PEDIATRIC

SURGERY:
ORCHIDOPEXY
Group 1
Group
One

Group 1
1.Cassandra
2. Dk Norsyafinaz
3.Mike Mac Donald
4.Norhafizah
Learning Outcome
 Describe the pediatric surgical anatomy.
 Explain perioperative nursing consideration.
 Describepreparation of specific requirements
and instrument for pediatric surgery
(Orchidopexy).
 Explainand demonstrate assisting in common
pediatric procedure.
Introduction
 Pediatric surgery is a highly specialized and unique area of
perioperative nursing in which the patients provide a
unique challenge.
 Pediatric includes the neonate; infant; child adolescent
and with recent advances, the fetus.
 The pediatric patient often need surgery for congenital
anomalies that threaten life or the ability to function.
 And as far as we know that there a lot of anomalies that
may occur to the pediatric, one and most common is
undescended testis that occurs to boy.
 It can be congenital or acquired.
Definition of Orchiopexy

 Isthe surgical placement and fixation of the testicles

in a normal anatomic position in the scrotal sac.

 If
the testis fails to descend into scrotum during
gestation, it is considered undescended.

 An undescended testis becomes arrested somewhere

along its normal path of descent.
Cont…
 If
it is palpable in a position other than its
normal path of descent, its position is
considered to be ectopic.
Describe the pediatric surgical anatomy

a.Airway/pulmonary status
b.Cardiovascular status
c.Temperature regulation
d.Metabolism
e.Fluid management
 Airway/Pulmonary status
 From infancy to adulthood, resulting from increase in airways size,
transformations in the rigidity of airways and chest structures, and
major changes in neuromuscular status.

 Smaller airways can become compromised with even a minor amount

of swelling.

 Loose teeth common in children ages 5 to 14 years.

Cardiovascular status

 Heartrate is the predominant determinant of

cardiac output in infants and children.
 Bradycardia drastically decreases cardiac
output.
 Lower proportion of muscle to connective tissue
till age 1 to 2 years, making infants preload
insensitive.
 Blood loss.
Temperature status
 Risk of hypothermia
 Hyperthermia
 Cold stress
 Maintain normothermia
 Warming blanket
Metabolism

 Children younger than age 2 years have immature liver

function.

 Medication distribution is different in neonates and infants

compared with older children.

 Infants have immature blood-brain barrier and decreased

protein binding, show that increased sensitivity to
sedatives, opioids and hypnotics.
Fluid Management

 Renal function at birth is immature, and ability of the

kidneys to concentrate urine is limited, so the infant is much
more prone to dehydration.
 Complete maturation of renal function occurs at about 2
years.

 Body weight of the child, length of time without fluids.

 Primary factors in calculation of the child hydration needs.

Perioperative
nursing
consideration
Implementation of care

1. Remaining with the child during induction,

positioning & prepping the surgical site.
The perioperative nurse engages in play with
toddler during preoperative assesment.
Positioning: Hyperextension or hyperflexion of
the joint is avoided to prevent nerve traction
type injuries ( e.g brachial plexus).
Cont.

2. Make sure the pediatric patient’s family

regular updates of the child
To decrease their anxiety.
Help the foster a sense of trust in the
healthcare professional caring their child.
Instrumentation

1. Use of basic instrument set, grouped

according to type surgery (e.g minor,
major)
Minor (circumsicion) : circumsicion pead
surgery set
Major (gastrostomy) : pead general
surgery set.
cont

2. Use a complete range of instrument size

is to make the appropriate size available to
each child.
E.g use straight mosquito artery forceps to
clamp bowel infant during gastrostomy
surgery
Anesthetic consideration
 Preparethe equipment and supplies are
scaled down to match the size of patient
& different anesthesia circuits and
delivery.
E.g size endotracheal tube:
2.5 mm to 3.0mm (8 to 9 FR) Newborn
3.5 mm to 4.5 mm (10 to 14 FR) Infant
5.0mm (15 FR) Small child
7.0mm to 7.5mm (21 FR) most adolescents/
teens
 cont
 Iv line and iv solution
Used 500mls for young
patient younger than 8 years
Insert iv line after induction
with mask anesthesia,
depending on the patient
diagnosis & medical history.
Applied (2.5 lidocaine,
2.5% prilocaine) or ( 4%
lidocaine) cream before
insert the iv line, if before
 Medication
 Must closely observe the child
intraoperatively for any toward
reaction of medication (Patient
Safety)
 Distraction method during induction
of anesthesia can minimize the a
child’s stress & anxiety.
 Singing softly & telling story.
 For older childer, providing a relax
mental image (diversion technique)
 Parent’s of the child
The perioperative nurse should explain
how the OR will appear & who will be
present in the OR, how the child
induction will performed.
Explain how the parent service provider @
child therapist should present to escort
the parent to and from the OR so that
perioperative nurse can focus on
providing care after patient has been
induced.
Pain Management
Asses the pediatric patient level pain.
1.

The perioperative nurse assesses the

child pain by communicating with the
child on his/her level.
2.Use Pain Rating scale to
determine level of pain:
The Face,legs Activity,
cry,Consolability (FLACC)
scale : for children between
age 2 month to 7
year/individual unable to
communicate their pain.
Wong Baker Face scale with
facial expression
(numerical scale with 10
worst, color scale with red)
3. Physiologic indicator of pain
Increased the blood pressure,Respiration, & heart rate and
restlessness
These indicator can reflect the anxiety or fear.

4. Parental involvement.
The parent should be queried about the child’s previous
experiences with the pain & be taught the non behavior

5. Nurse should investigate all complaint of pain or

discomfort & be sensitive to behavioral & nonverbal cues
to determine treatment.
Effective pain management
Pharmacologic method:
-by given Patient -controlled
analgesic (PCA) for children

Effective pain
management
Non Pharmacologic method
-distraction,relaxation,guided
imagery, behavioral contracting
& cutaneous stimulation
Preparation of
specific requirements
and instruments for
pediatric surgery.
ORCHIDOPEXY SURGERY
 Preparation of set and equipment
1. Orchidopexy Set

2. Electro surgery unit (ESU)

 Active electrode ( Bipolar forceps)
 ESU machine with foot paddel

3. Suction apparatus if needed

 Suction machine
Suction tubing
 Basic set ( Orchidopexy Set)
1. Clamping and occluding instrument
 Halsted Mosquito forceps x 4

2. Grasping and holding instrument

 Adson forceps ( toothed and non-toothed )
 Gillies and Mc indoe forceps
 Allis forceps x 2 ( to apply lahey swab )
Cont..
3. Dissecting and cutting instrument
 BP handle with scalpes blade size 15
 Metzenbaum scissor Curved and Straight

4. Retracting and exposing instrument

 Small / Green Langenback retractor x 2

5. Closure and approximation instrument

 Needle holder
Cont..

6. Others

 Non perforated towel clip use in draping

 Sponge holder
 Gallipot

 Kidney dish
 Suture ( Vicryl 3/0 or 4/0 )
 Small dressing
Preparation of Specific Requirement and instrument of
Orchidopexy surgery in HWKKS Setting.
 Prepare appropriate basic set and
supplementaries (as HWKKS SETTING) for
examples;
-Orchidopexy set
-Bipolar Forcep and Cable
-ESU Machine
Cont..
-Suture 3/0 or 4/0 Vicryl round bodies, 4/0
Vicryl cutting (undye) for skin,
-CMC Oinment lastly to apply at surgical site
at scrotal area.
-Square “Opsite” dressing or small
Square“Primapore” dressing.
-Blade size 15.
-Supplementary green langenback.
Mayo Table
 Explain and demonstrate
assisting in
common pediatric procedure:
Orchidopexy
Intra operatively
 Assisting surgeon throughout surgery
-Give appropriate instrument step by step
-Helping surgeon to retract.
-Cutting the suture
-Anticipate actively in surgery.
 Perform surgical counting (second count), and informed
surgeon the correctness of the counting.
 Prepare and pass suture for closure.
 Performed the final count and pass the suture to the
surgeon closed to the skin. Also ready scissor to cut
the suture.
 Cont..

 ifthe testicle is in the groin area (where most

are found), surgeon will make a small incision
in the groin to free its attachments and bring
it down into the scrotum where it is fixed in a
pouch under the skin (pictured)
 If
some undescended testicles are associated
with a small hernia which need to tie off, at
the same time the surgeon will free all the
attachments to the testicle
Cont..

 Ifthe patient testicle is poorly-developed or

abnormal, surgeon usually will remove it
(orchidectomy done) to prevent problems in
later life (infection).
 Surgeon will close the wounds with absorbable
stitches (Commonly 3/0 or 4/0 Vicryl round
bodies) which normally disappear within two or
three weeks
 Conclusion
 Thesuccessful of Orchidopexy surgery are
not only depend to the great surgeon but
also a skillful and knowledgeable
perioperative nurse in assisting the surgery.
 Forsuccessful surgery perioperative nurse
should have a good knowledge in surgical
anatomy associated to the surgery,
consideration of care to pediatric patient,
preparation of instruments and a good skill
of assisting the surgeon.
 So we can proved that…

 BEHIND A GREAT SURGEON IS A GREAT PERIOPERATIVE NURSE !