circumcision procedure
TRANSCRIPT
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CIRCUMCISIONCIRCUMCISION
PROCEDUREPROCEDURE
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INDICATIONS:INDICATIONS:
Defnite Indication:Defnite Indication:
• PhymosisPhymosis
• ParaphymosisParaphymosis• istory o! rec"rentistory o! rec"rent
#a$anoposthitis#a$anoposthitis
Re$ati%e Indication:Re$ati%e Indication:
• Rec"rrent UTIRec"rrent UTI
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COMP&ICATIONSCOMP&ICATIONS
• 'o"nd in!ection'o"nd in!ection
• #$eedin(#$eedin(
• Inade)"ate remo%a$ o! !ores*inInade)"ate remo%a$ o! !ores*in
• Urinary retentionUrinary retention
• Necrosis + s$o"(h ($ansNecrosis + s$o"(h ($ans
• etcetc
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&OCA& PENI&E NER,E #&OC- &OCA& PENI&E NER,E #&OC-
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&OCA& PENI&E NER,E #&OC- &OCA& PENI&E NER,E #&OC-
• Dose :./0 m$ 12 &idocain 3itho"tDose :./0 m$ 12 &idocain 3itho"tepinephrinepinephrin
• Penis is prepared and drapedPenis is prepared and draped
• Pa$pate the in!erior 4order o! symphysisPa$pate the in!erior 4order o! symphysisp"4is 5SP6p"4is 5SP6
• Insert need$e 7 directed 891/89 cm to3ardInsert need$e 7 directed 891/89 cm to3ard.8 o;c$oc* position
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• Aspirate the syrin(e5 a%oidAspirate the syrin(e5 a%oidintra%asc"$ar + intracorporea$intra%asc"$ar + intracorporea$
in
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STEPS O> PROCEDURESTEPS O> PROCEDURE
Asses the condition o!Asses the condition o!
penis:penis:
• Norma$Norma$• A4norma$:A4norma$:
? ypospadiaypospadia
? c"r%ed penisc"r%ed penis
? In@amation 5 4a$anitis9In@amation 5 4a$anitis9
4a$anoposthitis64a$anoposthitis6
? etcetc
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SETS ARRANEMENTSETS ARRANEMENT
• .. !terile "#uipment!terile "#uipment? Syrin(e 50m&6 . pcSyrin(e 50m&6 . pc
? $o%es 51 pairs6$o%es 51 pairs6? P$ain and centered ho$e drapes 51pcs6P$ain and centered ho$e drapes 51pcs6
? Steri$e (a"BeSteri$e (a"Be
? Antiseptic so$"tion: .82 po%idoneAntiseptic so$"tion: .82 po%idoneiodineiodine
? #asin#asin
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SETS ARRANEMENTSETS ARRANEMENT
? Steri$e Stain$ess Stee$ Container 5. pc6Steri$e Stain$ess Stee$ Container 5. pc6
? emostat c$amps 5pcs6emostat c$amps 5pcs6? Anatomica$7S"r(ica$ >orceps 5. pc6Anatomica$7S"r(ica$ >orceps 5. pc6
? Need$e ho$der 5. pc6Need$e ho$der 5. pc6
? Scissor 5. pc6Scissor 5. pc6? >ine Cat("t 5/89/8 6>ine Cat("t 5/89/8 6
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SETS ARRANEMENTSETS ARRANEMENT
$.$. %on !terile "#uipment%on !terile "#uipment•&idocain C$+y$ocain in
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CIRCUMCISION PROCEDURECIRCUMCISION PROCEDURE
• Introd"ce yo"rse$! Introd"ce yo"rse$!
• Identi!y the patient : name9 a(e andIdenti!y the patient : name9 a(e andmedica$ record=medica$ record=
• In!ormed consentIn!ormed consent
• Preparation o! e)"ipmentPreparation o! e)"ipment
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• SET UP TE EUIPMENT:SET UP TE EUIPMENT:? Arran(e the $ampArran(e the $amp
? Arran(e steri$e fe$dArran(e steri$e fe$d? Drop the syrin(e into the steri$eDrop the syrin(e into the steri$e
container 3ith proper techni)"econtainer 3ith proper techni)"e
? Po"r antiseptic so$"tion into 4asinPo"r antiseptic so$"tion into 4asin? Prepare anesthetic so$"tionPrepare anesthetic so$"tion
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STEPS O> PROCEDURESTEPS O> PROCEDURE
• 'ash hand thoro"(h$y 3+ antiseptic'ash hand thoro"(h$y 3+ antiseptichandsoaphandsoap
• P"t on steri$e ($o%esP"t on steri$e ($o%es• enita$ area is care!"$$y prepared 3ithenita$ area is care!"$$y prepared 3ithpo%idone Iodinepo%idone Iodine
• P$ace the centered ho$e s"r(ica$ drape soP$ace the centered ho$e s"r(ica$ drape sothat the penis is in the center o! the ho$e=that the penis is in the center o! the ho$e=P"t the p$ain drape o%er the thi(hs=P"t the p$ain drape o%er the thi(hs=
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STEPS O> PROCEDURESTEPS O> PROCEDURE
• i%e $oca$ peni$e 4$oc* and inf$trationi%e $oca$ peni$e 4$oc* and inf$trationanesthesiaanesthesia
• Test the anesthetic eFect 4y pinchin( Test the anesthetic eFect 4y pinchin(
the !ores*in 3ith s"r(ica$ !orcepsthe !ores*in 3ith s"r(ica$ !orceps• Retract the !ores*in 9 remo%e theRetract the !ores*in 9 remo%e the
sme(ma 3ith (a"Be and re$ease a$$sme(ma 3ith (a"Be and re$ease a$$
($an"$ar adhesion 3ith the tip o!($an"$ar adhesion 3ith the tip o!
hemostat c$amp=hemostat c$amp=• C$ean the ($ans once a(ain 3ithC$ean the ($ans once a(ain 3ith
po%idone Iodinepo%idone Iodine
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Mar* the area o! !ores*inMar* the area o! !ores*inthat 3o"$d 4e eGcisedthat 3o"$d 4e eGcisedapproGimate$y at theapproGimate$y at the
corona$ area 4y pinchin(corona$ area 4y pinchin(it 3ith s"r(ica$ !orcepsit 3ith s"r(ica$ !orceps
• App$y t3o c$amp at tipApp$y t3o c$amp at tip
o! !ores*in 5.. o;c$oc*o! !ores*in 5.. o;c$oc*and .0 o;c$oc* position6and .0 o;c$oc* position6
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• The dorsa$ !ores*in is The dorsa$ !ores*in isc$amped 5.1 o;c$oc*c$amped 5.1 o;c$oc*position6 3ith a hemostatposition6 3ith a hemostatthat eGtends to 3ithin 89that eGtends to 3ithin 89cm o! the corona$ s"$c"scm o! the corona$ s"$c"s
• Another c$amp is app$iedAnother c$amp is app$ied%entra$$y9 3hich eGtends%entra$$y9 3hich eGtendsto the !ren"$"m= Thisto the !ren"$"m= This
dorsa$ 5.1 o;c$oc*6 c$ampdorsa$ 5.1 o;c$oc*6 c$ampare then remo%ed=are then remo%ed=
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a $on(it"dina$ mar*eda $on(it"dina$ mar*ed
tiss"e is then c"t 3ithtiss"e is then c"t 3ithscissor to the end pointscissor to the end point
o! c$amped tiss"eo! c$amped tiss"e
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The !ores*in is c"t and remo%ed The !ores*in is c"t and remo%edcirc"$ar$y $ea%in( 89 cm o! s*in atcirc"$ar$y $ea%in( 89 cm o! s*in atthe corona$ s"$c"s9 ta*in( care tothe corona$ s"$c"s9 ta*in( care to
$ea%e the !ren"$"m comp$ete$y intact=$ea%e the !ren"$"m comp$ete$y intact=
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Each 4$eedin( %esse$ isEach 4$eedin( %esse$ is
then c$amped and $i(atedthen c$amped and $i(ated
3ith fne cat("t=3ith fne cat("t=
Comp$ete eGcision o! the !orens
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• The s*in ed(es are The s*in ed(es are
approGimated 3ithapproGimated 3ithinterr"pted fne cat("tinterr"pted fne cat("ts"t"re=s"t"re=
• C$eansed the dirtC$eansed the dirt
54$ood+po%=Iodine 4y54$ood+po%=Iodine 4y(a"se 3etted 4y Na C&(a"se 3etted 4y Na C&physio$o(yphysio$o(y
• App$y anti4ioticApp$y anti4iotic+antiseptic Ba$! at the+antiseptic Ba$! at thes"t"red area and $ea%es"t"red area and $ea%eit 3itho"t dressin(it 3itho"t dressin(
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• ather and discard disposa4$eather and discard disposa4$ee)"ipment= C$ean non disposa4$ee)"ipment= C$ean non disposa4$e
e)"ipmente)"ipment
• 'ash yo"r hand thoro"(h$y 3ith'ash yo"r hand thoro"(h$y 3ithantiseptic hand soapantiseptic hand soap
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"valuation nd &ocumentation"valuation nd &ocumentation
"valuate the follo'ing criteria"valuate the follo'ing criteria::
• O4ser%e the possi4i$ity o! 4$eedin(O4ser%e the possi4i$ity o! 4$eedin(
&ocument the follo'ing&ocument the follo'ing ::
• Date and time o! circ"mcision proced"reDate and time o! circ"mcision proced"re
• Name o! physicianName o! physician