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The patient will be in supine position with the knee that is having the arthroscopy done on it is bent. An ioband is placed along the drape and leg. A sockinet drape is placed on the foot all the way up to mid-calf of the leg and then wrapped with gauze. Then an arthroscopy drape is place along the leg, an arthroscopy drape is needed for fluid control. As the scope is in the knee irrigation is constantly flowing into the leg to get adequate visual on the affected area. However, with all the irrigation that’s flowing into the knee it’s also flowing out and into the bag that is connected to the bottom of the arthroscopy drape. There is a suction connected to the bottom of the bag to suction out all the fluid before the bag overflows. An incision is made above the patella and that incision is for the canula for the fluid. The next incision is made below the kneecap on the right side with in the “soft notch” of the joint which is for arthroscope. The last incision is made at the bottom of the kneecap on the left side and that is for any arthroscopic instruments. Once the scope is inserted then the doctor has a visual of what is wrong with the knee. While the doctor is making the initial incisions the first count it performed. Since the incision is only a couple inches wide the count will only be of sharps and softs. The softs that are the ray-tecs there are always 10 ray-tecs in a pack. Next it would be needles, since there are anywhere between 2-4 suture packs opened there would be 2-4 needles counted. Next hypo-needles are counted, there is only one to count which is used to inject the local anesthesia. After, the knife blades are counted there are two opened on the field, one is used to make the initial cut, the second is opened just in cases. Then the bovie tip and scratch pad is counted long with a fred. A fred is is an anti-fog solution that the surgeon is able to wipe the laparscopic instruments one to prevent the camera from smudging or being blurry. One of the fundamental principles of safe and successful endoscopic procedures is an ability to maintain a clear operating field. Fogging of the laparoscopic lens, splatter of irrigation fluid, blood, and bodily fluids are among those factors that affect a surgeon’s ability to maintain a clear operating field. During an arthroscopy with a lateral retinacular release the doctor will try to get an adequate view of tissues on the inside and outside of the patella which are supposed to pull the patella equally each way. These tissues are call the medial (inside) and the lateral (outside) retinaculum. Throughout the scope the doctor can see that the patella is tilting more towards the outer part of the knee instead of being straight. This is extremely painful for the patient because occurs because of the chronic pull of the knee cap to the outside by the thigh muscles, creating a strain on the medical or inside tissues (the retinaculum). Over time if the strain is great enough, the medial tissues resisting the lateral pull of the muscles become painful. The pain comes from the tissue on the inside of the kneecap (the medial retinaculum). Once the doctor finds which side of the knee the lateral retinacular is effected the doctor will get the hook cautery and slowly cut with cautery the lateral retinacular to surgically release it. Once the knee is debrided and the lateral retinacular tendon is release the doctor will flush more fluid to irrigate and make sure they didn’t miss anything. The scope is then removed and the along with the instruments and the canula. The 3-0 vicryl suture on an SH needle is passed to the doctor as he begins to close the muscle layer of the first incision. Then the 5-0 monocryl is passed to close the skin on the first incision. Then the 3-0 vicryl is passed back to the surgeon to close the muscle layer of te next incision. After he finishes with the muscle layer then the 5-0 monocryl is passed to close the skin on the second incision. Then after that incision closed the 3-0 vicryl is passed to close the muscle layer of the last incision. Then the 5-0 monocryl is passed to begin closing the skin. While the skin is being closed the final count is performed. The softs are counted first there should be 10 raytecs, 2-4 suture needles, two knife blades, one hypo needle, one bovie tip, one scratch pad, and one fred. After the count is done, the nurse and tech are to tell the surgeon “count is correct”. The surgeon then would want a wet raytec and a dry reytec to clean up the surgical area of any skin prep or blood. The tech will dip a ray-tec in sterile saline or sterile water and pass it to the surgeon and he then begins to clean the area then a dry ray-tec is passed for him to dry the area and stitches before applying the dressings. Once it is clean the tech will pass mastisol and steri-strips cut into halves of thirds depending on the surgeon’s preference. Once the mastisol is applied the surgeon will wait a minute or two until it drys. Once it has dried the tech will pass the steri-strips with a pair of adson tissue forceps with teeth and the surgeon will use the forceps to apply the steri-strips. After the steri-strips are applied the procedure is done. The tech is free to pull the mayo stand away from the OR table and push the back table away from the OR table and begin separating the instruments. First, before anything all the sharps are to be contained and thrown away. Any suture needles, knife blades, hypo-needles, and bovie tip are to be thrown into the red hazard bin not into the trash. All the sharp instruments go into one basin and the non-sharp instruments go into another. Once the instruments are separated and placed into a cart then everything else is disposable and is wrapped up and thrown into the trash. Once everything with any bodily fluids is in the trash the tech is able to break scrub and ungown and throw it away While the tech is putting everything away and disposing to all the stuff the nurse, anesthesia, and surgeon transfer the patient over to the gerney to be transferred to PACU.

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