDGE AND TRY TO STRETCH IT.
HOWEVER, THE MANNEQUINS THEY DON'T STRETCH VERY WELL.
YOU WANT TO PULL THE DRESSING TOWARDS THE IV LINE,
RATHER THAN RIP IT STRAIGHT DOWN BECAUSE YOU DON'T WANT TO PULL THE IV LINE OUT.
OH, THAT WOULD BE A SAD DAY.
SOMETIMES YOU EVEN PUT A LITTLE PRESSURE ON THE OUTSIDE THE DRESSING JUST TO STABILIZE IT.
THE DRESS -- THE IV LINES ARE SUTURED IN.
SO IT'S NOT LIKE THEY'RE GOING TO SLIDE AROUND,
NEVERTHELESS YOU WANT TO STABILIZE THAT BASE SO THAT YOU'RE NOT PULLING IT OFF.
ONCE I HAVE TAKEN THE DRESSING OFF, I'M GOING TO PUT THAT OLD DRESSING INTO MY GLOVE
AND THEN GET RID OF IT HERE IN MY LITTLE BAG.
I AM GOING TO GO AHEAD AND SET MY TRASH BAG UP
AND YOU CAN PUT IT WHEREVER YOU THINK ITS CONVENIENT,
BUT IF YOU PUFF IT AGAIN IT WILL STAY OPEN NICE FOR YOU,
WHEREAS IF YOU DON'T, THEY TEND TO FLOP.
ALRIGHT, I AM GOING TO SET UP MY SUPPLIES. I WANT TO OPEN UP MY TRANSPARENT DRESSING.
AND THE TRUTH OF THE MATTER IS I REALLY DON'T NEED TO KEEP IT THAT STERILE
BECAUSE IT'S ALREADY PROTECTED ON BOTH SIDES.
IT'S PROTECTED HERE SO THE INSIDE IS STERILE
AND THE SURFACE THAT'S GOING TO GO AGAINST THE CLIENT IS PROTECTED BY THE BACKING.
SO IT'S REALLY VERY STERILE.
I AM NOT SEEING A TAB ON HERE FOR THE DATE, TIME AND INITIALS,
SO I AM GOING TO GET ONE MORE PIECE OF TAPE FOR MY LABEL.
DON'T WRITE ON CLIENT'S. IT HURTS AND IT JUST DOESN'T WRITE WELL.
SO I TRY TO DO WITH MY WRITING HERE.
AND I AM GOING TO SAY CHANGED -- WHICH IS A TRIANGLE. CHANGED TODAY. WHICH IS...
WHAT IS TODAY? THE 23RD?
23/04 AT 09 DB.
SO DATE, TIME AND INITIALS ON YOUR LITTLE TAPE.
ALRIGHT, THE NEXT THING I WANT TO DO IS GO AHEAD AND GET MY SWABS READY.
MAKE SURE YOU OPEN UP THE RIGHT END OF THE STICKS.
SOUNDS SILLY, BUT IF YOU OPEN UP THE WRONG END,
ALL THE LIQUID FALLS OUT AND OH, WHAT A MESS ON THE BETADINE.
THERE IS LITTLE TEAR TABS INSIDE. FEEL THE RIGHT END.
TRY TO KNOCK ALL THE FLUID DOWN AND THEN I AM GOING TO OPEN THIS UP,
AWAY FROM ME BECAUSE IT SPITS BETADINE AND THEN I TRY TO LEAVE A LITTLE TAB.
I WILL SHOW YOU WHAT I DO.
SQUISH THOSE STICKS OUT SO THAT YOU CAN GET TO THEM.
AND THEN I TRY TO LEAVE ME A LITTLE STAND BECAUSE I THINK IT'S COOL.
BUT IT HELPS ME REACH THOSE STICKS WITHOUT GETTING MY STERILE HANDS --
I AM GOING TO PUT GLOVES ON, ONTO TABLE AND STUFF.
ALTHOUGH THE END OF THE STICK IS ALL THAT'S GOING TO TOUCH THE PATIENTS --
SO THE STERILE GLOVES ARE ONLY TO FACILITATE THIS ACTIVITY AND NOT INTRODUCE ANY MORE BACTERIA.
I'M NEVER REALLY GOING TO TOUCH THEM.
SAME THING WITH ALCOHOL STICKS.
ALCOHOL STICKS ARE ONE OF THE HARDEST THINGS TO FIND IN THE FACILITIES.
THEY ALWAYS HAVE BETADINE, BUT I NEVER CAN FIND THESE CRAZY ALCOHOL STICKS
AND THEY ARE WONDERFUL, YOU JUST NEED THEM.
SO, AGAIN I'M GOING TO SET MYSELF A LITTLE STAND
AND GET MY LITTLE STICKS WHERE I CAN REACH THEM.
HOWEVER, IF YOU CAN'T FIND THE ALCOHOL STICKS YOU CAN USE ALCOHOL SWABS.
AND WHAT I DO IS I TEAR IT DOWN THE MIDDLE
WITHOUT TEARING IT THROUGH SO THAT MY ALCOHOL IS STICKING OUT
AND I SET MYSELF UP A LITTLE STAND. SO THAT I CAN GET TO IT.
I CALL THEM MY LITTLE BIRDS. AND I SAID IT.
MY LITTLE BIRDS ALL OVER HERE SO THAT YOU CAN GET TO THAT WITHOUT TOUCHING.
ALRIGHT, I DON'T REALLY NEED IT, BUT YOU CAN APPRECIATE WHAT I DID.
OKAY, I NEED TO STERILE GLOVE AGAIN SO YOU GET TWO CHANCES TO STERILE GLOVE.
BRING ALL OF YOUR GLOVES.
WE'RE GOING TO REUSE STERILE GLOVES WHEN WE DO STERILE DRESSINGS,
AROUND WEEK -- I DON'T KNOW, AFTER IV.
AND WE WILL USE THEM ONE MORE TIME TO ACCESS CENTRAL LINE.
SO YOU HAVE THREE ACTIVITIES THAT YOU'RE USING STERILE GLOVES FOR, SO KEEP SAVING THEM.
ALRIGHT, YOU'RE GOING TO BE WATCHING ME.
YOUR JOB, WHENEVER YOU'RE INVOLVED IN ANY STERILE PROCEDURES
IS TO WATCH THE PROCEDURE AND TELL THE PERSON IF THEY'VE CONTAMINATED.
THAT IS YOUR JOB, SO YOU WATCH ME LIKE A HAWK.
WE'RE GOING TO PULL AND STRETCH.
IF YOU KIND OF PULL TO GET YOUR FOLDS OUT --
NOT TOO HARD BECAUSE YOU'LL RIP THE PACKAGE. IT WILL STAY OPEN.
OKAY, UP AND OUT.
I AM HANDLING IT BY THE OUTSIDE CUFF.
NOT TOUCHING, GRAB AND STICK MY HAND IN HERE.
UP AND OUT. NICE AND HIGH. I SLIDE MY HANDS IN.
NOTICE I HAVE NO RINGS ON.
RINGS ARE A PROBLEM WHEN YOU'RE DOING STERILE TECHNIQUE.
AND REALLY YOU SHOULDN'T BE WEARING THEM IN THE WORKPLACE AT ALL.
BECAUSE THEY HAVE BEEN CULTURING UNDERNEATH RINGS,
EVEN BANDS AND THEY HAVE BEEN FINDING BACTERIA, SO GET RID OF IT.
OKAY, HERE I AM VERY STERILE,
BUT I HAVE GOT TOUCH HIM WHO'S NOT STERILE.
WHAT'S THE POINT OF MY STERILE TECHNIQUE?
TO NOT INTRODUCE ANYTHING TO HIM.
HE'S ALREADY HIM SO IF I TOUCH HIM WITH HIM WHAT'S THE DIFFERENCE?
I JUST DON'T WANT TO INTRODUCE ANYTHING OUTSIDE OF HIM, GOT IT?
ALRIGHT, I AM GOING TO HAVE TO TOUCH THESE PACKAGES, THOUGH. SO THAT I CAN GET TO THEM.
SO I AM GOING TO CONTAMINATE THIS HAND.
I AM GOING TO SACRIFICE THIS HAND TO HOLD MY PACKAGE
SO THAT I CAN GET TO IT WITH MY STERILE HAND.
I AM STARTING WITH ALCOHOL.
THE REASON IS YOU'RE GOING TO CLEAN FIRST WITH ALCOHOL.
ALCOHOL IS CONSIDERED A DE-FATTING AGENT.
IT GETS THE FATS OFF OF THE SKIN SO THAT WHEN YOU PUT THE ANTI-BACTERIAL,
ANTI-MICROBIAL ON WHICH IS OUR BETADINE, THEN IT WILL WORK BETTER.
SOME INSTITUTIONS ONLY USE BETADINE AND SOME USE BOTH.
SO WE ARE GOING TO USE BOTH.
I THINK IT'S A GOOD TECHNIQUE.
I DON'T HAVE ANY REASON TO NOT USE IT. SO GO WITH WHATEVER YOUR QUALITY ASSURANCE SAYS.
BUT THE ALCOHOL MUST GO FIRST,
NOT SECOND BECAUSE YOU DON'T WANT TO CLEAN OFF THE ANTI-MICROBIAL.
ALRIGHT, I AM GOING TO GRAB BY THE STICK.
I AM GOING TO LIFT UP THIS IV LINE A LITTLE BIT
BECAUSE I NEED TO GET TO THE CENTER, WHERE THE IV IS COMING OUT.
WHERE I NEED IT TO BE MOST CLEAN AND GO OUT TO WHAT'S MOST DIRTY.
AND I AM GOING TO GO IN A CIRCULAR MOTION FOR ABOUT TWO INCHES...
AND CLEAN. AND TOSS.
- I'LL TAKE ANOTHER ONE. - IT'S NOT GOING TO BURN HIM?
- NOPE. IT SHOULDN'T.
NEVER HAD ANYONE COMPLAINING ABOUT IT, NOW THAT YOU SAY THAT.
AND OUT AND THEN A THIRD.
OH, SHOOT, I FORGOT TO CLEAN THE LINE, BUT I WILL DO THAT WITH THIS NEXT ONE.
I AM CLEANING -- NOTICE I AM CLEANING WITH THE FLAT SURFACE.
I'M NOT GOING IN WITH THE LITTLE POINT BECAUSE YOU GET BETTER COVERAGE
AND I CLEAN WITH THAT FLAP AND THEN I AM GOING TO TAKE THE OTHER SIDE OF SWAB
AND GO UP THE TUBING AND CLEAN THE TUBING.
I SHOULD HAVE DONE IT WITH THE OTHER TWO,
BUT I DIDN'T AND IT'S TOO LATE AND I AM GOING TO MAKE SURE I DO IT WITH MY BETADIN.
AND THEN THROW IT OUT.
THIS NEEDS TO DRY.
IT'S THE DRYING TIME THAT KILLS THE BACTERIA.
DON'T FAN. DON'T BLOW. WAIT IT OUT.
PEOPLE WILL TAKE ABOUT 20 SECONDS TO A MINUTE TO DRY, MANNEQUINS NEVER DRY.
SO WE ARE GOING TO SAY, IT'S DRY.
IT'S EASIER IF YOU HOLD THIS AND WORK CLOSE TO YOUR ENVIRONMENT,
RATHER THAN LEAVE IT ON THE TABLE AND KEEP TRYING TO PICK UP AND COME BACK.
SO PUT IT IN YOUR HAND, USE YOUR LITTLE FINGER TO LIFT AND GO AGAIN TO THE CENTER.
I TRY TO GIVE MY BETADINES, JUST A LITTLE SQUEEZE BECAUSE THEY ARE SOPPY
AND I DON'T WANT BETADINE RUNNING DOWN THEIR ARMPITS OR ANYTHING,
SO SQUEEZE IT OUT A LITTLE.
AND THEN AGAIN FROM THE CENTER...OUT.
AND THEN ONE WIPE HERE.
WHAT YOU DON'T DO IS SCRUB BACK AND FORTH.
BECAUSE YOU TAKE WHAT'S DIRTY BACK INTO WHAT YOU NEED TO BE CLEAN.
SO ALWAYS ONE AND YOU'RE DONE.
SQUEEZE...
OUT ONE.
SQUEEZE. IT'S REALLY GET SOPPY ON HERE.
SO SEE MY HANDS REALLY NEVER TOUCH, BUT THEY ARE IN THE FIELD
AND SO THAT'S WHY WE KEEP THEM STERILE.
AND WE'RE GOING TO GO ON HIS BACKSIDE AND OUT.
ALRIGHT, LET IT DRY.
AT THIS POINT I DON'T REALLY NEED TO BE STERILE ANY MORE BECAUSE THIS IS ALREADY STERILE.
WHEN YOU'RE WORKING WITH YOUR TEGADERM -- THAT'S DRYING. I CAN START GETTING MY STUFF READY.
YOU WANT TO TAKE OUT THIS MIDDLE PIECE AND SO YOU'LL HAVE YOUR FRAME.
LEAVE THE FRAME.
I GAVE YOU TWO PIECES OF TEGADERM WHEN YOU CHECK YOUR KITS,
ONE TO PRACTICE WITH, AND ONE TO BRING TO TESTING.
OKAY SO YOU'LL NEED THAT OTHER ONE BECAUSE I DON'T HAVE ENOUGH FOR EVERYONE, EXCEPT FOR THESE.
ALRIGHT, THEN WE ARE GOING TO PEEL OFF THE BACK
AND I AM NOT GOING TO TOUCH THIS SURFACE BECAUSE I NEED THAT TO BE STERILE.
THE FRAME KEEPS THAT FROM PUFFERING ON ITSELF.
I'M GOING TO GO AHEAD AND LAY THIS ON,
SO THAT I CAN SEE THE IV LINE RIGHT IN THE MIDDLE
AND LAY IT FLAT AND PUT ALL MY EDGES DOWN NICE AND SMOOTH
BECAUSE YOU DON'T WANT WRINKLES IN THERE.
AND THEN THERE SHOULD BE A LITTLE EDGE RIGHT HERE AND AS YOU'RE PULLING THIS EDGE OFF --
THIS IS COMING OFF VERY GOOD HERE.
HOW ARE YOU DOING THERE, MR. SPADE?
I AM ALMOST DONE.
SMOOTH THOSE EDGES SO THAT THEY ARE NOT WRINKLY AND THEY WILL STAY ON.
THEN PEEL THE FRAME OFF.
IF YOU GUYS GOT NEW TEGADERMS -- AND I DON'T KNOW WHAT THEY HAVE SENT YOU.
SOMETIMES THEY HAVE A LITTLE LABEL THAT'S ON THE FRAME AND YOU CAN PEEL --
YOU CAN HAVE ALREADY WRITTEN YOUR DATE, TIME AND INITIALS ON THAT LITTLE PIECE OF PAPER.
I LOVE THOSE AND THEN JUST STICK THAT PAPER HERE ON THE EDGE.
BUT THIS ONE DIDN'T HAVE IT. SO I PUT MY DATE, MY CHANGED LABEL HERE.
YOU WANT TO PUT YOUR CHANGED LABEL ON THE DRESSING,
BUT AWAY FROM THE CENTER POINT,
SO THAT YOU CAN SEE IF YOU'VE GOT ANY SIGNS OF INFECTION,
ANY DRAINAGE, REDNESS, THAT KIND OF STUFF.
BUT I HAVE MY DATE HERE.
THEN I NEED TO SECURE THIS TUBING SO IT'S NOT FLOPPING ALL OVER
AND PULLING MY DRESSING OFF.
WHEN YOU STABILIZE YOUR TUBING,
YOU WANT TO MAKE SURE THAT YOU STABILIZE IT TO A STABLE POINT OF THE BODY.
SO I'M NOT GOING TO TAPE IT TO THE ARM, THAT WILL DO NO GOOD.
SO YOU MAKE SURE THAT YOU TAKE YOUR TAPE,
I PUT IT ON THE TUBING AND THEN I STICK IT TO ITSELF ON THE BACK.
AND THEN I STICK IT ON TO THE SHOULDER.
THAT WAY THE TUBING TAKES THE TRAUMA,
RATHER THAN IT GETTING PULLED OUT OR THE TAPE TAKES THE TRAUMA WHEN IT GETS TUGGED,
RATHER THAN PULLING ITSELF OUT OF THE CLIENT.
ALRIGHT, THERE YOU GO.
HOW DOES THAT FEEL?
LOOKS GOOD. SHOULDN'T NEED TO CHANGE THAT FOR A COUPLE OF DAYS.
GET YOU DOWN ON HERE.
NOW, THE DOCTOR DOESN'T WANT YOU TO TAKE A SHOWER YET WITH THAT BECAUSE OF YOUR IV TUBING.
SO GO AHEAD AND WAIT, WE WILL DO SPONGE BATHS FOR NOW.
YOU CAN PROBABLY TAKE A TUB BATH AND GET THE WAIST WET,
BUT YOU STILL DON'T WANT TO SOAK THAT BECAUSE THEY CAN'T SOAK THEM YET.
WE USUALLY DON'T LET THEM SHOWER WITH IV LINES
BECAUSE ITS STILL -- IT'S NOT THAT OCCLUSIVE.
BECAUSE WHERE THE TUBING IS, IT LIFTS THE DRESSING AND IT'S GOING TO GET WET.
ALRIGHT, I'M GOING TO GO AHEAD AND REMOVE MY GLOVES, CLEAN UP MY AREA.
I ALREADY TOLD YOU ABOUT HOW OFTEN TO CHANGE THE DRESSING.
I CAN'T THINK OF A THING.
I WASHED MY HANDS AND DOCUMENT.
MAKE SURE YOUR BED'S IN THE LOW POSITION.
DON'T FORGET ABOUT YOUR BEDS AND YOUR SIDE RAILS.
BETTER GET THAT BACK INTO YOUR MIND AGAIN.
AND VOILA! THAT'S IT.
THREE STATIONS. YOU'RE GOING TO SCRUB.
YOU'RE GOING TO OPEN THAT LITTLE KIT AND DO YOUR STERILE FIELD,
STERILE GLOVING AT ONE STATION AND YOU'RE GOING TO COME TO THE THIRD STATION
AND DO YOUR LITTLE STERILE THING.
ALL THE MANNEQUINS IN 179 ARE SET UP WITH CHEST IV LINES,
BUT THEY ARE REALLY FOR TESTING,
YOU KNOW THAT WE WANT FIRST SEMESTER TO PRACTICE PRETTY MUCH IN 179.
YOU'VE ALSO BEEN MOVED AGAIN AND YOUR PRACTICE ROOM IS 182 AND YOU CAN OVERFLOW INTO HERE.
SO YOU CAN PRACTICE OFF THIS MANNEQUIN.
BERTHA THERE, SHE DOESN'T HAVE A CENTRAL LINE,
BUT YOU CAN PRACTICE OFF HIM.
BUT YOU CAN SEE THAT WE HAVE ALL THESE CHESTS ON THE TABLE IN THERE
AND THOSE ARE SET UP FOR YOU TO PRACTICE ON THOSE IF YOU WANT.