Circumcision Procedure

8/17/2019 Circumcision Procedure

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CIRCUMCISIONCIRCUMCISION

PROCEDUREPROCEDURE


2/23

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


3/23


4/23

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


8/23

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


9/23

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


10/23


? 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


11/23


$.$. %on !terile "#uipment%on !terile "#uipment•&idocain C$+y$ocain in


12/23

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


14/23


• '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=


15/23


• 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


17/23

• 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=


18/23

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=


20/23

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(


22/23

• 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


23/23

"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

Documents

Circumcision Procedure