Manual.de.Enfermeria.Quirurgica.docx

8/17/2019 Manual.de.Enfermeria.Quirurgica.docx

http://slidepdf.com/reader/full/manualdeenfermeriaquirurgicadocx 1/250









Lic. Enf. Silvia Rosalía Rincón SánchezLicenciatura en Enfermería por la Universidad Autónoma de Morelos.

Subefe del !epartamento de "estión de Educación # $apacitaciónen Enfermería% &ospital "eneral de M'(ico ).!.*rofesora del $urso *ost'cnico de Enfermería +uir,r-ica% &"M/*0. Asesora de la asi-natura de !ocencia en Enfermería E0E)U0AM1

Sistema de Universidad Abierta.

Mtra. Martha "arcía 2loresMaestría en Administración de &ospitales # Salud *,blica.

Licenciatura en Enfermería por la Universidad Autónoma de Morelos.Subdirectora del &ospital "eneral de M'(ico.

Auditor interno para el *roceso de certificaciónde Establecimientos de servicios de salud.

/nte-rante del Subcomit' t'cnico de enfermería de la $omisión$oordinadora de /nstitutos 0acionales de Salud

# &ospitales de Alta Especialidad.Secretaria del $omit' &ospitalario de Emer-encias # !esastres.

*lan acción para certificar el *ro-rama &ospital Se-uro.*residenta del subcomit' de enfermería del $omit' 0acionalpara la Atención del Enveecimiento de la Secretaría de Salud

# la Red Me(icana para la Atención al Enveecimiento.$oordinadora de Enfermería de la Asociación Me(icana de &ospitales.

Esta obra es parte de la 3iblioteca del &ospital "eneral de M'(ico

MÉXICO • BOGOTÁ • BUENOS AIRES • CARACAS • GUATEMALAMADRID • NUEVA YORK • SAN JUAN • SANTIAGO • SAO PAULOAUCKLAND • LONDRES • MILÁN • MONTREAL • NUEVA DELHISAN FRANCISCO • SIDNEY • SINGAPUR • ST. LOUIS • TORONTO



Director editorial: Javi! " L#$ F!a%a Editor de desarrollo: Ma$&' B!$a' P(!)Corrección de estilo: A'*+$,+ M+$!+- P(!)Supervisora de producción: Á$%'a Sa'a, Caa"aComposición y formación: G!i,'"a G+$)/') Ba,0i"a

NOTALa medicina es una ciencia en constante desarrollo. $onforme suran nuevos conocimientos% se re4uerirán

cambios de la terap'utica. El 5los6 autor5es6 # los editores se han esforzado para 4ue los cuadros de dosificación medicamentosa sean precisos # acordes con lo establecido en la fecha de publicación. Sin embar-o%ante los posibles errores humanos # cambios en la medicina% ni los editores ni cual4uier otra persona 4ueha#a participado en la preparación de la obra -arantizan 4ue la información contenida en ella sea precisao completa% tampoco son responsables de errores u omisiones% ni de los resultados 4ue con dicha información se obten-an. $onvendría recurrir a otras fuentes de datos% por eemplo% # de manera particular%habrá 4ue consultar la hoa informativa 4ue se adunta con cada medicamento% para tener certeza de 4uela información de esta obra es precisa # no se han introducido cambios en la dosis recomendada o en lascontraindicaciones para su administración. Esto es de particular importancia con respecto a fármacos nuevos o de uso no frecuente. 7ambi'n deberá consultarse a los laboratorios para recabar información sobre

los valores normales.

MA0UAL !E E02ERMER8A +U/R9R"/$A

P!+1i2i"a 'a !3!+"&44i#$ 0+0a' + 3a!4ia' " ,0a +2!a5 3+! 4&a'6&i! 7"i+5 ,i$ a&0+!i)a4i#$ ,4!i0a "' "i0+!.

DERECHOS RESERVADOS 8 9:;95 !,340+ a 'a 3!i7!a "i4i#$ 3+!HOSPITAL GENERAL DE MÉXICO

E"i0a"+5 i73!,+ - 3&2'i4a"+5 4+$ a&0+!i)a4i#$ "' H+,3i0a' G$!a' " M(<i4+.

E"i0a"+ 3+! M4GRA=>HILL INTERAMERICANA EDITORES5 S.A. " C.V. A

subsidiary of The McGraw!ill Companies" #nc$P!+'+$%a4i#$ Pa,+ " 'a R*+!7a ;:;?5 T+!! A5 Pi,+ ;@5 C+'. D,a!!+''+ Sa$0a F5D'%a4i#$ Á'va!+ O2!%#$ C.P.:;@5 M(<i4+5 D.F.Mi72!+ " 'a C/7a!a Na4i+$a' " 'a I$"&,0!ia E"i0+!ia' M<i4a$a R%. N+. @

ISBN: 978-607-15-0625-2

;9?@: ;;@?9;:I73!,+ $ M(<i4+ P!i$0" i$ M<i4+



$ontenidoP!#'+%+

P!*a4i+

Capítulo 1. G$!a'i"a",

Capítulo 2. C$0!a' " 6&i3+, - ,0!i'i)a4i#$ CEYE

Capítulo 3. A3a!a0+, '40!+7("i4+,

Capítulo 4. C'a,i*i4a4i#$ " 1!i"a,

Capítulo 5. C'a,i*i4a4i#$ " 'a, 4i!&%a,

Capítulo 6. Lava"+ " 7a$+,

Capítulo 7. P!3a!a4i#$ " 'a !%i#$ a +3!a!

Capítulo 8. P+,i4i+$, 6&i!!%i4a, 7/, *!4&$0,

Capítulo 9. P!+4"i7i$0+, ,34ia', $ 'a ,a'a 6&i!!%i4a

Capítulo 10. Ti73+, 6&i!!%i4+, *&$"a7$0a',

Capítulo 11. C+'+4a4i#$ - 7a$+ " 7,a, a&<i'ia!,

Capítulo 12. R+3a 6&i!!%i4a

Capítulo 13. F&$4i+$, " 'a $*!7!a 4i!4&'a$0

Capítulo 14. F&$4i+$, " 'a $*!7!a i$,0!&7$0i,0a

Capítulo 15. I$,0!&7$0a' 6&i!!%i4+

$"i4 a'*a2(0i4+

vii

i<

;

;?

;

@

?

@

@

;;

;9?

;@

;?

;@;

;

9:

99@

v





*rólo-oT!a"i4i+$a'7$05 ' H+,3i0a' G$!a' " M(<i4+ 1a ,i"+ &$a i$,0i0&4i#$""i4a"a a 'a "+4$4ia $+ ,#'+ $ ' !&2!+ 7("i4+5 ,i$+ $ 7&41+, +0!+,7/,5 ,34ia'7$0 $ ' " $*!7!a. L+, 7/, " ;:: a+, 6& $+, 3!4"$ "," ,& i$a&%&!a4i#$ 1a$ i"+ *+!0a'4i$"+ ,0+, 3!430+,1a4ia 'a "+4$4ia5 $ "+$" ' 4+$+4i7i$0+ 1a i$4!7$0a"+ 4+$0&$>"$07$0 '+, a4!v+, " 0<0+,5 !vi,0a, - 2i2'i+04a,5 a 0a' %!a"+ 6&!,&'0a */4i' 3!"!, $0! 0a$0a i$*+!7a4i#$5 3+! '+ 6& 1+- $ "a5 (,0a

"2 ,! 4&i"a"+,a7$0 ,'44i+$a"a - ,i73'i*i4a"a 3a!a "a!' &$a a3'i>4a4i#$ 0i' i$7"ia0a $ 'a a,i,0$4ia " $&,0!+, $*!7+, ' 3&!+ a40+" ,i$00i)a! 0a' 4a$0i"a" " 3&2'i4a4i+$,5 1a4!'a, $0$"i2', 3a!a6&i$ 'a, +4&3a!/ $ ,& "ia!ia 'a2+! -5 a"7/,5 1a4!'+ $ ,3a4i+, 2!v,- !,0!i$%i"+,5 ,i$ "&"a , 0!a"&4 v!"a"!a7$0 $ &$a 'a2+! 0i0/$i4a.

E' Manual de enfermer%a &uir'r(ica ,0/ 2a,a"+ $ 'a <3!i$4ia "'4+0i"ia$+ a40&a! " 'a $*!7!a 6&i!!%i4a " $&,0!a i$,0i0&4i#$5 4+$ - 3a!a '+, 3a4i$0, 6& , 1a$ "4i"i"+ 3+! $&,0!+ 1+,3i0a' 3a!a 'a

a0$4i#$ " ,&, 3a"4!,5 ,i73! a' 4+2i+ " '+, 3!i$4i3i+, 4i$0> *i4+,&$iv!,a'7$0 a430a"+, - 4+$ ' !i%+! (0i4+ 6& $+, 4a!a40!i)a.A,i7i,7+5 3!0$" 3!+3+!4i+$a! !*!$4ia, !a', - +3+!0&$a, a 'a,$*!7!a,5 6& ', 3!7i0a$ 3'a$a!5 3!i+!i)a! - va'&a! ,&, a44i+$,"$0!+ "' /!a 6&i!!%i4a. L+, ;? 4a30&'+, 6& '+ *+!7a$ va$ ","07a, 4+$ 7i!a, 3a$+!/7i4a,5 1a,0a +0!+, 4+$ a4!4a7i$0+, ,34>*i4+,5 0+"+, 0i', - " a3'i4a4i#$ "ia!ia $ ,& "a a "a $ ' 4a"a v) 7/,4+73'+ 7&$"+ " '+, 6&i!#*a$+,. E,0 ,*&!)+ "i0+!ia' i$i4ia",4!i2i$"+ ' /!a *,i4a "' 6&i!#*a$+ - ,& *&$4i+$a'i"a"5 3a,a$"+ 3+!'a 4$0!a' " 6&i3+, - ,0!i'i)a4i#$5 7a$+ " a3a!a0+, '40!+7("i> 4+,$ ' 6&i!#*a$+5 3a!a ",3&(, a2+!"a! 07a, " !'va$0 a40&a'i"a" 4+7+' " 4'a,i*i4a4i#$ " 1!i"a, - " 4i!&%a,. P+,0!i+!7$0 , $*+> 4a a'a2+!"a "' 3a4i$0 $ ' 6&i!#*a$+ 7i,7+5 i$4'&-$"+ 4a30&'+, 6&v!,a$ ,+2! ' 'ava"+ " 7a$+,5 3!3a!a4i#$ " 'a !%i#$ a +3!a!5 3+,i4i+$, 6&i!!%i4a, 7/, *!4&$0, - 3!+4"i7i$0+, ,34ia', $ '/!a 6&i!!%i4a5 $*a0i)a$"+ '+, 0i73+, 6&i!!%i4+, *&$"a7$0a',5 'a4+'+4a4i#$ - 7a$+ " 7,a,5 a, 4+7+ '+ !*!$0 a 'a !+3a 6&i!!%i4a.

vii



viii : *rólo-o

Fi$a'7$0 ",4!i2 'a, *&$4i+$, " 'a $*!7!a 4i!4&'a$0 - 'a, " 'ai$,0!&7$0i,0a5 3a!a 0!7i$a! 4+$ &$ 4a30&'+ ,+2! i$,0!&7$0a'.

A 0+"a, '&4,5 'a ,0!&40&!a4i#$ "' 3!,$0 Manual de enfermer%a

&uir'r(ica5 'i0!a'7$0 viaa 3+! 0+"+, '+, a,340+, !a', a 4+$,i"!a! $0a$ 3!a%7/0i4a +!i$0a4i#$ -5 ,i$ '&%a! a "&"a,5 +4&3a!/ &$ 3!,0i> %i+,+'&%a! $0! 'a 2i2'i+%!a*a <i,0$0 "' 07a. H+- v 'a '&) $ ,& 3!i7!a"i4i#$ 6&5 "a"+ ' 3!+*,i+$a'i,7+5 $iv' a4a"(7i4+ - ""i4a> 4i#$ "'a, a&0+!a,5 , 3!*i'a 3a!a "i4i+$, *&0&!a, 4+7+ &$ v!"a"!+ !*!$0 3a!a 'a $*!7!a 6& 4+$,a%!a ,& 'a2+! a' i$0!i+! " '+, 6&i> !#*a$+,.

N+ 6&"a 7/, 6& a%!a"4! 'a "i,0i$4i#$ " 'a 6& 1 ,i"+ +20+ a' 3!7i0i!7 ,4!i2i! 'a, 3!,$0, 3a'a2!a, " +0!a +2!a 4i$0*i4a 6& 1a44!4! ' a4!v+ "i0+!ia' "' H+,3i0a' G$!a' " M(<i4+5 6& a 'ava$%&a!"ia $ ' 4&i"a"+ " 'a vi"a5 1+- $ "a , ' G$!a' " '+,H+,3i0a',.

Dr$ )rancisco *$ +avarro ,eynoso

Di!40+! G$!a'H+,3i0a' G$!a' " M(<i4+



*refacio

La 3!i$4i3a' i$0$4i#$ "' Manual de enfermer%a &uir'r(ica , $0!%a!5" &$a 7a$!a 2!v - ,$4i''a5 'a, 0(4$i4a, - 3!+4"i7i$0+, 2/,i4+, 6&0+"a $*!7!a 6& i$4&!,i+$a $ ' /!a "2 4+$+4!. Ta72i($ ,0/"i!i%i"+ ,34ia'7$0 a '+, ,0&"ia$0, " $iv' 2/,i4+ - " *+!> 7a4i#$,34*i4a $ ,0a *a,4i$a$05 4+73'a - a' 7i,7+ 0i73+ i7> 3a40a$0

/!a. L+, ;? 4a30&'+, 6& 4+$0i$ 4+$*+!7a$ &$a %&a 2/,i4a 3a!a 3'a$a!5 3!i+!i)a! - va'&a! 'a, a40ivi"a", "$0!+ "' 6&i!#*a$+.

E,0 0<0+ 4+$0i$ i$*+!7a4i#$ *&$"a7$0a' 6& 3a!0 "," 'a4+$*+!7a4i#$ "' /!a *,i4a - 'a, 4+$"i4i+$, #30i7a, " *&$4i+$a>7i$0+5 1a,0a ' 6&i3a7i$0+5 04. A,i7i,7+5 ""i4a &$ 4a30&'+ 3a!a",4!i2i! 'a, *&$4i+$, " 'a $*!7!a 4i!4&'a$0 i$,0!&7$0i,0a $ '+, 3!+4"i7i$0+, ,34ia',5 4+7+ '+ , ' 0i73+ ,(30i4+ - 'a ,a'a 4+$0a>7i$a"a 6&5 ,i 2i$ , 4i!0+ a 'a *41a $+ , 1a "0!7i$a"+ 'a 7a%$i0&"

- a'4a$4 6& 0i$$ $ 'a 3!v$4i#$ " 'a, i$*44i+$,5 $ ,0a +2!a , 3+$ a 4+$,i"!a4i#$ "' '40+!5 -a 6& , &$a 3!/40i4a " v!"a"!a4+0i"ia$i"a" $ i$,0i0&4i+$, " ,a'&" , 0!a0a " 7"i"a, "i!i%i"a, ai73"i! 'a ''%a"a " 7i4!++!%a$i,7+, 3a0#%$+, a' 7"i+ a,(30i4+5 ,"4i!5 +!i$0a"a, a 3!v$i! 'a 4+$0a7i$a4i#$ 7i4!+2i+'#%i4a.

E, &$a +2!a 4+$,0!&i"a ,$4ia'7$0 "," ' 3&$0+ " vi,0a "+>4$05 a,i,0$4ia' - 0(4$i4+5 "a"a 'a <3!i$4ia " 7/, " ?: a+, $ 'a*+!7a4i#$ " !4&!,+, 1&7a$+, " $*!7!a $ ,0a ,34ia'i"a".

Ta72i($ ,0/ " 7a$i*i,0+ 'a vi,i#$ "i!40iva5 $ vi!0&" " 'a a73'ia -<4',a 3!/40i4a " ,0 1+,3i0a' " a'0a ,34ia'i"a"5 a ,0 !,340+.

E,0a7+, 4+$v$4i"a, " 6& ,!/ " %!a$ a3+-+ 3a!a 6&i$ '+ 4+$>,&'05 ,+2! 0+"+ 3a!a ' 3!,+$a' 6& 3+! 3!i7!a v) , i$4+!3+!a a 'a,/!a, 6&i!!%i4a,. N+ , 3!,$0a &$ a$/'i,i, <1a&,0iv+ " 0+"+, '+,07a, !'a4i+$a"+,5 3&, , &$a +2!a 4+$42i"a 3a!a a2+!"a! 07a, 2/>,i4+, + '7$0a', 3+! ''+5 ,i , ",a 3!+*&$"i)a! $ ' 07a5 'a i$*+!>7a4i#$ v!0i"a $ ,0 0<0+ i$"&"a2'7$0 "2 4+73'7$0a!, 4+$ 'a

'40&!a " 2i2'i+%!a*a 4+73'7$0a!ia.E, 7&- i73+!0a$0 3a!a 'a, a&0+!a, !*!i! 6& ,0 Manual de en

fermer%a &uir'r(ica , ' !,&'0a"+ " &$a 4+1,i#$ " v+'&$0a", +!i$>0a"a, 4+$ *i$, 7!a7$0 a4a"(7i4+,5 " &$a i$,0i0&4i#$ 4$0$a!ia5 'a4&a' , 1a 4a!a40!i)a"+ ,i73! 3+! ,& 3!+2a"a v+4a4i#$ 3+! 'a $,>

ix



x: *refacio

a$)a5 a "+$" a4&"$ $*!7!a, $+ ,#'+ " 0+"a 'a R32'i4a M<i>4a$a5 ,i$+ 0a72i($ " a'%&$+, 3a,, " A7(!i4a La0i$a5 3a!a !4i2i!

*+!7a4i#$ ,34*i4a $ ' /!a 6&i!!%i4a.S 1a ,4!i0+ 3a!a !,3+$"! a 'a $4,i"a" 3&a$0 6& 3!va'4

$0! ' 3!,+$a' " $*!7!a "' H+,3i0a' G$!a' " M(<i4+ " 4+$>0i$&a! 0!a$,7i0i$"+ 'a, <3!i$4ia, - vi"$4ia, a' !,340+ "' 0!a2a+6& , !a'i)a $ 'a, /!a, 6&i!!%i4a,5 " 0a' *+!7a 6& ,0a, 0(4$i4a, - 3!+4"i7i$0+, 3!7a$)4a$ - , !3'i6&$5 4+$ '+ 4&a' , 4+$0i$&a!/+*!4i$"+ 4&i"a"+, 4$0!a"+, $ 'a, $4,i"a", 3!+3ia, " '+, 3a4i$>0, 4a$"i"a0+, a 4i!&%a5 a"7/, " +0+!%a! &$a a0$4i#$ i$"ivi"&a'i)a"a4+$ 4a'i"a" - 4a'i") -5 a$0 0+"+5 &$a 4i!&%a ,%&!a - 'i2! " !i,%+,.C+$ 0+"+ ''+ , "a !,3&,0a a 'a 4+$*ia$)a 6& 3a4i$0, - a&0+!i"a","3+,i0a$ $+ ,#'+ $ 'a, $*!7!a,+,5 ,i$+ 0a72i($ $ 0+"+ ' 3!,+>$a' 6& 4+$*+!7a ' 6&i3+ 6&i!!%i4+.

E, 3!4i,+ $*a0i)a! 6& ,4!i2i! !3!,$0a &$a !,3+$,a2i'i"a" 1i,>0#!i4a - ,+4ia' 3a!a 4+$ 'a 3+2'a4i#$ - 4+$ 'a 7i,7a 3!+*,i#$5 3+! '+ 6&,a27+, 6& $+ , &$a 73!,a */4i' ,i$ 72a!%+5 4+$ ''+ *av+!47+,6& $&,0!a i$,0i0&4i#$ "( 4+$0i$&i"a" a ,& 'a2+! 4+7+ 1+,3i0a'>,4&'a.

P+! '0i7+5 'a, a&0+!a, <3!,a7+, &$ 7!4i"+ a%!a"4i7i$0+ a 'a,a&0+!i"a", - "7/, 3!,+$a' 6&5 " 7a$!a "i!40a + i$"i!40a5a3+-a!+$ 4+$ $0&,ia,7+ 'a 'a2+!a4i#$ " ,0 0<0+ 6& 1+- 0i$ &,>0" $ ,&, 7a$+, - 6& ,3!a7+, ,a ' i$i4i+ " 0+"+, '+, 6& ' 3!>,+$a' "' H+,3i0a' G$!a' " M(<i4+ E' G$!a' " '+, H+,3i0a',54+7+ 2i$ ,&' !*!i!'+ ' "+40+! F!a$4i,4+ Nava!!+ R-$+,+5 a40&a'"i!40+! " ,0a i$,0i0&4i#$ "2 - 7!4 ,4!i2i!. A 0+"+,5 7&41a,%!a4ia,.

Silvia ,$ ,incón S-nche.

Martha Garc%a )lores

M(<i4+5 D.F.

$

apítulo

1

Generaliae!



A!pe"to! le#ale!E$*!7!a , ' 4&i"a"+ 6& , +0+!%a a 'a, 3!,+$a, $ 'a, "i*!$> 0,0a3a, " ,a'&" + $*!7"a". E,0+, 4&i"a"+, , !a'i)a$ $ 4+7$ 4+$+0!a, 3!+*,i+$, - 0a72i($ " 7a$!a a&0#$+7a. E$ %$!a'5 'a$*!7!a 0i$ 'a !,3+$,a2i'i"a" " $4a7i$a! ,&, ,*&!)+, 1a4ia '*+7$0+ " $0+!$+, ,%&!+, $+ ,#'+ 3a!a ' 3a4i$05 ,i$+ 0a72i($ 3a!a'a 3!/40i4a 3!+*,i+$a'.

D," ' 3&$0+ " vi,0a '%a'5 'a $*!7!a " 6&i!#*a$+ ,0/ +2'i>%a"a a 2!i$"a! 4&i"a"+ +3+!0&$+ - !a)+$a2'5 3+! '+ 6& , i73+!0a$06& 3a!a !4! ,& 3!+*,i#$ 4+$+)4a 'a, $+!7a, - !%'a, " '+, 4&i"a>"+, 6& 3!+3+!4i+$a5 ",a!!+''a$"+ &$a 3!/40i4a "+4&7$0a"a 6& ' 3!7i0a +30i7i)a! ,& ",73+ 4+$ '+, 3a4i$0, 6& !6&i!$ " ,&,!vi4i+. A,i7i,7+5 "i41+, "+4&7$0+, ,!vi!/$ " a3+-+ 3a!a 4+$0i>$&a! 4+$ 'a i$v,0i%a4i#$ 6& !"&$" $ &$a 7+!a " '+, 4&i"a"+, 6& 3!+3+!4i+$a5 "*i$i! 'a 4+$"&40a 6& "2 ,%&i! !,340+ a' 0!a> 0a7i$0+

" 4a"a 3a4i$0 - 0$! &$a 3a!0i4i3a4i#$ 7/, a40iva $ 'a, 3+'0i4a, ",a'&".

La 3!/40i4a 3!+*,i+$a' " 'a $*!7!a5 $ 4&a'6&i!a " ,&, ,3>4ia'i"a",5 ,0/ !%i"a 3!i$4i3a'7$0 3+! 'a '%i,'a4i#$ " 4a"a ,0a"+ +$a4i#$5 4&-+, 4#"i%+, - !%'a7$0+, ,34i*i4a$ '+, "2!,5 !,3+$,a> 2i'i"a", - "!41+, " ,0a a40ivi"a".

M"ia$0 ' ,0a2'4i7i$0+ " &$ 4+$0!a0+ " 0!a2a+ 32'i4+ + 3!iva"+5 ' 3!,+$a' " $*!7!a +0+!%a 4&i"a"+, a 'a, 3!,+$a, 6& '+

!6&i!$ a 4a72i+ " &$ ,a'a!i+ - 3!,0a4i+$, 3+! 3a!0 "' 3a0!#$. E,0a!'a4i#$ " 0!a2a+ i$4'&- "2!,5 "!41+, - +2'i%a4i+$, 6& , 3!4i,+ 4&73'i! 3a!a vi0a! $*!$0a! 3!+4,+, '%a', a"7i$i,0!a0iv+,54ivi', + 3$a',.

1



2 :Manual de enfermería 4uir,r-ica

P+! '+ a$0!i+!5 'a $*!7!a 6&i!!%i4a ,0/ +2'i%a"a a

• P!+3+!4i+$a! 4&i"a"+, " 7a$!a *i4i$0 - *i4a).• O0+!%a! 4&i"a"+, 4+$ 2a, $ 'a, $+!7a, '%a', ,0a2'4i"a, $4a"a &!i,"i44i#$.

• Sa'va%&a!"a! $ 0+"+ 7+7$0+ 'a i$"ivi"&a'i"a" i$0%!i"a" "' 3a4i$0.

$ala pr%"ti"a

C+$"&40a 6& ,&3+$ &$a a44i#$ $%'i%$0 + a'%&$a +7i,i#$ 3+! 3a!0 "&$ 3!+*,i+$a' " 'a ,a'&"5 6& , 0!a"&4 $ &$ "a+ + ',i#$ a' &,&a> !i+-+ 3a4i$0.

Ca2 !4+!"a! 6& 'a $+!7a " 4&i"a"+ 6& "2 a3'i4a!, $ 4a,+ "7a'a 3!/40i4a , 'a 6& <i,0a $ ' 7+7$0+ $ 6& , 3!+"&+ ' "a+5-a 6& !,&'0a i$a"4&a"+ a3'i4a! $+!7a, a40&a', a a44i"$0, 6& , 3!+"&!+$ 0i73+ a0!/,.

P+! '+ a$0!i+!5 , i73+!0a$0 6& 'a $*!7!a 6&i!!%i4a ,0( *a7i>'ia!i)a"a 4+$ 'a, i$$+va4i+$, $ 7a0!ia " '%i,'a4i#$ " 'a 3!+*,i#$5'+, 4a72i+, $ 'a, 3+'0i4a, i$,0i0&4i+$a',5 a, 4+7+ 4+$0a! 4+$ ' 4+$+>4i7i$0+ " 'a, 0(4$i4a, - 3!+4"i7i$0+, 7/, *40iv+, 7"ia$0 &$a4+$,0a$0 a40&a'i)a4i#$.

E, 3!i7+!"ia' 1a4! 1i$4a3i( $ 6& 4a"a 7i72!+ "' 6&i3+ 6&i>!!%i4+ , !,3+$,a2' " 'a 7a$!a $ 6& !a'i)a 'a, 0a!a, 6& ' 4+>!!,3+$"$5 3+! '+ 6& "2 ,0a! 4+$,4i$0 " 'a, !,3+$,a2i'i"a",

'%a', 6& a"6&i! 4+$ ' 3a4i$0.T+"+ a40+ 3!+"&4i"+ 3+! ",4&i"+ , 4'a,i*i4a 4+7+ $%'i%$4ia5 -a&$ 4&a$"+ (,0a $+ 4+$,0i0&- &$a 0!a$,%!,i#$ 4+7+ 0a'5 ' 3!,+$a' "$*!7!a "2 0$! 3'$+ 4+$+4i7i$0+ " 'a, ,i0&a4i+$, $ 6& &$",4&i"+ 3&" 3+$! $ 3'i%!+ a' 3a4i$05 -a 6& $+ ,#'+ , ',i+$a a(,0 ,i$+ 0a72i($ a' 6&i3+ " 0!a2a+ -5 3+! 0a$0+5 a 'a i$,0i0&4i#$.

&xpeiente "líni"oLa $*!7!a " 6&i!#*a$+ 0i$ $0! +0!a, +2'i%a4i+$, 'a " a3'i4a! 'a,7+!, ,0!a0%ia, a *i$ " a,%&!a! ' 4&73'i7i$0+ $ 0i73+ - *+!7a" 'a, $+!7a, a"7i$i,0!a0iva, !,340iva, 3a!a 6& &$ 3a4i$0 3&"a ,!,+70i"+ a 3!+4"i7i$0+ 6&i!!%i4+.



$apítulo ; : "eneralidades 3

E' <3"i$0 4'$i4+ , &$ "+4&7$0+ 7("i4+ " 4a!/40! '%a'5 3&, 4+$0i$ 0+"a 'a i$*+!7a4i#$ 2/,i4a 3a!a 'a 0+7a " "4i,i+$, 4+$!,340+ a' 0!a0a7i$0+ "' 3a4i$0. A,i7i,7+5 , 'a 2a, 3a!a a430a! +

$%a! 'a 7a'a 3!/40i4a + $%'i%$4ia $ 4a,+ " 6& , 3!,$0$ ">7a$"a, '%a',.

E$ vi,0a " '+ a$0!i+!5 , 3!i7+!"ia' 6& 'a $*!7!a " 6&i!#*a> $+!vi, " 7a$!a ,4!&3&'+,a ' 4+$0$i"+ "' 7i,7+5 4+$ a3%+ a' +!"$6& "i40a 'a $+!7a +*i4ia' NOM>;>SSA;>; "' <3"i$0 4'$i4+4+$ 2a, $ 'a &!i,"i44i#$ 6& 4+!!,3+$"a. E' +20iv+ " "i41a $+!7a, ' ,0a2'4i7i$0+ " '+, 4!i0!i+, " +!"$ 4i$0*i4+5 04$+> '#%i4+ -a"7i$i,0!a0iv+ +2'i%a0+!i+, $ 'a 'a2+!a4i#$5 i$0%!a4i#$5 &,+ - a!41iv+

"' <3"i$0 4'$i4+. E$ ' <3"i$0 0a72i($ "2!/$ i$> 0%!a!,0+"a, 'a, $+0a, " $*!7!a %$!a"a, "&!a$0 ' 0!a0a7i$0+ "' 3a4i$0.

'o(a e en)er*eríaLa 1+a " $*!7!a5 4+$,i,0$0 $ 'a, $+0a, 3!+3!a0+!ia,5 0!a$,>

+3!a0+!ia, - 3+,+3!a0+!ia,5 , &$ i73+!0a$0 !%i,0!+ 6& 3!7i0 &$a

4+7&$i4a4i#$ *40iva $0! ' 3!,+$a' " ,a'&" 7"ia$0 'a i$*+!7a>4i#$ 6&5 1+!a 0!a, 1+!a5 "," ' i$%!,+ 1a,0a ' %!,+ "' 3a4i$05 ,vi!0 $ ,0 "+4&7$0+. P!7i0 4+$*!+$0a! 'a, #!"$, 7("i4a, - '+, 3'a$, " 4&i"a"+, " $*!7!a 4+$0i$ "iv!,+, '7$0+, 6&4+$,0i0&-$ 'a 2a, 3a!a ' 4&i"a"+ "&!a$0 ' 3!i+"+ +3!a0+!i+5 4+$ '+6& 3&" %a!a$0i)a!, 'a 4+$0i$&i"a" - 4a'i"a" "' 7i,7+. E$ "i41+"+4&7$0+ , !%i,0!a$ 0a72i($ '+, 141+, - a40+, !'a0iv+, a 'a a0$>4i#$ 3!,0a"a a' 3a4i$0.

A"7/,5 'a $*!7!a a,i$0a $ ,0a 1+a 'a, +2,!va4i+$, !'a>0iva, a 'a va'+!a4i#$5 ' "ia%$#,0i4+5 'a i$0!v$4i#$5 'a va'&a4i#$ - 'a!,3&,0a "' 3a4i$0.

E' 3!,+$a' " $*!7!a $&$4a "2 +'vi"a! 'a !,3+$,a2i'i"a" (0i>4a - '%a' 6& , %$!a5 a' 1a4! ,0a, a$+0a4i+$,5 " !,30a! 'a i$"i>vi"&a'i"a" " '+, 3a4i$0,5 a, 4+7+ 3!+0%!'+, " 3!/40i4a, i'%a', +",1+$,0a,5 3+! '+ 6& "2 4+$,i"!a! "0$i"a7$0 'a, 4+$,4&$>4ia, 3+,i0iva, + $%a0iva, 6& %$!a ' !%i,0!+ " ,0a i$*+!7a4i#$.

Ca"a i$,0i0&4i#$ 0i$ ,&, 3!+3ia, $+!7a, - !%'a7$0+, 3a!a 'a 'a> 2+!a4i#$ " 'a "+4&7$0a4i#$ 6& , %$!a a$0,5 "&!a$0 - ",3&(, "'a a0$4i#$ " &$ 3a4i$0. Si$ 72a!%+5 $ 4&a'6&i! 4a,+ "i41+,!%i,0!+, "2$ 4&73'i! 4+$ 'a, ,i%&i$0, 4a!a40!,0i4a,



4 : Manual de enfermería 4uir,r-ica

• L0!a 4'a!a - '%i2'.• N+0a, 3!4i,a, - $0$"i2',.• G&a!"a! &$ +!"$ 4!+$+'#%i4+ *41a - 1+!a.

• Ha4! a$+0a4i+$, +20iva,5 vi0a$"+ ",4!i2i! &i4i+, " va'+!.• E$ 4a,+ " a44i"$0, + i$4i"$0,5 a$+0a!'+, " 7a$!a i$7"ia0a.• Evi0a! 0a41a"&!a, + $7$"a"&!a,.• E$ 4a,+ " &$a $+0a 'a2+!a"a *&!a " +!"$ 4!+$+'#%i4+5 (,0a ">

2!/ 6&"a! !%i,0!a"a a' *i$a' 4+$ &$a '-$"a " $+0a 3+,0!i+!.• U0i'i)a! a2!via0&!a, %$!a'7$0 a430a"a,.• N+ "a! '$a, + ,3a4i+, $ 2'a$4+.• N+72! - *i!7a " 'a $*!7!a !,3+$,a2'.

• E' 4+'+! " 0i$0a "2!/ 4+!!,3+$"! a' 0&!$+ 7a0&0i$+5 a)&' v,> 3!0i$+5 v!" $+40&!$+5 !++.

Con!enti*iento in)or*aoE, &$ "+4&7$0+ " 4a!/40! '%a' $ ' 6& , ,34i*i4a$ '+, !i,%+,

6& 3&" $*!$0a! &$ 3a4i$0 a' i$%!,a! a &$a i$,0i0&4i#$ " a0$4i#$

7("i4a. E' 3!,+$a' " ,a'&" i$v+'&4!a"+ $ ' ,%&i7i$0+ "' 3a4i$0,0/ +2'i%a"+ a +20$! ,0 4+$,$0i7i$0+ " 7a$!a v+'&$0a!ia.Pa!a 6& "i41+ 4+$,$0i7i$0+ ,a 4+$,i"!a"+ 4+7+ v/'i"+ "2

,0a! *i!7a"+ 3+! ' 3!+3i+ 3a4i$0 + 3+! &$ *a7i'ia! '%a'7$0 a&0+>!i)a"+. E, i73+!0a$0 3!+3+!4i+$a! 0+"a 'a i$*+!7a4i#$ a4!4a " '+,!i,%+,5 2$*i4i+,5 a'0!$a0iva, - 4+$,4&$4ia, "' 0!a0a7i$0+.

La, a&0+!i)a4i+$, " '+, 3a4i$0, " ,+70!, a "0!7i$a"+, 3!+4"i7i$0+, -a ,a$ "ia%$#,0i4+,5 4&!a0iv+,5 " !1a2i'i0a4i#$ + "

4&a'6&i! +0!+ 0i3+ "2$ ,+'i4i0a!, a$0, " ''va!'+, a 4a2+5 $ ' $>0$"i"+ " 6& ,i , 4+$,i$0 ' 3!+4"i7i$0+ 4+$ '+, !i,%+, 6& (,0+,i73'i4a$5 $+ "i,4&'3a a' !,3+$,a2' $ 4a,+ " "a+,5 0+"a v) 6& ,$4&$0! 6& a40&# 4+$ $%'i%$4ia5 3!4i3i0a4i#$5 i73!i4ia5 "+'+ + 7a'a 3!/40i4a. E,0+, 4+$,$0i7i$0+, ,0/$ ,0a2'4i"+, $ 'a N+!7a O*i4ia'M<i4a$a NOM>;>SSA; 3a!a ' 7a$+ "' <3"i$0. E$0!+0!+, *i%&!a$

• I$%!,+ 1+,3i0a'a!i+.

• I$0!v$4i#$ 6&i!!%i4a.• A73&0a4i#$5 7&0i'a4i#$ + <0i!3a4i#$ +!%/$i4a.• E73'+ " a$,0,ia %$!a'.• M"i+, i$va,iv+,.




• M(0+"+, "*i$i0iv+, " 3'a$i*i4a4i#$ *a7i'ia!. • Di,3+,i4i#$ " #!%a$+, - 0i"+,.• T+"+ a40+ 6& !3!,$0 !i,%+ a'0+.

E$ 'a 7a-+!a " '+, 1+,3i0a',5 , ' 3!,+$a' " $*!7!a ' 6& ,$4a!%a " v!i*i4a! 6& ,0+, *+!7a0+, ,0($ "2i"a7$0 !6&i,i0a"+,.E$ 4a,+ " 6& $+ , $4&$0!$ ,0+, "+4&7$0+, $ ' <3"i$05 'a$*!7!a ,0a!/ +2'i%a"a a "a! avi,+ 3a!a 6& , 3!+4"a a ,&,3$"! ' 3!+4"i7i$0+ 1a,0a !4a2a! ,0a "+4&7$0a4i#$5 4+$ '+ 6& , vi0a!/6& ' 3!,+$a' -+ 'a 3!+3ia i$,0i0&4i#$ $*!$0$ &$ 4+$Qi40+ '%a'.

E' 3!i$4i3a' +20iv+ "' 4+$,$0i7i$0+ i$*+!7a"+ , ",'i$"a! !,>

3+$,a2i'i"a",5 - "2 +20$!, i$"3$"i$07$0 " 'a 7a%$i0&" "' 3!+4"i7i$0+ 6&i!!%i4+ a' 6& ,!/ ,+70i"+ ' 3a4i$0. N+ "2 4+$0$! 0!7i$+'+%a 7("i4a + a2!via0&!a,5 - "2 ,!

4'a!+ - $0$"i2' 3a!a &$a 3!,+$a 6& $+ 3!0$)4a a' 6&i3+ " 3!+>*,i+$a', ""i4a"+, a' 4&i"a"+ " 'a ,a'&". L+ a$0!i+! a-&"a!/ a "i,7i>$&i! '+, !i,%+, a 6& ,0/ <3&,0a 'a 3!+*,i#$ -5 '+ 7/, i73+!0a$05 ' 3a4i$0 3+"!/ !4i2i! &$a a0$4i#$ " 4a'i"a" 4+$ a3%+ a 'a, $+!7a, - 3!+4"i7i$0+, 6& ,0a2'4 'a '%i,'a4i#$ vi%$0.

+e"o*ena"ione!E$ +4a,i+$,5 - "2i"+ a ,& $a0&!a')a5 'a, 4i!&%a, , 3!a40i4a$ " 7a>$!a &!%$05 - a&$ 4&a$"+ (,0a, ,+$ 3!+%!a7a"a,5 '+, 3a4i$0, i$%!>,a$ a' 1+,3i0a' 3+!0a$"+ +20+, " va'+! 4+7+ a$i''+,5 3&',!a,5 '$0, +4+''a!,.

A' !,340+5 , !4+7i$"a 1a4! &$ !%i,0!+ 3+! ,4!i0+ " ,0+,

'7$0+,5 !*!i! ' '&%a! "+$" , !,%&a!"a$ -+ ' $+72! " 'a 3!>,+$a a 6&i$ , ' $0!%a$ 3a!a 4&,0+"ia. E,0+ vi0a!/ 6& ' 3!,+$a'$4a!%a"+ " 'a !434i#$ "' 3a4i$0 0$%a 3!+2'7a, '%a',.

D i%&a' 7a$!a5 , *&$"a7$0a' ' 7a$+5 4+$,!va4i#$ i"$>0i*i4a4i#$ " 'a, 3i)a, + 7&,0!a, "&!a$0 ' 3!i+"+ 0!a$,+3!a0+!i+5 3&, &$a 7a$i3&'a4i#$ i$4+!!40a " (,0a, 3&" 3!+v+4a! "ia%$#,0i> 4+,6&iv+4a"+,5 + a0!i2&i! (,0+, a' 3a4i$0 6& $+ 4+!!,3+$"5 '+ 6& 0!a!/4+$,4&$4ia, " +!"$ '%a'.

Fi$a'7$05 , i73+!0a$0 1a4! 1i$4a3i( $ 'a !'va$4ia " 1a4!&$a 4+!!40a i"$0i*i4a4i#$ "' 3a4i$0 a' i$%!,a! a 'a ,a'a " +3!a>4i+$, - &,0+ a$0, " i$i4ia! 'a 4i!&%a5 4+$ '+ 6& , vi0a!/ 4&a'6&i!!!+! 6& 3&"i!a a4a!!a! 4+$,4&$4ia, ,!ia,.



6: Manual de enfermería 4uir,r-ica

,rea )í!i"a el -uir)ano

/e!"rip"inA 4+$0i$&a4i#$ , ",4!i2$ '+, 3!i$4i3i+, 2/,i4+, " &$ /!a 6&i!!>

%i4a. E, i73+!0a$0 !*!i! 6& <i,0$ 7&41+, - 7&- va!ia"+, ,0i'+, -*+!7a, ,i$ 72a!%+5 3+! '+ 6& !,340a a' 4+7$ "$+7i$a"+! " 'a4+$,0!&44i#$5 ' "i,+ + ,6&7a "' 6&i!#*a$+ "2 $*+4a!, 2/,i4a>7$0 a ,0a2'4! 2a!!!a, + *i'0!+, 3a!a '+, 3+,i2', 4+$0a7i$a$0, "'7"i+5 0a', 4+7+ 7a0!ia',5 6&i3+,5 ai! i$4'&,+ 3!,+$a,5 6& 0a7>

2i($ ,+$ *&$0, 3+0$4ia', " 4+$0a7i$a4i#$. A,i7i,7+5 "2 ,0a2'>4!, &$a 2a!!!a $0! 'a, /!a, 4+$0a7i$a"a, + ,(30i4a, - 'a, a,(30i4a,.La &$i"a" 6&i!!%i4a , &$a i$,0a'a4i#$ ,34ia'7$0 a4+$"i4i+$a>

"a "$0!+ "' 1+,3i0a'5 a, 4+7+ &$ ,i0i+ e/ profeso 3a!a 3!a40i4a! i$0!>v$4i+$, 6&i!!%i4a,. Di41a &$i"a" !6&i! " &$ "i,+ a!6&i040#>$i4+ - * ,i4+ <4'&,iv+ "2i"+ a 6& "2 4+$0a! 4+$ )+$a, ,34*i4a, -!,0!i$%i"a, 3a!a 'a, a40ivi"a", 3!+3!a0+!ia,5 0!a$,+3!a0+!ia, - 3+,>+3!a0+!ia, *i%&!a ;>;. E,0/ 3!+vi,0a " 7a0!ia' - 6&i3+ 4+73'+5 - $

''a 4i!4&'a$ " 7a$!a 4+$,0a$0 7("i4+,5 $*!7!a, - $ %$!a'

i#ura 11. Eemplo de unidad 4uir,r-ica.




0+"+ ' 6&i3+ 1&7a$+ - ' 7a0!ia' $4,a!i+ 3a!a 'a a0$4i#$ " '+, $>*!7+,. A1 , 73'a$ 0(4$i4a, - 3!+4"i7i$0+, ,34*i4+, 6& vi0a$+ 3!vi$$ a' 7/<i7+ 'a $0!a"a " 0+"a 4'a, " 2a40!ia, - 7i4!++!>

%a$i,7+, a 'a, i$,0a'a4i+$,.Pa!a ,& 2&$ *&$4i+$a7i$0+5 ' 6&i!#*a$+ "2 ,0a! &2i4a"+ $ &$a

)+$a " */4i' a44,+ - 0$! 4+'i$"a$4ia 3!i$4i3a'7$0 4+$ ' ,!vi> 4i+" &!%$4ia, - 'a &$i"a" " 4&i"a"+, i$0$,iv+,.

D ,! 3+,i2' "2 ,0a! a'a"+ " /!a, 4+$ 0!/*i4+ 3,a"+ " 3!>,+$a,5 " ,!vi4i+, 4+7+ 4+$,&'0a <0!$a - $ %$!a' " 4&a'6&i! /!a"+$" 1a-a 3a4i$0, i$*40+4+$0a%i+,+,.

E, $4,a!i+ 6& 0+"a &$i"a" 6&i!!%i4a 4&$0 4+$ ,!vi4i+, 2/,i>4+, 4+7+ !a"i+'+%a i7a%$5 'a2+!a0+!i+ 1i,0+3a0+'+%a5 $0! +0!+,.La ,&3!*i4i " 3a!", - 3i,+, "2 ,! 'i,a5 " 7a0!ia' $+ 3+!+,+5 3a!a*a4i'i0a! ,& 7a$0$i7i$0+ - 'i73i)a.

O(etivoA,%&!a! a' 7/<i7+ ' ai,'a7i$0+ " 'a &$i"a" 6&i!!%i4a "' !,0+ "'

1+,3i0a' 3a!a i73"i! 'a 4+$0a7i$a4i#$ - 0!a$,7i,i#$ " i$*44i+$,5 '+6& 3!7i0i!/ a' 6&i3+ " ,a'&" vi0a! 4+73'i4a4i+$, a' 3a4i$0.

La &$i"a" 6&i!!%i4a , "ivi" $ 0!, %!a$", /!a,

• Á!a $%!a.• Á!a %!i,.• Á!a 2'a$4a.

<rea ne-raE, 3!+3ia7$0 ' /!a " a44,+ a 'a &$i"a" 6&i!!%i4a 3+! ''a 4i!4&>'a$ 7("i4+,5 $*!7!a,5 0(4$i4+,5 4a7i''!+, - $ %$!a' 0+"+ ' 3!>,+$a' i$v+'&4!a"+ $ 'a a0$4i#$ "' 3a4i$0. S "2 4i!4&'a! $ ,0a/!a 3+!0a$"+ 2a0a + &$i*+!7 4'$i4+ ,0a )+$a ,0a!/ 4+7&$i4a"a 4+$ 'a)+$a %!i, 7"ia$0 0!a73a " 2+0a, - 0!a73a " 4a7i''a,. E,0a )+$a0a72i($ , ",i%$a 4+7+ /!a 3!+3!a0+!ia - $ ''a , !vi,a$ 'a, 4+$>"i4i+$, $ 6& , 3!,$0a"+ ' 3a4i$0 - , !a'i)a 'a 7a-+! 3a!0 "'0!a2a+ a"7i$i,0!a0iv+.

E$ ,0 ,i0i+ , &2i4a$ '+, ,a$i0a!i+,5 'a, !%a"!a,5 '+, v,0i"+!, -'a, +*i4i$a, a"7i$i,0!a0iva, a1 ' 6&i3+ 6&i!!%i4+ 4a72ia ' &$i*+!74'$i4+ &$i*+!7 i$,0i0&4i+$a' 3+! ' &$i*+!7 6&i!!%i4+.



8: Manual de enfermería 4uir,r-ica

S $4&$0!a "'i7i0a"+ 3+! 'a ''a7a"a )+$a $%!a5 '&%a! <4'&,iv+ 3a!a 'a !434i#$ " '+, 3a4i$0,5 'a 4&a' "2 ,0a! 3!+vi,0a " 4a7a,>4a7i''a5 2a$4+, " a'0&!a5 0!i3i(, - &$a 4$0!a' " $*!7!a, "+0a"a "'

7a0!ia' - 6&i3+ $4,a!i+, 3a!a 'a a0$4i#$ a' 3a4i$0 $ ' 3!+3>!a0+!i+ i$7"ia0+.

=ona -risC+7+ '+ i$"i4a ,& 4+'+!5 ,0a /!a ,0/ ,&0a a 7a-+! !,0!i44i#$ - 0a7> 2i($ , 4+$+4i"a 4+7+ )+$a 'i73ia , i73!,4i$"i2' 0!a$,i0a! $ ,0a/!a 4+$ &$i*+!7 6&i!!%i4+5 ' 4&a' 4+$,i,0 $ &$ 3ia7a " a'%+"#$

6& 4+$,0a " "+, 3i)a,5 *i'i3i$a 4+$ 4&''+ $ V " 7a$%a 4+!0a5 3a$>0a'#$ a73'i+ - 4+$ &$a a2!0&!a 'a0!a'5 a"7/, "' 4&2!3'+ %+!!+ +0&!2a$05 4&2!2+4a - 2+0a, ",41a2',.

La $*!7!a " 6&i!#*a$+ $&$4a "2 +'vi"a! 6& 'a 4+!!40a 3+!>0a4i#$ "' &$i*+!7 4+$0!i2&- a vi0a! 4+$0a7i$a4i#$ + i$*44i+$,4!&)a"a, 6& 3&"$ 3+$! $ 3'i%!+ 'a vi"a "' 3a4i$05 '+ 6& !3!>,$0a &$ 7a-+! 4+,0+ 3a!a 'a i$,0i0&4i#$ - 3a!a ' 3!+3i+ 3a4i$0.

A6& , &2i4a ' /!a " 'ava"+ "' i$,0!&7$0a' 6&i!!%i4+5 'a 4$>

0!a' " 6&i3+, - ,0!i'i)a4i#$ CEYE $ 'a 6& , 3!3a!a5 ,0!i'i)a -a'7a4$a 6&i3+ - 7a0!ia' $4,a!i+, 3a!a 'a 4i!&%a5 a, 4+7+ &$a 1a> 2i0a4i#$ 3a!a a$,0,ia5 "+$" , a'7a4$a$ 7"i4a7$0+, i$,&7+,.

C!4a " '+, 6&i!#*a$+, ,0/$ i$,0a'a"a, 0a!a, 3a!a ' 'ava"+ 6&i!!>%i4+ " 7a$+,5 'a, 4&a', "2$ 0$! &$a 3!+*&$"i"a" a"4&a"a 3a!a 3!v$i! ,a'3i4a"&!a, - vi0a! 6& , 1&7")4a ' &$i*+!7. La ,a'i"a "a%&a , 3+! 7"i+ " &$ 0&2+ 'va"+5 " 7a$!a 6& 3!7i0a 7a$0> $!'+, 2!a)+, $ 3+,i4i#$ v!0i4a' '+ i"a' , 6& 'a, 0a!a, 4&$0$ 4+$ &$

,i,07a '40!#$i4+ 3a!a a44i+$a!'a, " 7+"+ 6&5 &$a v) i$i4ia"+ ''ava"+5 $+ , 0$%a 4+$0a40+ a'%&$+ 4+$ 'a, 7i,7a,.

La, i$,0a'a4i+$, 3+! '+ %$!a' 4&$0a$ 4+$ 3a,i''+, 'a0!a', 3+! '+,6& , "a a44,+ a 'a 4a7i''a "' 3a4i$0 3+! "i41+, 3a,i''+, 0a72i($ ,0!a,'a"a i$,0!&7$0a'5 !+3a - 7a0!ia' 6& 1a ,i"+ &0i'i)a"+ $ +3!a>4i+$,5 - , 4+$,i"!a$ 4+$0a7i$a"+,.

D$0!+ "' /!a %!i, 0a72i($ , &2i4a 'a )+$a " 3+,+3!a0+!i+5 $"+$" , !4i2 a' 3a4i$0 i$7"ia0a7$0 ",3&(, " 4+$4'&i"a 'a 4i>

!&%a. E,0 ,i0i+ "2 ,0a! 6&i3a"+ 4+$ 4a7a,>4a7i''a5 0+7a, " +<%>$+5 a,3i!a"+!, 73+0!a"+,5 0!i3i(,5 4a!!+ !++5 4+'41+$, 0(!7i4+,5 a,4+7+ &$a 36&a 4$0!a' " $*!7!a, "+0a"a "' 7a0!ia' - ' 6&i3+$4,a!i+, 3a!a 'a a0$4i#$ "' 3a4i$0 $ ' 3+,+3!a0+!i+ i$7"ia0+.




=ona blancaE, &$a )+$a " a2,+'&0a !,0!i44i#$5 -a 6& , 4+$,i"!a &$ '&%a! ,0(!i'5

- , $ "+$" , !a'i)a$ 'a, i$0!v$4i+$, 6&i!!%i4a,. E, 3!i7+!"ia'6& 0+"+ ' 3!,+$a' 6& 0!a$,i0a 3+! a6& , a3%& " 7a$!a ,0!i40aa 'a, ,i%&i$0, !4+7$"a4i+$,

• P+!0a! 4+!!40a7$0 ' &$i*+!7 6&i!!%i4+.• D2 4+$0a! 4+$ &$ a,+ 3!,+$a' ,4!&3&'+,+.• Ua, 4+!0a,5 'i73ia, - ,i$ ,7a'0.• N+ &,a! $i$%$ 3+,0i)+ 3'&4a,5 3,0aa,5 &a,5 3&3i'$0,.• Evi0a! ' &,+ " +-!a 3&',!a,5 a$i''+,5 7"a''a,5 04..

• Evi0a! ' &,+ " a"+!$+, $ ' 3'+.• Ci!4&'a! $ &$a 7i,7a "i!44i#$5 vi0a$"+ ' 3a,+ " 7a0!ia',

4+$0a7i$a"+, 3+! /!a, 'i73ia,.• Ma$0$! 4!!a"a, 'a, 3&!0a, " ,0a )+$a "&!a$0 0+"+ ' 3!+4>

"i7i$0+ 6&i!!%i4+.

O2,!va! ,0a, !4+7$"a4i+$, 3!7i0 +*!4! a '+, 3a4i$0,&$a 7a-+! ,%&!i"a"5 3!+ ,+2! 0+"+ vi0a 4+73'i4a4i+$, 3+! a44i>

"$0,.

Cara"terí!ti"a! e la !ala -uirr#i"a

La ,a'a 6&i!!%i4a + " +3!a4i+$,5 0a72i($ 4+$+4i"a 4+7+ )+$a "0!a$,+3!a0+!i+5 "2 0$! 4a!a40!,0i4a, 7&- 3a!0i4&'a!, 3a!a 3!+> 3+!4i+$a! &$ a72i$0 ,%&!+ - *i4a) $ "+$" ' 3a4i$0 - ' 3!,+$a'" ,a'&" 3&"a$ 3!7a$4! 3+! 0i73+ 3!+'+$%a"+ ,i$ i$4+$v$i$0,.

or*a ta*aoP+! '+ %$!a' ,+$ " *+!7a 4&a"!a$%&'a!5 ,& 0a7a+ va!a " &$+,

a 795 ,%$ ' 0i3+ " 4i!&%a 6& , 3!a40i6&. E, 7&- i73+!0a$0!4+!"a! 6& $ 4i!&%a " 0!a,3'a$0 - 4i!&%a 4a!"i+3&'7+$a!5 $0!+0!a,5 , !6&i! "i,3+$! " 7a-+! ,3a4i+ "2i"+ a 'a, 4a!a40!,0i4a, -4+73'i"a" " ,0 0i3+ " 3!+4"i7i$0+,.

i!o te"o pareE' 3i,+ "2 ,! " 7a0!ia' !,i,0$0 a' a%&a - 6& $+ ,a 4+$"&40+!

" 4+!!i$05 ,0+ a *i$ " vi0a! 4a!%a, '40!+,0/0i4a, 6& 3&"a$ 4a&>




,a! a44i"$0,. La, ,6&i$a, - 'a, 3a!", " ,0+, ,3a4i+, "2$ ,!!+7a,5 " */4i' 'ava"+5 ,i$ 2!i''+ - ,i$ 4+'+!, 6& !,&'0$ ,0!,a$0, +*a0i%a$0, 3a!a 'a vi,0a5 " 7a$!a 6& , *a4i'i0 'a 'i73i)a i73i"a 'a

a4&7&'a4i#$ " 7i4!++!%a$i,7+, 3a0#%$+,.E, i$"i,3$,a2' 6& 'a, 3a!", " 'a, 1a2i0a4i+$, ",0i$a"a, 3a!a

' &,+ " 6&i3+, " !a-+, X ,0($ !4&2i!0a, 4+$ 3'+7+. E$ 4a,+ " 3!+4"i7i$0+, " &!%$4ia $ ,a'a, ",3!+vi,0a, " ,0 !4&2!i7i$0+5 ' 3!,+$a' "2 73'a! 7a$"i', " ,0 7i,7+ 7a0!ia'.

uerta!

E$ 'a 7a-+!a " 'a, i$,0i0&4i+$, 32'i4a, + 3!iva"a, , &0i'i)a$ 3&!0a,a2a0i2',5 4+$ &$ vi,+! + 7i!i''a " *+!7a 4i!4&'a! + 4&a"!a$%&'a!. A4>0&a'7$0 1a- $ ' 7!4a"+ 3&!0a, a&0+7/0i4a, 6& ,''a$ " 7a$!a1!7(0i4a5 '+ 6& 3!7i0 0$! &$ a72i$0 7/, a,(30i4+.

A,i7i,7+5 "2 v!i*i4a!, ,i73! ' 4+!!40+ *&$4i+$a7i$0+ "'+, ,i,07a, " v$0i'a4i#$5 3&, '+, %a,, a$,0(,i4+, 6& , &0i'i)a$ 3&"$ a4&7&'a!, - 4a&,a! 7+',0ia, a' 3!,+$a' " ,a'&"5 3+! '+ 6& ,i73+!0a$0 &0i'i)a! " 7a$!a 4+!!40a ' 4&2!2+4a,.

Ta72i($ , &0i'i)a$ ,i,07a, " Q&+ 'a7i$a! 3a!a "i,7i$&i! a'7/<i7+ 'a $0!a"a " ai! 4+$0a7i$a"+. Di41+, ,i,07a, 3!7i0$ 6& 'ai! 3a, 3+! va!i+, *i'0!+,5 i$4'&-$"+ 'a '&) &'0!avi+'0a5 4+$ '+ 6& ,"i,7i$&- 'a 3+,i2i'i"a" " 4+$0a7i$a4i#$.

Te*peraturaLa 073!a0&!a " &$a ,a'a 6&i!!%i4a , %!a"a " a4&!"+ 4+$ "+,

va!ia2',1) El paciente. L+, 3a4i$0, %!i/0!i4+,5 3!+ ,+2! 0+"+ '+, $+>

$a0+,5 'a40a$0, - 3"i/0!i4+,5 3i!"$ ' 4+$0!+' " 'a 073!a0&!a 4+$*a4i'i"a"5 3+! '+ 6& $ &$ 3!+4"i7i$0+ 6&i!!%i4+ 'a $*!7!a "2vi%i'a! 6& 'a 073!a0&!a , 7a$0$%a ,0a2'5 '+ 4&a' , '+%!a 7"ia$04+73!,a, 4a'i$0, -+ ,+'&4i+$, 6& , ,+70$ a 2a+ Ma!a5 4+$4&-+ 3!+4"i7i$0+ , vi0a 6& '+, 3a4i$0, 4ai%a$ $ 1i3+0!7ia - , 3!vi$$ 4+73'i4a4i+$,.

2) El tipo de ciruga. E$ 4a!"i+4i!&%a 3+! '+ %$!a' , i73+!0a$07a$0$! 'a ,a'a a &$a 073!a0&!a 3+! "2a+ " '+, ; C ,i$ 72a!>%+5 3a!a 'a, 4i!&%a, %$!a', , i73+!0a$0 7a$0$! &$a 073!a0&!a 3!+7"i+.



$apítulo ; :"eneralidades 11

A$0, " &$a 4i!&%a5 , *&$"a7$0a' 6& 'a $*!7!a " 6&i!#*a$+!vi, ' <3"i$0 "' 3a4i$05 3&, ,0+ ' 3!7i0i!/ 0+7a! 'a, 7"i>

"a, 3!0i$$0, " a4&!"+ 4+$ ' 0i3+ " i$0!v$4i#$ " 6& , 0!a0.

lu*ina"inLa i'&7i$a4i#$ , 7&- i73+!0a$05 3&, "2 3!+3+!4i+$a! &$a vi,i#$4'a!a "' ,i0i+ 6&i!!%i4+5 '+ 6& 2!i$"a ,%&!i"a" a' 6&i3+ " ,a'&" a'!a'i)a! ' 3!+4"i7i$0+. La, '/73a!a, "2$ 3$"! "' 041+ - ,0a! 3!+vi,0a, " a!0i4&'a4i+$, 6& 3!7i0a$ 4+'+4a!'a, $ "i*!$0, 3+,i>

4i+$,5 a &$a a'0&!a a"4&a"a 3a!a ,& */4i' 7a$+.La '&) " 'a '/73a!a 3!i$4i3a' ,&3!i+! "2 0$! 'a, ,i%&i$0, 4a>

!a40!,0i4a,

• N+ "2 3!+"&4i! 2!i''+, $i ",'&72!a7i$0+,.• N+ "2 3!+"&4i! ,+72!a,5 '+ 4&a' , '+%!a a' "i!i%i! '+, "+, 1a4, "

'&) 1a4ia &$ /$%&'+ 4+$v!%$0.• Ca3a4i"a" 3a!a a&,0a!, $ 4&a'6&i! 3+,i4i#$ + /$%&'+. • D */4i' 'i73i)a.

E, i73+!0a$0 !4+!"a! 6&5 "&!a$0 'a 4i!&%a5 'a, '/73a!a, "2$,! 7+vi"a, '+ 7$+, 3+,i2' 3a!a !"&4i! 'a "i,3!,i#$ "' 3+'v+ ,+2! '4a73+ ,0(!i'.

$oiliarioLa ,a'a 6&i!!%i4a "2 ,0a! 6&i3a"a 4+$ 7+2i'ia!i+ 2/,i4+ " a4!+i$+<i"a2'5 4&-a, 4a!a40!,0i4a, vi0$ 'a 4+$"&44i#$ " '40!i4i"a"5 6&,a 'i,+ - " */4i' 'i73i)a.

S !6&i! 4+$0a! 4+$ 2a$4+, %i!a0+!i+,5 $4,a!i+, 3!i$4i3a'7$0 3a!a ' a$,0,i#'+%+5 6&i$ !6&i! 4+'+4a!, a 'a a'0&!a " 'a 4a2)a "' 3a4i$0 "&!a$0 ' 3!+4"i7i$0+ "i41+, 2a$4+, 0a72i($ ,+$ 0i> ', 3a!a ' !,0+ "' 6&i3+5 -a 6& 4i!0a, 4i!&%a, !6&i!$5 "a"a ,&4+73'i"a" - 'a 3!4i,i#$ 6& "7a$"a$5 6& ' 4i!&a$+ - ,& 6&i3+ 3!7a$)4a$ ,$0a"+,.

Banco! de altura. Si!v$ %$!a'7$0 3a!a 0$! &$a 7+! vi,i#$"' ,i0i+ 6&i!!%i4+5 - 6&i$ '+ &0i'i)a 4+$ 7a-+! *!4&$4ia , 'a $*!>7!a i$,0!&7$0i,0a5 -a 6& " ,0a 7a$!a 0i$ "+7i$i+ "' 4i!4&i0+6&i!!%i4+.

"u#eta! de patada. S+$ !4i3i$0, 3!+vi,0+, " !&"a, - , 7a>$a$ 4+$ '+, 3i,5 " a1 ,& $+72!. E$ 'a ,a'a 6&i!!%i4a , !"&4 a'



12 : Manual de enfermería

4uir,r-ica

7/<i7+ 'a 7a$i3&'a4i#$ " '+ 6& , 4+$,i"!a 4+$0a7i$a"+5 3+! '+ 6&,0a, 4&20a, ,+$ i73!,4i$"i2',5 -a 6& $ ''a, , 4+'+4a 0+"a 'a

2a,&!a 6&i!!%i4a 6& , %$!a "&!a$0 'a 4i!&%a.E,0a, 4&20a, "2$ 4+'+4a!, i$va!ia2'7$0 " 'a ,i%&i$0 7a>

$!a "+, 'a0!a', - &$a a 'a 4a24!a " 'a 7,a 6&i!!%i4a. La, 'a0!a',,+$ ,#'+ 3a!a %a,a,5 a3#,i0+,5 4+73!,a,5 0+!&$"a,5 3$!+,5 ,+2!a$0, ",&0&!a, - 0+"+, '+, ",41+, 6& 4+$0$%a$ 4&a'6&i! ,&,0a$4ia + 3!+"&40+ +!%/$i4+ 4+7+ ,a$%!5 +!i$a - Q&i"+, 4+!3+!a', , "2 4+'+>4a! 2+',a !+a 4+7+ '+ ,0a2'4 'a $+!7a +*i4ia'. La 4&20a 6& , 4+'+4a$ 'a 4a24!a , <4'&,iva 3a!a ",41a! ' 7a0!ia' 6& ' a$,0,i#'+%+7a$a "&!a$0 ' 3!+4"i7i$0+ a$,0(,i4+. E, i73+!0a$0 6& 'a 2a,&> !a, 4'a,i*i6& - 7a$ " a4&!"+ 4+$ 'a N+!7a O*i4ia' M<i4a$a 3a!a7a$+ " RPBI.

$ripi%. E,0+, a!04&'+, ,+$ &0i'i)a"+, 3a!a 4+'+4a! 'a, 2+',a, -+*!a,4+, " ,+'&4i+$, - 7"i4a7$0+, 6& , a"7i$i,0!a$ a' 3a4i$0 $' 0!a$,+3!a0+!i+ a' i%&a' 6& ' "7/, 7+2i'ia!i+5 0a72i($ ,0/$ 3!+vi,0+, " !&"a,5 &$ ,i,07a 6& !%&'a 'a a'0&!a - va!ia, ,a'i$0, 6& 3!7i0$ 4+'+4a! 7/, " &$a ,+'&4i#$.

A,i7i,7+5 <i,0$ 4a"$a, 6& 3$"$ "' 041+5 3!+vi,0a, " !i', 3a!a *a4i'i0a! ,& ",3'a)a7i$0+5 - 6& ,i!v$ 3a!a 4+'+4a! ,+'&4i+$,,0a, 4a"$a, ,+$ " ,&7a &0i'i"a" - $+ +4&3a$ ,3a4i+ $ 'a 3!i*!ia "'4i!4&i0+ 6&i!!%i4+.

&e!a 'uir(rgica. E$ (,0a , 4+'+4a a' 3a4i$05 4+$ 4+'41#$ + 4+$!4&2i!0+ " 7a0!ia' " vi$i'+5 4+$ &$ ,i,07a 74/$i4+ + 1i"!/&'i4+6& 3!7i0 ,&2i!5 2aa! + 4+'+4a! a' 3a4i$0 $ "i*!$0, 3+,i4i+$,.A"7/,5 ,0/ 3!+vi,0+ " !&"a, - *!$+,.

&e!a auiliar o de ri*+n. Ta72i($ 4+$+4i"a 4+7+ 7,a !40a$%&>'a!5 , "+$" 'a $*!7!a 6&i!!%i4a 4+'+4a !+3a5 i$,0!&7$0a'5 7a0!ia' i$,&7+, !6&!i"+, 3a!a ' 3!+4"i7i$0+. La $*!7!a 6& i$,0!&>7$0a 'a 4i!&%a 0i$ a2,+'&0+ 4+$0!+' " ,0a 7,a5 -a 6& , 7a$a 3+! 0i73+, 6&i!!%i4+,5 a"7/, " 6& , 1a4$ "ivi,i+$, 3a!a ' 7a> $+" i$,0!&7$0a' - 7a0!ia' 'i73i+5 ,&4i+ - 4+$0a7i$a"+. Ta72i($ ,+$i"a', 3a!a 3!+4"i7i$0+, ,34ia',.

&e!a de &a,o. Ta72i($ ''a7a"a 7,a 3&$05 ,0 7&2' ,0/ 3!+vi,0+ " !&"a,5 - 0i$ &$ ,+3+!0 - &$ 0+!$i6&0 6& 3!7i0 a">4&a! 'a a'0&!a5 a, 4+7+ &$ 7a!4+ 3a!a 4+'+4a! 'a 41a!+'a " Ma-+ " a1,& $+72!5 6& 4+$0i$ ' i$,0!&7$0a' !6&!i"+ 3a!a 'a 4i!&%a.

&e!a a!teur. E$ ''a , 4+'+4a ' 7a0!ia' - 6&i3+ $4,a!i+ 3a!a!a'i)a! ' 'ava"+ 6&i!!%i4+ - 'a a$0i,3,ia "' /!a 6& 1a2!/ " +3>



$apítulo ; :"eneralidades 13

!a!, 0a72i($ ,i!v 3a!a a&<i'ia! a' a$,0,i#'+%+ $ '+, 3!+4"i7i$0+,"&!a$0 'a i$"&44i#$ a$,0(,i4a.

T+"+ ,0 7a0!ia' "2 i$va!ia2'7$0 ,0a! 3!+vi,0+ " !&"a,5 3&, ,0+ 3!7i0 6& ' 6&i3+ 3&"a ",3'a)a!, 4+$ !a3i") $ 4a,+ "!6&!i!'+.

A""e!orio!T+"a, 'a, ,a'a, 6&i!!%i4a, "2$ 4+$0a! e/ profeso 4+$ 0+7a, " 4+>

!!i$0 0!i*/,i4a5 " 3!*!$4ia5 0+7a, 73+0!a"a, " +<%$+5 4a!!+ "

a$,0,ia5 +<70!+ " 3&',+5 4a!!+ !++5 a,3i!a"+!, - &$i"a" " '4>0!+4+a%&'a4i#$.

La, ,a'a, $ 6& , !a'i)a 4i!&%a 3+! $"+,4+3ia "2$ ,0a! 3!+>

vi,0a, " 7a$#70!+ " i$,&Qa"+! " CO9 - 7+$i0+!, " i7a%$.

E, i73+!0a$0 4+$0a! 4+$ &$ $%a0+,4+3i+5 -a 6& 3+! 'a $a0&!a'>)a " 'a, 4i!&%a, , $4,a!i+ !vi,a! '+, ,0&"i+, !a"i+%!/*i4+,. Ca27$4i+$a! 6& 0+"+ !%i,0!+ + a$+0a4i#$ a,$0a"+ $ ' <3"i$0 "24+$0$! 'a 1+!a $ 6& "i41+ !%i,0!+ *& 141+5 3+! '+ 6& , 7&-

i73+!0a$0 &$ !'+ " 3a!" 3a!a 7"i! 0i73+, "&!a$0 a'%&$+, 3!+>4"i7i$0+,5 4+7+ 4+'+4a4i#$ " 0+!$i6&0, - a"7i$i,0!a4i#$ " 7>"i4a7$0+,5 i$4'&,+ $ ,i0&a4i+$, 4!0i4a, 4+7+ 3a!+ !,3i!a0+!i+ &1+!a " $a4i7i$0+. Fi$a'7$05 ' 6&i3a7i$0+ " a44,+!i+, $ 'a ,a'a6&i!!%i4a "3$"!/ " 'a ,34ia'i"a" " 6& , 0!a0.

A"7/,5 , $4,a!i+ 6& 0+"+ ' 3!,+$a' , *a7i'ia!i4 4+$ 'a ,>0!&40&!a - ' "i,+5 '+ 6& 3!7i0 6& 'a, a40ivi"a", " 4a"a 7i72!+"' 6&i3+ " ,a'&" , a!0i4&'$ - ''v$ a 4a2+ 4+$ a3%+ a $+!7a, -

3!+4"i7i$0+, ,0a2'4i"+, 3+! 'a i$,0i0&4i#$5 " *+!7a 0a' 6& , +0+!>%& &$a a0$4i#$ ,%&!a - " 4a'i"a".

:ilio#ra)ía

A!41&$"ia G A. Educación &uir'r(ica. E". F!a$4i,4+ M($") C!va$0,. 33. ;. M(<i4+.

Ga&$0'00 B P. Enfermer%a m0dico&uir'r(ica. E". Ha!4+&!0 B!a4. 33.9:. Ma"!i". ;@.

H+,3i0a' G$!a' " M(<i4+. M4a$+%!a7a. 9::;.Ma!0$) D S. Ciru(%a" bases del conocimiento &uir'r(ico. E". M4G!a>

Hi'' I$0!a7!i4a$a. 33. 9@. M(<i4+. ;@.



$apítulo

C

CLLLDO

15




O(etivo

A,%&!a! 'a "i,0!i2&4i#$ " 6&i3+5 7a0!ia' i$,0!&7$0a' " 7a$!a*i4i$0 - *i4a)5 0!a0a$"+ ,i73! " +30i7i)a! 0i73+ - !4&!,+, "7a$!a 0a' 6& , '+%! +0+!%a! &$ ,!vi4i+ " 4a'i"a".

,rea )í!i"a e la C&;&

/e!"rip"inLa CEYE , $4&$0!a $ ' /!a %!i, " 'a &$i"a" 6&i!!%i4a. A' i%&a'

6& &$a ,a'a " 6&i!#*a$+5 0a72i($ "2 0$! 3i,+,5 3a!", - 041+, "7a0!ia', " */4i' 'i73i)a. E, i73+!0a$0 6& 0$%a &$a v$0i'a4i#$a"4&a"a "2i"+ a 6& , 3!+"&4 "7a,ia"+ va3+! " a%&a5 '+ 6& %>$!a 4a'+! a,i7i,7+5 ' 3!,+$a' " $*!7!a 6& 'a2+!a $ ,0 ,i0i+7a$i3&'a 3'&,a " %a,a5 a'%+"#$5 !+3a5 3a3' - "7/, 7a0!ia',. LaCEYE , "ivi" 2/,i4a7$0 $ 0!, /!a, ; /!a 4+$0a7i$a"a -+ /!a

$+ 4!0i4a 9 /!a 'i73ia -+ ,7i4!0i4a5 - /!a ,0(!i' -+ 4!0i4a.

<rea contaminada #>o área no críticaSi0i+ "+$" , !a'i)a 'a !434i#$ "' i$,0!&7$0a' - ' 6&i3+ 6& *&&0i'i)a"+ $ 4i!&%a ,&4i+5 ' 4&a' , 'ava"+ " 7a$!a 74/$i4a + 4+$'ava"+!a &'0!a,#$i4a 3a!a ,& ",4+$0a7i$a4i#$.

<rea limpia #>o semicrítica+$a "+$" , !a'i)a$ 'a ,'44i#$ - 73a6&0a"+ " '+, a!04&'+, 3a!a,+70!'+, a' 3!+4,+ " ,0!i'i)a4i#$. E,0a /!a "2 4+$0a! 4+$ a7> 3'ia, 7,a, " 0!a2a+ - 4+73!,a, 6&i!!%i4a, ,&*i4i$0, 3a!a ' a!7a>"+ " '+, 3a6&0, + 2&'0+, " 7a0!ia' i$,0!&7$0a' 6&i!!%i4+5 4i$0a0,0i%+ - 772!0,. A1 , 1a''a$ '+, "i*!$0, 0i3+, " a&0+4'av,.

<rea est'ril #>o críticaE$ ,0 ,i0i+ , a'7a4$a$ '+, 2&'0+, - 3a6&0, 6& 1a$ 4+73'0a"+ ,& 3!+4,+ " ,0!i'i)a4i#$ - 6& , $4&$0!a$ 'i,0+, 3a!a ,! &0i'i)a"+,.E,0a /!a "2 0$! a$a6&', e/ profeso 3a!a ' a'7a4$a7i$0+ "'7a0!ia' ,0(!i'. E, &$a )+$a 4a0a'+%a"a 4+7+ " 4i!4&'a4i#$ !,0!i$%i"a.



$apítulo ? : $entral de e4uipos # esterilización 5$E@E6 17

$<too! e e!terili=a"inU$a " 'a, 3!i$4i3a', 4a&,a, " 4+73'i4a4i+$,5 4+$ *!4&$4ia '0a>

',5 , 'a 3!,$4ia " i$*44i+$, 3+,+3!a0+!ia,5 3+! '+ 6& ' 6&i3+6&i!!%i4+ "2 0+7a! 'a, 3!4a&4i+$, $4,a!ia, 3a!a vi0a! i$*4>4i+$, 4!&)a"a, 6& 4+73'i6&$ + i$4'&,+ 3+$%a$ $ !i,%+ 'a vi"a "' 3a4i$0.

A *i$ " '+%!a! '+ a$0!i+! <i,0$ "i*!$0, 3!+4"i7i$0+, 3a!a",0!&i! %(!7$, 3a0#%$+, - $+ 3a0#%$+,. M"ia$0 "i41+, 3!+>4"i7i$0+,5 '+, 6&i3+,5 ' i$,0!&7$0a' 6&i!!%i4+5 '+, i73'a$0, -7&41+, +0!+, "i,3+,i0iv+, ,+$ ,+70i"+, a &$ 3!+4,+ " ",i$*44i#$ -+

,0!i'i)a4i#$5 4&-a *i$a'i"a" , vi0a! 'a 4+$0a7i$a4i#$ "&!a$0 ' 3!+4"i7i$0+ 6&i!!%i4+. E,0a a40ivi"a" , "$+7i$a ,0!i'i)a4i#$ -<i,0$ va!i+, 7(0+"+, 3a!a !a'i)a!'a5 4+$ ' +20iv+ " ",a3a!4! 0+"a*+!7a " vi"a 7i4!+2ia$a $ +20+, 6& 1a2!/$ " &0i'i)a!, $ 'a,i$0!v$4i+$, 6&i!!%i4a,.

La e!teriliaci+n ,5 $0+$4,5 &$ 3!+4,+ * ,i4+ + 6&7i4+ 7"ia$>0 ' 6& , ",0!&- + 'i7i$a 0+"a *+!7a " vi"a 7i4!+2ia$a $ +20+,i$a$i7a"+,. T+"+, '+, 6&i3+,5 !+3a5 i$,0!&7$0a' - a"i0a7$0+, 6& ,

&0i'i)a$ "&!a$0 &$a 4i!&%a "2$ ,! ,+70i"+, a ,0 3!+4,+.La i$1i2i4i#$ + 'i7i$a4i#$ " '+, 7i4!+2i+, 3&" '+%!a!, 7>

"ia$0 a%$0, * ,i4+, + 6&7i4+,. A 4+$0i$&a4i#$ , "*i$ " 7a$!a 2!v 4a"a 3!+4"i7i$0+ $4a7i$a"+ a 'a ",0!&44i#$ " "i41+, +!%a>$i,7+,5 '+ 4&a' , " &0i'i"a" 3a!a "i*!$4ia!'+,.

/ipiea. G$!a'7$0 ,0a a40ivi"a" , !a'i)a &0i'i)a$"+ a%&a 4+$+ ,i$ "0!%$0 3a!a !7+v! " 7a$!a 74/$i4a 'a 7a0!ia +!%/> $i4a +,&4i"a".

e!inectante!. S&,0a$4ia, 3a!a ",0!&i! '+, %(!7$, + 7i4!++!>%a$i,7+, 6& 4a&,a$ i$*44i#$5 3!,$0, $ i$,0!&7$0a' & +0!+, +2> 0+, a <434i#$ " 'a, ,3+!a, 2a40!ia$a, - '+, 1+$%+,5 '+, 4&a','+%!a$ ",0!&i! ' 3!+0+3'a,7a " 'a 4('&'a. L+, ",i$*40a$0, ,+$ " %!a$&0i'i"a" $ 'a 'i73i)a " 'a, 3a!",5 3i,+,5 041+, - 7+2i'ia!i+ " a4!+i$+<i"a2' " 'a ,a'a 6&i!!%i4a.

3nti!%ptico!. S&,0a$4ia, a3'i4a"a, $ 3i'5 7&4+,a + 0i"+ viv+ 3a!a 3!v$i! + "0$! ' 4!4i7i$0+ " 7i4!++!%a$i,7+, 3+! i$1i2i>4i#$ " ,& a40ivi"a" + 3+! ,& ",0!&44i#$. S+$ 4+73&,0+, 6& i73i"$ 'a 3!+'i*!a4i#$ " 7i4!++!%a$i,7+,5 3!+ 6& $+ ''%a$ a ",0!&i!'+, ,#'+ 3&"$ a3'i4a!, " 7a$!a 0#3i4a $ 3i' - 7&4+,a,5 ,i$ 6& (,0a, 3!,$0$ "a+ a'%&$+.




4uir,r-ica

Bacterio!t4tico. S&,0a$4ia 4&-a a3'i4a4i#$ "0i$ ' 4!4i7i$0+ 2a40!ia$+5 '+ 4&a' $+ i73'i4a ,& ",0!&44i#$5 3+! '+ 6& ,i ' a%$0

3a0#%$+ '+%!a ,0a2'4!, $ &$ 7"i+ *av+!a2'5 !a$&"a ,& !3!+>"&44i#$.

ericida. A%$0 6& ",0!&- 7i4!++!%a$i,7+,5 ,34ia'7$0 3a0#%$+,5 $ 0i"+, viv+, - +20+, i$a$i7a"+,. D a4&!"+ 4+$ ' %!>7$ ,+2! ' 6& a40a , ' "$+7i$a *&$%i4i"a5 vi!&4i"a + 2a40!i4i"a.

&!terili=a"in por *<too! )í!i"o!

Altas temperaturas 5calor6U$+ " '+, 7(0+"+, 7/, *40iv+, 3a!a ",0!&i! a '+, 7i4!++!%a$i,7+,4+$,i,0 $ a3'i4a! a'0a, 073!a0&!a, 4+72i$a"a, 4+$ &$ 'va"+ %!a"+" 1&7"a". La *i4a4ia a' a3'i4a! ,0 7(0+"+ "3$" 3!i$4i3a'7$0"' 0i73+ " <3+,i4i#$ - 'a 073!a0&!a. Ca2 !4a'4a! 6& 0+"+, '+,7i4!++!%a$i,7+, ,+$ ,&,430i2', a 'a a44i#$ "' 4a'+!5 3&, (,0 3!+>v+4a ",$a0&!a'i)a4i#$ " 'a, 3!+0$a,5 *&,i#$ - ",+!%a$i)a4i#$ " 'a,

772!a$a,5 a, 4+7+ 3!+4,+, +<i"a$0, i!!v!,i2', $ '+, 7i4!++!>%a$i,7+,.

E, i73+!0a$0 "i,0i$%&i! $0! 4a'+! 17"+ - 4a'+! ,4+. E' 4a'+!17"+ 7a0a 7i4!++!%a$i,7+, 3+!6& 4+a%&'a ,&, 3!+0$a, - , 7/,!/3i"+ - *40iv+ $ 4a72i+5 ' 4a'+! ,4+ ",0!&- '+, 4+73+$$0, 6&>7i4+, 7"ia$0 'a +<i"a4i#$.

Esterilización por calor h,medo

E#ullici+n. E,0 7(0+"+ 3+4+ &0i'i)a"+ $ 'a a40&a'i"a" 4+$,i,0$ 'a 'va4i#$ " 'a 073!a0&!a 1a,0a '+, ;:: C "&!a$0 ;? 7i$&0+,5a'4a$)a$"+ a, 'a 2&''i4i#$ "' a%&a $ 'a 6& , $4&$0!$ i$7!,+, '+,i$,0!&7$0+, - 6&i3+,. E, " ,&7a i73+!0a$4ia $*a0i)a! 6& 'a2&''i4i#$ $+ ,i%$i*i4a ,0!i'i)a4i#$5 3+! '+ 6& ,0 0i3+ " 3!+4"i>7i$0+ ,#'+ "2 &0i'i)a!, $ 4a,+, <0!7+,.

$indaliaci+n. S !4&!! a ,0 7(0+"+ 4&a$"+ 'a, ,&,0a$4ia, 6&>7i4a, $+ 3&"$ 4a'$0a!, 3+! a!!i2a " '+, ;:: C5 -a 6& ,& ,0!&40&>

!a 3&" ,! "aa"a. E,0 7(0+"+ 4+$,i,0 $ ' 4a'$0a7i$0+ "' 7a0>!ia' a &$a 073!a0&!a " : a ;:: C 3+! &$a 1+!a5 "&!a$0 "a,5 4+$ 3!i+"+, " i$4&2a4i#$ " *+!7a ,&4,iva. D ,0a 7a$!a5 'a, ,3+!a,!,i,0$0, %!7i$a$ "&!a$0 ' 3!i+"+ " i$4&2a4i#$5 - 'a, 4('&'a, v>%0a0iva, ,+$ ",0!&i"a, $ 'a ,i%&i$0 <3+,i4i#$ a' 4a'+!.



$apítulo ? :$entral de e4uipos # esterilización 5$E@E6 19

Esterilización por vapor a presión

E$ ,0 7(0+"+ " ,0!i'i)a4i#$ , 73'a va3+! ,a0&!a"+ , "4i!5 a&$a 3!,i#$ 7a-+! a 'a a07+,*(!i4a5 '+ 6& 3!7i0 3!+"&4i! 4i!0a 1i>"!a0a4i#$5 4+a%&'a4i#$ 1i"!#'i,i, " 'a, a'27i$a, - 3!+0$a, " 'a,4('&'a, 7i4!+2ia$a,. E, ' 7(0+"+ 7/, 3!/40i4+ 3a!a 'a ,0!i'i)a4i#$5 -a6& 7"ia$0 (,0 , '+%!a$ 073!a0&!a, 7/, a'0a, a 'a, +20$i"a, 3+!2&''i4i#$. E' a3a!a0+ &0i'i)a"+ 3a!a ,0 3!+4"i7i$0+ , "$+7i$aa&0+4'av5 ' 4&a' , ",4!i2 a 4+$0i$&a4i#$.

3utoclae. E, &$ i$,0!&7$0+ 6& 4+$,0a " &$a 4a'"!a " 4+2!5

,+,0$i"a 3+! &$a 4a7i,a <0!$a 70/'i4a 6& $ 'a 3a!0 i$*!i+! !4i24a'+! 3+! 4+72&,0i#$ " %a, + 3+! &$a !,i,0$4ia '(40!i4a. S 4i!!a $ 'a 3a!0 ,&3!i+! 3+! &$a 0a3a " 2!+$4 6& 3+, 0!, +!i*i4i+, &$+ 3a!a '7a$#70!+5 +0!+ 3a!a ' ,4a3 " va3+! - ' 0!4!+ 3a!a &$a v/'v&'a ",%&!i"a" 6& *&$4i+$a 3+! 4+$0!a3,+.

L+, ,0!i'i)a"+!, ,0/$ 4+$*+!7a"+, 3+! "+, 4+73a!0i7i$0+,5 &$+, 'a 4a7i,a <0!$a - ' +0!+ 'a 4/7a!a i$0!$a5 "+$" , 4+'+4a$ '+,a!04&'+, 6& ,!/$ ,+70i"+, a ,0!i'i)a4i#$. E<i,0$ 2/,i4a7$0 "+,

0i3+, " ,0!i'i)a"+!, + a&0+4'av, - , 7$4i+$a$ a 4+$0i$&a4i#$.E' e!teriliador de de!plaaiento graitacional5 4&-+ *&$4i+$a>

7i$0+ 4+$,i,0 $ 6& &$a v) 4!!a"a 'a 3&!0a 1!7(0i4a7$0 ' va> 3+! 3$0!a " 'a 4a7i,a a 'a 4/7a!a "2i"+ a 6& ' ai! , 7/, 3,a"+6& ' va3+!5 (,0 , ",3'a)a 1a4ia a2a+5 <3&',a$"+ a, ' ai! " 'a 4/>7a!a - 0a72i($ ' " '+, +20+, 6& ,!/$ ,0!i'i)a"+,. D ,0a 7a$!a5' ai! 0!7i$a *i'0!/$"+, 1a4ia 'a 0&2!a " ",41+,.

Ta72i($ ,0/ ' e!teriliador de preaco 4&a$"+ 'a 3&!0a " ,0

,0!i'i)a"+! , ,''a 1!7(0i4a7$05 <0!a ' ai! " 'a 4/7a!a 3+! 7>"i+ " va4+ 3a!a !73'a)a!'+ 3+! va3+! i$-40a"+ 3+! 7"i+ " &$a 2+72a. E,0 0i3+ " ,0!i'i)a"+! , 7/, *i4a) "2i"+ a 6& $+ a0!a3a ai!- 3+, 7a-+! 4a3a4i"a" " 3$0!a4i#$.

E$0! 'a, v$0aa, " &0i'i)a! ' a&0+4'av , 6& !3!,$0a &$ 7(>0+"+ 4+$#7i4+5 !/3i"+5 ,%&!+ - *i4a)5 ,i$ *40+, a"v!,+,5 -a 6& $+"a !,i"&+, 0#<i4+,. P+! '+ a$0!i+!5 'a 7a-+!a " 'a, i$,0i0&4i+$, ">"i4a"a, a' 4&i"a"+ " 'a ,a'&" '+ &0i'i)a$ 4+7+ 3!i$4i3a' 7(0+"+ " ,>

0!i'i)a4i#$. L+, i$4+$v$i$0, "' 7(0+"+ , 6& $+ , a"4&a"+ 3a!a,0!i'i)a! 7a0!ia' 0!7+'/2i' $i ,0!i'i)a ,&,0a$4ia, 4+7+ ' 3+'v+.

A'%&$+, 7a0!ia', 6& , !4+7i$"a ,0!i'i)a! 4+$ va3+! ,+$

• I$,0!&7$0a' 6&i!!%i4+ " a4!+ i$+<i"a2'.• Ma0!ia' " vi"!i+.




• Ma0!ia' " %+7a.• Ma0!ia' 0<0i'.• S+'&4i+$, a4&+,a,.

• T+"+ 7a0!ia' 4&-a ,34i*i4a4i#$ 3+! 3a!0 "' *a2!i4a$0 i$"i6&6& , 3&" ,+70! a ,0 3!+4,+.

P+! +0!a 3a!05 '+, 7a0!ia', 6& $+ , !4+7i$"a ,0!i'i)a! 4+$va3+! ,+$ '+, ,i%&i$0,

• S&,0a$4ia, +'+,a,.• S&,0a$4ia, %!a,a,.• Ma0!ia' 0!7+,$,i2'.

• I$,0!&7$0a' 6&i!!%i4+ 4!+7a"+ + $i6&'a"+.• La3a!+,4+3i+,5 $"+,4+3i+, + '$0,.• A!04&'+, '(40!i4+, ,i$ 4+2!0&!a ,34ia'.• T+"+ 7a0!ia' 6& $+ 0+'! 'a <3+,i4i#$ a' 4a'+! - a 'a 1&7"a".

+e"o*ena"ione! para la li*pie=alavao envoltura el *aterial

e in!tru*entalA *i$ " 6& 0+"+ 3!+4,+ " ",i$*44i#$ - ,0!i'i)a4i#$ , ''v a 4a2+" 7a$!a 4+!!40a5 ' 7a0!ia' i$,0!&7$0a' 6& ,!/ ,+70i"+ a,0!i'i)a4i#$ "2 ,0a! 3!*40a7$0 'i73i+ - 'i2! " !,i"&+,5 -a 6&(,0+, 3&"$ i73"i! 6& ' 7(0+"+ + a%$0 ,0!i'i)a$0 $+ 1a%a4+$0a40+ a"4&a"+ 4+$ ' 7a0!ia' -+ i$,0!&7$0a'5 3!+v+4a$"+ 6& 'a, 2a40!ia, ,0($ 3!+0%i"a, 3+! ,0a 2i+4a!%a - , $&0!a'i4 'a *i4a4ia "' 3!+4"i7i$0+.

Pa!a '+%!a! 6& ' 7a0!ia' i$,0!&7$0a' , $4&$0! 'i2! " ,> 0+,7i4!++!%a$i,7+, "2$ &0i'i)a!, a%$0, $&0!+, 3a!a 'a 'i73i)a$"+)i75 +!01+)i75 04.5 43i''+ " 4!"a, 2'a$"a, - a%&a 0i2ia. E$a'%&$a, i$,0i0&4i+$, , &0i'i)a &$a 0i$a 6& *&$4i+$a 3+! &'0!a,+$i"+ -!a'i)a 'a 'i73i)a "' i$,0!&7$0a'.

U$a v) 6& ' 7a0!ia' i$,0!&7$0a' , 1a$ ,+70i"+ a ,0 3!+>4,+ " 'i73i)a "2$ ,! 73a6&0a"+, ,0 3!+4"i7i$0+ "2 2a>,a!, ,+2! 0+"+ $ a,%&!a! 'a ,0!i'i"a" - %a!a$0i)a! ,& */4i' 7a$+.

E$ 'a a40&a'i"a" <i,0$ va!ia"+, 7a0!ia', 3a!a ,0 *i$5 4+7+ 'a,0'a, " 7&,'i$a " a'%+"#$ " a'0a 4a'i"a"5 3a3' 0i3+ K!a*05 3a3' %!a>"+ 7("i4+5 a, 4+7+ 'a 4+72i$a4i#$ " 3a3' - 3'/,0i4+.




E, 7&- i73+!0a$0 4+'+4a! &$a $v+'0&!a "+2' a 0+"+ 7a0!ia' i$,0!&7$0a' e/ profeso 3a!a 'a 4i!&%a "2i"+ a 6& 'a 3!i7!a $v+'0&!a

, !0i!a"a 3+! 'a $*!7!a 4i!4&'a$0 - , 4+'+4a "i!40a7$0 $ 'a7,a !40a$%&'a! + " Ma-+5 4+$ '+ 6& , vi0a 4&a'6&i! 0i3+ " 4+$0a>7i$a4i#$. Ca2 !4+!"a! 6& $ ,0a 7,a , 7a$a$ 7a0!ia' - 6&i3+,0(!i' $ 0+"+ 7+7$0+.

+e"o*ena"ione! al "olo"ar

la "ar#a en el auto"laveL+, 2&'0+, $+ "2$ !2a,a! &$a a'0&!a " : a ?: 475 "2i"+ a 6& ,i

1a- 4+$0a40+ 4+$ 'a 4/7a!a5 (,0+, , 1&7"4$. D2$ 4+'+4a!, '+, 2&'0+, a 4i!0a "i,0a$4ia &$+, " +0!+,5 4+$ ' +20iv+ " 3!7i0i! 'a 4i!>4&'a4i#$ " va3+! 'a, 4aa, 70/'i4a, "2$ 0$! +!i*i4i+, 3a!a 3!7i0i!' 3a,+ " va3+!. T+"+ !4i3i$0 ,#'i"+ "2 ,! a4+7+"a"+ " 4+,0a"+'+, !4i3i$0, - *!a,4+, " 4!i,0a'5 a, 4+7+ 'a, !i$%a, a,30+5 "2$4+'+4a!, 4+$ 'a 2+6&i''a 1a4ia a2a+. E, i73+!0a$0 6& a$0, " 4+'+4a!

4a"a 4a!%a $ ' a&0+4'av , v!i*i6& 6& (,0 , $4&$0! 'i73i+.

ro"e!o e e!terili=a"inreparaci+n. E,0a *a, "' 3!+4,+ 4+$,i,0 $ 'a <3&',i#$ "' ai!

- 'a 3$0!a4i#$ "' va3+! a 3!,i#$ &$a v) 6& ' va3+! ''$a 3+! 4+7> 3'0+ 'a 4/7a!a5 'a 073!a0&!a , i$4!7$0a , "4i!5 a 7a-+! 3!,i#$57a-+! 073!a0&!a " ,0!i'i)a4i#$.

Epo!ici+n. E' 4i4'+ " ,0!i'i)a4i#$ i$i4ia a 3a!0i! " 6& ' 0!7#>70!+ - ' 7a$#70!+ " 3!,i#$ !%i,0!a$ 'a, 4i*!a, i$"i4a"a,. La 07> 3!a0&!a 3!+7"i+ !6&!i"a 3a!a 'a ,0!i'i)a4i#$ , ;9; a ;? C5 4+$&$a 3!,i#$ " 9: a 9 '23&'%95 $ !'a4i#$ 4+$ 'a a'0&!a ,+2! ' $iv' "'7a!. E$ ' 4a,+ " 'a Ci&"a" " M(<i4+ , !6&i!$ 9: '2. E, i73+!0a$0!4+!"a! 6& a 7a-+! 073!a0&!a5 , !6&i! 7$+! 0i73+ " <3+,i>4i#$ a' 4i4'+ " ,0!i'i)a4i#$.

$iclos de esterilizaciónT+"+ 7a0!ia' i$,0!&7$0a' ,+70i"+, a ,0!i'i)a4i#$ !6&i!$ " &$0i73+ ,34*i4+5 " a4&!"+ 4+$ ,&, 4a!a40!,0i4a, " 0<0&!a5 3+!+,i>"a"5 0a7a+5 04(0!a 4&a"!+ 9>;.




Cuaro 21. *ro#ecto de mantenimiento hospitalario. 5Manualde operación de autoclave% Manual de procedimientos de la $E@E% &"M.6

Material"uantes% erin-as desechablesLí4uidos$ristal o vidrioRopa% telas% -uatas # al-odones/nstrumental

Recomendaciones

7iempo de esterilización; minutos?B minutos ?minutos CBminutos Dminutos

U$a v) 4+$4'&i"+ ' 3!+4,+ " ,0!i'i)a4i#$5 '+, 2&'0+, , a'7a4$a$$ a$a6&',5 '+, 4&a', "2$ 0$! 3&!0a, " 4!i,0a'5 %&a!"a! &$a "i,>0a$4ia a3!+<i7a"a $0! 041+ - 3i,+ $+ 7$+! a 9? 47 $i 7a-+! a 4751&7"a" a3!+<i7a"a " : a : - 073!a0&!a 3+! "2a+ " '+, 9 C5- ,0a! a'a"+, " /!a, " 0!/$,i0+ 3,a"+. E, 3!*!i2' a'7a> 4$a!'+,$ !4i3i$0, " 7a''a + 4a$a,0a $ '&%a! " '+, " ,&3!*i4i ,#'i"a5

"2i"+ a 6& $ ,0+, '0i7+, , a4&7&'a$ 3+'v+ - 2a40!ia, 4+$ 7a-+!*a4i'i"a". E, i73+!0a$0 1a4! &$a 'i73i)a *!4&$0 " ,0+, ,i> 0i+, 4+$'a *i$a'i"a" " vi0a! 4+$0a7i$a4i#$. A,i7i,7+5 "2 !a'i)a!, &$a4+$,0a$0 i$,344i#$ " '+, 2&'0+,5 vi0a$"+ $ '+ 3+,i2' 'a 7a$i> 3&'a4i#$ " (,0+, 3a!a 4+$,0a0a! 'a i$0%!i"a" " '+, 3a6&0, $ 4a,+ "'a 7/, 'i%!a ,+,341a " !+0&!a + 3!,$4ia " 1&7"a"5 -a ,a $ ',i0i+ " a'7a4$a + "' 73a6&5 "2 3!+4"!, a ,& !,0!i'i)a4i#$.

Fida de ana4uelE, &$ 4+$430+ 6& 1a4 !*!$4ia a' 0i73+ $ 6& &$ 3a6&0 3&"7a$0$! ,& ,0!i'i"a" 4&a"!+ 9>9. E' 0i73+ " a'7a4$a "3$" "*a40+!, 4+7+ 4a!a40!,0i4a, "' 7a0!ia' 6& , 1a ,0!i'i)a"+ - "' 0i3+" $v+'0&!a 6& , 1a &0i'i)a"+5 7a$i3&'a4i#$ - 4+$"i4i+$, a7> 2i$0a',. E' 0i3+ " $v+'0&!a 6& 7a-+! !,i,0$4ia +*!4 a 'a 4+$0a7i>$a4i#$ , ' " 3'/,0i4+>3a3' - 3'/,0i4+ ,''a"+ a' 4a'+!5 7i$0!a, 6& 'a6& 7$+! !,i,0$4ia +*!4 , 'a " 7a0!ia' $+ 0i"+.

E$ &$ a!04&'+ 3&2'i4a"+ $ 'a !vi,0a Desarrollo cient%fico de enfer

mer%a $ &'i+ " ; 3+! Pa'a4i+, G&0i(!!) G7a - 4+'a2+!a"+!,5 ,1a4 !*!$4ia a 'a vi%$4ia "' 6&i3+5 ' 7a0!ia' - 'a !+3a ,0!i'i)a"a4+$ va3+!. S 4+$4'&- 6& ,0+, 2&'0+, 3&"$ a'4a$)a! &$ 3!+7"i+ "




Cuaro 22. Fida de ana4uel. 5Ruth G2% ?BBC.6

MaterialMaterial no teidoSábanas% campos% etc.% con ;DB hebras de cuatro

espesores% con ?HB hebras de doble espesor*elículas plásticas selladas con cintaMaterial envuelto en sábana% sellado al calor%

cubierta antipolvo*apel plástico sellado al calor

$aducidadCB díasI semanas

C mesesH semanas

; aJo

vi"a " a$a6&' 1a,0a " "a, 4&a$"+ 'a $v+'0&!a , " 3a3' %!a"+7("i4+5 ''%a a "&!a! 1a,0a ; "a,.

$alor secoM(0+"+ 6& 4+$,i,0 $ ' &,+ " ai! 4a'i$0 6& 3!+v+4a 'a 7&!0 7i>4!+2ia$a 3!+"&4i"a 4+7+ 4+$,4&$4ia " 74a$i,7+, " 0!a$,*!$4ia

" $!%a5 a"7/, " +<i"a4i#$.

7ipos de esterilizadores3ire caliente. M4a$i,7+ a44i+$a"+ 3+! &$ v$0i'a"+! 6& 1a4

4i!4&'a! ai! $0! '+, 2&'0+,5 " 0a' 7a$!a 6& , '+%! &$ i$4!7$0+ $'a 073!a0&!a.

"onducci+n por graedad. M4a$i,7+ 7"ia$0 ' 4&a' ' va3+! $'a 4a7i,a " &$ ,0!i'i)a"+! " ",3'a)a7i$0+ %!avi0a0+!i+ <3&',a ai!*!+ a' *+$"+ " 'a 4/7a!a ' 0i73+ " <3+,i4i#$ a ,0 74a$i,7+ ,'a!%+ 3a!a a,%&!a! 'a 4+$"&44i#$ " 4a'+! a 0!av(, " '+, 2&'0+,.

E$0! '+, 7a0!ia', !4+7$"a"+, 3a!a ,! ,0!i'i)a"+, 4+$ 4a'+!,4+ , $4&$0!a$ '+, ,i%&i$0,

• I$,0!&7$0a' 6&i!!%i4+ 4!+7a"+.• Ma0!ia', " vi"!i+5 a'&7i$i+ + 3+!4'a$a.• A4i0,5 3a!a*i$a5 ,&,0a$4ia, %!a,a,5 va,'i$a.

• P+'v+, 0a'4+.P+! +0!a 3a!05 '+, 7a0!ia', 6& $+ "2$ ,! ,0!i'i)a"+, 4+$ 4a>

'+! ,4+ ,+$

• Ma0!ia' 0<0i' a'%+"#$5 ,"a,5 'i$+5 04..• G+7a,.




• Ma0!ia', ,i$0(0i4+,.• T+"+ 7a0!ia' 6& , a'0! a 'a 073!a0&!a " 0!a2a+.

A'%&$a, v$0aa, " 'a ,0!i'i)a4i#$ 3+! 4a'+! ,4+ ,+$ 6& $+ "aa' *i'+ "' i$,0!&7$0a' 3&$)+4+!0a$0 + *i$+ a"7/,5 vi0a 'a 4+!!+,i#$"' a4!+ i$+<i"a2' - 3$0!a 4+$ *a4i'i"a" $ a!04&'+, 6& $+ 3&"$,0!i'i)a!, 4+$ %a, + va3+! a 3!,i#$. E$ 0a$0+ 6& a'%&$a, ",v$0aa,,+$ 6& !6&i! " &$ 0i73+ 7/, 3!+'+$%a"+ " <3+,i4i#$ a' 4i4'+ ",0!i'i)a4i#$ ",0!&- 7a0!ia' " 4a&41+ - 0'a.

E<i,0$ +0!+, 7(0+"+, * ,i4+, " ,0!i'i)a4i#$5 4+7+ 'a !a"ia4i#$i+$i)a$0 !a-+, %a77a - !a-+, 4a0#"i4+, - 'a $+ i+$i)a$0 !a-+, &'0!a>

vi+'0a5 7i,7a 6& , &0i'i)a"a ,#'+ 3+! 'a, %!a$", i$"&,0!ia, "2i"+ a,& a'0+ 4+,0+.

Esterilización por m'todos 4uímicos

K(ido de etilenoLa ,0!i'i)a4i#$ 7"ia$0 ,0 3!+4,+ 4+$,i,0 $ 6& ,0a ,&,0a$4ia6&7i4a 7a0a a '+, 7i4!++!%a$i,7+, - ,&, ,3+!a, "2i"+ a 6& i$0!*i>! $ '+, 3!+4,+, !3!+"&40iv+, - 70a2#'i4+, " 'a 4('&'a , a'0a7$0

<3'+,iv+ i$Qa7a2' a' 7)4'a!, 4+$ ' "i#<i"+ " 4a!2+$+. E,0 7(>0+"+ , 4+$+4 4+7+ ,0!i'i)a4i#$ 4+$ %a,. E' 0i73+ " <3+,i4i#$ a',0!i'i)a! "3$" " 'a 4+$4$0!a4i#$5 1&7"a"5 073!a0&!a5 "$,i> "a"- 0i3+ " 7a0!ia' 6& , ,+70 a' 3!+4,+.

A'%&$a, " ,&, v$0aa, ,+$ 6& 0i$ 7a-+! 4a3a4i"a" " 3$0!a>4i#$ $ 7a0!ia', 3+!+,+,5 ,&' ,! a$0i4+!!+,iv+ - , i"a' 3a!a ,0!i>'i)a! 3!+"&40+, a'0a7$0 ,$,i2', a' 4a'+!.

E$0! '+, i$4+$v$i$0, 6& 3!,$0a , 1a''a$ ' 141+ " 6& , &$ 3!+"&40+ 6&7i4+ i$Qa7a2'5 7&0/%$+ - 4a$4!%$+. Ta72i($ , &$ 3!+4,+ 7/, 'a!%+ - 4+,0+,+ $ 4+73a!a4i#$ 4+$ ' a&0+4'av " va3+!5a"7/, " 6& $ +4a,i+$, +!i%i$a 3!+"&40+, 0#<i4+, 4+7+ '0i'$%'i4+' a' 4+72i$a!, 4+$ ' a%&a5 + a' 4+$0a40+ 4+$ ,+'&4i#$ ,a'i$a +,a$%!5 *+!7a 4'+!1i"!i$0i'$+5 ,&,0a$4ia 0a72i($ 4+$,i"!a"a 0#<i4a.R6&i! " &$ 3!+4,+ " ai!a4i#$ 3!+'+$%a"+ "2i"+ a 6& ,0 %a, ,a2,+!2 $ 7a0!ia' " 4a&41+5 3+'i0i'$+ + ,i'i4+$a. D2 vi0a!, ,&i$1a'a4i#$ "2i"+ a 6& 3!+v+4a i!!i0a4i#$ " 'a, 7&4+,a,5 $/&,a5 4>*a'a5 "3!,i#$ "' ,i,07a $!vi+,+5 v#7i0+5 4+$0!a40&!a, 7&,4&'a!, -"i,$a.

L+, 7a0!ia', !4+7$"a"+, 3a!a ,! ,0!i'i)a"+, 4+$ #<i"+ "0i'$+ ,+$



$apítulo ? : $entral de e4uipos # esterilización 5$E@E6 25

• Ca&41+ - 3'/,0i4+ %!a"+ 7("i4+.• Ca0(0!,5 ,+$"a,5 0&2+, - 6&i3+, 3a!a $"+,4+3ia5 i$1a'+0!a3ia

- a$,0,ia.

• I$,0!&7$0a' 4+$ *i'+ 4+7+ 0i!a,5 %&2ia, - 3&$0a, " '40!+4a&>0!i+.

• E6&i3+ '40!#$i4+.

P+! +0!a 3a!05 '+, 7a0!ia', 6& $+ "2$ ,! ,0!i'i)a"+, 4+$ #<i>"+ " 0i'$+ ,+$

• Ma0!ia' " 3+'i0i'$+ - 0'a,.• L6&i"+,5 3+'v+, - %!a,a,.

• Ma0!ia', "7a,ia"+ 3+!+,+,.reparaci+n de aterial para e!teriliar. E' 7a0!ia' 6& ,!/

,+70i"+ a ,0 3!+4,+ "2 ,0a! 4+73'0a7$0 'i73i+ - ,4+. L+, 3a6&0, 6& , 4a!%a$ $ ' ,0!i'i)a"+! "2$ ,0a! ,&*i4i$07$0,3a!a"+, 3a!a 6& ' %a, 3&"a 4i!4&'a! " 7a$!a 'i2! - a"4&a"a 3+!0+"a ,& ,&3!*i4i. T+"+ i$,0!&7$0a' + 6&i3+ 6& 0$%a a"a30a"+!,"2 ,! ",a!7a"+ a *i$ " *a4i'i0a! ,& ,0!i'i)a4i#$.

roce!o de e!teriliaci+n. ; 1ac%o. C+$,i,0 $ va4ia! - <0!a! 3+!

4+73'0+ ' ai! " 'a 4/7a!a5 '+, a!04&'+, - '+, 73a6&,. E' %a, $> 0!aa 3!,i#$ 1a,0a '+%!a! &$a 073!a0&!a " ? a : C. 9 E/posición.M(0+"+ 3+! ' 4&a' , 4!a 1&7"a" 7"ia$0 'a i$-44i#$ " va3+! a'i$0!i+! " 'a 4/7a!a5 "2i"+ a 6& 'a, ,3+!a, ,4a, - ",1i"!a0a"a, ,v&'v$ 7/, !,i,0$0, a 'a a44i#$ "' %a,. E,0+ '0i7+ 1a4 6& ' #<i"+" 0i'$+ a40 4+$ 7a-+! *i4a4ia.

Eacuaci+n. E, $4,a!i+ 6& a' 0(!7i$+ "' 3!+4,+ , va4& '%a, 4+$ ' *i$ " !,0a2'4! 'a 3!,i#$ a07+,*(!i4a $ 'a 4/7a!a.

3ireaci+n. P!+4,+ " ,&7a i73+!0a$4ia 4&-a *i$a'i"a" , 'i7i> $a!'a, 3a!04&'a, !,i"&a', "' %a, 4+$0$i"+ $ '+, a!04&'+, 3+! ,& a'0+%!a"+ " 0+<i4i"a" 4&a"!+ 9>. E,0 3!i+"+ " ai!a4i#$ 3&"

Cuaro 23. Aireación.

7iempo de aireación

H horas;? horas?D horasI días

7emperatura

B $ B$Especificaciones del manualEspecificaciones del manual




3!+'+$%a!, 1a,0a 3+! ,i0 "a,5 "3$"i$"+ " 'a, 4a!a40!,0i4a, "'7a0!ia' ,0!i'i)a"+.

ecoendacione!. E' 3!,+$a' " $*!7!a5 6& a 7$&"+ 7a$>

a ,0+, "i,3+,i0iv+,5 "2 +2,!va! 'a, ,i%&i$0, 7"i"a, " ,%&!i"a"

• U,+ " 2a0a " 7a0!ia' i73!7a2'.

• U,+ " %&a$0, " $+3!$+.• Ma,4a!i''a ,34ia'.• E<3+,70!+.

E' 3!,+$a' $+ "2 !a'i)a! ,0 3!+4"i7i$0+ 3+! 0i73+ 3!+>

'+$%a"+5 -a 6& 'a <3+,i4i#$ !%&'a! $ &$a +!$a"a " 0!a2a+ 3&" 3!+v+4a! a$7ia $+!7+40i4a $+!7+4!#7i4a. La <3+,i4i#$ !%&'a! 3+!a+, 3&" 4a&,a! '&47ia5 'i$*+7a5 0&7+!,5 a'0!a4i+$, 7&0/%$a,5a2+!0+ ,3+$0/$+5 $iv', a'0+, " a$,i"a" - "3!,i#$5 a, 4+7+ a'0>!a4i#$ " 'a 77+!ia - 'a 4+$4$0!a4i#$.

E' #<i"+ " 0i'$+ 3&" 4+72i$a!, 4+$ ,&,0a$4ia, ",0!&40+!a, "'a 4a3a " +)+$+5 3a!a ,& *40+ 4+7+ 7(0+"+ " ,0!i'i)a4i#$. La,$*!7!a, - '+, $*!7!+, $+ "2$ +'vi"a! 6& ' 4&i"a"+ 6& +0+!>

%a$ $+ , 'i7i0a ,#'+ a' i$"ivi"&+ + a' %!&3+ " (,0+,5 ,0 4&i"a"+ "2 i!7/, a''/ , "4i!5 "2 ,0a2'4!, &$ 4+73!+7i,+ 3a!a &,a! " 7a$!a!a4i+$a' - !,3+$,a2' '+, !4&!,+,5 4+$ 'a *i!7 i$0$4i#$ " 3!+4&!a!0a72i($ ' 4&i"a"+ "' a72i$0.

2ormaldehído -aseosoM(0+"+ " ,0!i'i)a4i#$ 6&7i4a 4&-+ 74a$i,7+ " a44i#$ , 'a 4+a>%&'a4i#$ " 'a, 3!+0$a, 4'&'a!, " 'a 2a40!ia.

roce!o de e!teriliaci+n. E$ 'a 0a3a " preparaci+n , <3&',a 'ai! - , i73i" 'a $0!a"a " va3+!. D,3&(,5 "&!a$0 'a epo!ici+n5 $ 'a$0!a"a " ,0 *+!7a'"1"+ a 'a 4/7a!a "2 ,! $ ,0a"+ %a,+,+ -va3+!5 4+$ ' *i$ " 7a$0$! 'a 073!a0&!a !6&!i"a.

E$ 'a 0a3a " eacuaci+n5 a' 0(!7i$+ "' 4i4'+ " ,0!i'i)a4i#$5 ,<3&',a ' *+!7a'"1"+. S i$0!4a'a$ $0!a"a, " va3+! 4+$ &$ $7!+va!ia"+ " va4+,5 , *i$a'i)a 4+$ va4+ 3!+*&$"+ - $0!a"a " ai! ,0(>!i'5 - " ,0a 7a$!a , 4+$,i%& "i,7i$&i! !,i"&+, - ' ,4a"+ " '+,

+20+,.A'%&$a, " 'a, v$0aa, " ,0a 0(4$i4a ,+$ ,& 2a+ 4+,0+5 6& $+ ,

!6&i! " &$ 3!+4,+ 3!+3ia7$0 " ai!a4i#$ - 6& ' 4i4'+ " ,0>!i'i)a4i#$ , 4+!0+. S&, ",v$0aa, ,+$ 6& i!!i0a 772!a$a, - 7&4+,a,5




a"7/, " 6& a' 4+$0a40+ 4+$ 'a 3i' 3!+"&4 "!7a0i0i, 0a72i($ , &$ 3+0$0 4a!4i$#%$+5 3!+"&4 a'!%ia - 7&0a4i+$,.

*lasma peró(ido de hidró-enoE' 3'a,7a 4+7+ 0a' , 4+$,i"!a"+ 4+7+ ' 4&a!0+ ,0a"+ " 'a 7a0!ia"2i"+ a 6& ,& ,0!&40&!a 7+'4&'a! , "i*!$0 a 'a "' '6&i"+5 ,#'i"+ +%a,+,+. E' 3!#<i"+ " 1i"!#%$+ , &$ 4+73&,0+ 6& */4i'7$0 3&"4+$v!0i!, a' ,0a"+ 3'a,7/0i4+5 a40iva!, - 3!+"&4i! va3+! !a4> 0iv+. S&,!a"i4a', 'i2!, ",0!&-$ 'a, *&$4i+$, vi0a', " 'a, 2a40!ia,5

i$0!a40&a$"+ 4+$ '+, /4i"+, $&4'i4+,5 $)i7a, - 772!a$a, 4'&'a!,.S%$ 'a 7a$!a $ 6& '+, ,0!i'i)a"+!, 4+$vi!0$ ' 3!#<i"+ "1i"!#%$+ $ 3'a,7a5 , ', 4'a,i*i4a $ 0!, 0i3+, ; " 3'a,7a5 9 " 3'a,7a %a,+,+ - " *a, " va3+!.

roce!o de e!teriliaci+n. E' aco , 4!a"+ 3a!a <0!a! +20+, -ai! 4i!4&'a$0 " 'a 4/7a!a 3a!a ''+ , a&7$0a 'a 3!,i#$ " 'a 4/7a!a- , ,a4a ' +<%$+. D ,0a 7a$!a , 4+$,i%& 0a72i($ 'i7i$a! '+,7i4!++!%a$i,7+, a!+2i+, ,0 4i4'+ "&!a a3!+<i7a"a7$0 ;? 7i$&>

0+,. C+$ 'a i$-44i#$ , 4+'+4a$ 'a, 4/3,&'a, 4+$0$i"a, $ ' 4a!0&41+5 "0a' *+!7a 6& , i$-40 ' 3!#<i"+ " 1i"!#%$+ a 'a 4/7a!a " ,>0!i'i)a4i#$.

D&!a$0 'a diu!i+n ' 3!#<i"+ " 1i"!#%$+ , a40iva"+ 3+! 7"i+" !a"i+*!4&$4ia5 , *+!7a ' 3'a,7a - , %$!a '&) &'0!avi+'0a ,0a*a, , !3i0 "+, v4, $ ' 4i4'+. E$ 'a *a, " entilaci+n , *i'0!a 'ai! 3a!a 4+73$,a! 'a 3!,i#$ " 'a, 4/7a!a, <0!$a i$0!$a " ,0a7a$!a , +20i$$ 3a!04&'a, " +<%$+ - 0!a)a, " 1&7"a".

E$0! 'a, v$0aa, " ,0 7(0+"+ 4a2 7$4i+$a! 6& $+ , $4,a>!i+ 4+$0a! 4+$ i$,0a'a4i+$, ,34ia', + 4+73'a, a"7/,5 ' 4i4'+ ",0!i'i)a4i#$ , 7&- 4+!0+ - ' 7a$+ "' ,0!i'i)a"+! , a&0+7a0i)a>"+. P+! +0!a 3a!05 $0! ,&, i$4+$v$i$0, ,0/ ' 141+ " 6& !6&i!73a6&, " 7a0!ia' 7&- ,34*i4+, 4+7+ ' 3+'i3!+3i'$+ - 2+',a,0-v5 a"7/, " 6& $+ , 3+,i2' ,0!i'i)a! '6&i"+,.

<cido perac'tico

M(0+"+ " ,0!i'i)a4i#$ 6&7i4a $ 3!,$0a4i#$ '6&i"a ,0/ 4+$,0i0&i>"+ 3+! /4i"+ a4(0i4+ 7/, &$ /0+7+ " +<%$+5 , 4+7+ '+, 7i4!++!%a$i,>7+,5 , ",0!&-$ 3+! 3!+4,+ " +<i"a4i#$ a 3!+0$a, ",$a0&!a'i)a"a,.

E,0 0i3+ " ,0!i'i)a"+! , a&0+7a0i)a"+ - 0i$ 7'0i3', 4+$0>$"+!, 6& 3!7i0$ *ia! '+, +20+, 6& 1a2!/$ " ,0!i'i)a!,. E,0




4uir,r-ica

7(0+"+ *&$4i+$a a 073!a0&!a, " ?? C "&!a$0 ;9 7i$&0+,. F&$4i+$a4+$ 4i4'+, " 4i!4&'a4i#$ " a%&a 3a!a $&a%a!5 - ' a%&a , ,0!i'i)a"a

7"ia$0 772!a$a, " *i'0!a4i#$. T+"+ ' 4i4'+ " ,0!i'i)a4i#$ "&!a $ 3!+7"i+ : 7i$&0+,.

E$0! ,&, v$0aa, , 4&$0a 6& $+ 4a&,a i!!i0a4i#$ a' 4+$0a40+ 4+$ 3i' - 7&4+,a,5 $+ , 0#<i4+ $i 3!+"&4 4+!!+,i#$ " '+, 70a', , &$ 3!+4,+ " 4+!0a "&!a4i#$ - ' ,0!i'i)a"+! , */4i' " i$,0a'a!. A'%&$a, ",&, ",v$0aa, ,+$ 6& ' 7a0!ia' i$,0!&7$0a' 6& , ,0!i'i)a$ 3+!,0 7(0+"+ $+ "2$ a'7a4$a!,5 3+! '+ 6& , ' "2$ &,a! "i$7"ia0+. A"7/,5 ,#'+ 3&"$ ,0!i'i)a!, a!04&'+, 6& 3!7i0a$ ,&i$7!,i#$.

ni"aore! el "ontrol e la e!terili=a"inE,0+, i$"i4a"+!, 3!7i0$ 4+$0!+'a! - %a!a$0i)a! 'a 4a'i"a" " '+, 3!+>

4,+, " ,0!i'i)a4i#$ " '+, 3a6&0,. L+, 0i3+, " i$"i4a"+!, ,+$ 0!,1) !ico!. S+$ i$"i4a"+!, 6& *&$4i+$a$ a' 0i73+ 6& , 4+73'>

0a ' 4i4'+ " ,0!i'i)a4i#$. B/,i4a7$0 ,+$ 7a$#70!+, " 3!,i#$ -

073!a0&!a5 v/'v&'a,5 %!/*i4a, - 0!7#70!+, " a&0+4'av.2) uico!. S&,0a$4ia, 6& 4a72ia$ " 4+'+! &$a v) 6& , 1a$

4&73'i"+ 'a, 4+$"i4i+$, " 4+$4$0!a4i#$ "' a%$0 ,0!i'i)a$05 07> 3!a0&!a - 0i73+. A-&"a$ a "i,0i$%&i! '+, a!04&'+, ,0(!i', " '+, 6& $+'+ ,0/$. E$0! '+, 7/, &0i'i)a"+, *i%&!a$ 4i$0a, 0,0i%+5 0i6&0a, + 0i!a," 3a3' i73!,+ 4+$ !a40iv+, 6&7i4+, 6& 4a72ia$ " 4+'+!. E'+20iv+ , i$"i4a! a' 3!,+$a' 6& 7a$a '+, 3a6&0, 6& 'a 4a!%a ,,0!i'i)#. E,0+, i$"i4a"+!, $+ 2!i$"a$ 'a 4!0)a " 6& '+, 7i4!++!%a>

$i,7+, , 1a$ 'i7i$a"+5 - 3a!a ,0+ <i,0$ '+, i$"i4a"+!, 2i+'#%i4+,.) Biol+gico!. P!7i0$ 4+73!+2a! 6& 'a ,0!i'i)a4i#$ " '+, a!>

04&'+, , 1a ''va"+ a 4a2+ " 7a$!a *40iva. S+$ a73+''0a, " vi"!i++ 3'/,0i4+ 6& 4+$0i$$ ,3+!a, " 7i4!++!%a$i,7+, viv+, - !,i,0$0, a'+, "i*!$0, 7(0+"+, " ,0!i'i)a4i#$. A *i$ " v!i*i4a! 'a ,0!i'i)a>4i#$ 3+! %a, #<i"+ " 0i'$+5 *+!7a'"1"+ - 4a'+! ,4+ , !4+7$"a> 2' &0i'i)a! 2acillus subtilis va! ni(er 43a (lobi( a @ C " 073!a0&!a$ &$ 0i73+ 7$i7+ " 1+!a,.

T+"a 7+$i0+!i)a4i#$ " 'a ,0!i'i)a4i#$ "2 !a'i)a!, " 3!*>!$4ia $ 4a"a 4i4'+ - $ 4a"a 0&!$+. T+"+, '+, 3!+4,+, ",4!i0+, a6&,+$ !,3+$,a2i'i"a" "' 3!,+$a' " $*!7!a a",4!i0+ a' /!a. P+! '+a$0!i+!5 , i73+!0a$0 4+$,i"!a! ' 4&73'i7i$0+ " 'a, ,i%&i$0, *&$>4i+$,.




2unciones de la enfermera en la $E@E

• F&$4i+$, 0(4$i4a, - a"7i$i,0!a0iva, 3!+3ia, "' ,!vi4i+.• L'va! &$ 4+$0!+' 3+! i$v$0a!i+ "' i$,0!&7$0a' - 6&i3+.• Ma$0$! ' i$,0!&7$0a' - ' 6&i3+ $ #30i7a, 4+$"i4i+$,.• Ma$0$! <i,0$4ia " '+, i$,&7+, $4,a!i+, 3a!a 4&2!i! 'a ">

7a$"a " 4i!&%a.• C+$0!+'a! - "i,0!i2&i! " 7a$!a 6&i0a0iva 0+"+ ' 6&i3+5 i$,0!&>

7$0a' - 7a0!ia' " 4a$ - " 4+$,&7+.• A3'i4a! 'a, 0(4$i4a, 4+!!40a, 3a!a 'a 3!3a!a4i#$5 ,0!i'i)a4i#$ -

a'7a4$a7i$0+ "' i$,0!&7$0a' - ' 6&i3+ 6&i!!%i4+.• A3'i4a! 'a, $+!7a, +*i4ia', - "i,3+,i4i+$, 6& ,0a2'4 'a i$,0i>0&4i#$.

• S&3!vi,a! - 4+$0!+'a! 6& ' 3!+4,+ " ,0!i'i)a4i#$ , ''v a4a2+ " 7a$!a 4+!!40a.

• P!3a!a! 0+"+ ' i$,0!&7$0a'5 7a0!ia' - 6&i3+ $4,a!i+ 3a!a 'a4i!&%a.

• C+'+4a! i"$0i*i4a4i#$ + 772!0 a 4a"a 3a6&0 + 2&'0+ 6&i!!%i>

4+5 i$"i4a$"+ 'a *41a " ,0!i'i)a4i#$ - 4a"&4i"a".• C+$0!+' " 'a 4a'i"a" " '+, 3!+4,+, " ,0!i'i)a4i#$ 7"ia$0 'aa3'i4a4i#$ " i$"i4a"+!, 2i+'#%i4+,.

:ilio#ra)ía

H!$/$") G. T0cnicas &uir'r(icas en enfermer%a. E"i0+!, " T<0+,M<i4a$+,. 33. :9. M(<i4+. 9::.

Ma$&a' " 3!+4"i7i$0+, " 'a CEYE5 HGM. P!+-40+ " 7a$0$i>7i$0+ 1+,3i0a'a!i+. Ma$&a' " +3!a4i#$ " A&0+4'av.

Ri$4#$ S. C+$+4i7i$0+ "' 3!,+$a' " $*!7!a " 'a vi%$4ia !a'" ,0!i'i)a4i#$. E' 4a,+ " CEYE "' H+,3i0a' G$!a' " M(<i4+.M(<i4+. N+v. 9::;.

R&01 F J. #nstrumentación &uir'r(ica. W "i4i#$. E"i0+!ia' Pa$a7!i4a>

$a. 33. @. 9::.



$apítulo

A

LEE

31




D2i"+ a '+ a$0!i+!5 'a ,%&!i"a" " "i41+, a3a!a0+, 4+2!a %!a$!'va$4ia - 1a4 $4,a!ia &$a ,4!&3&'+,a !vi,i#$ - va'&a4i#$ "'

6&i3+ a$0, " 4a"a 3!+4"i7i$0+ 6&i!!%i4+. P+! '+ !%&'a! , 1a 4+$>,i"!a"+ 6& '+, !!+!, , "2$ ,#'+ a *a''a, 6& 4+70$ 'a, 3!,+$a,4&a$"+ 3!,0a$ &$ ,!vi4i+ " ,a'&". Si$ 72a!%+5 a 7"i"a 6& ava$)a 'a0(4$i4a - 'a 04$+'+%a5 , 4+$,0a0a 6& ,0+, !!+!, , "2$ 0a72i($ a&$ 7a' *&$4i+$a7i$0+5 a, 4+7+ a &$ &,+ !!#$+ "' 6&i3+ - " '+,a3a!a0+, '(40!i4+,5 3+! '+ 6& "2 <0!7a!, 'a ,%&!i"a" a' &0i'i)a!>'+,. La $*!7!a ,i73! "2 v!i*i4a! ' 2&$ ,0a"+ - *&$4i+$a7i$>0+ "' 6&i3+ 6& 1a2!/ " &0i'i)a!, 3a!a 'a 4i!&%a5 3&, ,0a 7"i"a!"&4 ' !i,%+ " a44i"$0, 6&i!!%i4+,.

E' 0i3+ - 'a, 4a!a40!,0i4a, " '+, "i,3+,i0iv+, '40!+7("i4+, &0i'i>)a"+, $ ' 3!+4"i7i$0+ 6&i!!%i4+ , !'a4i+$a$ 4+$ 'a ,34ia'i"a" "'a 4&a' , 0!a0 4a!"i+'+%a5 $&!+'+%a5 4i!&%a 3'/,0i4a - "7/,. E$vi!0&" " '+ a$0!i+!5 a 4+$0i$&a4i#$ , ",4!i2$ '+, "i,3+,i0iv+, 7$i>7+, i$"i,3$,a2', 3a!a 4&a'6&i! 4i!&%a.

&le"tro"auterioE' 4+$0!+' "' ,a$%!a"+ , *&$"a7$0a' "&!a$0 ' 3!+4"i7i$0+ 6&i>!!%i4+ - , ''va a 4a2+ 7"ia$0 'a 17+,0a,ia5 'a 4&a' , 0+!$a ,i7> 3! "i* 4i'5 3!+ a$ 7/, "&!a$0 &$ 3!+4"i7i$0+ 3+! $"+,4+3ia. Pa!a4+$0!+'a! ' ,a$%!a"+ 7"ia$0 17+,0a,ia $ ' 0!a$,+3!a0+!i+ ,i73+!0a$0 4+$0a! 4+$ &$ "i,3+,i0iv+ *i4a) - ,%&!+ ''a7a"+ '4>0!+4a&0!i+ 0a72i($ 4+$+4i"+ 4+7+ '40!+2i,0&!5 ' 4&a' 4+$,i,0 $ &$

,i,07a 6& &0i'i)a $!%a '(40!i4a $ 4&a'6&i!a " ,&, "+, 7+"a>'i"a", 7+$+3+'a! + 2i3+'a!. E, &$a 1!!a7i$0a 2/,i4a 3a!a !a'i)a! 'a17+,0a,ia>"i,44i#$ $ 'a 4i!&%a a2i!0a + 3+! $"+,4+3ia , 0!a0a " &$6&i3+ 6& 3!+"&4 &$a ,!i " 4+!!i$0, " a'0a *!4&$4ia 3a!a 4+!0a!54a&0!i)a! + 'i7i$a! 0i"+ 2'a$"+.

E<i,0$ va!i+, i$,0!&7$0+, 6& , "i*!$4ia$ 3+! 'a *!4&$4ia " ,&%$!a"+! - 6& 0i$$ 'a 4a3a4i"a" " 'va! ,& 073!a0&!a 1a,0a 9::5'+ 6& 4+$,0i0&- &$a ",v$0aa "2i"+ a 6& 4+$ ''+ 3!+v+4a$ $4!+,i," 0i"+, a"-a4$0, i73+!0a$0,. S&' 3!+"&4i! 4i!0a 4a$0i> "a" "1&7+ a' 1a4! 4+$0a40+ 4+$ ' 0i"+5 '+ 4&a' "i*i4&'0a 'a vi,i#$ $ 'ai$0!v$4i#$ 6&i!!%i4a.

La 'i0!a0&!a !*i! 6& ,0 a3a!a0+ '40!+7("i4+ +*!4 ,i%$i*i>4a0iva, v$0aa,5 4+7+ 7$+! 0i73+ 3a!a 'a i$4i,i#$ - "i,7i$&4i#$ "'



$apítulo C : Aparatos electrom'dicos 33

,a$%!a"+. S 73'a 3a!a ,44i+$a! 'a, 4a3a, " 'a 3a!" a2"+7i$a'5 a<434i#$ " 'a 3i'. Di41+ a3a!a0+ &0i'i)a 4+!!i$0 '(40!i4a 7+$+3+'a! -

2i3+'a!.

Cir"uito *onopolarLa 4+!!i$0 , a3'i4a"a 7"ia$0 &$ '40!+"+ 3+,i0iv+5 4i!4&'a 3+! 0+"+

' 4&!3+ - !%!,a a' %$!a"+! 7"ia$0 &$a 3'a4a %!a$" + '40!+"+$%a0iv+5 6& , 1a''a $ 4+$0a40+ *i!7 4+$ 'a 3i' "' 3a4i$0. E' 4i!4&i>0+ 7+$+3+'a! , ' 7/, &0i'i)a"+ $ 'a 4i!&%a $"+,4#3i4a 3+! ,& %!a$

3+"! 17+,0/0i4+.

*rocedimiento• A,%&!a! 6& 'a 3'a4a + '40!+"+ ,0( 'i73ia - ,4a.• V!i*i4a! 6& 'a 3'a4a 0$%a ,&*i4i$0 %' 4+$"&40+!.• C+'+4a! 'a 3'a4a 3!*!$07$0 $ &$ ,i0i+ ,4+ - ,i$ &,+, " 4+$>

0i$&i"a" + 3!,$4ia " v''+ $ 'a 3i' "' 3a4i$0.

• Vi%i'a! 6& 'a 3'a4a $+ 1a%a 4+$0a40+ 4+$ a"i0a7$0+, 70/'i4+,. • V!i*i4a! 6& 'a 3'a4a ,a '+ 2a,0a$0 %!a$".

E, i73+!0a$0 !a'i)a! ' 3!+4"i7i$0+ " 7a$!a ,%&!a 3a!a vi>0a! ',i+$, 3+! 6&7a"&!a,5 ,+2! 0+"+ 4&a$"+ , 0!a0a " 4i!&%a $>"+,4#3i4a. Di41a, ',i+$, 3&"$ ,!

• L,i#$ 0(!7i4a "i!40a.• Fa''a $ ' ai,'a7i$0+ "' i$,0!&7$0+.• C+$0a40+ "' '40!+"+ a40iv+ 4+$ i$,0!&7$0+, 4+$"&40+!,.

• A4+3'a7i$0+ + 3a,+ " 4+!!i$0 "," ' '40!+"+ a &$ 4+$"&40+!a"-a4$0 ,i$ $4,i"a" " 4+$0a40+.

Cir"uito ipolarE, &$ 4i!4&i0+ 6& %$!a 4+!!i$0 7"ia$0 &$ 4a2' 4+$40a"+ a &$a,

3i$)a, ,34ia', &$a " 'a, 3&$0a, , " 3+'a!i"a" 3+,i0iva - 'a +0!a $>%a0iva. Pa!a 6& 'a 4+!!i$0 4i!4&' - , 4+$,i%a "0$! ' Q&+ ,a$%&>$+ , i73+!0a$0 3i$)a! &$a 3+!4i#$ " 0i"+. La 7+"a'i"a" 2i3+'a! , 'a7/, &0i'i)a"a "&!a$0 &$a 4i!&%a a2i!0a.

La 0(4$i4a 4+$ 4i!4&i0+ 2i3+'a! , 'a 7/, !4+7$"a"a 3a!a "i,7i>$&i! '+, !i,%+, -a ",4!i0+, ,i$ 72a!%+5 $+ , 7&- a430a"a 3+! ,&7$+! 3+"! 17+,0/0i4+. E, 7&- i73+!0a$0 7$4i+$a! 6& $&$4a




4uir,r-ica

"2 73'a!, ' '40!+4a&0!i+ 3a!a ,44i+$a! ' i$0,0i$+ %!&,+5 -a6& $ ,0 4+$"&40+ , 3!+"&4 %a, 70a$+ - 3+! 4+$,4&$4ia 3&"

%$!a!, &$a <3'+,i#$.La, 3a!0, " 6& 4+$,0a ' '40!+2i,0&! ,+$ &$i"a" 4$0!a'5 '/3i)

+ 3i$)a ",7+$0a2'5 3'a4a $&0!a 4+$ 4a2'5 0+7a " 0i!!a - 3"a' "7a$"+ 3a!a 4+!0 + 17+,0a,ia.

:i!turí ar*ni"oE,0 "i,3+,i0iv+5 6& 4+7$)# a ",a!!+''a!, $ 'a "(4a"a " ;:>;5

4+!0a - 4+a%&'a '+, 0i"+, 3+! 'a 4+$v!,i#$ " 'a $!%a '(40!i4a $$!%a 74/$i4a 7"ia$0 &$a 1+a vi2!a$0 vi2!a4i+$, a a'0a *!>4&$4ia5 ?? ::: H)5 4+$ '+ 6& , '+%!a 2&$a 17+,0a,ia - 7$i7a '>,i#$ 0(!7i4a $ va,+, " 1a,0a 77 " "i/70!+. R"&4 'a 17+!!a%iai$0!a+3!a0+!ia - 'a, v$0&a', 17+!!a%ia, 3+,+3!a0+!ia,5 - 0!a2aa a&$a 073!a0&!a 6& $&$4a ,&3!a '+, : C5 4+$ 4&-+ ",73+av$0aa a' '40!+2i,0&!.

C+$,0a " &$ %$!a"+!5 &$ 0!a$,"&40+! - 0!7i$a', ' 3!+3i+ 2i,>0&! ,0a, 3i)a, ,+$ i$0!4a72ia2',5 - ' a3a!a0+ ,0/ "i,a"+ 3a!a4+!0a!5 4+a%&'a! - "i,4a!.

A40&a'7$0 ,0a 1!!a7i$0a , &$a 3i)a 3!i7+!"ia' 3a!a 'a 4i>!&%a 'a3a!+,4#3i4a5 a, 4+7+ $ 4i!&%a %i$4+'#%i4a5 &!+'#%i4a5 $&>!+'+%a5 0!a&7a0+'+%a5 4i!&%a 4a!"i+va,4&'a! - 0+!/4i4a5 4i!&%a a2i!0a4+$v$4i+$a' $"+4!i$a5 13/0i4a5 4+'+!!40a' - 4i!&%a %$!a'.

E$ 'a a40&a'i"a" , 4&$0a 0a72i($ 4+$ &$ 2i,0&! " '0i7a %$>!a4i#$ ''a7a"+ a!%#$ 3'a,7a5 4&-+ ",73+ , a$ 7/, 3!4i,+ 6& '"' 2i,0&! a!7#$i4+ "2i"+ a 6& !a'i)a 4+!0, - vi0a ' ,a$%!a"+7"ia$0 4+a%&'a4i#$ i$7"ia0a.

E,0 ,i,07a *&$4i+$a 7"ia$0 &$a 4+73&0a"+!a 6& ,&7i$i,0!a 'a4+!!i$0 '(40!i4a &,0a 3a!a 4a&0!i)a!5 - 'a 073!a0&!a , ,i73! 7$+! a 'a 6& a'4a$)a ' 2i,0&! a!7#$i4+5 '+ 4&a' !3!,$0a &$a 7a-+! v$0aa,+2! '+, 2i,0&!, a$0!i+!7$0 7$4i+$a"+,.

A!piraorE, &$ "i,3+,i0iv+ i73!,4i$"i2' 3!+vi,0+ " &$+ + "+, va,+, 4+'40+!,5

2+72a " va4+5 7a$%&!a, " i$0!4+$<i#$ - &$ ,i,07a " !%&'a4i#$" va4+. C+7+ 0+"+ 6&i3+ 6&i!!%i4+5 4&$0a 4+$ !&"a, 3a!a ,& */4i'0!a,'a"+.




E, &0i'i)a"+ $ ' /!a 6&i!!%i4a 3a!a a,3i!a! '6&i"+, -+ Q&i"+, 6&, %$!a$ "&!a$0 'a 4i!&%a. Ta72i($ , " %!a$ &0i'i"a" 3a!a <> 0&2a!a' 3a4i$0 - a,3i!a! 'a, ,4!4i+$, !,&'0a$0,.

ro"ei*ientoE' a,3i!a"+! , 4+$40a"+ 7"ia$0 &$ 0&2+ " '/0< + 4&a'6&i! 7a0>

!ia' " 4a&41+ + 3'/,0i4+ ,0(!i'. S ' 4+'+4a &$ a"i0a7$0+ "$+7i$a"+4/$&'a -a$a!5 'a 4&a' "2 ,! ,0(!i' "2i"+ a 6& $0!a "i!40a7$0$ 4+$0a40+ 4+$ 'a 1!i"a 6&i!!%i4a5 - a,3i!a ' ,a$%!a"+ - '+, '6&i"+,

%$!a"+, "&!a$0 'a +3!a4i#$. E' a,3i!a"+! 0a72i($ , &0i'i)a"+ 3+! 'a$,0,i#'+%+ a' !v!0i! 'a a$,0,ia5 3+! '+ 6& 'a 4/$&'a "2 ,! 4a7> 2ia"a 3+! &$a $&va5 " 7+"+ 6& , 3!4i,+ a4!4a! 0+"+ ' ,i,07a a 'a4a24!a "' 3a4i$0.

E' ,i,07a "2 ,! 4+$40a"+ a' i$i4ia! 'a 4i!&%a 'a $*!7!a "2v!i*i4a! 6& $+ , $4&$0! ''$+ + 6& ' 0&2+ ,0( "+2'a"+ & +2,0!&i>"+ 3+! 7a0!ia' ,#'i"+. La, 4a!a40!,0i4a, " '+, a,3i!a"+!, va!a$ "a4&!"+ 4+$ 'a 7a!4a 6& '+, "i,0!i2&-5 3+! '+ 6& , !4+7$"a2'

4+$,&'0a! ,i73! ' 7a$&a' " +3!a4i#$.

Col"n t<r*i"oL+, 1&7a$+, !6&i!$ &$a 073!a0&!a 4+!3+!a' i$0!$a 4+$,0a$> 0 3a!a 7a$0$! &$a *&$4i#$ *i,i+'#%i4a - 70a2#'i4a $+!7a'5 -a 6&4&a$"+ ,0a 073!a0&!a , a'0!a $ 7a-+! + 7$+! %!a"+ 3!+v+4a ,i>0&a4i+$, " ,&7a &!%$4ia5 4+7+ $ '+, 3a4i$0, ,+70i"+, a 4i!&%a5 $

6&i$, , 3!,$0a 1i3+0!7ia $+ i$0$4i+$a' "2i"+ a 'a a$,0,ia5 ,+2!0+"+ $ ' 0!a$,+3!a0+!i+ - 3+,+3!a0+!i+ i$7"ia0+5 -a 6& 'a 4a3a4i"a""' +!%a$i,7+ , v "i,7i$&i"a 3a!a !%&'a! 'a 073!a0&!a. P+! '+a$0!i+! , i73+!0a$0 4+$0a! 4+$ 6&i3+ ,34ia' 3a!a 4+$0!+'a! 'a073!a0&!a "' 3a4i$0 ,+70i"+ a 4i!&%a. La *&$4i#$ 3!i$4i3a' "' ,04+'41#$ , 3!+3+!4i+$a! 4a'+! a' 3a4i$0 "&!a$0 'a 4i!&%a5 4+$+20+ " vi0a! 'a 1i3+0!7ia - 'a, 4+73'i4a4i+$, "!iva"a, " ''+.

E$ ,0+, 4a,+, ' 7(0+"+ 7/, a73'ia7$0 "i*&$"i"+ 3a!a 4+$,!>

va! 'a 073!a0&!a , ' &,+ "' 4+'41#$ 0(!7i4+. E, &$ "i,3+,i0iv+ 6& ,a40iva 7"ia$0 &$ ,i,07a " 4i!4&'a4i#$ " a%&a - ,& *&$4i+$a7i$0+ ,7&- !/3i"+. E, *a40i2' !%&'a!'+ "," ? 1a,0a ; C. E' 4+'41#$ "2,0a! 6&i3a"+ 4+$ ,i,07a, " a'a!7a 0a$0+ vi,&a' 4+7+ a&"i2'5 " 0a'




4uir,r-ica

*+!7a 6& a' a40iva!, 'a a'a!7a , ",4+$40 'a 4a'*a44i#$ " 7a$!aa&0+7/0i4a5 4+$ '+ 6& , vi0a!/$ a44i"$0, 4a&,a"+, 3+! 6&7a"&!a,.

Ya , $*a0i)# 'a i73+!0a$4ia " 7a$0$! 'a 073!a0&!a a"4&a"a"' 3a4i$05 ,+2! 0+"+ " $+$a0+, 3"i/0!i4+, - a"&'0+, 7a-+!,. E,i73+!0a$0 i$,i,0i! $ 6& 'a a$,0,ia - 'a 4i!&%a ,+$ *a40+!, 6& 4+$>0!i2&-$ a 6& ' +!%a$i,7+ "i,7i$&-a ,& 4a3a4i"a" 3a!a 4+$0!+'a! 'a073!a0&!a.

Pa!a 'a 3!/40i4a " 'a a$,0,i+'+%a5 'a N+!7a O*i4ia' M<i4a$a NOM>;@:>SSA;>; !*i! '+ ,i%&i$0 $ ,& 3&$0+ ;.9.; ;D2!/a,%&!a! 6& 'a &$i"a" 7("i4a 4&$0 4+$ ' 6&i3+ 6& 3!7i0a 7a$>0$! 'a 073!a0&!a a"4&a"a "' 3a4i$0 7"ia$0 a'%&$+ " '+,'7$0+, "i,3+$i2',5 4+7+ &$ 4+'41#$ 0(!7i4+5 4a,4a"a, 1&7i"i*i4a>"+!a,5 4a'$0a7i$0+ " 'a, ,+'&4i+$, a"7i$i,0!a"a,5 + 4&2!i$"+ 4+$%&a0a + 3'/,0i4+ 'a, /!a, <3&,0a, 6& $+ ,a$ ,+70i"a, a i$0!v$>4i#$ 6&i!!%i4a.

C&a$"+ $+ , 4&$0a 4+$ ,0 0i3+ " "i,3+,i0iv+,5 a 7$&"+ , &0i>'i)a %&a0a - a'%+"#$5 ,+2! 0+"+ $ $+$a0+, - 'a40a$0,5 4&a$"+ (,0+, ,+$,+70i"+, a 4i!&%a. A,i7i,7+5 3a!a 7a$0$! a &$a 073!a0&!aa"4&a"a 'a, ,+'&4i+$, a2#$5 i,+"i$5 04. &0i'i)a"a, 3a!a ' 'ava"+74/$i4+ - 'a a$0i,3,ia5 (,0a, ,+$ ,+70i"a, a 2a+ Ma!a 3a!a ''+5'+, *!a,4+, , 4+'+4a$ $ &$ !4i3i$0 4+$ a%&a 4a'i$0 1a,0a 4+$,%&i!6& 'v$ ,& 073!a0&!a.

A'%&$a, 3!4a&4i+$, 6& , $4,a!i+ +2,!va! ,+$ 'a, ,i%&i$0,

• V!i*i4a! ' 4+!!40+ *&$4i+$a7i$0+ "' 4+'41#$ 0(!7i4+.• V!i*i4a! 6& 0$%a ' $iv' " a%&a !6&!i"+.

• N+ "a! i$,0!&7$0+, 3&$)+4+!0a$0, $4i7a5 "2a+ + a &$ 'a"+"' 4+'41#$.• C+'+4a! &$a 4+73!,a + 4a73+ " 0a' 7a$!a 6& a2a!6& 0+"a 'a

,&3!*i4i "' 4+'41#$.• N&$4a "2$ &0i'i)a!, 2+',a, + %&a$0, 4+$ a%&a 4a'i$05 3&, ,>

0+, a!0*a40+, i73!+vi,a"+, $+ 3!7i0$ 0$! &$ !%i,0!+ 4+!!40+ "'a 073!a0&!a 4+!3+!a' - ''%a$ a 4a&,a! ',i+$,5 ,+2! 0+"+ $ 3a4i$0, 3"i/0!i4+,.

$onitor e !i#no! vitale!La 7+$i0+!i)a4i#$ " 'a, 4+$,0a$0, vi0a', , &$ *a40+! *&$"a7$0a' $ ',%&i7i$0+ "' ,0a"+ 4'$i4+ "' 3a4i$0 - 4+$,0i0&- &$ 3a!/70!+




6& i$"i4a ,& ,0a"+ 17+"i$/7i4+. La 7"i4i#$ " 'a, 4+$,0a$0, vi0a>', $ i$"ivi"&+, ,+70i"+, a 3!+4"i7i$0+, 6&i!!%i4+, , i$"i4a$ "7a$!a 3!7a$$0 "&!a$0 ' 3!+4,+ 6&i!!%i4+ $ 'a, ,i%&i$0, 9 +

1+!a, "2$ 7"i!, 4a"a ;? a : 7i$&0+,5 - ",3&(, " ,0 0i73+ ,!4+7i$"a *40&a! " $&v+ 'a 7"i4i#$ 4a"a 4&a0!+ 1+!a,.

E' 7+$i0+! 3a!a ,i%$+, vi0a', ,0/ 3!+vi,0+ " &$a 3a$0a''a " a'0a!,+'&4i#$ 6& 3!7i0 +2,!va! '+, ,i%$+, vi0a', "' 3a4i$0.

Cara"terí!ti"a! ieale! e un *onitor4cil coniguraci+n. A44,+ !/3i"+ 3a!a ,0a2'4! 'a, *&$4i+$,

2/,i4a, a'a!7a 4+$ ,+$i"+ a"4&a"+ 0i73+ 7$i7+ 3a!a 'a vi,&a'i>)a4i#$.

4cil de operar. Ra3i") 3a!a 4a72i+ " 3a!/70!+, "&!a$0 ' 7+>$i0+!+ 3+,i2i'i"a" " 7"i! 3!,i#$ a!0!ia' $+ i$va,iva " *+!7a 7a>$&a' - a&0+7/0i4a 7+,0!a! 0$"$4ia, - a!!i07ia, 3!7i0i! !%i,0!+ $ 3a3' "2 ,! 3+,i2' 4+$*i%&!a!'+ i$0!3!0a!'+ ,i$ $4,i"a" " &$7a$&a' " &,&a!i+5 a"7/, " 6& "2 +*!4! 7$,a, " a-&"a $4a,+ " 6& , &0i'i4$ *&$4i+$, $+ 1a2i0&a',.

i!e*o !iple. Vi,&a'i)a4i#$ " 'a 3a$0a''a , "4i!5 'a, 4&!va, - '+,"a0+, $&7(!i4+, "2$ ,! 4'a!+, "," va!i+, /$%&'+, 'a, a'a!7a, "> 2$ ,! vi"$0, &,+ "' 4+'+! 3a!a 'a, "i*!$0, 4&!va,5 6& 3!7i0a$i"$0i*i4a! !/3i"a7$0 ' 3a!/70!+ $ 4&,0i#$ $ 'a 3a$0a''a.

$ipo! de alara!. D !i,%+ vi0a'5 " 7$,a + " avi,+. E, i73+!>0a$0 6& 4&$0$ 4+$ &$ v+'&7$ ,&3!i+! a' !&i"+ a72i$0a' - , a4>0iv$ $ ' 7+7$0+ $ 6& '+, '7i0, ,0a2'4i"+, , !2a,$ & +4&!!a&$ i73!vi,0+.

E, !4+7$"a2' 6& ' 3!,+$a' " $*!7!a v!i*i6& ,& 4+!!4>0+ *&$4i+$a7i$0+ a$0, - "&!a$0 'a 4i!&%a. C&$0a$ 4+$ &$a 2a0!a!4a!%a2' 6&5 $ 4a,+ " a&,$4ia " '40!i4i"a"5 7a$0i$ ,& *&$4i+>$a7i$0+ 3+! &$ 'a3,+ 7$i7+ " "+, 1+!a,.

&-uipo *aterialLa 7+$i0+!i)a4i#$ "' $*!7+ !6&i! " a3a!a0+, '40!#$i4+, 6&

!$a$ 'a, 4a!a40!,0i4a, ",4!i0a,. D2$ ,! 7+"&'a!,5 i$0!4a72ia> 2', - 4+$ 3+,i2i'i"a" " aa"i! $&v+, 7#"&'+, 3a!a +0!+, 3a!/70!+,vi0a',. L+, 7+$i0+!, 4&$0a$ 4+$ 4a2', 6& , 4+$40a$ a "iv!,+,,$,+!, 3a!a !4+%! - !%i,0!a! 'a, ,a',5 a, 4+7+ 7+,0!a! 'a, 4+$,>




0a$0, vi0a',. A 4+$0i$&a4i#$ , 'i,0a$ a'%&$a, " 'a, 7"i4i+$, 7/,i73+!0a$0,.

recuencia re!piratoria. E' 4i4'+ !,3i!a0+!i+ 4+73!$" &$a *a,

i$,3i!a0+!ia , "4i!5 $0!a ai! - +<%$+ a '+, 3&'7+$, - &$a *a, ",3i!a4i#$5 $ 'a 4&a' , <3' a$1"!i"+ 4a!2#$i4+ a' <0!i+!. E' 7+$i0+!!%i,0!a &$ "a0+ $&7(!i4+ - &$a +$"a 6& i$"i4a ' 0i3+ " !,3i!a4i#$.

Saturaci+n de ogeno. C+$+4i"a 0a72i($ 4+7+ +<i70!a " 3&'>,+5 7i" 3!i$4i3a'7$0 'a i$0$,i"a" "' 3&',+ a!0!ia' - 'a ,a0&!a4i#$ "17+%'+2i$a. Pa!a ''+ , 4+'+4a &$ ,$,+! 3!*!$07$0 $ '+, ""+,$"i4 + a$&'a!5 ' 4&a' 3+, &$ 7i,+! " '&) - &$ *+0+"040+! 6&0!a$,*i! a' 7+$i0+! ,0 '0i7+5 4+$ 2a, $ &$ a'%+!i07+5 !%i,> 0!a "7a$!a 3!7a$$0 ' ,0a"+ " ,a0&!a4i#$. E<i,0$ "i*!$0, 0i3+, ",$,+!,5 '+ 4&a' "3$" "' 7+$i0+! - " 'a "a" "' 3a4i$0.

E, $4,a!i+ 0$! $ 7$0 'a, ,i%&i$0, 3!4a&4i+$, a' 4+'+4a!' +<70!+

• R0i!a! &a, 3+,0i)a,5 a, 4+7+ ' ,7a'0 " (,0a,5 -a 6& 3&"$ 3!+v+4a! *a',a, '40&!a,.

• N+ &0i'i)a! '40!+2i,0&! 7&- 4!4a "' +<70!+.

• V!i*i4a! 6& $+ 1a-a *&$0, " '&) 6& a3&$0$ a' +<70!+.recuencia cardiaca. S "*i$ 4+7+ ' $7!+ " v4, 6& ' 4+>

!a)#$ !a'i)a ' 4i4'+ 4+73'0+ " ''$a"+ - va4ia"+ " ,&, 4/7a!a, $4i!0a &$i"a" " 0i73+. La *!4&$4ia 4a!"ia4a , &$ !Q+ " 'a 4+$>0!a44i#$ + ,,0+' "' 4+!a)#$ , "4i!5 4&a$"+ , <3&',a 'a ,a$%! a'!,0+ " 'a 4+$+7a5 , <3!,a $ 4+$0!a44i+$, 3+! 7i$&0+.

&onitoriaci+n cardiaca. S !a'i)a 7"ia$0 &$ 4+$40+! 4+$ 0!,4a2', 4+$v$4i+$a' + 1a,0a 4i$4+ 4a2', ECG 4+73'0+5 '+, 4&a', ,

4+$40a$ a '40!+"+, 4+'+4a"+, a $iv' 0+!/4i4+5 7i,7+, 6& "2$ 0>$! 2&$a a"1,i#$5 $+ 4a&,a! i!!i0a4i#$ $ 'a 3i' - 3!+"&4i! ' 7$i7+ "i$0!*!$4ia, 4+$ ' !,0+ " '+, 7+$i0+!,.

re!i+n arterial. F&!)a + 3!,i#$ 6& !4 'a ,a$%! a ,& 3a,+ 3+!'a, 3a!", a!0!ia',. E,0/ "0!7i$a"a 3+! ' %a,0+ 4a!"ia4+ - 'a !,i,>0$4ia va,4&'a! 3!i*(!i4a. E$ ,0 4a,+ ,+$ "+, 'a, 7"i"a, " 3!,i#$ 'a,i,0#'i4a 6& , 'a 3!,i#$ 7/<i7a - 'a "ia,0#'i4a 6& , 'a 3!,i#$7$i7a. E' !%i,0!+ $ ' 7+$i0+! 3&" ,! 4+$,0a$0 + a i$0!va'+,.

&onitoriaci+n de la pre!i+n arterial. C+$40+! 4+$ &$ ,+'+ 4a2'6& , a&,0a a' 7a$%+ 6& 3+!0a ' 3a4i$0 $ &$a <0!7i"a".

&onitoriaci+n de la teperatura. É,0a , +20i$ 7"ia$0 &$4a2' 4+$40a"+ a &$ '40!+"+ 6& , 4+'+4a $ 'a 3i' "' 3a4i$0.




:o*a e in)u!in

Di,3+,i0iv+ '40!#$i4+ 4&-a *&$4i#$ 4+$,i,0 $ ,&7i$i,0!a! " 7a$!a 3!+%!a7a"a - 4+$0!+'a"a &$a ,&,0a$4ia "0!7i$a"a5 3+! va i$0!av$+> ,aa 0+"+ 3a4i$0 4&-a 4+$"i4i#$ '+ !6&i!a.

E' 4+!!40+ &,+ - *&$4i+$a7i$0+ " ,0+, "i,3+,i0iv+, , " ,&7ai73+!0a$4ia5 3&, "i,7i$&-$ ' 3+!4$0a " !!+! 1&7a$+ $ ' ,&>7i$i,0!+ i$0!av$+,+ " '6&i"+, - 7"i4a7$0+,. D2i"+ a ,& 'va"+4+,0+5 $+ $ 0+"a, 'a, i$,0i0&4i+$, " ,a'&" , 4&$0a 4+$ ,0 0i3+ "04$+'+%a.

La, 2+72a, " i$*&,i#$ , &0i'i)a$ 4+$ 7a-+! *!4&$4ia $ 'a, /!a," 0!a3ia i$0$,iva - a$,0,ia5 a&$6& ,& &,+ 3&" <0$"!, a 3a4i$0, 4+$ 4i!0a, 4+73'i4a4i+$, 6& ''%a$ a 6&i!#*a$+5 " a1 'ai73+!0a$4ia " 6& 'a $*!7!a a",4!i0a a' 6&i!#*a$+ 4+$+)4a ,& *&$>4i+$a7i$0+.

A'%&$a, 2+72a, " i$*&,i#$ 3&"$ 7a$a! va!ia, ,+'&4i+$, "7a$!a ,i7&'0/$a i$"3$"i$0. U$a 2+72a 6& 7a$a "+, + 7/,,+'&4i+$, 4+$ 4+$0!+', i$"3$"i$0, " i$*&,i#$ 0i$ "+, + 7/, 4a>

$a',.A'%&$a, " ,&, 4a!a40!,0i4a, 7/, !'va$0, ,+$

• P!4i,i#$.

• S%&!i"a" - 4+$*ia2i'i"a".• S&7i$i,0!+ 4+$,0a$0.• Si,07a, " 4+$0!+'. •

A'a!7a,.• A'i7$0a4i#$ '(40!i4a - " 2a0!a,.

Carro e ane!te!iaE,0 "i,3+,i0iv+5 4+7+ 0+"+ ' 7+2i'ia!i+ 6&i!!%i4+5 ,0/ *a2!i4a"+ 4+$a4!+ i$+<i"a2' a"7/,5 , $4&$0!a 3!+vi,0+ " 4a+$, 3a!a a'7a>4$a! 7a0!ia' 4+7+ 4/$&'a,5 'a!i$%+,4+3i+,5 ,+$"a,5 7a,4a!i''a, - 7>"i4a7$0+, a$,0(,i4+,5 $0! +0!+,. C&$0a 4+$ ,+3+!0 3a!a 7+$i0+! -a

",4!i0+5 4i!4&i0+ a$,0(,i4+ 4+$ 2+',a " !,!v+!i+5 va3+!i)a"+! "1a'+0a$+ - !,3i!a"+! a&0+7/0i4+ 0a72i($ 3&" ,0a! 3!+vi,0+ " &$4+$0$"+! " ",41+, " 7a0!ia' 3&$)+4+!0a$0 - 4+$0a! 4+$ !&"a, 3a!a &$ */4i' ",3'a)a7i$0+.




&-uipo e re!u"ita"in

/e!)irilaorDi,3+,i0iv+ 6& a"7i$i,0!a 41+6&, + ",4a!%a, '(40!i4a, a 0!av(, "

'a 3a!" 0+!/4i4a " 7a$!a 3!+%!a7a"a - 4+$0!+'a"a a,i7i,7+5 a3'i4ai73&',+, " 4+!!i$0 " a'0a a73'i0&" 3a!a !,0a2'4! ' !i07+ - 'a *&$>4i#$ 4+$0!/40i' $+!7a' "' 4+!a)#$ $ 3a4i$0, 4+$ *i2!i'a4i#$ v$0!i4&>'a!5 0a6&i4a!"ia - a&,$4ia " 3&',+.

7ipos de desfibriladorese!i#riladore! eterno! anuale! o de pala!. E,0a 4'a, " ",*i>

2!i'a"+!, 4+$,0a " &$a 3a$0a''a 3a!a !%i,0!+ " '40!+4a!"i+%!a7a5 "+, 3a'0a, 3a!a 'a a3'i4a4i#$ " ",4a!%a '(40!i4a5 4a2' " + ? "!i>va4i+$,5 '40!+"+, a"1,iv+, - 4a!%a"+! " 2a0!a.

La 4+!!i$0 '(40!i4a 6& 73'a$ ,0+, 6&i3+, , "i!40a - ,+20i$ a 3a!0i! " 'a 4+!!i$0 a'0!$a " &$a i$,0a'a4i#$ 4+$v$4i+$a'7"ia$0 &$ 4+$v!0i"+! " 4+!!i$0 4&$0a 4+$ &$a 2a0!a 6& 3!>

7i0 a'7a4$a! $!%a5 &$ i$0!!&30+! " $4$"i"+>a3a%a"+ - +0!+ "4a!%a. E' 6&i3+ "a ,a'i"a a 'a ",4a!%a '(40!i4a a 0!av(, " &$ 4a2' 6&0!7i$a $ 'a, 3a'a,. E' ",*i2!i'a"+! , 4+$40a a' 3a4i$0 4+$ &$ 4a2'" 0!, + 7/, '40!+"+, 6& 3!7i0 ' 7+$i0+!+ 4+$0i$&+ $ 3a$0a''a56& 3&" !%i,0!a!, $ 3a3' " ,! $4,a!i+.

E, 7&- i73+!0a$0 6& 'a 3!,+$a 6& +3!a 'a, 3a'a, "' ",*i2!i'a>"+! v!i*i6& 6& $a"i ,0( 1a4i$"+ 4+$0a40+ "i!40+ + i$"i!40+ 4+$ ' 3a4i$0 "&!a$0 ,& &0i'i)a4i#$.

A 4+$0i$&a4i#$ , "'i$a ' 3!+4"i7i$0+ a ,%&i!• E$4$"! ' "i,3+,i0iv+ - *ia! '+, '40!+"+,.• R0i!a! 0+"+ 0i3+ " 1&7"a" "' 3a4i$0.• A3'i4a! 3a,0a 4+$"&40+!a + %a,a, 73a3a"a, " ,+'&4i#$ ,a'i$a a 'a,

3a'a, "' ",*i2!i'a"+!5 vi0a$"+ 6& (,0a, 1a%a$ 4+$0a40+ $0! ,.• C+'+4a! 'a, 3a'a, *i!77$0 $ 4+$0a40+ 4+$ ' 0#!a<5 &$a $ ' v(!>

0<5 "2a+ " 'a 4'av4&'a "!41a5 - +0!a $ ' /3<5 + )+$a i$*!i+! i)6&i!"a "' 0#!a<. E' 0a7a+ " 'a, 3a'a, ,0a!/ $ !'a4i#$ 4+$ 'a"a" - 0a7a+ "' 0#!a< "' 3a4i$0.

• E$ ' 4a,+ " *i2!i'a4i#$ v$0!i4&'a! , "2 3+$! ' 7a$"+ $ a,i$>4!#$i4+. E, i73+!0a$0 7$4i+$a! 6& 3a!a 'a 4a!"i+v!,i#$ "24+'+4a!, ' 7a$"+ $ ,i$4!#$i4+. N+ 1a- 6& 3!"! " vi,0a 6& 'a




*i2!i'a4i#$ v$0!i4&'a! - 'a 4a!"i+v!,i#$ 0i$$ &$ 0!a0a7i$0+ 4&-a"i*!$4ia , 7$i7a !,340+ a' &,+ "' ",*i2!i'a"+!.

• Ca!%a! ' ",*i2!i'a"+! J%. La 4a!%a va!a " a4&!"+ 4+$ 'a "a"

- 3,+ "' 3a4i$0.• Avi,a! a 0+"a, 'a, 3!,+$a, 6& , ,3a!$ "' 3a4i$0 - 4+73!+2a!

$&va7$0 6& 3!,i,0 'a *i2!i'a4i#$ v$0!i4&'a!.• P!,i+$a! " 7a$!a ,i7&'0/$a '+, 2+0+$, " a72a, 3a'a, 3a!a

3!+v+4a! 'a ",4a!%a.• C+73!+2a! 6& , 1a-a 7+"i*i4a"+ ' !i07+ "' ECG.• V!i*i4a! 6& , 1a-a !4&3!a"+ ' 3&',+.• E$ 4a,+ " $+ +20$! !,3&,0a 3+,i0iva5 3!+4"! a +0!a ",4a!%a.

E, 7&- i73+!0a$0 0$! 'a 3!4a&4i#$ " a3'i4a! %' 4+$"&40+! "7a$!a a3!+3ia"a 3a!a vi0a! 6& ' 3a4i$0 ,&*!a 6&7a"&!a,. A,i>7i,7+5 "2 4+$,0a0a!, $ 0+"+ 7+7$0+ 6& $+ , 1a%a 4+$0a40+ 4+$70a', 4+7+ '+, " 'a 4a7a.

e!i#riladore! eterno! autoatiado!. R4i$07$0 , 1a$"i,a"+ 7+"'+, ava$)a"+, " ",*i2!i'a"+!, <0!$+, a&0+7a0i)a> "+,54&-a, 3!i$4i3a', 4a!a40!,0i4a, ,+$ 6& 73'a$ '40!+"+, " ",4a!%a

a&0+a"1!i2',5 '+ 6& 3!7i0 'a ",*i2!i'a4i#$ ,i$ 7a$i3&'a> 4i#$ 3+,$ &$ 7i4!+3!+4,a"+! i$0!$+ 6& a$a'i)a ' !i07+ 4a!"ia4+ - avi,aa' +3!a"+! "' 6&i3+ ,i , 3!,$0a *i2!i'a4i#$ v$0!i4&'a! + 0a> 6&i4a!"iav$0!i4&'a!. L+, 6&i3+, 0+0a'7$0 a&0+7a0i)a"+,5 a' "040a! 'a 3!,$4ia" 0a6&i4a!"ia v$0!i4&'a! + *i2!i'a4i#$ v$0!i4&'a!5 4a!%a$ ' $iv' "$!%a !6&!i"+ " a4&!"+ 4+$ &$ 3!+0+4+'+ 3!+%!a7a"+5- " i%&a' 7a$!a "!iva 'a a3'i4a4i#$ "' 41+6& '(40!i4+ a' 3a4i$0.

e!i#riladore! eterno! !eiautoatiado!. E' 7a$+ " ,0+,

",*i2!i'a"+!, "7a$"a 7a-+! 3a!0i4i3a4i#$ "' +3!a"+!. D2 +3!i>7i!, &$ 2+0#$ 3a!a i$"i4a! a' a3a!a0+ 6& !a'i4 &$ a$/'i,i, "' !i07+4a!"ia4+ "' 3a4i$05 4+$ '+ 6& , +20i$ &$ avi,+ 6& i$"i4a 6& "2a40iva!, ' 2+0#$ " ",4a!%a "' ",*i2!i'a"+! ,i , 1a i"$0i*i4a"+ 3!>,$4ia " *i2!i'a4i#$ v$0!i4&'a!.

Carro ro(oC+$,0i0&- &$ 4+73'7$0+ "' ",*i2!i'a"+!5 -a 6& , &0i'i)a$ " 7a>$!a ,i7&'0/$a. E$ ,0 4a!!+ , 4+$4$0!a$ " 7a$!a +!"$a"a 7a>0!ia'5 6&i3+ - 7"i4a7$0+, 3a!a 'a a0$4i#$ +3+!0&$a - a"4&a"a $ 'a,7a$i+2!a, " !a$i7a4i#$ 4a!"i+3&'7+$a!.






• V!a3a7i'+• C'+$i"i$a• Ni*"i3i$a

• Ni0!+3!&,ia0+

ela=ante! u!culare!

• S&44i$i'4+'i$a• B!+7&!+ " v4&!+$i+

3nalg%!ico! , !edante!

• Ti+3$0a' ,#"i4+

• Dia43a7• Mi"a)+'a7• P!+3+*+'• Di*$i'1i"a$0+i$a0+• Na'+<+$a• Na'2&*i$a• F'&7a4$i'+• M+!*i$a

• F$0a$i'+

>tro!

• Hi"!+4+!0i,+$a• M0i'3!"$i,+'+$a •

D<a70a,+$a• F&!+,7i"a• T+*i'i$a

• Ra$i0i"i$a• H3a!i$a ,#"i4a

• S&'*a0+ " 7a%$,i+ M%SO

• C'+!&!+ " 3+0a,i+ KC'

• Bi4a!2+$a0+ " ,+"i+ NaHCO

Solucione! cri!talina!

• S+'&4i#$ *i,i+'#%i4a a' :.

• Ri$%! 4+$ 'a40a0+• D<0!+,a a' ? - ;:• Ma$i0+' a' ;• S+'&4i+$, %'&4+*i,i+'#%i4a, a' :.?




E'uipo! para inu!i+n

• Mi4!+%+0!+,

• Ma4!+%+0!+,• Ca0(0!, i$0!av$+,+, $7,. ;5 ;5 9: - 99• G&a$0,• J!i$%a, " 5 ?5 ;: - 9: 44• Ga,a,

E'uipo de oigenaci+n

• F&$0 " +<%$+ 4+$ 3!,i#$ a"4&a"a

• A72• C/$&'a, $a,a',

E'uipo de laringo!copio!

• La!i$%+,4+3i+, !40+, - 4&!v+, $7,. ;5 95 - • S+$"a, +!+0!a6&a', $7,. 5 .?5 @5 @.?5 5 .?5 5 .? - ;:• M/,4a!a, 'a!$%a, $7,. ;5 95 - • C/$&'a, " Ma-+

• G&a,• Pi$)a " Ma%i''• C/$&'a " Ya$a1&!• S+$"a, " a,3i!a4i#$• Li"+4a$a $ a!+,+'

E, i73+!0a$0 1a4! a6& &$a !Q<i#$ a4!4a "' &,+ " 'a 0'*+>$a 4'&'a! + 0'(*+$+ 7#vi'. Si 2i$ , 4i!0+ 6& (,0 , 1a 4+$v!0i> "+$ &$ "i,3+,i0iv+ " &,+ 4+0i"ia$+ - 6& 'a, 3!,+$a, , 4+7&$i4a$ 3+!

,0 7"i+ $ 4&a'6&i! '&%a! - $ 0+"+ 7+7$0+5 a, 6& ' 3!,+> $a' ",a'&" $ %$!a' $+ ,0/ <$0+ "' &,+ i$"i,4!i7i$a"+ " ,0 0i3+ "04$+'+%a. E, i73+!0a$0 vi0a! ,& &,+ 4!4a " a3a!a0+, '40!+> 7("i4+,$ *&$4i+$a7i$0+5 4+7+ ",*i2!i'a"+!,5 7a!4a3a,+,5 2+72a, "i$*&,i#$5 7+$i0+!, " ,i%$+, vi0a',5 04.5 3&, 3&"$ 3!+v+4a!,"i*!$0, 4+73'i4a4i+$,5 "," i$0!*!$4ia $ ' *&$4i+$a7i$0+ "'+, "i,3+,i0iv+, '40!+7("i4+, 1a,0a5 7/, %!av a$5 a&7$0a! ' !i,%+6&i!!%i4+ 3a!a ' 3a4i$0 - ' 3!+3i+ 3!,+$a'5 '+ 4&a' 3&" ",$4a>

"$a! "7a$"a, " 0i3+ '%a'. E$ vi,0a " ''+5 , 4!&4ia' 6& ' 3!,+$a'1a%a 4+$4i$4ia " 'a i73+!0a$4ia " 3!,4i$"i! "' &,+ " ,0+, a3a!a> 0+,$ ' 6&i!#*a$+.




:ilio#ra)ía

Ca,0''a$+ C. Electrocardio(raf %a cl%nica. S%&$"a "i4i#$. E"i0+!ia' E'>,vi!. 3. ?.

Ka$1i!a E5 Ki$+,1i0a T5 O7&!a K. U'0!a,+$i4a''->a40iva0" "vi4, *+!$"+,4+3i4 ,&!%!-. Min #nvas Ther Allied Technol >. ;.

Ma$&a' " &,&a!i+ " 6&i3+, Ba<0! " M(<i4+.M+'i$a P F5 Pa'a4i+ MME. P&',i+<i70!a$ ,ev$ ,ol de Enfermer%a. 9::9.



$apítulo

C

'DL"LL

CE4

47




Ci"atri=a"in i)eria

o por !e#una inten"inE' 4i!! , !a'i)a ",3&(, " 7/, " 9 1+!a, - , "a 6& '+, 2+!",

&$0$5 ,i$ 4+'+4a! &$a ,&0&!a + 4&a'6&i! +0!+ 7a0!ia'. P!+"&4 &$a4i4a0!i) " 7&- 7a'a 4a'i"a" - ,& 4&!a4i#$ 0a!"a 7/, 0i73+.

Cierre o "i"atri=a"in

por ter"era inten"inTa72i($ ''a7a"+ 4i!! "i*!i"+ + 3!i7a!i+ 0a!"+5 , &$ 7(0+"+ 6&

4+$,i,0 $ 3!i$4i3i+ $ "a! a2i!0a 'a 1!i"a5 - ",3&(, " 4&a0!+ "a,a3!+<i7a"a7$05 - -a 6& , +2,!v 0i"+ " %!a$&'a4i#$ 'i73i+5 4>!!a! 7"ia$0 i$0!v$4i#$ 6&i!!%i4a - 4+$ &$a ,&0&!a.

E' 4i!! 3+! 4&a!0a i$0$4i#$ a'&" a' 0i3+ " 1!i"a, 6& , 3!0$>" 4!!a! 7"ia$0 4+'%a+, i$!0+,.

E<i,0 +0!a 4'a,i*i4a4i#$ " 'a, 1!i"a,5 'a 4&a' , ,0a2'4 " a4&!>

"+ 4+$ ' !i,%+ " 4+$0a7i$a4i#$5 - , 4a0a'+%a " 'a ,i%&i$0 7a$!a'i73ia5 'i73ia>4+$0a7i$a"a5 4+$0a7i$a"a - ,&4ia. E,0a 4'a,i*i4a4i#$ 1a,i"+ i$,0a&!a"a 3+! ' +ational ,esearch Council " EUA - *& a"+30a"a 3+! ' American Colle(e of Sur(eons - ,0/ vi%$0 $ 'a a40&a'i"a".

'eria li*piaH!i"a 6&i!!%i4a ,i$ i$*44i#$ $ 'a 6& $+ <i,0 i$Qa7a4i#$ - $+ ,

3$0!a ' 0!a40+ !,3i!a0+!i+5 "i%,0iv+5 %$i0a' + &!i$a!i+. E,0a, 1!i"a, ,4i!!a$ " 3!i7!a i$0$4i#$ -5 $ 4a,+ " !6&!i!'+5 , 4+'+4a$ "!> $a,4!!a"+,. La, 1!i"a, i$4i,i+$a', 6& +4&!!$ 3+! 0!a&7a0i,7+ $+ 3$0!a$0 "2$ i$4'&i!, $ ,0a 4a0%+!a ,i 4&73'$ 4+$ '+, 4!i0!i+,",4!i0+, 4+!!,3+$"$ a 4i!&%a '40iva.

'eria li*pia"onta*inaa

E$ ,0 0i3+ " 1!i"a 6&i!!%i4a , 3$0!a ' 0!a40+ !,3i!a0+!i+5 "i%,>0iv+5 %$i0a' + &!i$a!i+5 3!+ 2a+ 4+$"i4i+$, 4+$0!+'a"a, ,34*i4a>7$0 4i!&%a, 6& 4+73!+70$ ' 0!a40+ 2i'ia!5 ' a3($"i45 'a va%i$a -'a +!+*a!i$%. E, 3!4i,+ a,%&!a!, " 6& $+ <i,0a vi"$4ia " i$>*44i#$ + 6& , 1a-a !+0+ 'a 0(4$i4a 6&i!!%i4a ,0(!i'5 -a 6& , 0!a,3a,a



$apítulo D : $lasificación de heridas 49

&$a 2a!!!a 4+$0a7i$a"a 3+! 7i4!++!%a$i,7+,. P+! 73'+5 'a 1!i"a "'a 4+'4i,040+7a , 4a0a'+%a"a 4+7+ 'i73ia>4+$0a7i$a"a "2i"+ a 6&a' ,44i+$a! 'a va 2i'ia! 'i0i/,i4a5 'a Q+!a 2a40!ia$a 1a4 4+$0a40+ 4+$

''a. La 3+,i2i'i"a" " i$*44i#$ $ ,0 0i3+ " 1!i"a, , 'va"a.

'eria "onta*inaaE, &$a 1!i"a a2i!0a - " +!i%$ a44i"$0a'. S 3!+"&4 $ 4i!&%a,

"+$" , !+73 0+0a'7$0 'a 0(4$i4a 6&i!!%i4a ,0(!i'5 4+7+ 7a,a4a!"ia4+ a2i!0+ + "!!a7 a2&$"a$0 " '6&i"+ i$0,0i$a'. La, 1!i"a, $6& , $4&$0!a$ ,i%$+, " i$Qa7a4i#$ a%&"a $+ 3&!&'$0a "2$

i$4'&i!, $ ,0a 4a0%+!a.

'eria !u"iaH!i"a 0!a&7/0i4a a$0i%&a 4+$ !0$4i#$ " 0i"+ ",vi0a'i)a"+ 6& 0i>

$ i$*44i#$ 4'$i4a + v,4!a 3!*+!a"a. E,0a "*i$i4i#$ i$"i4a 6& '+,+!%a$i,7+, 4a&,a$0, " 'a i$*44i#$ 3+,+3!a0+!ia ,0a2a$ 3!,$0, $' 4a73+ +3!a0+!i+ a$0, " 'a 4i!&%a.

C+7+ -a , 7$4i+$#5 'a, 1!i"a, 6&i!!%i4a, ,+$ i$0$4i+$a"a,5 3+!'+ 6& , 4i!4&$,4!i2$ a &$ ,i0i+ 7&- ,34*i4+5 3+! '+ 4&a' 'a $*!>7!a 4i!4&'a$0 - $ ,34ia' 'a i$,0!&7$0i,0a "2 0$! 'a 3!4a&4i#$" ''va! a 4a2+ " 7a$!a 7&- !i%&!+,a ' ,i%&i$0 3!+4"i7i$0+ a'*i$a'i)a! 'a 4i!&%a. U$a v) 4+$4'&i"a 'a i$0!v$4i#$ 6&i!!%i4a - 6& ,1a-a !0i!a"+ 0+"+ 0i3+ " 7a0!ia' i$,0!&7$0a' a'!""+! "' 3a4i$0

• R0i!a! 0+"+ <4"$0 " ,4!4i+$, - ,+'&4i+$, 4+$ 4+73!,a, +

%a,a, 17"a, 4+$ ,+'&4i#$ ,0(!i'.• S4a! 4+$ +0!a 4+73!,a + %a,a ,0(!i'.• C&2!i! " 7a$!a i$7"ia0a 'a 1!i"a 4+$ &$ a3#,i0+ + %a,a ,0(!i'. • C&a$"+ 6&"$ "!$a, i$,0a'a"+,5 , 4+'+4a!/$ "!$a, + 2+',a,

a"4&a"a, 3a!a 4&a$0i*i4a! ' %a,0+.• C+'+4a! 4i$0a a"1,iva 7a0!ia' 6& $+ ',i+$ 'a 3i' "' 3a4i$05

4+7+ 4i$0a 7i4!+3+! + 0!a$,3+!0 3a!a ,&0a! '+, a3#,i0+,.• V!i*i4a! 6& , 'i7i$ 0+"+ 0i3+ " <4"$0 " ,+'&4i+$, a$0i>

,(30i4a, 7"ia$0 'i73i)a 4+$ a%&a ,0(!i'.E$ ' 3+,+3!a0+!i+ i$7"ia0+

• O2,!va! 4a!a40!,0i4a, "' ,i0i+ 6&i!!%i4+ 4+'+!5 073!a0&!a "'a 3i'5 3!,$4ia " ,a$%!a"+ + " ,4!4i+$, 3&!&'$0a,5 +'+!.




4uir,r-ica

E$ !'a4i#$ 4+$ 'a, 1!i"a,5 <i,0$ a73'i+, - va!ia"+, ,0&"i+, 6&a3+!0a$ i$*+!7a4i#$ a2&$"a$0 !,340+ a' 0!a0a7i$0+ 6& "2 "a!, a

'a, 1!i"a, 6&i!!%i4a,. E,0 4a30&'+ $*a0i)a 'a *&$4i#$ 0a$ i73+!0a$> 06& ",73a 'a $*!7!a a' a"+30a! 7"i"a, %$!a',5 $+!7a, -7a$+, &$iv!,a'7$0 a430a"+, 6& "2 a3'i4a! $ 4a"a 4a,+ 3a!0i>4&'a!5 0!a0a$"+ ,i73! " 3!ivi'%ia! a' 7/<i7+ a' 3a4i$05 4+$ '+ 6&4+$0!i2&i!/ a "i,7i$&i! 'a 3!+2a2i'i"a" " i$*44i#$ "' ,i0i+ 6&i!!%i4+.

A&$ 4&a$"+ , +2,!v$ ,0a, 7"i"a, " 3!4a&4i#$ $ ' 3+,+3>!a0+!i+ i$7"ia0+5 ''%a$ a 3!,$0a!, i$*44i+$, $ ' ,i0i+ 6&i!!%i4+.

U$a i$*44i#$ , !,&'0a"+ " 'a i$0!a44i#$ $0! &$ a%$0 i$*4>4i+,+5 &$ 1&(,3" ,&,430i2' - ' a72i$0 i"a' "i41a i$0!a44i#$ , 3!+"&4 7"ia$0 &$ 74a$i,7+ " 0!a$,7i,i#$. L+, a%$0, 0i+'#%i4+," &$a i$*44i#$ ,+$ 3!i$4i3a'7$0 2a40!ia,5 vi!&, - 1+$%+,.

E' a'0+ $iv' 04$+'#%i4+ a'4a$)a"+ $ 'a 4i!&%a 1a 3!7i0i"+ ,&3>!a! 3!+2'7a, 4+7+ 'a 17+!!a%ia - ' "+'+!5 6& , 3!,$0a$ 4+$ 7&>41a *!4&$4ia $ 'a 3!/40i4a. Si$ 72a!%+5 <i,0 0+"ava &$ 3!+2'7a 3+! ,&3!a! 'a i$*44i#$ "' ,i0i+ 6&i!!%i4+ + i$*44i#$ 3+,+3!a0+!ia.

La i$*44i#$ "' ,i0i+ 6&i!!%i4+ , &$a 4+73'i4a4i#$ *!4&$0 -4a0a,0!#*i4a $+ ,#'+ "," ' 3&$0+ " vi,0a " 'a ,a'&" ,i$+ 0a72i($ $ 'a,340+ 4+$#7i4+5 3&, , 4a&,a$0 " i$4a3a4i"a" i$4'&,+ 3&" 3!+v+4a! 'a 7&!0. U$a i$*44i#$ " ,0 0i3+ 0a72i($ 'va '+, 4+,0+,0a$0+ 3a!a ' 3a4i$0 4+7+ 3a!a 'a, i$,0i0&4i+$, " ,a'&".

D2i"+ a '+ a$0!i+!5 , i73+!0a$0 6& ' 3!,+$a' " $*!7!a "'/!a 6&i!!%i4a ,0a2')4a 3!*40a7$0 2i$ 'a, !&0i$a, - 3!+0+> 4+'+,6& 1a2!/$ " ,%&i!, a *i$ " 4+$0!i2&i! $ 'a 3!v$4i#$ " 'a,i$*44i+$, "' ,i0i+ 6&i!!%i4+.

>uturaS&0&!a! , ' 3!+4,+ " a3'i4a! 'a ,&0&!a $ a'%$ 0i"+ & #!%a$+ "'

4&!3+ 1&7a$+ 3+! $"5 'a ,&0&!a , ' 7a0!ia' 0i' 3a!a *av+!4! 'a4i4a0!i)a4i#$ " &$a 1!i"a 7"ia$0 ' a*!+$0a7i$0+ 6&i!!%i4+ " ,&, 2+!", + <0!7+, 4+$ ' 3!i$4i3a' +20iv+ " 7a$0$!'+, &$i"+,5 "i,>7i$&-$"+ 'a 0$,i#$ $0! ''+, - 7a$0$i($"+'+, *i!7, $ a3+,i4i#$1a,0a 6& 4i4a0!i4$. E' a40+ " ,&0&!a! ,i!v 3a!a v$4! 'a, 0$,i+$, +*&!)a, 6& 0i$"$ a ,3a!a! '+, 2+!",.

D a4&!"+ 4+$ 'a N+!7a O*i4ia' M<i4a$a NOM>:@>SSA;>;5'a, ,&0&!a, ,+$ 3!+"&40+, *a2!i4a"+, 4+$ 12!a, " 7a0!ia', ,i$0(0i4+,a2,+!2i2', - $+ a2,+!2i2',5 4i$0a, 3&!i*i4a"a, " i$0,0i$+, " a$i7a>



$apítulo D :$lasificación de heridas 51

',5 *i'a7$0+, " ,"a5 0<0i',5 a4!+5 04.5 i$!0,5 $+ a$0i%($i4+,5 a3i>!+%($i4+, - a0#<i4+,. Ta72i($ , "$+7i$a a, a' 1i'+ &0i'i)a"+ 3a!a 'i%a!

'+, va,+, ,a$%&$+, + a3!+<i7a! '+, 0i"+,.D2i"+ a ,& 4+$,0a$0 v+'&4i#$5 ' 7a0!ia' " ,&0&!a 1a ''%a"+ a &$

%!a"+ " !*i$a7i$0+ 0a' 6& i$4'&- ,&0&!a, "i,a"a, 3a!a 3!+>4"i7i$0+, 6&i!!%i4+, ,34*i4+,5 - 'a, 1a- i$4'&,+ 3a!a "i,7i$&i! ' 3+0$4ia' " i$*44i#$ 3+,+3!a0+!i+.

La ,&0&!a 3!*40a $+ <i,0 0+"ava ,i$ 72a!%+5 'a, 3!+3i"a",%$!a', " &$a 2&$a ,&0&!a i$4'&-$

• F'<i2i'i"a" 3a!a */4i' 7a$+ - ,%&!i"a" " $&"+,5 4a3a) " !,i,>0i! 4&a$"+ , a$&"a5 ,i$ ",1i'a41a!, + 4+!0a!,.• F&!)a 0$,i' a'0a - &$i*+!75 6& 3!7i0a ' &,+ " 7a0!ia' "'>

%a"+.• Di/70!+ ,&av - ,i73! &$i*+!7 a '+ 'a!%+ "' 1i'+ " ,&0&!a. •A430a4i#$ #30i7a " '+, 0i"+,.• P!+3i"a", $+ '40!+'0i4+5 $+ 4a3i'a!5 $+ a'!%($i4+ - $+ 4a!4i>

$+%($i4+.

• C+73+!0a7i$0+ 3!"4i2'.• N+ *!!+7a%$(0i4+5 4+7+ , ' 4a,+ " 'a, ,&0&!a, " a4!+ i$+<i>"a2'.

• R,i,0$0 a' $4+%i7i$0+ " '+, 0i"+,.• A2,+!2i2',5 , "4i!5 4+$ 7$i7a !a44i#$ 0i,&'a! ",3&(, " 4&7>

3'i! ,& 3!+3#,i0+.• Li2!, " ,&,0a$4ia, 6& *av+!)4a$ ' 4!4i7i$0+ 7i4!+2ia$+. • F/4i' " 7a$a!5 ,0(!i' - 'i,0a 3a!a ,! &,a"a.

E$ 'a a40&a'i"a" <i,0$ 7'0i3', - va!ia"+, 7a0!ia', " ,&0&!a5 3+! '+ 6& , $4,a!ia &$a 4'a,i*i4a4i#$ 6& 4+$,i"! 0+"a, - 4a"a &$a" ,&, 4a!a40!,0i4a,5 4+$ 'a *i$a'i"a" " 6& 'a $*!7!a "0!7i$4&/' , ' 7a0!ia' 7/, i$"i4a"+ 6& 1a2!/ " &0i'i)a!, "&!a$0 ' 3!+>4"i7i$0+ 6&i!!%i4+ 4&a"!+ >;. E' 4&a"!+ >9 7&,0!a '+, 0i73+," a2,+!4i#$ " '+, "i*!$0, 7a0!ia', " '+, 6& ,0/$ 'a2+!a"+,.

Cat#ut !i*ple o "r*i"oHi'+, 3!+4,a"+, " 4+'/%$+ a'0a7$0 3&!i*i4a"+. E' 3+!4$0a>

" 4+'/%$+ 6& 3+, "0!7i$a ,& *&!)a " 0$,i#$ - ,& 4a3a> 4i"a" 3a!a 6& ' +!%a$i,7+ 'a a2,+!2a ,i$ !a44i+$, ,4&$"a!ia,. La 7a0!ia 3!i7a 3a!a ,& 'a2+!a4i#$ , +20i$ " 'a ,&27&4+,a "




Cuaro 41. $lasificación del material de sutura se-,n su ori-en.

0atural

5animal6$at-ut simple$at-ut crómicoSeda

0atural 5ve-etal6

Lino Al-odón

Sint'tico

*oliamida*oli'ster*olidio(anona <cido poli-licólico*oli-lactín N;B*olipropileno*olietileno

Mineral Acero*lata

i$0,0i$+ "'%a"+ " +va + va4a. Si , 0!a0a 4+$ ,a', " 4!+7+ 4a0%&04!#7i4+5 'a a2,+!4i#$ , 7/, '$0a - 4a&,a 7$+, i!!i0a4i#$ 6& ' 4a0>%&0 ,i73' "2 &0i'i)a!, $ 7"i+ a,(30i4+5 3&, $ 7"i+, i$*40a"+,0i$" a 'a !&30&!a.

,"io poli#li"li"o ?exn@E, &$ 3+'7!+ "' /4i"+ %'i4#'i4+5 4+$ &$ 0!$)a"+ 7/, !,i,0$0 6& '

4a0%&0 "&!a$0 'a *a, 4!0i4a " 'a 4i4a0!i)a4i#$ 3!+"&4 7$+, !a44i#$" '+, 0i"+,. S a2,+!2 $ &$ 0i73+ a3!+<i7a"+ " 9 a ,7a$a,.

Cuaro 42. Materiales de sutura absorbibles% no absorbibles #tiempo apro(imado de absorción.

Absorbibles$at-ut simple$at-ut crómicoMonocr#l 5poli-lecaprone6Ficr#l o de(ón 5poli-lactina6*!S 5polidio(anona% polímero de poli'ster6

$at-ut

$at-ut crómico

<cido poli-licólico

*oli-lactina N;B

*olidio(anona

0o absorbiblesSeda0#lon*roleneMersileneEthibond

a I días

; a ?B días

NB a ;?B días

IB días

;HB días




oliioxanonaM+$+*i'a7$0+ ,i$0(0i4+ 6& 3+, &$ 'a!%+ 3!i+"+ 3a!a ,& a2,+!4i#$

7,, , 4a!a40!i)a 3+! ,& <4'$0 *&!)a 0$,+!a5 7$i7a !>a44i#$ " '+, 0i"+, - 2aa a*i$i"a" 3+! '+, 7i4!++!%a$i,7+,. S !4+>7i$"a ,& &,+ $ 3'a$+, 3!+*&$"+,.

oli#la"tina 910 ?vi"rl@Ma0!ia' 0!$)a"+ 4a3a) " !"&4i! 'a 3$0!a4i#$ " 'a a%&a $ '+, *i>

'a7$0+, " 'a ,&0&!a5 a,%&!a$"+ 2aa 3(!"i"a " 'a *&!)a 0$,i'. Sa2,+!2 3+! !a44i#$ i$Qa7a0+!ia a3!+<i7a"a7$0 $ : "a, - 3&"&,a!, a&$ 4&a$"+ <i,0a i$*44i#$.

D a4&!"+ 4+$ ' ,i0i+ $ ' 6& , 3!a40i4a - 'a, $4,i"a", " 'ai$0!v$4i#$5 , ' 0i3+ " 7a0!ia' 6& , &0i'i)a $ 'a, ,&0&!a, 4&a"!+ >. L+, 4&a"!+, > a >@ 7&,0!a$ "i*!$0, 4!i0!i+, " 4'a,i*i4a4i#$ "'7a0!ia' " ,&0&!a.

N+ "2 +'vi"a!, 6& <i,0$ +0!+, 0i3+, " ,&0&!a 4+7+ 'a, %!a3a,,0 , &$ 0i3+ " ,&0&!a 74/$i4a a'a72!, 70/'i4+, 6& , a3'i4a 4+$&$a $%!a3a"+!a 7a$&a'5 3!+ 6& "2i"+ a ,& 4+,0+ a'0+ $+ , 0a$ 3+3&'a!. Si$ 72a!%+5 ,+$ *i4i$0, "2i"+ a 6& a4+!0a$ " 7a$!a ,i%>$i*i4a0iva ' 0i73+ $ ' 0!a$,+3!a0+!i+ -5 3+! 4+$,4&$4ia5 ' " a$,>0,ia. A,i7i,7+5 <i,0$ 47$0+, 6&i!!%i4+, 3a!a a*!+$0a! '+, 2+!", "&$a 1!i"a ,i$ $4,i"a" " &$a ,&0&!a 4+7+ 0a'.

+e"o*ena"ione! para el *ane(o

e la! !utura!• V!i*i4a! 'a *41a " 4a"&4i"a".

• A2!i! ,#'+ 'a, ,&0&!a, $4,a!ia, 3a!a ' 3!+4"i7i$0+.• V!i*i4a! 6& , $4&$0! ,0(!i' 73a6& 'i2! " !+0&!a, + $>

7$"a"&!a,.• T!a44i+$a!'a 4+$ ,&avi"a" 3a!a vi0a! ,3a!a4i#$ 3!7a0&!a " 'a

a%&a.

• Ma$i3&'a4i#$ 7$i7a ' 7a$+ <4,iv+ 4+$ %&a$0, 3&" "2i>'i0a!'a - ",1i'a41a!'a.

• N+ +3!i7i!5 a3!0a! + 0+7a! '+, 1i'+, " ,&0&!a 4+$ 3i$)a, 6&i!!>%i4a,.




4uir,r-ica

Cuaro 43. Uso 4uir,r-ico de las suturas.

$at-ut

<cido poli-licólico# poli-lactina

*olidio(anona

Seda

Lino

*oliamidas

*oli'ster

*olietileno

*olipropileno

Acero ino(idable

Estóma-o% intestino% vesícula% vías biliares% víasurinarias% ,tero% aponeurosis

Aponeurosis% peritoneo% estóma-o% intestino% vesícula% vías biliares% vías urinarias% cavidad oral #ciru-ía -inecoló-ica

9til en sitios 4ue re4uieren una elevada resistencia1oftalmolo-ía

*iel% anastomosis vascular% arteriotomías% li-aduras%

cerebro% oftalmolo-ía # sistema di-estivoSutura de heridas 4ue re4uieran alta resistencia #

lar-a permanencia

*iel superficial% aponeurosis% sueción de paredabdominal% cierre de pared abdominal% sutura deli-amentos capsulares # tendones

Es la sutura de elección para el refuerzo permanente de válvulas cardiacas artificiales% anastomosis

di-estivas% coledocotomías% sutura tendinosa*iel% fascias% hernias% eventraciones

$iru-ía plástica% vascular% pared abdominal% nervios

*ara suturas de -ran resistencia a la tracción consueción de pared abdominal% tendinosas% ciru-íatorácica del esternón% laparotomías # donde lacapacidad de cicatrización est' disminuida

Cuaro 44. $lasificación de los materiales para sutura por color.

$olor

0e-ro

AzulFerde

MarfilMarrón oscuroMorado3ei-e/ncoloro

Sutura

Seda% poli'ster% poliamida

*oli'ster% poliamida% polipropileno*oli'ster% ácido poli-licólico% poli-luconato

Lino% cat-ut simple$at-ut crómico <cido poli-licólico*oli'ster% ácido poli-licólico*oli-luconato





56 : Manual de

enfermería 4uir,r-ica

• N+ +3!i7i!'a5 ,0i!a!'a + 3a,a!'a 3+! a%&a. • U0i'i)a! ,i73! 0(4$i4a ,0(!i'.

• La N+!7a O*i4ia' M<i4a$a !4+7i$"a a'7a4$a! $ '+4a', 4&> 2i!0+,5 3!+0%i"+, "' 4+$0a40+ 4+$ a%&a ''&via + 4&a'6&i! +0!+'6&i"+ - " 'a <3+,i4i#$ "i!40a a '+, !a-+, "' ,+'5 '+, " *&$0," 4a'+! - va3+!,.

Fi$a'7$05 , 3!4i,+ "*i$i! 6& ' 4a'i2! " &$a ,&0&!a , "0!>7i$a $ 4!+,5 , "4i!5 7/, 4!+, 4+!!,3+$" a &$ "i/70!+ 7$+!5 -7$+, 4!+, a'&" a &$ 7a-+! %!+,+! 3+! 73'+5 &$a ,&0&!a "' ; ,

7/, %!&,a 6& &$a 9:5 - ,0a '0i7a , 7/, %!&,a 6& &$a :5 - a,,&4,iva7$0.

A#u(aI$,0!&7$0+ " a4!+ i$+<i"a2'5 36&+ - 7&- *i$+5 6& 0!7i$a $ 3&$0a - ,0/ 3!+vi,0+ " &$ +a' $ &$+ " ,&, <0!7+, 3a!a i$,!0a! '1i'+ + ,&0&!a. A40a 4+7+ %&a " 'a ,&0&!a a 0!av(, "' 0i"+5 3+! '+ 6&"2 ,! !,i,0$0 - $+ *!ia2'5 vi0a$"+ " ,0a 7a$!a 6& , "+2' +!+73a.

Cara"terí!ti"a! e la! a#u(a!C+$,0a$ " 0!, 3a!0,

1) unta. Pa!0 6& 1a4 ' 3!i7! 4+$0a40+ 4+$ ' 0i"+ 3!*+!/$>

"+'+. S& 3&$0a 3&" ,! !"+$"a5 4+!0a$0 + !+7a.2) "uerpo. R40+ + 4&!v+

• ;9 4!4&'+. D 7a-+! &0i'i"a" $ 4avi"a", 3!+*&$"a,.• ? " 4!4&'+. 0i' $ 4avi"a" $a,a' - +!a'5 0!a40+ 2i'ia! - &!+%$i0a'.• ; " 4!4&'+. D 7a-+! &,+ $ 4i!&%a +*0a'7+'#%i4a.• " 4!4&'+. F!4&$07$0 &0i'i)a"a $ a3+$&!+,i,5 3!i+,0i+5

*a,4ia,5 0$"+$,5 0i"+ 7&,4&'a! - 3i'.

La, a%&a, +,0$0a$ 'a, i$i4ia', FS for s3in5 3a!a 3i' - CE® ®cutin( ed(e5 3a!a 4+!0 '+ a$0!i+! 3!7i0 i"$0i*i4a!'a, */4i'7$0 -"a!', &$ &,+ a"4&a"+.

) >=o u o=al. Si0i+ 3+! "+$" , i$,!0a 'a ,&0&!a.La, a%&a, a0!a&7/0i4a, , "$+7i$a$ a, "2i"+ a 6& 'a ,&0&!a

,0/ a 3!,i#$ "$0!+ "' ++5 '+ 6& 1a4 6& ' "i/70!+ " 'a a%&a - "




'a ,&0&!a ,a$ 3!/40i4a7$0 i%&a',5 4+a"-&va$"+ a 6& ' 0!a&7a0i,7+a' 0i"+ ,a 7$+! a"7/,5 ' *i'+ " ,& 3&$0a , 7&- ,&3!i+! $ 4+7> 3a!a4i#$ 4+$ +0!a, a%&a,5 '+ 6& *a4i'i0a ,& 3$0!a4i#$.

:ilio#ra)ía

Ga&$0'00 B P. *rincipios y pr-ctica de la enfermer%a m0dico&uir'r(ica.S%&$"a "i4i#$. Ha!4+&!0 B!a4. V+' I.

L+2+ E. Manual de ur(encias &uir'r(icas. 9W "i4i#$. E". IMC. 9:::. N+!7a O*i4ia' M<i4a$a NOM>:@>SSA;>;.S41a!0). *rincipios de ciru(%a. W "i4i#$. V+' I. E"i0+!ia' I$0!a7!i>

4a$a.



$apítulo

Cla!i)i"a"in

LDCL

C",EL

59




• E<0i!3a4i#$ " 0&7+!, 4!2!a', + a 4&a'6&i! $iv'. • R3a!a4i#$ " 7a'*+!7a4i+$, #,a, $ 4!/$+ - 4a!a.

• R3a!a4i#$ " 4a!"i+3a0a, 4+$%($i0a,5 0!a,3'a$0 " #!%a$+, - !> 3a!a4i+$, i$0,0i$a',.

• Ci!&%a " 'a ,3i$a "+!,a' - 0!a0a7i$0+ " ',i+$, 3!+"&4i"a, 3+!0!a&7a0i,7+, 4+$0&,+, %!av,.

"iruga enor. S !a'i)a 4+$ a$,0,ia '+4a' - ,&3+$ &$ 7$+!!i,%+ - 7$+! 0i73+ " ,0a$4ia.

E' 0i73+ " !4&3!a4i#$ , 4+!0+ - ' 3a4i$0 !0+!$a 4+$ !a3i") a

,&, a40ivi"a", $+!7a', $+ !6&i! 1+,3i0a'i)a4i#$. La, 4+73'i4a>4i+$, $ ,0+, 0i3+, " 4i!&%a ,+$ 7&- ,3+!/"i4a,. E$0! '+, 73'+,7/, 4+7&$, " 4i!&%a 7$+! *i%&!a$

• Ca0a!a0a,.• Ti73a$+,0+7a.• R3a!a4i#$ " 1!$ia,.• R3a!a4i#$ " *!a40&!a, " '+, 1&,+,.• E<0i!3a4i#$ " ',i+$, $ 'a 3i'.

• Bi+3,ia " 0&7+!,.

Cla!i)i"a"in e a"uero"on el o(etivo e la "iru#ía

iagn+!tica o eploradora. S !a'i)a 3a!a 4+$+4! ' +!i%$ " '+,

,$0+7a,5 + 'a <0$,i#$ + ',i#$ " &$a $*!7"a" 3. .5 2i+3,ia,5'a!i$%+,4+3ia,5 04..

"iruga curatia. S ''va a 4a2+ 3a!a <0i!3a!5 !3a!a! + ,&,0i0&i!0i"+, $*!7+, 3. .5 <0i!3a4i#$ "' a3($"i4.

"iruga reparadora. S !a'i)a 3a!a 4+!!%i! 'a *&$4i#$ 3!"i"a +"*+!7i"a", 3. .5 *!a40&!a,5 3!#0,i, 7i0!a'5 04..

"iruga paliatia. S &0i'i)a 3a!a a7i$+!a! '+, ,$0+7a, " 'a $>*!7"a"5 3!+ ,i$ ''%a! a ,! 4&!a0iva 3. .5 <0i!3a4i#$ 3a!4ia' " 0&>7+!,.

"iruga electia. E, ' 0i3+ " i$0!v$4i#$ $ 'a 6& , "a a 'i2!'44i#$ "' 3a4i$0 ,i , !a'i)a + $+ $0! +0!a, , 4&$0a$5 3+! 7> 3'+5 'a 4i!4&$4i,i#$5 <0i!3a4i#$ + 4&!0a " $v+,5 04. E,0+, 3!+4"i>7i$0+, $+ 4+73!+70$ 'a vi"a "' 3a4i$0.

"iruga pl4!tica. S& *i$ 3!i$4i3a' , ' a,340+ ,0(0i4+ - 7+!a! 'aa3a!i$4ia *,i4a "' 3a4i$0.



$apítulo :$lasificación de las ciru-ías 61

Cla!i)i"a"in en )un"in

el #rao e ur#en"ia?rgencia inediata. P+$ $ 3'i%!+ 'a vi"a5 - $ ''a $+ , "i,3+$

" 0i73+ 3a!a ,0a2i'i)a! a' 3a4i$0.?rgencia dierida. P+$ $ 3'i%!+ 'a vi"a5 3!+ , "i,3+$ " &$

0i73+ 4+!0+ 3a!a ,0a2i'i)a! a' 3a4i$0 "," ' 3&$0+ " vi,0a 17+>"i$/7i4+.

rograada. N+ <i,0 $4,i"a" " 1a4!'a " 7a$!a !/3i"a +

*+!0&i0a 4+7+ ,&4"5 3+! 73'+5 $ &$a 4+'4i,040+7a - $+ 3+$ $ 3'i%!+ 'a vi"a "' 3a4i$0.

Electia. N+ 3+$ $ 3'i%!+ 'a vi"a "' 3a4i$0 - , 3!+%!a7a 4+$4i!0+ 0i73+ " a$0i4i3a4i#$ ' 3a4i$0 "0!7i$a ,i , !a'i)a + $+.

Tipo! e "iru#íaS%$ ' 3!+2'7a 6& , !6&i!a ,+'&4i+$a! + '+, #!%a$+, 6& , v$

a*40a"+, 3+! 'a i$0!v$4i#$5 'a 4i!&%a 3&" 4'a,i*i4a!, $"iruga general. E$ ,0a 7+"a'i"a" , i$0!vi$ a 3a4i$0, 4+$

3!+2'7a, " 0!a40+ %a,0!+i$0,0i$a'5 ,i,07a 2i'ia!5 1%a"+5 2a)+5 3/$>4!a, - 7a7a5 a, 4+7+ 1!$ia, " 'a 3a!" a2"+7i$a'. I$4'&- 'a 4i!&%a" 'a 0i!+i",.

"iruga tor4cica. S +4&3a " 0+"a, 'a, +3!a4i+$, !'a4i+$a"a,4+$ ' 4+!a)#$5 '+, 3&'7+$, - ' ,#*a%+.

"iruga ortop%dica o trauatol+gica. E, &$a ,34ia'i"a" 6& ,

$4a!%a " 'a, i$0!v$4i+$, $ a!0i4&'a4i+$, - 1&,+, a 4a&,a " 0!a&>7a0i,7+,5 !+0&!a, + ",%a,0.

Neurociruga. I$0!v$4i#$ 6&i!!%i4a 6& i$v+'&4!a a' ,i,07a$!vi+,+ 7("&'a ,3i$a' - 4!2!+.

"iruga ailoacial. E,34ia'i"a" +"+$0+'#%i4a 6& , +4&3a " 'a,i$0!v$4i+$, $ 'a 2+4a.

"iruga de otorrinolaringologa. E,34ia'i"a" $4a!%a"a "' 0!a>0a7i$0+ 6&i!!%i4+ " $*!7"a", "' +"+5 'a, va, a(!a, ,&3!i+> !,$a!i)5 2+4a5 ,$+, 3a!a$a,a', *a!i$% - 'a!i$% - " 'a, ,0!&40&!a, 3!#<i7a, " 'a 4a!a - ' 4&''+.

"iruga pl4!tica , recon!tructia. E,0 0i3+ " 4i!&%a 0i$ 4+7+ 3!i$4i3a' *i$ !3a!a! 'a, "*+!7i"a", - 4+!!%i! 'a, "*i4i$4ia, *&$4i+>$a', 7"ia$0 'a 0!a$,*+!7a4i#$ "' 4&!3+ 1&7a$+.






v+ " *i2!a #30i4a 6& 1a4 3+,i2' &0i'i)a! va!i+, 7(0+"+,5 $0! '+, 6&, i$4'&-$ '+, ,i%&i$0,

• 3rtro!copia. P+! 7"i+ "' $"+,4+3i+ , 3&" +2,!va! ' i$>0!i+! " &$a a!0i4&'a4i#$. E,0a 0(4$i4a , &0i'i)a"a 4+$ *!4&$4ia 3a!a <a7i$a! - !3a!a! 'a a!0i4&'a4i#$ " 'a !+"i''a.

• Bronco!copia. E$ ,0 4a,+ ' $"+,4+3i+ , i$0!+"&4i"+ a 'a, 3!i$4i3a', va, !,3i!a0+!ia,. E, &$a 0(4$i4a 6& 3!7i0 va'&a! -"ia%$+,0i4a! 3!+2'7a, 3&'7+$a!,5 va'+!a! +2,0!&44i+$,5 +20$!7&,0!a, " 0i"+, + " '6&i"+, - <0i!3a! 4&!3+, <0!a+,.

• "i!to!copia. E' $"+,4+3i+ , &0i'i)a"+ 3a!a va'+!a! - 0!a0a! 'a 3a!0i$0!$a " 'a &!0!a - 'a 4avi"a" v,i4a'.

E, 7&- i73+!0a$0 !*!i! 6& ,0+, $+ ,+$ '+, $i4+, 3!+4"i7i$>0+,5 -a 6& $ 'a a40&a'i"a" <i,0$ "iv!,a, 0(4$i4a, $ 'a, 6& ' $"+,>4+3i+ , 'a 1!!a7i$0a 3!i$4i3a'.

Ciru#ía l%!er

E$ ,0 0i3+ " 3!+4"i7i$0+, , a3'i4a$ 1a4, " '&) i$0$,+, ,+2!"0!7i$a"+, ,i0i+, + 4('&'a, $ 'a, 6& , a&7$0a 'a 073!a0&!a 1a,0a'+%!a! ,& 'i7i$a4i#$. C+$ ,0a 0(4$i4a , !!a"i4a$ 0&7+!, - 0i"+,$*!7+, - , 4i!!a$ va,+, ,a$%&$+,. E, 0i' 0a72i($ $ 'a 4i!&%a,0(0i4a.

Ciru#ía roti"a

D," 'a a3a!i4i#$ " 'a 4i!&%a 'a3a!+,4#3i4a , +!i%i$# &$a !v+'&4i#$$ 'a 3!/40i4a " 'a, 0(4$i4a, 6&i!!%i4a, " "iv!,a, ,34ia'i"a",. E,00i3+ " 4i!&%a 1a "a"+ '&%a! a &$a i$0$,a i$v,0i%a4i#$ 6& 1a 3!>7i0i"+ &$a v+'&4i#$ " '+, ,i,07a, 6& $ 3+4+ 0i73+ 1a$ a2i!0+ 3a,+ a' &,+ " 2!a)+, 74/$i4+, 4+$0!+'a"+, 3+! &$ 4i!&a$+ $ 3!+4>"i7i$0+, " 4i!&%a %$!a'5 3"i/0!i4a5 4a!"i+va,4&'a!5 $&!+4i!&%a -+!0+3"ia5 $0! +0!a,.

E, a, 4+7+ 1a ,&!%i"+ 'a 4i!&%a !+2#0i4a5 " 0'3!,$4ia5 + 0>

'4i!&%a$ E,0 3!+4"i7i$0+ , 2a,a $ "+, 4+$430+, *&$"a7$0a',!a'i"a" vi!0&a' - 4i2!$(0i4a.

E' ",a!!+''+ " ,0a 4i!&%a , "2 $ %!a$ 7"i"a a' i$%$i!+P1i'i33 G!$5 6&i$ "," ;9 4+7$)# a !a'i)a! i$v,0i%a4i+$,$4a7i$a"a, a' ",a!!+''+ " ,0+, 3!+0+0i3+,.




4uir,r-ica

E$ ; , &0i'i)# ' !+2+0 E,+3+ 3a!a 4+$"&4i! &$ 'a3a!+,4+3i+,0 !+2+0 !a 4+$0!+'a"+ 7"ia$0 4+7a$"+, " 3i - 3a'a$4a,. E$ ;?5

'a 73!,a 6& a"6&i!i# ,&, "!41+, ' !a'i)# a'%&$a, a"a30a> 4i+$, -7/, 0a!" , !a'i)a!+$ 'a, 3!i7!a, 4i!&%a, 3+! 0'3!,$4ia a 4+!0a"i,0a$4ia.

Ta', ava$4, "i!+$ '&%a! a &$a ,%&$"a %$!a4i#$ " ,i,07a,5 6&a1+!a , 4+$+4i"+ 4+7+ DZVi$4i5 ' 4&a' &0i'i)a v!,i+$, 04$+> '#%i4a,7/, v+'&4i+$a"a, 6& i$4'&,+ +2"4$ a 4+7a$"+, " v+). A,i7i,7+5, i$0%!# &$ ,+*0a! 6& a"7i0 ' 7a$+ "' 6&i3+ "6&i!#*a$+5 "a$"+ '&%a! a '+, "$+7i$a"+, 6&i!#*a$+, i$0'i%$0,.

C+$ ' 0i73+ , "i,# +0!+ !+2+05 &,5 4+$ ' 6& , 3!a40i4a>!+$ a'%&$a, 3'a,0ia, 0&2a!ia,. E<i,0$ "a0+, 6& 3!7i0$ a,v!a! 6& a 'a*41a , 1a$ !a'i)a"+ 7/, " 9?: ::: 4i!&%a, 4+$ ,0 !+2+0 $ E&!+3a5 N+!0a7(!i4a - M(<i4+.

*articipación de enfermeríaen la ciru-ía robótica

Evi"$07$05 'a $*!7!a ,34ia'i,0a $ ' 4a73+ " 'a $*!7!a6&i!!%i4a !6&i! 4+$0a! 4a"a v) 7/, 4+$ 7a-+! 4+$+4i7i$0+ - a3>0i0&", a,5 3+! 73'+5 &$a $*!7!a 6& , ",a!!+'' $ ' /72i0+ "'a 4i!&%a !+2#0i4a "2 0$! 7a-+!, - a40&a'i)a"+, 4+$+4i7i$0+, 6&!"&$"$ $ &$a 4+730$4ia 'a2+!a' ,&3!i+!5 4+7+

• E<3!i$4ia 7$i7a " a+, $ "iv!,a, ,34ia'i"a", 6&i!!%i>4a,.

• E<3!i$4ia $ 4i!&%a 7$i7a7$0 i$va,iva.• C+$+4i7i$0+, 2/,i4+, $ 2a,, " "a0+,5 i$*+!7/0i4a - &,+ " ,+*0>a!.

• Ca3a4i"a" 3a!a 'a 0+7a " "4i,i+$, - 'i"!a)%+.

A,i7i,7+5 a'%&$a, " ,&, 0a!a, $ ,0 0i3+ " i$0!v$4i+$, i$>4'&-$

• M+$0a - 4+$<i#$ " '+, 4+73+$$0, "' 6&i3+ !+2#0i4+.• V!i*i4a4i#$ "' 4+!!40+ *&$4i+$a7i$0+ "' ,i,07a.

• C+'+4a4i#$ " *&$"a, $ '+, 2!a)+, "' !+2+0.• C+'+4a4i#$ "' !+2+0 $ 3+,i4i#$5 ,i$ i$0!*!i! 4+$ +0!+, 6&i3+,

"' 6&i!#*a$+.• Ca72i+ - ,&,0i0&4i#$ " '+, "i,0i$0+, i$,0!&7$0+, $ '+, 2!a)+,

"' !+2+0.



$apítulo : $lasificación de las ciru-ías 65

• A0$4i#$ a 'a, v$0&a'i"a", 6& 3&"a$ ,&!%i! $ ' *&$4i+$a>7i$0+ "' !+2+0 "&!a$0 ' 3!+4,+.

Ciru#ía a*ulatoriaE, &$a 7+"a'i"a" 6& 1a 4+2!a"+ %!a$ i73+!0a$4ia $ 0+"+ ' 7&$"+ -

$ '+, '0i7+, a+, $ M(<i4+ - +0!a, $a4i+$,. E,0 0i3+ " 4i!&%a 0i$%!a$", v$0aa, 3a!a ' 3a4i$05 $0! 'a, 6& ",0a4a 'a 4+7+"i"a" "!4&3!a!, $ ' 1+%a!5 &$a 7$+! 3!+2a2i'i"a" " i$*44i+$, -5 3+!4+$,4&$4ia5 vi0a! a'%&$a, +0!a, 4+73'i4a4i+$,. A"7/,5 4+$0!i2&- a 3!+7+v! 'a 4&'0&!a "' a&0+4&i"a"+ $ ' 3a4i$0 - ,& *a7i'ia.

La 4i!&%a a72&'a0+!ia , 'a 3!/40i4a " 3!+4"i7i$0+, 6&i!!%i4+,0!a3(&0i4+, + "ia%$#,0i4+, " 2aa 4+73'i"a" - !i,%+5 $ 'a 4&a' ' 3a4i$0 , +3!a"+ - $via"+ ' 7i,7+ "a a ,& 1+%a!5 ",3&(, " &$ 3!i+"+ " +2,!va4i#$ - 4+$0!+'.

E$0! a'%&$a, " 'a, i$0!v$4i+$, 6& , 3!a40i4a$ 4+7+ 4i!&%aa72&'a0+!ia , $4&$0!a$ 'a 4i!&%a +!0+3("i4a5 'a, i$0!v$4i+$, %i>$4+'#%i4a,5 'a 4i!&%a +*0/'7i4a - 'a 4i!&%a 3'/,0i4a5 $0! +0!a,.

$iru-ía ambulatoria ma#orS !a'i)a 7"ia$0 a$,0,ia %$!a'5 '+4a'5 !%i+$a' + ,"a4i#$5 - , !>6&i! a0$4i#$ 3+,+3!a0+!ia 7$i7a - " 4+!0a "&!a4i#$5 3+! '+ 6& 'i$%!,+ 1+,3i0a'a!i+ 3&" ,! 1a,0a " &$a 1+!a a$0, "' 3!+4"i7i$>0+. A,i7i,7+5 ' 3a4i$0 3&" ,! "a"+ " a'0a a'%&$a, 1+!a, ",3&(, "6& 'a 4i!&%a 1a-a 4+$4'&i"+. D," ' 3&$0+ " vi,0a a"7i$i,0!a0iv+5 $+, !6&i! 6& ' 3a4i$0 +4&3 &$a 4a7a5 '+ 6& !3!4&0 " 7a> $!a

3+,i0iva $ '+, %a,0+, %$!a"+, 3&, !4i2 &$a 3!+$0a a'0a.E, i73+!0a$0 6& ' 3!,+$a' " $*!7!a , $*+6& $ +0+!%a!

a0$4i+$, 3+,+3!a0+!ia, ,34*i4a, - 6& $+ ,a$ $4,a!ia7$0 i$>0$,iva, 4+7+ 3a!a !6&!i! &$a ,0a$4ia 1+,3i0a'a!ia 3!+'+$%a"a.

$iru-ía ambulatoria menorS "$+7i$a a, a '+, 3!+4"i7i$0+, 6&i!!%i4+, 0!a3(&0i4+, + "ia%>$#,0i4+, " 7$+! 4+73'i"a" 6&5 a "i*!$4ia " 'a 4i!&%a 7a-+! a7> 2&'a0+!ia5 ,#'+ !6&i!$ a$,0,ia '+4a' + 0!+$4&'a!. E' 3a4i$0 v&'v a,& "+7i4i'i+ ' 7i,7+ "a " 'a i$0!v$4i#$ - !6&i! " &$ 3!i+"+7$i7+ " +2,!va4i#$ 3+,+3!a0+!ia. Di41+, 3!+4"i7i$0+, a 7$&>"+ , !a'i)a$ $ 'a, 4+$,&'0a, <0!$a, + $ 'a, /!a, " &!%$4ia,.




E$ 4&a'6&i! &$i"a" 1+,3i0a'a!ia "+$" , !a'i)a$ i$0!v$4i+$,6&i!!%i4a, a72&'a0+!ia, , 'i7i0a"+ ' 0i73+ 3a!a 6& ' 3!,+$a' "$*!7!a !a'i4 &$a va'+!a4i#$ 3!+3!a0+!ia. Si$ 72a!%+5 ,0 3!>

,+$a' "2 ,i73! 0$! &$ 7(0+"+ 3a!a ''va! a 4a2+ ,0a, va'+!a4i+$,5-a 6& ,0+ 3!7i0 +20$! "a0+, 6& !"&$"a!/$ $ &$a a0$4i#$ " 4a>'i"a" - ,%&!a 3a!a ' 3a4i$0. La va'+!a4i#$ 3!7i0 "040a! 4&a'6&i!,i0&a4i#$ a$+!7a' 6& 3&"a 4a&,a! 6& 'a 4i!&%a ,a ,&,3$"i"a. Ta7> 2i($ , !4a2a$ "a0+, $4,a!i+, 3a!a %a!a$0i)a! &$ 4&i"a"+ 3+,+3!a0+>!i+ i$"ivi"&a'i)a"+5 , "4i!5 a4+!" a 'a, $4,i"a", " 4a"a 3a4i$0.

La va'+!a4i#$ 3!+3!a0+!ia 0i$ 4+7+ *i$ 3!i$4i3a' !"&4i! 'a a$>,i"a" "' 3a4i$0 - va'+!a! 'a i$*+!7a4i#$ 6& $4,i0a !4i2i! 0a$0+ ('4+7+ ,& *a7i'ia.

E, i73+!0a$0 7$4i+$a! 6& $ ' H+,3i0a' G$!a' " M(<i4+5 a 3a!0i! "' a+ 9::5 , 1a 0!a2aa"+ 4+$ ' ,i,07a " 4+$,!a 3!,+$a>'i)a"a 7"ia$0 ''a7a"a, 0'*#$i4a, a 3a4i$0, 4+$ "iv!,+, "ia%$#,>0i4+, "i41+ ,i,07a , 1a 4+$,0i0&i"+ $ &$ 74a$i,7+ 7&- a"4&a"+ 3a!a i$"ivi"&a'i)a! 'a a0$4i#$. E$ ' 4a,+ " 'a 4i!&%a a72&'a0+!ia ,07(0+"+ 3&" ,! a3'i4a2' 3a!a "a! a0$4i#$ a "i,0a$4ia a' 3a4i$0 3+,>+3!a"+5 4+$ '+ 6& , '+%!a !"&4i! 'a a$,i"a" - '+, 4+,0+, 0a$0+ 3a!a ('4+7+ 3a!a 'a, i$,0i0&4i+$,.

$riterios de enfermería para ciru-íaambulatoria

• E' 3a4i$0 "2 0$! 2&$ ,0a"+ %$!a'.• E' 3a4i$0 "2 ,! a&0+,&*i4i$0.• E' 3a4i$0 $+ "2 3a"4! $*!7"a", a,+4ia"a, 6& !6&i!a$

4&i"a"+, ,34ia',.• E' "+7i4i'i+ "' 3a4i$0 "2 ,! !'a0iva7$0 3!#<i7+ a' 1+,3i0a'.• D 3!*!$4ia ' 3a4i$0 0$"!a 6& ,0a! $ 4+$"i4i+$, " ,!

a0$"i"+ 3+! ,&, *a7i'ia!, $ ,& "+7i4i'i+.• S !4+7i$"a $+ i$4'&i! 'a40a$0, - 3!7a0&!+, 7$+!, " &$

a+5 3+! !i,%+ a 6& 3!,$0$ a3$a 3+,+3!a0+!ia.

L+, 4&i"a"+, 3+,+3!a0+!i+, ,+2! '+, 4&a', 'a $*!7!a "2 ,>

0a! a' 0a$0+ , 4'a,i*i4a$ $ i$7"ia0+, - 7"ia0+,Inediato!

• C+'+4a! a3#,i0+ 6&i!!%i4+ $ 'a 1!i"a.• T+7a! ,i%$+, vi0a',.




• Vi%i'a! 4a!a40!,0i4a, " 'a 1!i"a 4+'+!5 073!a0&!a5 ,4!4i+$,. •V!i*i4a! 6& '+, ,i%$+, - ,$0+7a, " 'a a$,0,ia , 1a-a$ !v!0i"+

$ ,& 0+0a'i"a".

&ediato! @alta a doicilio)

• V!i*i4a! 'a 0+'!a$4ia a 'a va +!a'.• I$*+!7a! 3+! ,4!i0+ a' 3a4i$0 ' 0i3+ " 4&i"a"+, 6& "2 0$!

- 'a *!4&$4ia 4+$ 6& "2$ a"7i$i,0!/!,'.• E$ 4a,+ " 3!,4!i34i#$ " 7"i4a7$0+,5 i$*+!7a! a' 3a4i$0 ,+>

2! 'a va " a"7i$i,0!a4i#$ - "+,i,.• C+7$0a! 4+$ ' 3a4i$0 4&/', ,+$ '+, ,i%$+, " a'a!7a - 6&( 1a>

4! $ 4a"a 4a,+ 3. .5 *i2!5 "+'+!5 ,a'i"a " '6&i"+ + 7a0!ia' 3&!&'$0+ 3+! 'a 1!i"a5 17+!!a%ia5 04..

R,340+ a 'a i73+!0a$4ia " 'a a3'i4a4i#$ " 'a, $+!7a,5 !*!i"a-a $ +0!+, 4a30&'+,5 4a2 ,&2!a-a! 6& ' 3!+3#,i0+ " 'a N+!7a O*i> 4ia'M<i4a$a NOM>9:?>SSA;>9::9 3a!a 'a 3!/40i4a " 'a 4i!&%a 7a-+!a72&'a0+!ia , ,34i*i4a! 4+$ 4'a!i"a" '+, !6&i,i0+, 6& "2$ 4&2!i!'+, 3!+*,i+$a', 6& !a'i)a$ "i41a, i$0!v$4i+$, - a'%&$a, 4a!a40>!,0i4a, a"7i$i,0!a0iva, - " *&$4i+$a7i$0+ 4+$ 'a, 6& "2$ 4+$0a! 'a,

/!a, " '+, ,0a2'4i7i$0+, "+$" , !a'i4$ 'a, 7i,7a,.La $*!7!a 6&i!!%i4a 4i!4&'a$0 i$,0!&7$0i,0a 0i$ &$a

*&$4i#$ 4'av $ 0+"a, 'a, 4i!&%a, -a ",4!i0a,5 3&, " ,& ",73+"3$" 'a 3!3a!a4i#$ - ' a"4&a"+ *&$4i+$a7i$0+ " 'a ,a'a 6&i!!>%i4a. E,0a, $*!7!a, ,+$ a%$0, *a4i'i0a"+!, "' ",a!!+''+ - 3!*4>4i+$a7i$0+ " '+, 3!+4"i7i$0+, " 'a, "iv!,a, ,34ia'i"a",5 - ,&a40ivi"a" 4+a"-&va a 'a $,a$)a>a3!$"i)a " '+, "7/, 3!+*,i+$a>', "' 6&i3+ " ,a'&".

Ane!te!iaA *i$ " !a'i)a! a'%&$a " 'a, 4i!&%a, -a ",4!i0a, , $4,a!i+ ,+7>

0! a' 3a4i$0 a &$ 3!+4"i7i$0+ 3!vi+ ''a7a"+ a$,0,ia. E' 0(!7i$+a$,0,ia , !*i! a 'a a&,$4ia %$!a' + 3a!4ia' " 'a ,$,i2i'i"a". E$ '4a,+ " &$ 3!+4"i7i$0+ 6&i!!%i4+5 , i$"&4i"a 3+! 7"i4a7$0+, 6&a40a$ $ ' ,i,07a $!vi+,+ 4$0!a'5 - 4&-+ +20iv+ , 3!+"&4i! +i$1i2i! ' 7+vi7i$0+ - 'a !,3&,0a ,+7/0i4a *!$0 a &$ ,07&'+ "+>'+!+,+ 0a72i($ 3&" 3!+"&4i! &$ ,0a"+ " i$4+$,4i$4ia. L+ a$0!i+!,i%$i*i4a 6& , 3!+"&45 " 7a$!a a!0i*i4ia'5 &$a "3!,i#$ !v!,i2' "',i,07a $!vi+,+ 4$0!a'.




E<i,0$ "i*!$0, 0i3+, " a$,0,ia - 'a '44i#$ " 4&/' 73'a!%&a!"a !'a4i#$ 4+$ ' 3a"4i7i$0+ 6&i!!%i4+ 6& , !a'i)a!/. A' !,> 340+5 <i,0 'a ,i%&i$0 4'a,i*i4a4i#$

Ane!te!ia lo"alM"ia$0 ''a , 3!+"&4 'a 3(!"i"a " ,$,a4i#$ $ &$ /!a ,34*i4a

"' +!%a$i,7+5 ,i$ 4+73!+70! 'a 3(!"i"a " 4+$4i$4ia - ,i$ "0!i>7$0+ "' 4+$0!+' " 'a, *&$4i+$, vi0a',. E' %!a"+ " a*40a4i#$ $!vi+>,a va!a $ !'a4i#$ 4+$ 'a 0(4$i4a 73'a"a $ 'a a3'i4a4i#$ "' a$,0(,i>

4+ '+4a'. La a$,0,ia '+4a' 0i$5 a ,& v)5 'a, ,i%&i$0, va!ia$0,

Superficial o tópicaS a3'i4a $ *+!7a " a!+,+'5 %+0a, + i$-44i#$ " 00!a4a$a5 'i"+4a$a504.5 $ 'a 7&4+,a 2&4a' + $a,a'. S& *i$a'i"a" , a$,0,ia! 'a, 0!7i$a>4i+$, $!vi+,a, ,&3!*i4ia', - ,& *40+ "&!a a3!+<i7a"a7$0 : a ?7i$&0+,.

*or infiltraciónS i$-40a$ 7"i4a7$0+, 4+7+ 'i"+4a$a5 3!+4a$a - 2&3iva4a$a "i>!40a7$0 $ ' 0i"+ 6& , 7a$i3&'a!/ "&!a$0 'a 4i!&%a5 , "4i!5 $'a "!7i, + $ ' 0i"+ 4'&'a! ,&24&0/$+.

3lo4ueo epidural o espinalE, 3!+"&4i"+ 3+! 'a i$-44i#$ " &$ a$,0(,i4+ '+4a' $ ' ,3a4i+ 3!i"&!a'5

3a!a '+ 4&a' , i$0!+"&4 &$a a%&a $0! 'a, a3#*i,i, ,3i$+,a, " 'a, v(!0> 2!a, 4!vi4a',5 0+!/4i4a, + '&72a!,. E,0 2'+6&+ 3&" ,! ,i73' i$-4>0a$"+ ' a$,0(,i4+ &$a ,+'a v) + 4+$0i$&+ "a$"+ 4+'+4a"+ &$ 4a0(0! 3a!a a"7i$i,0!a! "+,i, ,&4,iva,.

Ta72i($ , "$+7i$a a$,0,ia 3i"&!a'5 ,&3!a"&!a' + <0!a"&!a' ,&$a 0(4$i4a a$,0(,i4a &0i'i)a"a 3!i$4i3a'7$0 $ 4i!&%a, $ a2"+7$ -7i72!+, i$*!i+!,5 a, 4+7+ 3a!a 4+$0!+'a! ' "+'+! "&!a$0 ' 0!a2a> +" 3a!0+. S& 3!i$4i3a' v$0aa , ,& 4a3a4i"a" 3a!a 7a$0$! a$,0,ia4+$0i$&a ",3&(, " i73'a$0a! &$ 4a0(0! 3i"&!a'5 '+ 6& 3!7i0 6& 'aa$,0,ia 4+$0i$ 1a,0a ' 3!i+"+ 3+,+3!a0+!i+ 4+7+ a$a'%,ia57"ia$0 ' &,+ " 4+$4$0!a4i+$, 7/, 2aa, " */!7a4+, a 0!av(, "'4a0(0! 3i"&!a'.




E$ ' 4a,+ " 'a a$,0,ia !a6&"a5 '+, a$,0(,i4+, , i$0!+"&4$ a$iv' "' 4&a!0+ + 6&i$0+ ,3a4i+ i$0!v!02!a'5 $ ' ,3a4i+ ,&2a!a4>

$+i"+.E$ ,0a va!i"a"5 ' a%$0 a$,0(,i4+ 1a4 4+$0a40+ 4+$ ' '6&i"+

4*a'+!!a6&"+ - , ",3'a)a a '+ 'a!%+ " 'a 7("&'a ,3i$a'5 3+! '+ 6&0+"+, '+, $!vi+, 6& , $4&$0!a$ $ ' 0!a-40+ ,+$ a$,0,ia"+,.

E,0a 4'a, " a$,0,ia , i"a' 3a!a 3!+4"i7i$0+, 6&i!!%i4+, $7i72!+, i$*!i+!,5 4a"!a5 3!i$(5 3a!0 i$*!i+! "' a2"+7$ - 4+>'&7$a '&72a!5 a, 4+7+ $ 3!+4"i7i$0+, a2"+7i$a', ,&3!i+!, 4+>'4i,040+7a - !,44i#$ %/,0!i4a.

A 4+$0i$&a4i#$ , 'i,0a 7a0!ia' - 6&i3+ 6& "2 ,0a! "i,3+$i2' 3a!a ' 3!+4"i7i$0+ " a$,0,ia! a &$ 3a4i$0.

&aterial , e'uipo para #lo'ueo

• ; 41a!+'a " Ma-+.• ; 4a73+ ,$4i''+.• ; 4a73+ *$,0!a"+.

• F'a$!a 4+$ 4&a0!+ 0+!&$"a,.• Pi$)a 41i4a " a$i''+,.• Ba0a.• T+a''a.

C&a$"+ ' 6&i3+ , 3!3a!a"+ $ ' /!a " CEYE " 'a &$i"a" 6&i>!!%i4a5 $+ i$4'&- 'a, !i$%a, - ' 4a0(0!5 7i,7+, 6& , 3!+3+!4i+$a$a' a$,0,i#'+%+ "&!a$0 ' 3!+4"i7i$0+.

E'uipo de!ec<a#le para #lo'ueo D&!a' III 6&i3+, 3a!a a$,0,ia®3i"&!a'.

• A%&a " T&+1-. Ca'i2! ;@. L+$%i0&" @? a ; 77.• Ca0(0! 3i"&!a'. Ca'i2! ; G. L+$%i0&" :: a ; :?: 775 !a"i+3a4+

4+$ a"a30a"+! L&! 7a41+.• a%&a, 1i3+"(!7i4a, 4a'i2! ;G [ 775 9;G [ 775 9?G [

; 77.

• ; !i$%a " ;: 44. • ; !i$%a " 44.• ; !i$%a " 9: 44.• %a,a, ,4a, " ;: [ ;: 47.• S+'&4i#$ " -+"+3+vi"+$a : 7'. • C1a!+'a 4+$ a$0i,(30i4+.




• Ca73+ 1$"i"+.• Ca73+ " 0!a2a+.

*rocedimientoO enfermera circulanteE' 3!+4"i7i$0+ 6& "2 ,%&i! 'a $*!7!a , "'i$a " 'a ,i%&i$07a$!a

• O20$! i$*+!7a4i#$ " 'a, 4+$"i4i+$, "' 3a4i$05 0i3+ " 4i!&>%a5 0(4$i4a a$,0(,i4a5 7"i4a7$0+, - 6&i3+, a"i4i+$a', 6& ,73'a!/$ "&!a$0 'a i$0!v$4i#$.

• P!3a!a! 7a0!ia' - 6&i3+.

• C+'+4a! a' 3a4i$0 $ 3+,i4i#$ a"4&a"a "42i0+ 'a0!a'5 3+,i4i#$*0a' +5 $ 4a,+ " 2'+6&+, a'0+,5 ,$0a"+ a 'a +!i''a " 'a 4a7i''a v! 4a30&'+ .

• D,4&2!i! ' /!a 3a!a 'a 3&$4i#$.• A2!i! 6&i3+ 3a!a 2'+6&+ 3i"&!a'.• A-&"a! a' a$,0,i#'+%+ a 4+'+4a!, 2a0a - %&a$0, 4+$ 0(4$i4a 4>

!!a"a.• P!+3+!4i+$a! ,+'&4i+$, 3a!a 'a a$0i,3,ia " 'a !%i#$.

• P!+3+!4i+$a! 7"i4a7$0+, a$,0(,i4+,5 ,i%&i$"+ ,i73! 'a !%'a" '+, 4i$4+ 4+!!40+, 3a4i$05 7"i4a7$0+5 4a"&4i"a"5 "+,i, -va.

• C+'a2+!a! 3a!a 3a,a! - "a! 3+,i4i#$ a"4&a"a $ 'a 7,a 6&i!!%i4a 3a!a 'a 4i!&%a.

• R0i!a! 7a0!ia' - 6&i3+.• V!i*i4a! 6& 'a, i$"i4a4i+$, 6& "a ' a$,0,i#'+%+ " viva v+)

6&"$ !%i,0!a"a, $ 'a 1+a " a$,0,ia - 'a " $*!7!a.

Ane!te!ia #eneralinalatoria o enoveno!aLa a$,0,ia %$!a' , ' 3!+4"i7i$0+ $ ' 4&a'5 7"ia$0 'a a"7i>

$i,0!a4i#$ " */!7a4+, 3+! "i*!$0, va,5 , 4+$,i%& $ ' i$"ivi"&+ &$,0a"+ " 1i3$+,i,5 a$a'%,ia5 !'aa4i#$ $&!+7&,4&'a! - ,0a2i'i"a" "

!Q+, "' ,i,07a $!vi+,+ a&0#$+7+. E' ,0a"+ "," 'i%!a7$> 0,$,i2' 1a,0a a2,+'&0a7$0 i$,$,i2' a '+, ,07&'+, <0!$+, "> 3$" " 'a 4a$0i"a" - 0i3+ " 7"i4a7$0+ a"7i$i,0!a"+. E,0 0i3+ "a$,0,ia 0i$ 0!, 0a3a,




1) Inducci+n. S a"7i$i,0!a &$ a%$0 i$"&40+! 1i3$#0i4+ 0i+> 3$0a'5 0+7i"a0+5 04. 3+! va $"+v$+,a 'a a$a'%,ia , '+%!a 4+$ 'aa,+4ia4i#$ " 7+!*$i4+, 3+! 'a 7i,7a va - %a,, a$,0(,i4+, 3+! va

i$1a'a0+!ia.2) Ecitaci+n. E' a%$0 a$,0(,i4+ 73i)a a ,&!0i! *40+ $ ,0a

0a3a ' 3a4i$0 3!,$0a "'i!i+5 ,$,i2i'i"a" a ,07&'+, - a40ivi"a"7&,4&'a! i$v+'&$0a!ia.

) lano 'uir(rgico. A6& -a , *a40i2' 3!+4"! a' a2+!"a 6&i>!!%i4+5 -a 6& ' 3a4i$0 , $4&$0!a 4+73'0a7$0 !'aa"+ i$>4+$,4i$0.

E$0! 'a, "iv!,a, 0(4$i4a, 3a!a a"7i$i,0!a! ,0 0i3+ " a$,0,ia*i%&!a$ 'a, ,i%&i$0,

7'cnica de inhalaciónS 4+72i$a$ "i*!$0, a$,0(,i4+, v+'/0i', 1a'+%$a"+, 4+7+ i,+Q&!a>$+5 1a'+0a$+5 ,v+Q&!a$+ - $Q&!a$+5 $ 4+72i$a4i#$ 4+$ #<i"+ $i0!+>,+5 ai! - +<%$+.

7'cnica ó(ido nitroso% narcóticos # relaanteE$ ,0a va!ia$0 , &,a ' #<i"+ $i0!+,+ 4+72i$a"+ 4+$ +<%$+ - $a!4#>0i4+,5 '+, 4&a', , "+,i*i4a$ " a4&!"+ 4+$ 'a *!4&$4ia 4a!"ia4a - 'a 3!,i#$ a!0!ia' "' 3a4i$0.

7'cnica intravenosa totalE$ ''a , 73'a 'a i$*&,i#$ 4+$0i$&a + 2+'+, *!4&$0, " 3!+3+*+' -+3i/4+,5 4+$ + ,i$ !'aa$0, 7&,4&'a!,. La 3!i$4i3a' v$0aa , 6& ' 3a4i$0 ",3i!0a 3!+$0+5 3+! '+ 6& , &0i'i)a 4+$ 7a-+! *!4&$4ia $4i!&%a a72&'a0+!ia. A 7$&"+ ' a$,0,i#'+%+ 4+72i$a 'a, 0(4$i4a,",4!i0a,5 -a 6& " ,0a 7a$!a !"&4 'a 3+,i2i'i"a" " 6& , 3!,$00+<i4i"a" 3+! "+,i, 'va"a " &$ ,+'+ a$,0(,i4+.

E$ '+, 3a4i$0, 7$+!, , &0i'i)a " 7a$!a 3!*!$0 'a 0(4$i4ai$1a'a0+!ia5 , "4i!5 ,#'+ %a,, a$,0(,i4+,.

*articipación de enfermeríaD&!a$0 ' 3!+4"i7i$0+ , 3!i7+!"ia' 6& 'a $*!7!a 4i!4&'a$07a$0$%a &$ 7+$i0+!+ a"4&a"+ " 'a, 4+$,0a$0, vi0a',5 "2i"+ a




6& 4a"a i$"ivi"&+ !a44i+$a " 7a$!a "i*!$0 - ''%a a 3!,$0a!!a44i+$, a"v!,a, a '+, 7"i4a7$0+, a$,0(,i4+,.

La $*!7!a 4i!4&'a$0 "2 a40&a! $ 0+"+ 7+7$0+ 4+$ !,3+$>

,a2i'i"a"5 !4+!"a$"+ 6& , i$0!a$,*!i2' - 6& 4a"a 7i72!+ "' 6&i> 3+ a,&7 '+, a40+, 6& !a'i4 -a ,a 3+! a44i#$ & +7i,i#$5 " a4&!"+4+$ 'a, 4+730$4ia, - *&$4i+$, 6& ' ,+$ a,i%$a"a,5 3+! '+ 6& $+ "2,a'i! "' /!a 6&i!!%i4a &$a v) i$i4ia"+ ' a40+ a$,0(,i4+ - 1a,0a 6&(,0 4&'7i$ v(a, 4a30&'+ ;. E' 0i3+ " a$,0,ia a' 6& , ,+70 a' 3a4i$0 , ",4!i2 2!v7$0 $ 'a 1+a " $*!7!a.

A,i7i,7+5 'a $*!7!a "2 4&73'i! 4+$ 'a, ,i%&i$0, a,i%$a4i+>$,

• V!i*i4a! ' 4+!!40+ *&$4i+$a7i$0+ "' 6&i3+ " a,3i!a4i#$ - "'+, *!a,4+, " ,&44i#$.

• V!i*i4a! ' *&$4i+$a7i$0+ "' ",*i2!i'a"+!5 a, 4+7+ 'a 3!,$4ia"' 4a!!+ " a$,0,ia 4+$ ,&, a"i0a7$0+, 'a!i$%+,4+3i+5 0&2+, $>"+0!a6&a',5 4/$&'a, +!+*a!$%a,5 7"i4a7$0+, a$,0(,i4+,5 04.v(a, 4a30&'+ .

• C+'a2+!a! 4+$ ' a$,0,i#'+%+ "&!a$0 0+"+ ' 3!+4"i7i$0+.

• T+"+ '+ a$0!i+! 3!,i%& ' +20iv+ " %a!a$0i)a! 'a, 4+$"i4i+$,6&i!!%i4a, #30i7a, 6& a,%&!$ &$a a0$4i#$ " 4a'i"a" 3a!a ' 3a4i$0.

:ilio#ra)ía

F&''! J R. #nstrumentación &uir'r(ica" principios y pr-ctica. W "i4i#$.E"i0+!ia' M("i4a Pa$a7!i4a$a. M(<i4+. 33. @9:.

G$!a'i0a0 " Ca0a'&$-a D3a!0a7$0 " Sa$i0a0 i S%&!0a0 S+4ia'.Ba!4'+$a. 9::9. Ci!&%a a72&'a0+!ia. C!i0!i+, 0(4$i4+, " a&0+!i>)a4i#$ a"7i$i,0!a0iva " '+, 4$0!+, a,i,0$4ia', $ ' /72i0+ " 'a4i!&%a a72&'a0+!ia - " 'a, <3'+!a4i+$, - 3!&2a, " "ia%$#,0i4+0!a3(&0i4a,5 *&!a "' /!a 6&i!!%i4a. NOM>9:?>SSA;>9::9. Pa!a'a 3!/40i4a " 'a 4i!&%a 7a-+! a72&'a0+!ia.

1003.a$,0,ia2.$,.&a24.7<a!0i4&'+,!,i"$0,a$,0,ia'+4+!!>%i+$a'.107. C+$,&'0a"+ ' "a 9 " ,30i72! " 9:;:.

Ma!0$) S D. 2ases del conocimiento &uir'r(ico. M4G!a>Hi''. M(<i4+. 33. 9. ;@.

$ a



p

í

tu

l

o

6

Bavao e *ano!

U$a " 'a, a40ivi"a", 7/, i73+!0a$0, - 4+7&$, $ 'a, &$i"a", 1+,> 3i0a'a!ia, , ' 'ava"+ " 7a$+,. E, vi0a' 0$! 3!,$0, '+, 2$*i4i+, ",0 3!+4"i7i$0+ - 0a72i($ " 'a, 4+73'i4a4i+$, 6& +!i%i$a ' $+''va!'+ a 4a2+ 4+$ 'a !i%&!+,i"a" 6& , !6&i!. Ba,0a !vi,a! 'a,,0a",0i4a, a$&a', " '+, 4$0!+, a,i,0$4ia', " 0+"+ ' 7&$"+ 3a!a4+73!+2a! 6& 'a i$*44i#$ , 'a 4+73'i4a4i#$ 7/, %!av5 6& !3!4&0$ a'0+, 4+,0+, 3a!a ' 3a4i$0 - 3a!a 'a, 3!+3ia, i$,0i0&4i+$,.

A *i$ " 4+73!$"! '+ 0!a,4$"$0 " ,0 3!+4"i7i$0+ , $4>,a!i+ !*!i! 6&5 "," ' 3&$0+ " vi,0a 3i"7i+'#%i4+5 ' 4+$0!+' " 'a,i$*44i+$, , i$,4!i2 "$0!+ " '+, 3!+3#,i0+, 7/, i73+!0a$0, 3a!a%a!a$0i)a! 'a 4a'i"a" " 'a a0$4i#$. E$ &$ %!a$ $7!+ " 4$0!+, a,i,>0$4ia', 'a 3!/40i4a "' 'ava"+ " 7a$+, 3+! 3a!0 " '+, 0!a2aa"+!, ",a'&" , i$&,0i*i4a2'7$0 2aa5 ,i0&a4i#$ 6& !3!4&0 $ ' 3a4i$0 3+! ' !i,%+ i$7i$$0 6& 3&" !3!,$0a! &$a i$*44i#$. La 3!+4&> 3a4i#$ 3+! 'a 4a'i"a" " 'a a0$4i#$ , 1a i$4!7$0a"+ $ '+, '0i7+,a+,5 ,+2! 0+"+ 3+! '+, a'0+, 4+,0+, 6& ,0+ ,i%$i*i4a. E$ 4+$,4&$4ia5' 3!,+$a' " $*!7!a "2 ,0a! a0$0+ 3a!a 6& 'a i$4i"$4ia " 'a,i$*44i+$, "!iva"a, "' i$4+!!40+ 3!+4"i7i$0+ $ ' 'ava"+ "7a$+, 3+$%a $ 3'i%!+ 'a ,a'&" " '+, 3a4i$0,.

E$ 'a 'i0!a0&!a 4i$0*i4a ",0a4a$ ,0&"i+, " i$v,0i%a4i#$ !'a0i>v+, a 'a i"$0i*i4a4i#$ " 'a Q+!a 2a40!ia$a. Ca2 !*!i! 6& ' 0(!7i$+



Q+!a a'&" a 6& 'a 7a-+!a " '+, 7i4!++!%a$i,7+, "' 4&!3+ 1&>7a$+ ,+$ 2a40!ia, 3!0$4i$0, a' !i$+ v%0a' "+, 0i3+, " (,0 ,",4!i2$ a 4+$0i$&a4i#$

lora #acteriana tran!itoria. S+$ 2a40!ia, 6& , $4&$0!a$ $ 'a,7a$+, 4+7+ !,&'0a"+ " 'a, a40ivi"a", 4+0i"ia$a,. S& 3!,$4ia , 4a,i

$&'a $ /!a, 'i73ia, - <3&,0a, " 'a 3i'5 - 3+! '+ !%&'a! , a"1i!$$ 'a %!a,a - 'a ,&4i"a". E,0+, +!%a$i,7+, , $4&$0!a$ $

73




7a-+! $7!+ $ '+, ,3a4i+, &$%&a', " '+, ""+, " 'a, 7a$+,5 - ,a"6&i!$ 3+! 4+$0a40+ 4+$ 3!,+$a, & +20+, i$*40a"+,5 4+'+$i)a"+, +

4+$ ,&3!*i4i, 4+$0a7i$a"a,. L+, +!%a$i,7+, 6& 3&"$ $4+$0!a!> ,4+7+ Q+!a 0!a$,i0+!ia ,+$5 $0! +0!+,5 *seudomonas" E$ coli" Serratia"

2acillus %!a7$%a0iv+,5 Staphylococcus aureus" 4lebsiella pneumoniae -enterococci. E, 3+,i2' 'i7i$a! ,0+, +!%a$i,7+, 7"ia$0 &$ 'ava"+ "7a$+, *!4&$0 - 4+$4i$)&"+. E,0a, 2a40!ia, ,+2!viv$ $ 'a 3i' 3+! 3!i+"+, 6& va$ "," &$+, 7i$&0+, 1a,0a va!ia, 1+!a, + "a,. C&a$"+,0 0i3+ " 2a40!ia, 3!7a$4 3+! &$ 0i73+ 3!+'+$%a"+5 , a"a30a$ a'7"i+ " 'a 3i' - , 4+$vi!0$ $ Q+!a !,i"$0.

lora #acteriana re!idente. S+$ +!%a$i,7+, 6& viv$ - , !3!+>"&4$ $ 'a 3i'5 va!a$ " &$a 3!,+$a a +0!a5 ,+$ " 2aa vi!&'$4ia -!a!a v) 4a&,a$ i$*44i+$, $ 'a 3i'. P+! '+ 4+7$ , ', $4&$0!a $'a, 4a3a, ,&3!*i4ia', - $ '+, 3'i%&, " 'a 3i' ,#'+ &$ 3+!4$0a "''+, viv $ 'a, 4a3a, 3i"(!7i4a, 3!+*&$"a,5 3+! '+ %$!a' $+ ,+$ 3a0#%$+,5 !4$ 4+$0!+' $ ' 4!4i7i$0+ " +0!+, 7i4!++!%a$i,7+,$+4iv+,5 ,0i7&'a$ ' ",a!!+''+ "' ,i,07a i$7&$ - ''%a$ a 3!+0%! a'+!%a$i,7+ " +0!a, i$*44i+$, - $*!7"a",. S+$ 7$+, ,&,430i2', a'a a44i#$ " '+, a$0i,(30i4+, 6& 'a, 2a40!ia, 0!a$,i0+!ia,5 - 3a!a 'i7i>$a!'a, , !6&i! " &$ 43i''a"+ + *!i44i#$ 7/, $(!%i4+. Ca2 ,a'a!6& , 3!/40i4a7$0 i73+,i2' 'i7i$a! $ ,& 0+0a'i"a" 'a, 2a40!ia, " 'a 3i'. L+, +!%a$i,7+, 6& , 4+$,i"!a$ 4+7+ Q+!a !,i"$0 ,+$ ,0a>*i'+4+4+, 4+a%&'a,a $%a0iv+, - "i*0!+i",5 $0! +0!+,.

E$ ,0 ,$0i"+5 , 4+73!$,i2' 6& 'a, 7a$+, 4+$,0i0&-$ ' v>14&'+ 7/, 4+7$ 3a!a 0!a$,7i0i! i$*44i+$,5 3+! '+ 4&a' , i73+!0a$06& ' 3!,+$a' ""i4a"+ a' 4&i"a"+ " 'a ,a'&" 3!a40i6& ' 'ava"+ "7a$+, 4+7+ 3a!0 " &$ 3!+4"i7i$0+ " !&0i$a a$0,5 "&!a$0 - ",> 3&(, " 7a$0$! 4+$0a40+ 4+$ '+, 3a4i$0,5 a, 4+7+ a$0, " $0!a! a'a, /!a, " 1+,3i0a'i)a4i#$5 - a$0, - ",3&(, " &$ 3!+4"i7i$0+6&i!!%i4+.

E,0a 0(4$i4a a,(30i4a , &$ 7(0+"+ !a'7$0 *40iv+ - 4+$#> 7i4+ 3a!a 3!v$i! 0+"+ 0i3+ " i$*44i+$,5 - vi0a $ %!a$ 7"i"a 'a0!a$,7i,i#$ " 7i4!++!%a$i,7+, " &$a 3!,+$a a +0!a5 " 7+"+ 6& ,4+$,0i0&- $ &$ +2,0/4&'+ 3a!a 'a "i,7i$a4i#$ 2a40!ia$a. E$ ' 'ava"+" 7a$+, i$0!vi$$ 7"i+, 74/$i4+, ' a%&a 4+!!i$0 - 'a *!i44i#$'i7i$a$ '7$0+, 7i4!+,4#3i4+, - 6&7i4+, ' a2#$ - 'a, ,+'&4i+$,a$0i,(30i4a, 7&',i+$a$ - *a4i'i0a$ 'a 'i7i$a4i#$ " a4i0,5 %!a,a,5 04..

La N+!7a O*i4ia' M<i4a$a " E7!%$4ia NOM>EM>::9> SSA9>9:: 3a!a 'a vi%i'a$4ia 3i"7i+'#%i4a5 3!v$4i#$ - 4+$0!+' "



$apítulo :Lavado de manos 75

'a, i$*44i+$, $+,+4+7ia',5 1a4 !*!$4ia a' 'ava"+ " 7a$+, $ ',i%&i$0 3&$0+

10.6 E' 3!+%!a7a " 0!a2a+ "' CODECIN "2!/ 4+$0$! 4+7+ 7$i>

7+5 $ *&$4i#$ " '+, ,!vi4i+, <i,0$0,5 '+, 'i$a7i$0+, 4+!!,3+$"i$>0, a 'a, ,i%&i$0, a40ivi"a",10.6.1 Hi%i$ " 'a, 7a$+,.10.6.1.1 T+"+ ' 3!,+$a' " ,a'&" "2 'ava!, 'a, 7a$+, 4+$ a(ua co

rriente5 a2#$ - 0+a''a, ",41a2', a' $0!a! $ 4+$0a40+ 4+$ ' a72i$01+,3i0a'a!i+.10.6.1.2 E$ 'a, &$i"a", " 4&i"a"+, i$0$,iv+,5 &!%$4ia,5 ai,'a"+, - +0!+,

6& 'a &$i"a" 4+$,i"! " i73+!0a$4ia5 , "2 &0i'i)a! a2#$ '6&i"+5 a(ua

corriente - 0+a''a, ",41a2',.10.6.1. E' a2a,0+ " 7a0!ia' - 6&i3+ $4,a!i+5 a, 4+7+ ,& 7a$0$i>7i$0+5 ,!/ !,3+$,a2i'i"a" " 4a"a ,0a2'4i7i$0+.10.6.1.A E$ 3!+4"i7i$0+, "+$" $+ , +2,!va 4+$0a7i$a4i#$ 4+$ ,a$%! +'6&i"+, 4+!3+!a',5 'a 'i73i)a " 'a, 7a$+, 3&" !a'i)a!, 4+$ a'4+1+'4+$ %'i4!i$a + a%&a - a2#$.10.6.1.5 E' 3!,+$a' " ,a'&" 6& ,0/ $ 4+$0a40+ "i!40+ 4+$ 3a4i$0,

"2 !4i2i! 4a3a4i0a4i#$ ,+2! ' 3!+4"i7i$0+ " 'ava"+ " 7a$+,5 a ,&i$%!,+ - 4a"a ,i, 7,,.

C+$ 2a, $ '+ a$0!i+!5 , *&$"a7$0a' 6& ' 3!,+$a' " ,a'&"

!a'i4 ,0 3!+4"i7i$0+

• A' i$i4ia! &$ 0&!$+.

• A$0, - ",3&(, " 0+4a! 0+"+ 0i3+ " 1!i"a,.• A$0, " 0$! 4+$0a40+ 4+$ 4&a'6&i! 3a4i$05 $ ,34ia' 4+$ '+,

i$7&$+"3!i7i"+,.• D,3&(, "' 4+$0a40+ 4+$ Q&i"+, + ,4!4i+$,.• D,3&(, "' 4+$0a40+ 4+$ !,!v+!i+, 4+7+ "!$+va4 + *!a,4+, "

a,3i!a4i#$.• A$0, " 3!3a!a! 7"i4a7$0+, - ,+'&4i+$, i$0!av$+,a, + a!0>

!ia',.• A$0, - ",3&(, " i! a' 2a+.• D,3&(, " 0+,! + ,0+!$&"a!.

• A' i$i4ia! 3!+4"i7i$0+, i$va,iv+,. • A' *i$a'i)a! ' 0&!$+.• D,3&(, " 0$! 4+$0a40+ 4+$ 6&i3+, - !+3a "' 3a4i$0.

Pa!a 4+a"-&va! a "i,7i$&i! - 'i7i$a! ,0+, 7i4!++!%a$i,7+, " 'a,

7a$+, , $4,a!i+ &0i'i)a! a'%&$+, a2+$, - ,+'&4i+$, a$0i,(30i4a,.




>olu"ione! anti!<pti"a!

U$ a$0i,(30i4+ , &$a ,&,0a$4ia 6& , a3'i4a a 'a 3i' + 0i"+, viv+, 3a!a 3!v$i! + "0$! 'a a44i#$ " '+, 7i4!++!%a$i,7+,. E$0! ,0+, a%$0,a$0i7i4!+2ia$+, ",0a4a$ '+, ,i%&i$0,

• odo. A$0i,(30i4+ " a44i#$ !/3i"a. M&- !a!a v) %$!a !a44i+$,a"v!,a,5 0a', 4+7+ i!!i0a4i#$ " 'a 3i'. S& 4+,0+ , 7&- 2a+ -!6&i! &$a 4+$4$0!a4i#$ a' $ a2+$,.

• oidona ,odada. \&7i4+ 6& !a'i)a ,& a44i#$ ",i$*40a$04&a$"+ 'i2!a ' -+"+ " ,&, 7+'(4&'a,. Ma$41a &$ 3+4+ 'a 3i' - ,

7$+, i!!i0a$0 6& ' -+"+ 3&!+ ,i$ 72a!%+5 3&" 3!+v+4a! a'!>%ia - , " a73'i+ ,340!+. C+72a0 4+$ %!a$ *40ivi"a" - , &$<4'$0 2a40!i4i"a 3a!a %!a73+,i0iva, - %!a7$%a0iva,5 a, 4+7+ Mycobacterium tuberculosis5 1+$%+, - vi!&,.

• "lor<eidina. A%$0 $+ i!!i0a$05 6& $+ , a2,+!2i"+ 3+! 'a 3i'.P!3a!a4i+$, " %'&4+$a0+ " 4'+!1<i"i$a5 $ 4+$4$0!a4i+$, "':.? a' ;.:5 " 2aa 0+<i4i"a" - *40+ !,i"&a' 3!+'+$%a"+ 1a,0a ,i,1+!a, ",3&(, " ,& a3'i4a4i#$. E<4'$0 a40ivi"a" 2a40!i4i"a

2a40!ia, v%0a0iva, %!a73+,i0iva, - %!a7$%a0iva,. E!4 a44i#$4+$0!a vi!&, 4+7+ 4i0+7%a'+vi!&,5 VIH5 1!3, i$Q&$)a.• 3lco<ol etlico @70C). Ca&,a ",$a0&!a'i)a4i#$ " 'a, 3!+0$a,. E<>

4'$0 a40ivi"a" 4+$0!a 2a40!ia, v%0a0iva, %!a73+,i0iva, - %!a7>$%a0iva,. I$1i2 a Mycobacterium tuberculosis - a40a 0a72i($ $a'%&$+, 1+$%+, - vi!&,. S i$a40iva a$0 'a 3!,$4ia " 7a0!ia+!%/$i4a. S !4+7i$"a ,& a'7a4$a7i$0+ a 073!a0&!a, $+ 7a>-+!, " 9; C.

Ca2 !4+!"a! 6& ,0a, ,&,0a$4ia, 0a72i($ 3&"$ ,! &0i'i)a"a, 3a!a 'a 3!3a!a4i#$ " 'a 3i' "' 3a4i$0 ,i0i+ 6&i!!%i4+ a$0, " &$ai$0!v$4i#$ 6&i!!%i4a.

La ,'44i#$ " &$ a%$0 a$0i,(30i4+ 3a!a ' 'ava"+ " 7a$+, ,0/"0!7i$a"a 3+! 'a, 4a!a40!,0i4a, - *40+, " 4a"a &$+ " ''+, 4+$!,340+ a ,& a44i#$5 *40+ !,i"&a'5 *i4a4ia5 ,%&!i"a" " &,+ - 4+,0+6& !3!,$0a 3a!a 'a i$,0i0&4i#$5 3!+ ,+2! 0+"+ "2 ,0a! 2a,a"a $ 'aa430a4i#$ "' 3!,+$a' 6& '+ &0i'i)a5 3+! '+ 6& "2 3+$!, ,3> 4ia'

($*a,i, $ +2,!va! '+, *40+, a"v!,+, 6& 3&"i!a$ 3!,$0a! a'&0i'i)a!'+.

E<i,0$ "+, 0(4$i4a, 3a!a ' 'ava"+ a"4&a"+ " 7a$+, ' 4'$i4+ - '6&i!!%i4+.



$apítulo :Lavado de manos 77

Bavao e *ano! "líni"o o *<i"o

F!i44i#$ 2!v - $(!%i4a " 'a, 7a$+, 6& $+ "&!a 7/, " : ,%&$"+,5- "&!a$0 'a 4&a' , !7&v 0+"a 7a0!ia +!%/$i4a + ,&4i"a"5 a, 4+7+Q+!a 0!a$,i0+!ia " 'a 3i' 3+! a44i#$ 74/$i4a5 a"6&i!i"a 3+! 4+$0a4> 0+!4i$0 4+$ +0!a, 3!,+$a,5 3a4i$0, + *#7i0,. E,0 3!+4"i7i$0+ 3&" !6&!i! 7a-+! 0i73+ 4&a$"+ 'a 3!,+$a a, '+ 4+$,i"! - ,%$' 0i3+ " 4+$0a7i$a4i#$ a' 4&a' , <3&,+.

E' aterial , e'uipo 6& , !6&i! 3a!a !a'i)a! &$ a"4&a"+ 'a>va"+ " 7a$+, ,

• Ta!a + 'ava7a$+,.• Ja2#$ 3!*!$07$0 '6&i"+5 4'+!1<i"i$a a' 9 + 3+vi"+$a -+>

"a"a a' a ;:.• T+a''a, " 3a3' ",41a2'.

A 4+$0i$&a4i#$ , ,2+)a ' procediiento 6& "2 ,%&i!,

• R0i!a! a'1aa, " ""+, - 7&4a,. Si 'a !+3a , " 7a$%a 'a!%a5"2 ,&2i!, (,0a 1a,0a ' $iv' "' 4+"+.

• A2!i! 'a ''av "' a%&a5 "a$"+ 4+!!! (,0a " 7a$!a i$i$0!!&73i>"a 1a,0a 6& *i$a'i4 ' 3!+4"i7i$0+.

• C+'+4a! 'a, 7a$+, - 7&4a, 2a+ ' 41+!!+ "' a%&a.• A3'i4a! " *+!7a a2&$"a$0 a2#$ a$0i,(30i4+ $ 'a, 7a$+,.• J&$0a! 'a, 3a'7a, " 'a, 7a$+, - *!+0a! 1a4i$"+ 7+vi7i$0+, "

!+0a4i#$ $0!'a)a! 'a, 7a$+, - ""+, - *!+0a! '+, ,3a4i+, i$0!"i>%i0a',5 4+$ 7+vi7i$0+, 1a4ia a!!i2a - 1a4ia a2a+.

• F!+0a! 'a, -7a, " '+, ""+,5 " &$a 7a$+ 4+$ 'a +0!a5 3a!a 'ava!'+, ,3a4i+, &$%&a', - 'a, &a,.

• F!+0a! 'a, 7&4a, 4+$ 7+vi7i$0+, !+0a0+!i+, " a!!i2a 1a4iaa2a+.

• E$&a%a! 'a, 7a$+, 2a+ ' 41+!!+ " a%&a5 7a$0$i($"+'a, ,i73!a $iv' " '+, 4+"+,5 " 0a' *+!7a 6& ' a%&a ,4&!!a 1a4ia 'a 3&$0a" '+, ""+,.

• E, 7&- i73+!0a$0 $+ 0+4a! ''av $i 'ava7a$+, 4&a$"+ 1a 4+$4'&i"+' 'ava"+ " 7a$+, 4'$i4+.

• S4a! 7&- 2i$ 4+$ 0+a''a " 3a3' ",41a2' "," 'a 3&$0a " '+,""+, 1a4ia 'a 7&4a5 ,i$ !%!,a!.

• E, i73+!0a$0 4!!a! 'a ''av " a%&a 4+$ 'a 0+a''a " 3a3' 4+$ 'a6& , 1a4 ' ,4a"+5 4+$ ' +20iv+ " $+ 4+$0a7i$a! " $&v+ 'a,7a$+,.




• P+! '0i7+5 'a 0+a''a " 3a3' , ",41a $ ' 4+$0$"+! 4+!!,> 3+$"i$0.

E, 3!i7+!"ia' 6& ' 'ava"+ , 1a%a 4+$ &$a *!i44i#$ 4+$,0a$0 - 4+$7+vi7i$0+, 4i!4&'a!, - *i!7,. Ta72i($ , !4+7$"a2' 6& 4&a$"+ ,&0i'i4 a2#$ ,#'i"+5 (,0 , 3a, 3+! ' 41+!!+ "' a%&a &$a v) *i$a'i)a> "+' 3!+4"i7i$0+5 a *i$ " vi0a! 'a "i,7i$a4i#$ " 7i4!++!%a$i,7+, 3+!,0a va. P+! ,0a !a)#$ ' 3!,+$a' $4a!%a"+ " 'a a"7i$i,0!a4i#$ "'/!a 6&i!!%i4a "2 ,i73! %,0i+$a! - v!i*i4a! 6& , 4&$0 4+$ a2#$'6&i"+5 ' 4&a' !,&'0a 7/, ,%&!+ - *i4a) " &0i'i)a! 6& ' ,#'i"+.

Bavao e *ano! -uirr#i"oS !4+7i$"a ,0a 0(4$i4a " 'ava"+ " 7a$+, a$0, " 4+'+4a! &$ 4a>

0(0! v$+,+ 4$0!a'5 $ 4&a'6&i! 0(4$i4a + 3!+4"i7i$0+ i$va,iv+5 a$04&a'6&i! 7a$i+2!a $ 3a4i$0, i$7&$+"3!i7i"+,5 3!7a0&!+, + 6&>7a"+,5 - $ 0+"a 4i!4&$,0a$4ia 6& !6&i!a 0(4$i4a ,0(!i'5 3!+ ,+2!0+"+ , !a'i)a ,i73! a$0, " &$a i$0!v$4i#$ 6&i!!%i4a.

S "*i$ 4+7+ &$a a44i#$ 74/$i4a 3+! *!+0 $(!%i4+ " 0+"a 'a

,&3!*i4i " 7a$+, - a$02!a)+, 4+$ a2#$ a$0i,(30i4+ + ,+'&4i#$ a$0i>7i4!+2ia$a - a%&a. S& 3!i$4i3a' +20iv+ , ",0!&i! 'a Q+!a 0!a$,i0+!ia -"i,7i$&i! 'a 4+$4$0!a4i#$ " 2a40!ia, " 'a Q+!a !,i"$0.

E' aterial , e'uipo $4,a!i+, 3a!a !a'i)a! &$ a"4&a"+ 'ava"+ "7a$+, 6&i!!%i4+ ,

• Ta!a 4+$ ,i,07a " 3"a' + '40!#$i4+.• C3i''+, + ,3+$a, ,0(!i',.• Di,3$,a"+! " a2#$ + ,+'&4i+$, a$0i,(30i4a, 4'+!1<i"i$a.

• A%&a 4+!!i$0.• C+73!,a,5 3a+, + 3a3' ,0(!i'.

ro"ei*ientoE, i73+!0a$0 i$i4ia! 4+$ &$ 'ava"+ " 7a$+, 4'$i4+5 6& i$4'&- 1&>7"4! 4+$ a%&a - a2#$ a$0i,(30i4+ 'a, 7a$+, 1a,0a '+, a$02!a)+,5 ?47 3+! a!!i2a "' 4+"+.

*rimer tiempoC+$ ' 43i''+ 6&i!!%i4+ - a2#$ a$0i,(30i4+5 , "2 *!+0a! 'a 3a'7a -' "+!,+ " 'a 7a$+5 a, 4+7+ '+, ,3a4i+, i$0!"i%i0a', - &$%&a',5



$apítulo : Lavado de manos 79

4+$ 7+vi7i$0+, 4i!4&'a0+!i+,5 "&!a$0 &$ 0i73+ a3!+<i7a"+ " "+,7i$&0+,5 ,i%&i$"+ ,i73! 'a !%'a " 'i73i+ a ,&4i+5 "i,0a' a 3!+<i7a'.E$&a%a! ' 43i''+ - " 7a$!a i$7"ia0a 1a4! ' 7i,7+ 3!+4"i7i$>

0+ $ 'a 7a$+ 4+$0!a!ia. D,3&(, , $4,a!i+ $&a%a! $ 3!i7! '&%a! 'a7a$+ $ 'a 6& , i$i4i# ' 43i''a"+ - ",3&(, 'a +0!a5 i$4'&-$"+ '43i''+5 ,i$ 1a4! 4+$0a40+ $0! ''a, - 7a$0$i$"+ 'va"+, $ 0+"+7+7$0+ '+, 2!a)+,.

Se-undo tiempoC+$ 43i''+ 6&i!!%i4+ - a2#$ a$0i,(30i4+5 , *!+0a 'a 3a'7a - ' "+!,+ "

'a 7a$+5 a, 4+7+ '+, ,3a4i+, i$0!"i%i0a', - &$%&a',5 1a,0a ' 0!4i+7"i+ "' a$02!a)+5 4+$ 7+vi7i$0+, 4i!4&'a0+!i+,5 ,i%&i$"+ ,i73! 'a!%'a " 'i73i+ a ,&4i+5 "i,0a' a 3!+<i7a'. D2 $&a%a!, ' 43i''+ - "7a$!a i$7"ia0a 1a4! ' 7i,7+ 3!+4"i7i$0+ $ 'a 7a$+ 4+$> 0!a!ia.E$0+$4, , $&a%a $ 3!i7! '&%a! 'a 7a$+ $ 'a 6& , i$i4i# '43i''a"+ - ",3&(, 'a +0!a5 i$4'&-$"+ ' 43i''+5 ,i$ 1a4! 4+$0a40+ $0!''a,5 4&i"a$"+ $ 0+"+ 7+7$0+ " 7a$0$! 'va"+, '+, 2!a)+,.

7ercer tiempoC+$ 43i''+ 6&i!!%i4+ - a2#$ a$0i,(30i4+5 *!+0a! 'a 7a$+ - ' 0!4i+7"i+ "' a$02!a)+ 1a,0a ''%a! 3+! a!!i2a "' 4+"+5 ,i%&i$"+ ,i7> 3!'a !%'a " 'i73i+ a ,&4i+5 "i,0a' a 3!+<i7a'. E$0+$4, , $&a%a '43i''+ - " 7a$!a i$7"ia0a , *40a ' 7i,7+ 3!+4"i7i$0+ $ 'a7a$+ 4+$0!a!ia. D,3&(, , $&a%a $ 3!i7! '&%a! 'a 7a$+ $ 'a 6& ,i$i4i# ' 43i''a"+ - ",3&(, 'a +0!a5 i$4'&-$"+ ' 43i''+5 ,i$ 1a4!4+$0a40+ $0! ''a, - 4&i"a$"+ $ 0+"+ 7+7$0+ " 7a$0$! 'va"+,

'+, 2!a)+,.Si73! , i73+!0a$0 a,%&!a!, " 6& ' $&a%& " 'a, 7a$+, ,

!a'i4 "," 'a 3&$0a " '+, ""+, 1a,0a '+, 4+"+,5 !,30a$"+ 'a, !%'a," a,3,ia *i%&!a >;.

Ma$0$! '+, 2!a)+, ,3a!a"+, "' 4&!3+ - 4+$ 'a, 7a$+, 1a4iaa!!i2a5 3!7i0i$"+ 6& ' a%&a ,4&!!a 1a4ia '+, 4+"+, "&!a$0 0+"+ ''ava"+ 6&i!!%i4+ ,a 3+,i4i#$ , 7a$0i$ 1a,0a ' 0!a,'a"+ a' i$0!i+! "'a ,a'a 6&i!!%i4a.

SecadoE' ,4a"+ " 'a, 7a$+, , !a'i)a $ 'a ,a'a 6&i!!%i4a 4+$ 4+73!,a,,0(!i',5 'a, 4&a', , "i,3+$$ &,0+ a$0, "' 'ava"+5 a' a2!i! ' 2&'0+




i#ura 61. Lavado de manos.

6&i!!%i4+5 7i,7+ 6& "2 3!3a!a! 'a $*!7!a i$,0!&7$0i,0a ,i>%&i$"+ 'a, 7i,7a, !%'a, " 'i73i+ a ,&4i+5 "i,0a' a 3!+<i7a' - " a!!i> 2a 1a4ia a2a+. D2 vi0a!, 6& '+, !,i"&+, " a%&a 4ai%a$ $ 'a !+3a"' 2&'0+ 6& , 4+$,i"!a ,0(!i'.

Recomendaciones relacionadascon el lavado 4uir,r-ico

• La 3i' - 'a, &a, "2$ 7a$0$!, 'i73ia, - $ 2&$ ,0a"+5 ,i$,7a'0 - 4+!0a,.

• A,%&!a!, " $+ &0i'i)a! 3+,0i)+, $ 'a, &a,.• R0i!a! 0+"a, 'a, a'1aa, " '+, ""+,5 'a, 7&4a, - ' 4&''+. •U0i'i)a! ,i73! 43i''+ + ,3+$a ,0(!i'.• A,%&!a!, 6& ' %+!!+ 4&2!a 0+"+ ' 4a2''+. •

A&,0a! ' 4&2!2+4a,.U$a v) *i$a'i)a"+ ,0 3!+4"i7i$0+5 " $i$%&$a 7a$!a - 2a+

$i$%&$a 4i!4&$,0a$4ia 'a $*!7!a 6&i!!%i4a 3&" 0+4a! +20+, 6& $+,0($ 0+0a'7$0 ,0(!i',.



$apítulo : Lavado de manos 81

E<i,0$ a'%&$a, ,i0&a4i+$, 3+! 'a, 6& ' 3!,+$a' a",4!i0+ a 'a,&$i"a", 1+,3i0a'a!ia, $+ !a'i)a ' 'ava"+ " 7a$+,5 $0! 'a, 6& 3&>"$ !*!i!, 'a, ,i%&i$0,

• I!!i0a4i#$ - !,6&"a" 3!+"&4i"a 3+! a2+$, - ,&,0a$4ia, a$0i,(3>0i4a,.

• Ta!a, - 'ava2+, i$,&*i4i$0,.• I$,&*i4i$4ia - "*i4i$4ia, $ '+, i$,&7+, !6&!i"+, 3a!a ' 3!+4>

"i7i$0+ 0+a''a, - a2+$, a$0i,(30i4+,.• S "a 3!i+!i"a" a 'a, $4,i"a", "' 3a4i$0.• C!$4ia " 6& ' &,+ " %&a$0, ,&,0i0&- ' 'ava"+ " 7a$+,. •

O'vi"+ + ",4&i"+.• Fa'0a " i$*+!7a4i#$ vi"$0 6& a3+- 'a i73+!0a$4ia " !a'i)a!,0 3!+4"i7i$0+.

C+$ 2a, $ '+ a$0!i+!5 '+, 4++!"i$a"+!, " 'a, /!a, 6&i!!%i4a,"2$ 7+0iva! a' 3!,+$a' 3a!a 6& a"+30$ 'a 0(4$i4a - 'a, !4+7$"a>4i+$, 3a!a ' 'ava"+ " 7a$+, $ ,0a /!a a,i7i,7+5 "2 a,%&!a!, 'a"+0a4i#$ " '+, i$,&7+, !6&!i"+, 3a!a ,0a 3!/40i4a $ 0i73+ - *+!> 7a. N+ !a'i)a! ,0 3!+4"i7i$0+ i73'i4a 6& $+ ,#'+ ' 3a4i$0 ,i$+

0a72i($ ' 3!+*,i+$a' " 'a ,a'&" , <3+$$ a 4+$0!a! a'%&$a 3a0+'+%a"!iva"a " 'a +7i,i#$ " "i41+ 3!+4"i7i$0+5 '+ 6& 3+"!a ,! 7+0iv+" "7a$"a, a' $+ ,%&i! 'a, !&0i$a, ,0a2'4i"a, 3+! 'a, i$,0i0&4i+$,.

A '+ 'a!%+ " ,0 4a30&'+ , 1a 141+ !*!$4ia a' a,340+ " 'a1i%i$ $ ' $0+!$+ " 'a 3!/40i4a 7("i4a. P+! ''+ , $4,a!i+ - 4+$>v$i$0 6& 'a $*!7!a !a'i4 ,& "ia!ia 'a2+! 4+$ a3%+ a "i41+, !>6&!i7i$0+,5 $+ ,#'+ $ ' 6&i!#*a$+5 ,i$+ 0a72i($ $ 'a, "iv!,a, /!a," '+, 4$0!+, 1+,3i0a'a!i+,.

A' 7i!a! ' $0+!$+ , 3!4i2$ '+, 4+$,0a$0, - 3!+*&$"+, 4a7> 2i+,6& 'a 1&7a$i"a" 1a %$!a"+. E$ ,0 4+$0<0+5 ' ,! 1&7a$+ ,!,3+$,a2' " '+, 4a72i+, 6& 1a$ 3!7i0i"+ 7+!a! ,& 4a'i"a" " vi"a5 3!+ 0a72i($ '+ , " 'a ",0!&44i#$ - "' 7a' &,+ " '+, !4&!,+,$a0&!a',. E$ ,0 ,$0i"+5 $*!7!a, - $*!7!+, 3+,$ 4+$+4i7i$>0+,5 1a2i'i"a", - 3!i$4i3i+, (0i4+, 6& ', 3!7i0$ !,+'v! "0!7i$a"a,,i0&a4i+$, !'a4i+$a"a, 4+$ 3!+2'7a, " ,a'&" 6& a6&a$ a '+, i$"i>vi"&+, + %!&3+, " 3!,+$a, 6& ,0/$ 2a+ ,& 4&i"a"+5 3+! '+ 6& "i41a

a0$4i#$ $+ "2 'i7i0a!, ,#'+ a' i$"ivi"&+5 ,i$+ 6& "2 <0$"!, a'4&i"a"+ "' $0+!$+5 "' 7"i+ - " '+, !4&!,+, $a0&!a',.

C+7+ , 2i$ 4+$+4i"+5 ,#'+ &$a 7$i7a 3a!0 "' a%&a <i,0$0 $'a Ti!!a ; 3&" ,! &0i'i)a"a 3a!a 4+$,&7+ 1&7a$+ - 0+"a $4,i>




4uir,r-ica

"a" 6& " ''+ "!iv. Ba+ ,0a 3!7i,a5 &$+ " '+, 7a-+!, 3!+2'7a,6& $*!$0a 'a 1&7a$i"a" $ 7&41a, 3a!0, "' 7&$"+ ,5 3!4i,a7$05

'a ,4a,) " a%&a5 -a ,a 3+! ",a2a,0+ + 3+! ' 7a' &,+ 6& , 1a4 " ''a.E$ ,0 4+$0<0+5 'a, $*!7!a, 0i$$ &$a !,3+$,a2i'i"a" ,i%$i>

*i4a0iva -a 6&5 ,i 2i$ , 4i!0+ 6& 'a 7a-+!a " '+, 3!+4"i7i$0+,6&i!!%i4+, 4+$''va$ 'a &0i'i)a4i#$ " a%&a5 <i,0 'a +2'i%a4i#$ " 1a4!&$ &,+ &,0i*i4a"+ - !a4i+$a' " ,0 !4&!,+ i$va'&a2'. E,0a, 3!+*,i+$a>', 0a72i($ 0i$$ ' 4+73!+7i,+ " $,a! a 0+"+, '+, 7i72!+, "'6&i3+ " ,a'&" a 6& 4+$,!v$ $ 'a 7"i"a " '+ 3+,i2' ,0 '7$>0+ vi0a' 3a!a +0+!%a! '+, ,!vi4i+, " ,a'&". A,5 6&"a " 7a$i*i,0+ 6& '4&i"a"+ " $*!7!a $+ "2 'i7i0a!, ,#'+ a '+, 3a4i$0,5 ,i$+ 6&"2 <0$"!, 0a72i($ a' 7"i+ ,+4ia' 4i!4&$"a$0.

E' a%&a , ,$4ia' 3a!a 'a vi"a ,i$ 72a!%+5 7&41a, v4, , 3a,a 3+! a'0+ ,& %!a$ i73+!0a$4ia - &0i'i"a"5 - 6&i)/ ,#'+ 1a,0a ' 7+7$0+ $6& 1a-a a&,$4ia + ,4a,) , 4&a$"+ , 4+7i$4 a $0$"! a 3'$i>0&" 6& , &$ '7$0+ i$"i,3$,a2' 3a!a 'a <i,0$4ia 1&7a$a.

Ta$ ,#'+ a 7+"+ " 73'+ $ &$ $0+!$+ 1+,3i0a'a!i+5 4+$,i"! '+6& "2 1a4!, a$0 &$ 3i,+"i+ " 1i3!0!7ia $ a'%$ 3a4i$0]4#7+ a3'i4a!a *!+ '+4a'^5 ]4+$ 4+73!,a, 17"a,^5 ]4+$ 1i'+^5 ]6&i>)/ 4+$ &$ 2a+ " 0i$a + !%a"!a^ T+"a, ,0a, +34i+$, ,+$ via2',5 ,i$72a!%+5 3a!a 0+"a, ''a, , i73!i+,+ 0$! a%&a "i,3+$i2'. E, ,#'+ &$73'+ $0! 4i$0+, 6& 3&"$ 4i0a!, !,340+ a' i73!,4i$"i2' &,+"' a%&a $ 4&a'6&i! i$,0i0&4i#$ " ,a'&".

A, 3&,5 ' a"4&a"+ 4&i"a"+ " $*!7!a5 4+7+ ' a%&a 7i,7a5,+$ i73!,4i$"i2', 3a!a ' 7a$0$i7i$0+ " 'a vi"a.

:ilio#ra)ía

F&''! J R. #nstrumentación &uir'r(ica. T!4!a "i4i#$. E"i0+!ia' Pa$>a7!i4a$a. M(<i4+. 33. @9:.

Hai$, B =. Bi2'i+04a 2/,i4a " $*!7!a. T+7+ ;. O<*+!" U$iv!>,i0- P!,,>Ha!'a. 3. ;.

Ma$&a' " vi%i'a$4ia 3i"7i+'#%i4a " i$*44i+$, $+,+4+7ia',. Di>!44i#$ G$!a' " E3i"7i+'+%a. M(<i4+. 9:::.

N+!7a O*i4ia' M<i4a$a " E7!%$4ia NOM>EM>::9>SSA9>9:: 3a!a 'a vi%i'a$4ia 3i"7i+'#%i4a5 3!v$4i#$ - 4+$0!+' " 'a, i$*4>4i+$, $+,+4+7ia',.



$apítulo

repara"in

7

e la re#in a operar

Ante"eente!D&!a$0 ' ,i%'+ XIX a'%&$+, 1+72!, " 4i$4ia "040a!+$ 'a 3!,$4ia" 7i4!++!%a$i,7+, 6& 4a&,a2a$ i$*44i+$,. A 3a!0i! " ,0 ",4&> 2!i7i$0+ , ,0a2'4i# 'a !'a4i#$ " "i41+, 7i4!++!%a$i,7+, 4+$ 'aa3a!i4i#$ " 4i!0a, $*!7"a",5 141+ 6& 3&,+ a' ",4&2i!0+ 'a $>4,i"a" " 7+!a! 'a, 3!/40i4a, " 1i%i$ $ '+, '&%a!, ",0i$a"+, a "a! a0$4i#$ a 'a ,a'&".

E' 4i$0*i4+ *!a$4(, L&i, Pa,0&! ;99>;? ",4&2!i# 6& ,0+,

7i4!+2i+, 3+"a$ 3!+v+4a! $*!7"a", - "7+,0!# 6& <i,0a 'a 3+>,i2i'i"a" " ",0!&i! a'%&$+, " ,0+, 7i4!++!%a$i,7+, 4+$ ' ,i73'141+ " ,+70!'+, a 073!a0&!a, 'va"a,.

A 3a!0i! " ,&, i$v,0i%a4i+$,5 va!i+, 4i$0*i4+, 4+$0!i2&-!+$ 4+$,& 4+$+4i7i$0+ 3a!a 4+72a0i! - ",0!&i! ,0+, 7i4!+2i+, 7"ia$0 a'>%&$+, 7(0+"+, *,i4+, - 6&7i4+, a *i$ " 3!+3+!4i+$a! &$ 7"i+ 7/,1i%i($i4+ a '+, 3a4i$0,.

A *i$a', "' ,i%'+ XIX5 F'+!$4 Ni%10i$%a' -a !*!a $ ,&, $+0a,

" $*!7!a 'a i73+!0a$4ia " 'a 7a$i3&'a4i#$ "' $0+!$+ "' 3a4i$>0 $ '+ !'a0iv+ a v$0i'a4i#$5 073!a0&!a5 i'&7i$a4i#$5 !&i"+ 1i%i$5- 4#7+ 'a i$Q&$4ia " ,0+, '7$0+, !3!4&0a $ 'a !4&3!a4i#$ "'a ,a'&" " '+, i$"ivi"&+,. R,340+ " 'a i73+!0a$4ia " 'a 1i%i$ $ '+,4$0!+, a,i,0$4ia',5 $ 'a a40&a'i"a" , ''va$ a 4a2+ 3!/40i4a, a,(30i4a,7&- 7i$&4i+,a, 4&-+ +20iv+ , 7a$0$! &$ a72i$0 '+ 7/, 'i73i+ 3+,i2' a *i$ " "i,7i$&i! a' 7/<i7+ 'a 3!,$4ia " 7i4!++!%a$i,7+,4a&,a$0, " i$*44i+$,.

E, $4,a!i+ $*a0i)a! 6& 'a i$4i"$4ia " 'a, i$*44i+$, $+,+4+>7ia', , &$ 3!+2'7a 6& ",a*+!0&$a"a7$0 $+ 1a ,i"+ 4+$0!+'a"+ $,& 0+0a'i"a"5 - 6& , 4a&,a " 4+73'i4a4i+$, 7/, %!av,. S& +!i%$

83




+2"4 $ %!a$ 7"i"a a 6& '+, 7(0+"+, &0i'i)a"+, $ 'a a0$4i#$ a '+, 3a4i$0, ,+$ $ ,& 7a-+!a i$va,iv+,5 3+! '+ 6& , 4+$,0i0&-$ $ &$a

3&!0a " $0!a"a 3a!a '+, 7i4!++!%a$i,7+,. C+$ 2a, $ '+ a$0!i+!5 ,i73+!0a$0 3!a40i4a! &$a 2&$a 0(4$i4a a,(30i4a5 ,0!a0%ia " ,&7ai73+!0a$4ia 3a!a 3!v$i! 'a, i$*44i+$,.

La 3!/40i4a " ,0a 0(4$i4a "&!a$0 ' 0!a$,+3!a0+!i+ "2 !a'i)a!> ,4+$ "i,4i3'i$a5 4&i"a"+5 0(4$i4a -5 ,+2! 0+"+5 4+$ 4+$4i$4ia 6&i!!> %i4a.E,0 4+$430+ i$$%a2' $ 'a 3!/40i4a 6&i!!%i4a 1a4 &,0a7$0!*!$4ia a 'a a&0+"i,4i3'i$a 2a+ 'a 4&a' "2 4+$"&4i!, 0a$0+ 'a $>*!7!a 4+7+ ' 6&i3+ " ,a'&" a' a3'i4a! '+, 3!i$4i3i+, " 'a a,3,ia -0(4$i4a ,0(!i'5 $4a7i$a"+, a !a'i)a! &$a 3!/40i4a !,3+$,a2' 4+$ 2a,$ ,0+, "+, 3!i$4i3i+, *&$"a7$0a',. E$ ,0 ,$0i"+5 Ni%10i$%a',a'a2a 6& 'a $*!7!a "2 0$! ,i73! &$ a'0+ ,$0i"+ "' "2!5a, 4+7+ 2&,4a! 'a 3!*44i#$ $ ,& 'a2+! "ia!ia. E,0a 4+$4i$4ia 6&i!!>%i4a i73'i4a &$a +2'i%a4i#$ 7+!a'5 &$a a40i0&" 1+$,0a "," ' 3&$0+ "vi,0a 4i$0*i4+ i$0'40&a'5 - 4+$,0i0&- &$a 3!/40i4a a&0+!!%&'a"a $!'a4i#$ 4+$ '+, va'+!, - ' 4+73+!0a7i$0+ $ ,& ",73+.

La 4+$4i$4ia 6&i!!%i4a ,0a2'4 6& "2$ a"7i0i!, '+, !!+!, "7a$!a !/3i"a - +3+!0&$a a *i$ " 0+7a! &$a "4i,i#$ a"4&a"a 3a!a!40i*i4a!'+, a 0i73+. La 4+$4i$4ia 6&i!!%i4a !6&i! 6& 'a i$,0!&>7$0a"+!a va' ' 3'i%!+ "' 3a4i$0 - 6& !7"i 'a ,i0&a4i#$ "7a$!a i$7"ia0a 4&a$"+ ,a 3+,i2'5 + 6& '+ i$*+!7 " i$7"ia0+ aa'%&i$ 6& 3&"a 1a4!'+. F&''!5 J.5 3/%. @.

C+$ 2a, $ '+ a$0!i+!5 - $+ ,#'+ $ ' /72i0+ 6&i!!%i4+ ,i$+ "7a$!a %$!a'5 'a, i$,0i0&4i+$, "2$ +0+!%a! ,i73! &$a a0$4i#$

2a,a"a $ $+!7a, (0i4a,5 4+$+4i7i$0+, - 1a2i'i"a",5 4+$ 4a'i"a" - 4a>'i")5 - 3!+3+!4i+$a! 4&i"a"+, $4a7i$a"+, a 1a4! ,$0i! ,%&!i"a" -4+$*ia$)a a '+, i$"ivi"&+,. E' 3!,+$a' " ,a'&" ,0/ +2'i%a"+ a !a'i)a!&$ 0!a2a+ 3!+*,i+$a' 4+$ !,3+$,a2i'i"a"5 vi0a$"+ ,i73! a' 7/<i7+ 3+$! $ 3'i%!+ 'a ,%&!i"a" i$0%!i"a" "' 3a4i$0.

repara"in e la piel

La i$0!v$4i#$ 6&i!!%i4a i73'i4a 'a a'0!a4i#$ " 'a, 2a!!!a, $a0&!a',"' +!%a$i,7+5 i$i4ia $ 'a 3i' "+$" , !a'i)a 'a i$4i,i#$. La 3i' , &$!,!v+!i+ " 2a40!ia, 4a&,a$0, " i$*44i+$, ,i$ 72a!%+5 <i,0$+0!+, *a40+!, a,+4ia"+, 3a!a 6& (,0a , 3!,$05 0a', 4+7+ ' ,0a"+%$!a' " ,a'&"5 'a "a" - '+, 1/2i0+, 1i%i($i4+, "' 3a4i$0. A"7/,5



$apítulo I : *reparación de la re-ión a operar 85

<i,0$ +0!+, 6& , a,+4ia$ 4+$ 'a, 4a!a40!,0i4a, "' 3!+3i+ a40+ 6&i>!!%i4+.

D2i"+ a '+ a$0!i+!5 "2 "i,7i$&i!, a' 7/<i7+ 'a 3!,$4ia " ,>

0+, 7i4!++!%a$i,7+, $ ' ,i0i+ 6& 1a2!/ " +3!a!,. C+7+ 7"i"a " 3!v$4i#$ - 3a!a !,0!i$%i! 'a 3+,i2i'i"a" " i$*44i+$,5 'a $*!7!a "'/!a 6&i!!%i4a "2 !a'i)a! a'%&$+, 3!+4"i7i$0+, 3a!a 3!3a!a! 'a 3i'- 4!a! &$ $0+!$+ '+ 7/, 1i%i($i4+ 3+,i2'.

E,0a 3!3a!a4i#$ "2 73)a! i$4'&,+ a$0, " 6& ' 3a4i$0 i$>%!, a 'a &$i"a" 6&i!!%i4a ' 3!i7! 3a,+ , 6& 0+7 &$ 2a+ 4+$a'%$ a2#$ a$0i,(30i4+ ,34ia' - 1a4i$"+ ($*a,i, $ ' a,+ "' ,i0i+ 6&,!/ ,+70i"+ a 4i!&%a.

Tri"oto*íaC+!0 0+0a' + 3a!4ia' " 4a2''+ + " v''+ "' /!a 6& 1a2!/ " +3!a!,5-a ,a 3+! 7(0+"+, *,i4+, !a,&!a"+ + "3i'a4i#$ 4+$ 3!+"&40+, 6&>7i4+,.

E$ &$a i$v,0i%a4i#$ 6& i$4'&-# 0!, 0i3+, " $,a-+,5 $ 'a 6&

3a!0i4i3a!+$ 7/, " ; ::: 3!,+$a, a 'a, 6& , ', 3!a40i4# 'i7i$a> 4i#$" v''+ 4+$ 7/6&i$a + 4!7a, "3i'a0+!ia,5 , !3+!0# $+ 1a2!$4+$0!a"+ "i*!$4ia, ,i%$i*i4a0iva,5 "," ' 3&$0+ " vi,0a ,0a",0i4+5!,340+ " 'a 3!,$4ia " i$*44i+$,. P+! '+ a$0!i+!5 , !4+7i$"a 'a'i7i$a4i#$ "' v''+ 4+$ 4!7a, "3i'a0+!ia,5 -a 6& 1a- &$a 7$+!+4&!!$4ia " i$*44i#$ $ 4+73a!a4i#$ 4+$ ' !a,&!a"+.

La 3!/40i4a " a*i0a! ' v''+ 4+$ 7/6&i$a + $avaa -a $+ , !4+>7i$"a $ 'a a40&a'i"a" "2i"+ a 6& , 3!+"&4$ 4+!0, - !+0&!a, 6&5

a&$6& 36&a,5 3!+v+4a$ 6& 'a, 2a40!ia, 4!)4a$ - , 7&'0i3'i6&$.Si$ 72a!%+5 "2$ 0+7a!, $ 4&$0a va!i+, *a40+!, 3a!a "4i"i! ,i ,0a 3!/40i4a , !a'i)a + $+5 $0! '+, 6& *i%&!a$ ' 0i3+ " 4i!&%a5 ,i0i+ " 'ai$4i,i#$5 a, 4+7+ 'a "4i,i#$ "' 4i!&a$+ a ,0 !,340+. E$ $&>!+4i!&%a5 4+$ 7&41a *!4&$4ia , 3!a40i4a 'a 0!i4+0+7a $ 'a !%i#$ 6&1a2!/ " +3!a!,.

E$ 4a,+ " 6& , !6&i!a !a'i)a! ' 3!+4"i7i$0+5 "2$ 0$!,$ 4&$0a 'a, ,i%&i$0, !4+7$"a4i+$,

• Ra'i)a! ' !a,&!a"+ 4+$ &$ 7/<i7+ " "+, 1+!a, a$0, " 'a 4i!&%a54+$ +20+ " 'i7i0a! 'a 3!+'i*!a4i#$ " 2a40!ia, 3+! 3(!"i"a "4+$0i$&i"a" " 'a 3i'. Si$ 72a!%+5 ,0a a40ivi"a" 0a72i($ 3&"!a'i)a!, $ 'a ,a'a 6&i!!%i4a 7i$&0+, a$0, " i$i4ia! 'a 4i!&%a.






7"ia$0 a44i+$, 74/$i4a, 0a''a"+5 4&-+ 3!i$4i3a' +20iv+ , 7a$>0$! 'i2! " 7i4!++!%a$i,7+, 0a$0+ ' ,i0i+ " 'a i$4i,i#$ 4+7+ ' /!a4i!4&$"a$0.

La ,+'&4i#$ 6& 3+! '+ 4+7$ , &0i'i)a 3a!a ,0 3!+4"i7i$0+ , 'a-+"+3+vi"+$a5 -a 6& $+ , 0#<i4a5 $+ i!!i0a $i 7a$41a. C+$vi$ ,a'a!6& ,0a 0(4$i4a "2 ''va!, a 4a2+ ,i%&i$"+ '+, 3!i$4i3i+, 2/,i4+,

• D' 4$0!+ a 'a 3!i*!ia. • D a!!i2a 1a4ia a2a+.• D '+ "i,0a' a '+ 3!+<i7a'. • D 'i73i+ a ,&4i+.

• D 'i73i+ a 'i73i+.

$aterial e-uipo• M,a " Ma-+ 3a!a 4+'+4a! '+, 7a0!ia', a &0i'i)a!5 a2#$ a$0i>

,(30i4+ " a73'i+ ,340!+ 4+7+ 'a -+"+3+vi"+$a $ ,3&7a -,+'&4i#$5 4'+!1<i"i$a.

• E6&i3+ " a,+ ,0(!i' %a,a, ,i$ !a-0<5 &$a Qa$!a5 &$ !i#$5 0!,

a3#,i0+,5 4+73!,a, - &$a, 3i$)a, " F+,0! + " a$i''+,. • G&a$0, ,0(!i',.• Ca73+, "+2', 'i73i+,.

ro"ei*iento• D,4&2!i! ' /!a 6& 1a2!/ " +3!a!,.• A4+7+"a! $ *+!7a a"4&a"a a' 3a4i$05 $ &$a 3+,i4i#$ a4+!"

4+$ ' 0i3+ " 4i!&%a 6& , 3!a40i4a!/.

• Di!i%i! 'a '&) " 'a '/73a!a a' ,i0i+ i$"i4a"+.• Si ' 3a4i$0 ,0/ 4+$,4i$05 "i!i%i!, ,i73! a (' + ''a 3+! ,&

$+72! - <3'i4a!' ' 3!+4"i7i$0+.• C+'+4a! 4a73+, "+2', 'i73i+, a '+, 'a"+, "' 3a4i$0. • A2!i! ' 6&i3+ " a,+ ,i73! 4+$ 0(4$i4a ,0(!i'.• V!0i! -+"+3+vi"+$a i,+"i$ $ ,3&7a $ ' !i#$5 i,+"i$ ,+>

'&4i#$ $ 'a Qa$!a.• Ca')a!, %&a$0, ,0(!i',. C&a$"+ $+ , 3+,i2' 4+$0a! 4+$ &$ a,i,>

0$0 3a!a ' 3!+4"i7i$0+5 , !4+7i$"a 4+'+4a!, ,#'+ ' %&a$0" 'a 7a$+ 4+$ 'a 6& , 1a!/ ' 'ava"+5 3a!a 6& 'a 7a$+ 4+$0!a!ia,i!va 4+7+ a&<i'ia! - 3+"! 0+7a! ' 7a0!ia' "&!a$0 ' 3!+4"i>7i$0+.




• I$i4ia! ' 'ava"+ $ ' ,i0i+ " 'a i$4i,i#$5 ,i%&i$"+ '+, 3!i$4i3i+, "a,3,ia &$iv!,a'7$0 a430a"+,5 4+$ 7+vi7i$0+, 4i!4&'a!,5 $,$0i"+ " 'a, 7a$4i''a, "' !'+5 4+$ &$ a3#,i0+ + 4+73!,a i7>

3!%$a"+ " a$0i,(30i4+5 - a,%&!/$"+, ,i73! " $+ 0+4a! 'a 3i'4+$ '+, %&a$0,5 - 1a4!'+ ,#'+ 4+$ ' a3#,i0+ + 4+73!,a.

• U$a v) 4&2i!0a ' /!a5 , ",41a ' a3#,i0+ - , 3!+4" a 0+7a!&$ ,%&$"+ a3#,i0+ 'i73i+ i73!%$a"+ 4+$ i,+"i$ ,3&7a5 - !> 30i! ' 3!+4"i7i$0+.

• C+$ &$ 0!4! a3#,i0+ 'i73i+ , !0i!a ' <4"$0 " i,+"i$ ,3&>7a.

• S "2 4+$,i"!a! "a! &$ a73'i+ 7a!%$ $ ' ,i0i+ 6&i!!%i4+

3a!a 'a, 7a$i+2!a, "&!a$0 ' 0!a$,+3!a0+!i+.

Anti!ep!iaT(!7i$+ 6& , !*i! a 'a 0(4$i4a 73'a"a 3a!a i73"i! 6& '+, 7i>4!++!%a$i,7+, , ,0a2')4a$ $ ' 3a4i$0. E,0 3!+4,+ , &$ 4+73'>7$0+ "' 'ava"+ 74/$i4+5 3&, ",0!&- 'a 7a-+!a " '+, 7i4!++!>

%a$i,7+, 3a0#%$+, 6& , $4&$0!a$ ,+2! 0i"+, viv+, 7"ia$0 'aa3'i4a4i#$ 0#3i4a " 0i$0&!a a$0i,(30i4+ 7)4'a"+ 4+$ a'4+1+' 0a' 4+7+-+"+5 3+vi"+$a -+"a"a5 4'+!1<i"i$a - a'4+1+' 0'i4+ a' @:5 $0! +0!+,v(a, 4a30&'+ .

C+$vi$ !*!i! 6& 'a 3i' $+ 3&" ,+70!, a &$ 3!+4,+ ",0!i'i)a4i#$5 -a 6& 4&a'6&i! 7(0+"+ 6& 3&"i!a a3'i4a!, 3a!a 'i7i>$a! 'a, 2a40!ia, ",0!&i!a 0a72i($ 'a 3i'5 3+! '+ 6& , !4+7$"a2'!a'i)a! 3!i7!+ &$ 'ava"+ 74/$i4+ - ",3&(, 'a a$0i,3,ia + 3i$0a"+

"' /!a 6& 1a2!/ " i$4i"i!,.

ro"ei*iento• R0i!a!, '+, %&a$0, 6& *&!+$ &0i'i)a"+, 3a!a ' 'ava"+ 74/$i4+.

• M+$0a! &$a %a,a $ &$a 3i$)a " F+,0! i73!%$a!'a 4+$ i,+"i$,+'&4i#$.

• D'i7i0a! 'a )+$a 6& , +3!a!/ " a4&!"+ 4+$ '+, '7i0, ,0a2'>

4i"+, 3a!a ' 0i3+ " 4i!&%a - 7"ia$0 ' 3i$0a"+ " '$a,5 4+$ 2a, $ '+, ,i%&i$0, 3!i$4i3i+, "' 4$0!+ a 'a 3!i*!ia5 " a!!i2a1a4ia a2a+5 " '+ "i,0a' a '+ 3!+<i7a'5 " 'i73i+ a ,&4i+5 " 'i73i+ a'i73i+.




• Pa,a! 'a %a,a &$a ,+'a v) $ 4a"a ,i0i+ 3!via7$0 "'i7i0a"+5 4+$7+vi7i$0+, *i!7, - &$i*+!7,.

Anti!ep!ia e la re#in ao*inalE$ 4a,+ " 4i!&%a $ 'a !%i#$ a2"+7i$a' "2 ,%&i!, ' ,i%&i$0 3!+>

0+4+'+;W %a,a D'i7i0a! ' /!a "i,0a' a $iv' "' ,0!$#$ 3+! a!!i2a5 a

$iv' " 'a, 00i''a,5 'a0!a' 1a,0a 'a '$a 7"ia a<i'a!5 - 3+! a2a+ 1a,0a '0!4i+ 7"i+ "' 7&,'+. C+$ 'a 3a!0 3+,0!i+! " 'a 7i,7a %a,a , ">'i7i0a ' /!a 3!+<i7a'5 ,i%&i$"+ '+, 7i,7+, '7i0,5 , "4i!5 , "i2&a

&$ !40/$%&'+ $ 0+"a 'a 4aa 0+!/4i4a5 ''%a$"+ 1a,0a ' 0!4i+ 7"i+ "'7&,'+5 ",3&(, " '+ 4&a' , ",41a 'a %a,a.

9W %a,a S i$i4ia ' 3i$0a"+ " 'a 3a!0 "i,0a' "' !40/$%&'+ 6& 3!via7$0 , *+!7# "' ,0!$#$ 1a,0a 'a !%i#$ ,&3!a32i4a5 " a!!i> 2a 1a4ia a2a+5 4+$ 7+vi7i$0+, &$i*+!7, - vi0a$"+ "a! ,3a4i+, ,i$ 3i$0a! a$0i,(30i4+5 - a $iv' " 'a 00i''a 2aa! 1a,0a ' 0!4i+ 7"i+ "'7&,'+.

W %a,a S !a'i)a " $&v+ ' 3!+4"i7i$0+ a$0!i+!.

W - ?W %a,a, E$ 'a 3a!0 3!+<i7a' , !a'i)a ' 3!+4"i7i$0+ a$0,",4!i0+5 vi0a$"+ ,i73! 0+4a! '+, %$i0a', "' 3a4i$0.

W - @W %a,a, S !a'i)a a$0i,3,ia <4'&,iva7$0 "' /!a %$i0a'5 -,#'+ 3+! 'a 3a!0 <0!$a. C&a$"+ , !6&i! i$,0a'a! ,+$"a v,i4a'5 'a,+ "2 !a'i)a!, 0a72i($ $ ' /!a i$0!$a " '+, %$i0a',.

C&a$"+ , 3!3a!a 'a 3i' "' a2"+7$ 3a!a 4i!&%a , !4+7$>"a2' 1a4! ($*a,i, $ ' /!a "' +72'i%+5 "2i"+ a 6& ,0a 36&a4avi"a" 3&" a'2!%a! i$4'&,+ 4&!3+, <0!a+,5 7i,7+, 6& ,i $+ ,+$

!7+vi"+, , 4+$vi!0$ $ &$ *a40+! ",$4a"$a$0 " i$*44i#$ 3+,>+3!a0+!ia.

E<i,0$ 3!+4"i7i$0+, 6&i!!%i4+, 6& !6&i!$ 'a i$,0a'a4i#$ "&$a ,+$"a 0!a$,&!0!a' ,+$"a " F+'-5 -a ,a 3a!a 4&a$0i*i4a4i#$ ,>0!i40a " '6&i"+, + 3a!a *a4i'i0a! ' 7i,7+ 3!+4"i7i$0+. E,0a ,+$"a "2i$,0a'a!, i$7"ia0a7$0 ",3&(, "' 'ava"+ 74/$i4+.

Ca2 ,&2!a-a! 6& , " ,&7a i73+!0a$4ia 1a4! &$a vi,i0a 3!>+3!a0+!ia a' 3a4i$0 3a!a v!i*i4a! ' 0i3+ - '+, !6&!i7i$0+, " 'a 4i>

!&%a5 '+ 6& 3!7i0i!/ 3!3a!a! 4+$ a$0i4i3a4i#$ ' 7a0!ia' - ' 6&i3+a"4&a"+ 3a!a ' 3!+4"i7i$0+.

A,i7i,7+5 - &$a v) 6& , 1a 4+$*i!7a"+ 'a $4,i"a" " i$,0a'a!,+$"a v,i4a'5 'a $*!7!a "2!/ 4a')a!, "+2', %&a$0, a$0, " i$i>




4uir,r-ica

4ia! ' 'ava"+ 74/$i4+5 3!+4"i$"+ " i$7"ia0+ a 'a i$,0a'a4i#$ " 'a,+$"a v,i4a'.

A 4+$0i$&a4i#$ , ",4!i2 ' 6&i3+ 6& "2 4+'+4a!, $ 'a 7,a!40a$%&'a! + " !i#$5 4+$ 0(4$i4a ,0(!i'. La $*!7!a i$,0!&7$0i,0a ,'a !,3+$,a2' " 3!3a!a! 'a ,+$"a5 4+$ 0(4$i4a ,0(!i'5 " 0a' *+!7a 6&,0( 'i,0a 3a!a ,& i$,0a'a4i#$ $ 4&a$0+ , 4+$4'&-a ' 'ava"+ 74/> $i4+.

Bavao *e"%ni"o anti!ep!ia"on in!tala"in e !ona ve!i"alen *u(ere!

$aterial• S+$"a " F+'- 4a'i2! " a4&!"+ 4+$ 'a, 4a!a40!,0i4a, "' 3a>

4i$0.• J!i$%a " ;: + 9: 44. • B+',a 4+'40+!a.

• G' '&2!i4a$0 (,0 $+ , 7a$a $ 'a 7,a " !i#$. • Ga,a, + a3#,i0+, ,i$ !a-0<.

ro"ei*iento• Si ' 3a4i$0 , $4&$0!a 4+$,4i$05 , i73+!0a$0 <3'i4a!' '

3!+4"i7i$0+.• Ra'i)a! ' 'ava"+ 74/$i4+ a$0, ",4!i0+.

• R0i!a! &$ 3a! " '+, "+2', %&a$0, 6& 3!via7$0 , 4a')a!+$56&"a$"+ ,#'+ 4+$ &$ 3a! 4a')a"+.

• S+'i4i0a! a 'a $*!7!a i$,0!&7$0i,0a ' 6&i3+ - v!i*i4a! 3!via>7$0 6& ' %'+2+ " 'a ,+$"a $+ 0$%a +!i*i4i+, ,0+ , 1a4 4+$&$a !i$%a - ,+'&4i#$ ,0(!i'.

• T+7a! 'a ,+$"a - $!"a!'a $ &$a 7a$+ 3a!a vi0a! 6& , 4+$0a>7i$.

• A&<i'i/$"+, " '+, ""+, $"i4 - 7"i+ " 'a +0!a 7a$+5 , a2!$'+, 'a2i+, 7a-+!, - 7$+!, 3a!a 6& 6&" <3&,0+ ' 7a0+ &!i>$a!i+.

• P!via 4+'+4a4i#$ " %' + '&2!i4a$0 $ 'a 3&$0a " 'a ,+$"a5 , i$>0!+"&4 'a ,+$"a $ ' 7a0+ &!i$a!i+.








• I$*!i+! T!4i+ 7"i+ "' 7&,'+. • La0!a' L$a 7"ia a<i'a!.

$iru-ía de cabeza # cuello• S&3!i+! B+!" "' 7$0#$.• I$*!i+! Niv' " 'a, 00i''a,. • La0!a' L#2&'+ " 'a +!a.

$iru-ía -inecoló-ica # -enitourinaria• S&3!i+! Niv' " 'a, 00i''a,.

• I$*!i+! T!4i+ 7"i+ "' 7&,'+. • La0!a' L$a 7"ia a<i'a!.

S i$4'&- ' a,+ " %$i0a', ,i%&i$"+ '+, 3!i$4i3i+, " 'a 0(4$i4aa,(30i4a5 " 'a 7a$!a -a ",4!i0a.

$iru-ía de laminectomía lumbar• S&3!i+! Niv' " 'a ,4/3&'a.

• I$*!i+! Pa!0 2aa " '+, %'0+,. • La0!a' L$a 7"ia a<i'a!.

L+, '7i0, " 'a 3!3a!a4i#$ " 'a 3i' , ,0a2'4$ $ *&$4i#$ "',i0i+ " 'a i$4i,i#$5 0+7a"+ ,i73! $ 4&$0a ' 0i3+ - 'a, 4a!a40!,0i4a," 'a 4i!&%a5 a, 4+7+ 'a, !%'a, " a,3,ia5 "a$"+ &$ 7a!%$ " ;: a 9:47 " 'a 3!i*!ia " 'a i$4i,i#$ 3a!a a,%&!a! &$a a"4&a"a 3!3a!a4i#$54+$ '+ 6& , +20i$ &$ 7a!4+ " ,%&!i"a" a"4&a"+ 3a!a 3!a40i4a! '

3!+4"i7i$0+ *i%&!a @>;.Si%&i$"+ ,0a, !%'a, - '+, 3!+0+4+'+, ,0a2'4i"+, 3+! 4a"a i$,0i0&>4i#$ " ,a'&"5 'a $*!7!a 3&" "0!7i$a! '+, '7i0, " 4a"a 4i!&%a4+$ 2a, $ ,& $a0&!a')a - ' 0i3+ " i$4i,i#$.

+e"o*ena"ione! ai"ionale!D2i"+ a' &,+ " %!a$ 4a$0i"a" " '6&i"+, a$0i,(30i4+,5 "2 v!i*i4a!,

6& (,0+, $+ 6&"$ a4&7&'a"+, "2a+ "' 3a4i$05 -a 6& 3&"$ 3!+v+4a! i!!i0a4i#$ $ 'a 3i' - %!av, 6&7a"&!a,.

D2 !4+!"a!, 6& ' a%&a , &$ 4+$"&40+! " '40!i4i"a" - 6&"&!a$0 ' 3!+4"i7i$0+ 6&i!!%i4+ , &0i'i)a$ "i,0i$0+, a3a!a0+, '4>




4uir,r-ica

i#ura 71. *revio a la ciru-ía se establecen los límites de la preparación dela piel.

0!+7("i4+,. A,i7i,7+5 , i73+!0a$0 !0i!a! 'a, 4+73!,a, 'a0!a', 6&, 4+'+4a$ a' 3a4i$0 4&a$"+ , 1a4 'a 3!3a!a4i#$ " 'a 3i'5 3&, ,&*&$4i#$ , 'a " a2,+!2! '+, '6&i"+,5 a"7/,5 ,i , "a$ a1 , 4+$vi!>0$ $ &$a *&$0 3+0$4ia' " 4+$0a7i$a4i#$.

Pa!a 'a 3!3a!a4i#$ " 'a 3i' $+ "2$ &0i'i)a!, %a,a, 4+$ 7a0> !ia'!a"i+3a4+ !a-0<5 3&, 3&"$ ''%a! a 7)4'a!, 4+$ 'a, %a,a, 6&$0!a$ a 4avi"a" - 4!a! 4+$*&,i#$ "&!a$0 ' 4+$0+ *i$a' 4i!! " 4a>vi"a".

D2 3!,0a!, ,34ia' a0$4i#$ a' 3a4i$0 3a!a "040a! ,$0+7a,6& 3&"i!a$ ,&%!i! a'!%ia a '+, 4+73+$$0, " 'a, ,+'&4i+$, a$0i>,(30i4a,5 3a!a '+ 4&a' , i73!,4i$"i2' v!i*i4a! ' <3"i$0. E,0 3!+>4"i7i$0+ "2 !a'i)a!, 4+$ 0+"+ "0$i7i$0+5 a *i$ " 4&73'i! 4+$ '

+20iv+ " !"&4i! a' 7$i7+ 'a 3!,$4ia " 2a40!ia, $ 'a 3i'5 3+! '+6& 'a $*!7!a "2 a$0i4i3a!, ,i73! a '+, 0i73+, 6&i!!%i4+,.Ha4!'+ " ,0a 7a$!a vi0a ,$0i! 'a 3!,i#$ "' !,0+ "' 6&i3+ -5 '+6& , 7/, i73+!0a$05 "i,7i$&- ' 0i73+ " 'a ,0a$4ia "' 3a4i$0 $' 0!a$,+3!a0+!i+.




+e#i!tro!

E, " ,&7a i73+!0a$4ia !4+%! '+, !%i,0!+, 4'$i4+, " $*!7!a $ '0!a$,+3!a0+!i+5 "+$" , a,i$0a$ '+, "a0+, " '+, 3!+4"i7i$0+, a 6&1a ,i"+ ,+70i"+ ' 3a4i$0. E, !4+7$"a2' ",4!i2i! " 7a$!a 2!v5 3!+ "0a''a"a5 ' 3!+4"i7i$0+ 6& , ,i%&i# $ 'a 3!3a!a4i#$ " 'a 3i'5a$+0a$"+ 4+$ 4'a!i"a" ' 0i3+ " ,+'&4i+$, &0i'i)a"a, 3a!a 'a a$0i,3,ia.

E' 4+$&$0+ " a44i+$, a 6& , ,+70 a' 3a4i$0 3a!a 3!3a!a!> '+*,i4a7$0 a' a40+ 6&i!!%i4+ ,0/$ $4a7i$a"a, a 3!+3+!4i+$a! 'a,4+$"i4i+$, i"a', 3a!a "i,7i$&i! 'a, 3+,i2i'i"a", " 4+73'i4a4i+$,6&5 $ &$ 7+7$0+ "a"+5 3&"i!a$ i73"i! ,& !/3i"a !4&3!a4i#$ "> 2i"+ a &$a 7a'a 0(4$i4a $ 'a a3'i4a4i#$ " '+, 3!+4"i7i$0+,. E$ ,0,$0i"+5 'a $*!7!a 6&i!!%i4a ",73a &$ 3a3' 3!3+$"!a$0 3a!aa,%&!a! 6& ,0a, 0(4$i4a, - 7(0+"+, , !a'i4$ 4+$ a3%+ a '+, 3!i$4i3i+, &$iv!,a'7$0 a430a"+,5 a, 4+7+ a 'a, $+!7a, - 3!+4"i>7i$0+, 6& ,0a2'4$ 'a, i$,0i0&4i+$, " ,a'&".

:ilio#ra)ía

F&''! J R. #nstrumentación &uir'r(ica. W "i4i#$. E"i0+!ia' M("i4a Pa$>a7!i4a$a. M(<i4+. 3. @9:.

K+)i! - 4+',. )undamentos de enfermer%a$ ?W "i4i#$. E"i0+!ia' M4>G!a>Hi'' I$0!a7!i4a$a. V+'. ;. M(<i4+. 3. ;?.

Ta$$! J5 =++"i$%, D5 M+$4a,0! K. Eliminación preoperatoria de vello

para reducir la infección del -rea &uir'r(ica$ Rvi,i#$ C+41!a$0!a"&4i"a. E$ 5a 2iblioteca Cochrane *lus. N7!+ 9. O<*+!".U3"a0 S+*0a! L0". 9::. Di,3+$i2' $ 1003.&3"a0>,+*0>a!.4+7. T!a"&4i"a " The Cochrane 5ibrary5 9:: I,,& 9. C1i>41,0!5 UK J+1$ =i'- S+$,5 L0".. F41a " 'a 7+"i*i4a4i#$ 7/,!4i$0 9 " 7a-+ " 9::.



$apítulo

*

MLL'

•••P

'••

97





$apítulo H : *osiciones 4uir,r-icas más frecuentes 99

La 3+,i4i#$ $ 6& , 4+'+4a a' 3a4i$0 ,0/ "0!7i$a"a 3+! ' 0i3+" 4i!&%a a,i7i,7+5 , 0+7a $ 4&$0a ' a2+!"a 6&i!!%i4+5 'a 0(4$i4a" a$,0,ia - +0!+, *a40+!, 4+7+ "a"5 ,0a0&!a5 3,+5 ,0a"+

4a!"i+3&'7+$a!5 i$0%!i"a" *,i4a - $*!7"a", a%!%a"a,. La 3+,i>4i#$ '%i"a "2 ,! 4+73a0i2' 4+$ 'a, *&$4i+$, vi0a',5 ,+2! 0+"+ 'a!,3i!a4i#$ - 4i!4&'a4i#$.

U$a 3+,i4i#$ 4+!!40a '+%!a "i,7i$&i! 3+,i2', 4+73'i4a4i+$,5 $>0! 'a, 6& *i%&!a$ ',i+$, va,4&'a!,5 $!vi+,a,5 a!0i4&'a!,5 7&,4&'a>!,5 6&7a"&!a,5 1!i"a, - 4+$0&,i+$,5 a, 4+7+ $4!+,i, " a'%&$a,)+$a,. C&a$"+ 'a 4+'+4a4i#$ , 4+73'i4a"a + '+, 3a4i$0, 3!,$0a$,+2!3,+5 , i73+!0a$0 &0i'i)a! a'%&$+, "i,3+,i0iv+, + a"i0a7$0+, ,>

34ia', 6& a-&"$ a '+%!a! 'a 3+,i4i#$ ",a"a.D2 0$!, 3!,$0 6& 4&a$"+ ' 3a4i$0 , $4&$0!a 2a+

*40+, " a$,0,ia %$!a'5 !%i+$a' + '+4a'5 'a ,$,i2i'i"a" "i,7i$&- +",a3a!45 '+ 6& ' i73+,i2i'i0a 3a!a !*!i! i$4+7+"i"a" 3+! 3!,i#$ +'a4!a4i#$ "&!a$0 ' a40+ 6&i!!%i4+. La $*!7!a , 'a 3!i$4i3a' !,> 3+$,a2' " 'a ,%&!i"a" "' 3a4i$0 $ ' 6&i!#*a$+ -5 3+! 0a$0+5 0i$'a +2'i%a4i#$ " ,a2! '+ ,i%&i$0

• C+!!40a &0i'i)a4i#$ " 'a 74/$i4a 4+!3+!a'.• P+,i4i+$, 6&i!!%i4a, 4+!!40a,.• M4/$i4a " 'a 7,a " +3!a4i+$, 7a$+ " '+, 4+$0!+', 3a!a

'va!5 ",4$"!5 $"!)a! - Q<i+$a! 0+"a, 'a, 3a!0, " 'a 7,a4+'+4a4i#$ " 'a, 3a!0, 7#vi', " 'a 7,a.

• M"i"a, 3!+040+!a, a,%&!a! 4+$ *!$+ 0+"a, 'a, !&"a, " 'a 7,a6&i!!%i4a.

• T$! 3!3a!a"+ ' 6&i3+ a"4&a"+ 3a!a 'a, "i*!$0, 3+,i4i+$,.

O(etivo!• P!+3+!4i+$a! ,%&!i"a" - 4+7+"i"a" a' 3a4i$0.

• Fa4i'i0a! 'a <3+,i4i#$ "' /!a 6&i!!%i4a a' 4i!&a$+.• Di,7i$&i! ' !i,%+ " *a40+!, a"v!,+, "&!a$0 ' 0!a$,+3!a0+!i+.• Fa4i'i0a! 'a 7+$i0+!i)a4i#$ "' 3a4i$0 a' a$,0,i#'+%+.

$e!a -uirr#i"aLa 7,a 6&i!!%i4a , i$"i,3$,a2' 3a!a '+%!a! &$a 3+,i4i#$ 4+!!40a. E,7&- i73+!0a$0 6& 'a $*!7!a 4+$+)4a ,&, 4a!a40!,0i4a, - 6&




, *a7i'ia!i4 4+$ ' 74a$i,7+ - ,&, a44,+!i+,. A,i7i,7+5 ,0a 7,a"2 a"a30a!, a 'a, "i*!$0, 3+,i4i+$, 6&i!!%i4a, 7"ia$0 '+, "i>v!,+, 74a$i,7+, 4+$ 6& v$%a 3!+vi,0a5 ,%$ ' 7+"'+ - ' *a2!i>

4a$05 3+! '+ 6& , !4+7i$"a ,i73! '! ' i$,0!&40iv+ 3a!a ,& &,+.E,a 7,a ,0/ 3!+vi,0a 4+$ "iv!,a, a!0i4&'a4i+$, 3a!a Q<i+$a!'a +

<0$"!'a a"7/,5 ,& 2a, 1i"!/&'i4a 3!7i0 7+v!'a 1a4ia a!!i2a5 1a4iaa2a+5 a '+, 'a"+, + i$4'i$a!'a. P+, a"i0a7$0+, $ '+, 3i, - $ 'a4a24!a 6& 3&"$ ,! !0i!a"+, + 4+'+4a!'+, " a4&!"+ 4+$ 'a, $>4,i"a", " 'a 4i!&%a. A,i7i,7+5 "2 v!i*i4a!, ,i73! 6& 'a 7,a,0( $ 2&$a, 4+$"i4i+$, - 6& 4&$0 4+$ 7a!4+ " a$,0,ia5 4+i$,5!+''+,5 0i!a$0,5 4i$0&!+$, " ,%&!i"a"5 a3+-a2!a)+,5 4a2)a'5 3i!$> !a,5,+3+!0,5 ,0!i2+,5 a"i0a7$0+, 3a!a *ia!5 04(0!a.

ro"ei*ientoLa 3+,i4i#$ 6&i!!%i4a 3&" !a'i)a!, a$0, + ",3&(, "' 3!+4"i7i$>0+ a$,0(,i4+. N+ +2,0a$05 '+ !4+7$"a2' , 6& (,0a , ''v a 4a2+&$a v) 4+$4'&i"+ ' a40+ a$,0(,i4+5 3+! '+ 6& 4a,i ,i73! , 4+'+4a a'

3a4i$0 $ "42i0+ "+!,a' + ,&3i$+5 3a!a 3+,0!i+!7$0 a4+7+"a!'+ $'a 3+,i4i#$ ",a"a. Ca2 ",0a4a! 6& &$a v) 6& 'a a$,0,ia 1a4*40+ ",a3a!4$ 'a, ,$,a4i+$, " "+'+!5 7+',0ia5 !i%i")5 04.5 - $4+$,4&$4ia 1a2!/ 6& 4+'a2+!a! - 4&i"a! a' 7/<i7+ 'a 4+!!40a &2i4a>4i#$ "' 3a4i$0 $ 'a 7,a " 4i!&%a 3a!a vi0a! 4&a'6&i! !i,%+.

A 4+$0i$&a4i#$ , !*i!$ 'a, 4&a0!+ 3+,i4i+$, 2/,i4a, 3a!a 4i!&>%a5 a, 4+7+ ,&, va!ia$0,.

1@ o!i"in !upina o e"ito or!alE' 3a4i$0 "2 ,! 4+'+4a"+ ,+2! ,& ,3a'"a + 2+4a a!!i2a5 4+$ 'a 4a>

2)a a'i$a"a 4+$ ' !,0+ "' 4&!3+5 '+, 2!a)+, - 'a, 7a$+, a'i$a"+, a'4&!3+5 - 'a, 3i!$a, !40a,5 3a!a''a, - a'i$a"a, 4+$ 'a 4+'&7$a v!>02!a' *i%&!a >;. E, 'a 3+,0&!a $a0&!a' "' 4&!3+ $ !3+,+. E,0a 3+,i>4i#$ , 'a 6& 4+$ 7a-+! *!4&$4ia , &0i'i)a $ 4i!&%a a2"+7i$a'5 "4a!a - 4&''+5 a, 4+7+ " 0#!a<.

Fariantes$rendelen#urg. E' 3a4i$05 $ "42i0+ "+!,a'5 , 4+'+4a"+ $ 'a

7,a i$4'i$a"a a ? !,340+ a' 3'a$+ "' ,&'+ *i%&!a >9. La 7i0a"




i#ura 81. *osición de dec,bito dorsal.

,&3!i+! "' 4&!3+ 6&"a 7/, 2aa 6& 'a 3'vi, - 'a, <0!7i"a", i$*>!i+!, 'a 4a2)a "' 3a4i$0 ,0/ 7&41+ 7/, 2aa 6& '+, 3i,.

1enta6as. S !41a)a ' 4+$0$i"+ a2"+7i$a' 1a4ia 'a 3a!0 ,&3!i+!54+$ '+ 6& , '+%!a &$a 7+! <3+,i4i#$ "' 17ia2"+7$ i$*!i+! - "'a 4avi"a" 3('vi4a.

Desventa6as. D2i"+ a 'a 4+73!,i#$ 6& 'a, v,4!a, !4$ $ '"ia*!a%7a5 , !"&4 'a 4a3a4i"a" !,3i!a0+!ia "' 3a4i$0.

$rendelen#urg inertida. E' 3a4i$05 $ "42i0+ "+!,a'5 , 4+'+>4a"+ $ 'a 7,a i$4'i$a"a a ? !,340+ a' 3'a$+ "' ,&'+ $ ,0 4a,+ 'a

i#ura 82. *osición de 7rendelenbur-.




4a2)a ,0/ 7/, 'va"a 6& '+, 3i, *i%&!a >. E, i73+!0a$0 4+'+4a!&$ 4+$ a 7a$!a " 0+3 $ '+, 3i, "' 3a4i$0 3a!a vi0a! 6& ,",'i4.

1enta6as$ S !41a)a ' 4+$0$i"+ a2"+7i$a' 1a4ia 'a 3a!0 i$*!i+!54+$ '+ 4&a' , '+%!a &$a 7+! <3+,i4i#$ "' 17ia2"+7$ ,&3!i+!. E,0a 3+,i4i#$ , &0i'i)a *!4&$07$0 3a!a 4i!&%a " va, 2i'ia!,5 %/,> 0!i4a- " 1ia0+ ,+*/%i4+.

o!ici+n de litotoa o ginecol+gica. Pa4i$0 a4+,0a"+ 2+4a a!!i> 2a5 7&,'+, Q<i+$a"+, ,+2! ' a2"+7$ - 3i!$a, ,+2! '+, 7&,'+, $'i%!a a2"&44i#$5 $ 0a$0+ 6& 'a, !+"i''a, '+ ,0/$ 7&41+ 7/, '+, %'0+,"' 3a4i$0 "2$ ,+2!,a'i! 'i%!a7$0 "' 2+!" " 'a 7,a *i%&!a >

. La, 3i!$a, , 7a$0i$$ ,&,3$"i"a, $ ,+3+!0, + ,0!i> 2+, 3!+0%i"a, 4+$ &$ 4+$ 3a!a vi0a! ,& 4+$0a40+ 4+$ ' 70a'.

C&a$"+ ' 3a4i$0 ,0( 2a+ *40+, " a$,0,ia %$!a' + " 2'+>6&+ 3i"&!a'5 "+, 3!,+$a, 'va$0a$ 'a, 3i!$a, " 7a$!a '$0a - ,i>7&'0/$a 4+$ &$a 'v !+0a4i#$ <0!$a " 'a 4a"!a - , a3+-a$ $ 'a, 3i!$!a, 3a!a vi0a! 'a,0i7a! 'a 3a!0 i$*!i+! " 'a ,3a'"a + 3!+v+4a!'&<a4i#$ " 4a"!a - !+"i''a.

E, !4+7$"a2' ''va! a 4a2+ ,0a a44i#$ 3+4+ a 3+4+ 3a!a vi0a!

",6&i'i2!i+ " 'a 3!,i#$ a!0!ia'5 6& 3&" 3!+"&4i! 41+6&. P&" 3!+"&4i!, ,0i!a7i$0+ "' $!vi+ 4i/0i4+ 3+! &$a i$a"4&a"a 4+'+4a>4i#$ " a3+-+, + 3+! !+0a4i#$ <4,iva " 'a, 4a"!a,.

C+$ ,0a va!ia$0 " 3+,i4i#$ , +20i$ &$a <3+,i4i#$ a"4&a"a "' 3!i$( - " '+, %$i0a',. E, 0i' 3a!a 3!+4"i7i$0+, " &!+'+%a5

i#ura 83. 7rendelenbur- invertida.




i#ura 84. *osición de litotomía o -inecoló-ica.

$"+,4+3ia &!0!a' - v,i4a'5 a, 4+7+ $ ' 3!i+"+ <3&',iv+ "&!a$0 ' 3a!0+.

o!ici+n de o!er o de roet. Pa4i$0 ,+2! ,& ,3a'"a + 2+4aa!!i2a5 2!a)+, - 7a$+, a'i$a"+, a' 4&!3+ 3i!$a, !40a, - 3a!a''a,5a'i$a"a, 4+$ 'a 4+'&7$a v!02!a'. E$ ,0 4a,+ 'a 4a2)a 4&'%a5 -a 6&, ' 4+'+4a &$ 4+$ 2a+ ' 4&''+5 4+$ +20+ " 7a$0$!'+ $1i3!<0$,i#$. S 4+$,i%& 0$! a2i!0a, 'a, va, a(!a, - a, ''%a! a 'a,va, !,3i!a0+!ia, 3a!a i$0&2a4i+$, + 4a$&'a4i+$,. E$ ,0a 3+,i4i#$ , 3+,i2' *40&a! 4i!&%a " 0i!+i", + 4&a'6&i!a 6& !6&i!a " 'a<3+,i4i#$ " ,0a 3a!0 " 'a a$a0+7a.

o!ici+n en e!a ortop%dica. E$ 3+,i4i#$ " "42i0+ "+!,a'5 *ia!'+, 3i, a 'a, 3'a4a, 7"ia$0 &$ v$"a - a4+'41a"+. L+, 2!a)+, "' 3a4i$0 "2$ ",4a$,a! ,+2! ' a2"+7$ + ,+2! ' a3+-a2!a)+,. E,0a 3+,i4i#$ 3!7i0 0!a44i+$a!5 !+0a!5 a"&4i! + a2"&4i! 'a, <0!7i"a", i$>*!i+!, , 0i' 3a!a !a'i)a! 3!+4"i7i$0+, " !"&44i#$ +!0+3("i4a5$4'ava"+ a$"+7+"&'a! " *(7&! - 3i!$a5 a, 4+7+ a'%&$a, 4i!&%a, "4a"!a.

2@ o!i"in prona o e e"ito ventralPa4i$0 ,+2! ,& a2"+7$5 2+4a a2a+ 'a 4a2)a , %i!a 1a4ia &$+ "

,&, 'a0!a', 2!a)+, - 7a$+, a '+, 'a"+,5 ",4a$,a$"+ $ ,+3+!0, a4+'>




41+$a"+, *i%&!a >?. L+, 3i, - 0+2i''+, , a3+-a$ ,+2! &$ 4+$ 3a!avi0a! 'a 3!,i#$ ,+2! '+, ""+, , !4+7i$"a 3+$! &$a 4+!!a ",%&!i"a" 2a+ 'a, !+"i''a,.

rotecci+n ocular. C&a$"+ , 7a$a ,0a 3+,i4i#$ , 4+!! '!i,%+ " 6& a3a!)4a$ '4!a, 4+!$a', 3+! 3!,i#$5 a&$ 4&a$"+ ,a &$a4i!&%a " 4+!0a "&!a4i#$5 3+! '+ 6& , !4+7$"a2' 4+'+4a! &$a "+$a141a " a'%+"#$ 4+$ v$"a $ 'a *!$0 "' 3a4i$0. E$ i$0!> v$4i+$,'a!%a, , a4+$,a2' a3'i4a! 3+7a"a 3i0'i)a$05 4!!a! 2i$ '+, 3/!3a"+,"' 3a4i$0 - 4&2!i!'+, 4+$ 0'a a"1,iva ,&av.

E,0a 3+,i4i#$ , 73'a $ 4i!&%a " 'a 3a!0 ,&3!i+! "' 0#!a<5 "'0!+$4+5 " 3i!$a,5 " 4+'&7$a5 4#44i<5 $&!+'+%a *+,a 3+,0!i+!5

04(0!a.

Farianteso!ici+n de lainectoa. S &0i'i)a 3a!0i4&'a!7$0 $ 'a, 'a7i>

$40+7a, " 'a 4+'&7$a 0+!/4i4a - '&72a!. S !6&i! " &$ ,+3+!0 6&'v ' 0!+$4+ " 0a' *+!7a 6& 6&" &$ ,3a4i+ 1&4+ $0! "+,'a0!a', 6& 3!7i0a$ &$ 7/<i7+ " <3a$,i#$ 0+!/4i4a 3a!a &$a a">

4&a"a !,3i!a4i#$. C+$ ' 3a4i$0 $ 3+,i4i#$ ,&3i$a , 3!+4" a 'aa$,0,ia &$a v) 3!3a!a"+ - 3!via i$"i4a4i#$ "' a$,0,i#'+%+5 , 3a,a " 'a 4a7i''a a 'a 7,a " +3!a4i+$,.

Pa!a *40&a! ,0a 7a$i+2!a , i73!,4i$"i2' 6& 0+"+ ' 6&i3+4+'a2+! 3a!a vi0a! 'a 0+!,i#$ " '+, 7i72!+, - 7a$0$! 'a 4a2)a a'i>

i#ura 85. *osición prona o de dec,bito ventral. *ara ciru-ías de tóra(posterior% columna% -l,teos # parte posterior de las e(tremidades inferiores.




$a"a 4+$ ' 0!+$4+ "&!a$0 ' 7+vi7i$0+5 a, 4+7+ 4&i"a! 'a, 4/$&'a, -0&2+, 6& ' ,+$ 4+'+4a"+, a' 3a4i$0 3a!a 'a a$,0,ia. A,i7i,7+5 "> 2$ 3!+0%!, 'a, !+"i''a,5 'a, 3i!$a, - '+, 3i, 4+$ 7a0!ia' a4+'41a"+.

o!ici+n para craneotoa. S 4+'+4a a' 3a4i$0 4+$ ' !+,0!+ 1a>4ia a2a+. La 4a2)a "2 ,+2!,a'i! "' 2+!" " 'a 7,a - 'a *!$0 ,0a!a3+-a"a $ &$ ,+3+!0 ,34ia' " 0a' *+!7a 6& 6&"a ,&,3$"i"a -a'i$a"a 4+$ ' !,0+ "' 4&!3+. L+, 2!a)+, "2$ &2i4a!, a '+, 'a"+, "'4&!3+5 - 'a, 3i!$a, - '+, 3i, 1a2!/$ " 3!+0%!, 4+$ ,/2a$a, -4+'+4a! a'7+1a"a, 2'a$"a, *i%&!a >.

o!ici+n genupectoral o de Dra!e. Á$%&'+ a' $iv' " 'a 4a"!a56& 3&" ,! 7+"!a"+ + a4$0&a"+ '+ 4&a' "3$" "' 0i3+ "

a2+!"a 3a!a 'a 4i!&%a - 4+$ 'a 4a2)a 4+$ !+0a4i#$ 'a0!a'. E$ ' 4a,+" 3a4i$0 7a,4&'i$+ , i73+!0a$0 4&i"a! 6& '+, %$i0a', $+ 6&"$4+73!i7i"+,5 " 7+"+ 6& "2$ 4a! $ *+!7a $a0&!a' *i%&!a >@. C+$,0a 3+,i4i#$ , '+%!a &$a <3+,i4i#$ 3!*40a 3a!a ''va! a 4a2+ 4i!&%a,4+7+ 17+!!+i"40+7a5 !,44i#$ " 6&i,0, 3i'+$i"a',5 04(> 0!a. Pa!a,0a i$0!v$4i#$ , !4+7i$"a ,3a!a! '+, %'0+, 4+$ 0i!a, " 0'aa"1,iva + 4+!!a, 3a!a 17+!!+i",5 4+$ '+ 6& , +20i$ &$a<3+,i4i#$ 0+0a' "' a$+. E,0a 3+,i4i#$ 0a72i($ , 4+$+4i"a 4+7+ $avaa

,vi''a$a + 7a1+70a$a.

i#ura 86. *osición para craneotomía. Esta posición se utiliza com,nmentepara tumores de fosa posterior.




i#ura 87. *osición de navaa sevillana o mahometana% es utilizada tambi'nmu# frecuentemente en paciente pediátrico.

3@ o!i"in en e"ito lateralE$ ,0a 3+,i4i#$ ' 3a4i$0 -a4 ,+2! ,& 'a"+ i)6&i!"+ + "!41+5

4+$ 'a ,3a'"a a' $iv' "' 2+!" " 'a 7,a5 '+, 2!a)+, <0$"i"+, a'*!$05 ,+2! &$ a3+-a2!a)+,. E$ ,0 4a,+ "2 0$!, 3!4a&4i#$ "4+'+4a! &$a a'7+1a"i''a $0! 'a, 3i!$a, 3a!a vi0a! 3!,i#$5 a, 4+> 7+4+'+4a! &$a 4+!!a " ,%&!i"a" 6& 3a, 3+! 'a 4!,0a i'ia4a5 'a 4&a' "2

*ia!, $ '+, 'a0!a', " 'a 7,a 4+$ +20+ " 7+!a! 'a ,0a2i'i> "a" "' 3a4i$0 *i%&!a >.

Farianteso!ici+n de Si! o !eiprona. E,0a 3+,i4i#$ , 7&- ,7a$0 a 'a

" "42i0+ 'a0!a'. E$ ''a ' 3a4i$0 , 4+'+4a"+ ,+2! ,& 'a"+ "!41++ i)6&i!"+ - , Q<i+$a ,& 3i!$a5 6& 6&"a $ 'a 3a!0 i$*!i+!5 4+$ 'a!+"i''a $ "i!44i#$ a' 341+ - "a$"+ '+, 2!a)+, a' *!$0 ,+2! &$ a3+>

-a2!a)+, *i%&!a >. D2 4+'+4a!, &$a a'7+1a"i''a $0! 'a, 3i!$a, 3a!a vi0a! 4+73!,i#$5 a, 4+7+ &$a 4+!!a " ,%&!i"a" 3+! $4i7a "'a 4!,0a i'ia4a.

i#ura 88. *osición en dec,bito lateral.




i#ura 89. *osición de Sims% con una de las piernas li-eramente Qe(ionada.

o!ici+n de lu#otoa. C+$ ' 3a4i$0 $ "42i0+ 'a0!a' "!>41+ + i)6&i!"+5 ,%$ ,a ' 4a,+5 , 1a4 4+i$4i"i! 'a a!0i4&'a4i#$ " 'a7,a 4+$ ' ,3a4i+ 4+,0+'&72a!. S Q<i+$a 'a 7,a 3a!a 6& a' 7i,7+0i73+ a&7$0 ' ,3a4i+ $0! 'a, 4+,0i''a, i$*!i+!, - 'a 4!,0a i'ia4a54+$ '+ 4&a' , 4+$,i%& &$a 7a%$*i4a <3+,i4i#$ 3a!a ''va! a 4a2+ 4i>!&%a " !i#$5 3'<+ ,i73/0i4+5 0!4i+ ,&3!i+! "' &!(0! - " 'a 3'vi,*i%&!a >;:. E$ ,0 4a,+ "2 4+'+4a!, &$a 4+!!a a 'a a'0&!a " 'a

4a"!a 3a!a ,&0a! a' 3a4i$0.

4@ o!i"in e olerE$ ,0a 3+,i4i#$ ' 3a4i$0 "2 ,0a! ,7i,$0a"+5 *+!7a$"+ &$ /$>

%&'+ " ?. L+, 2!a)+, ",4a$,a$ ,+2! 0a2'a, 3a!a''a, a 'a 7,a + ,+>

i#ura 810. *osición de lumbotomía1 se utilizan almohadillas entre laspiernas para evitar lesiones.




2! &$a a'7+1a"a 6& , 4+'+4a $ ' !%a)+ "' $*!7+ 'a, !+"i''a, ,a3+-a$ ,+2! 'a a!0i4&'a4i#$ " 'a 7,a - 'a ,44i#$ " '+, 3i, , 2aa 3a!a 4+$,%&i! Q<i#$ " 'a, !+"i''a,. E,0a 3+,i4i#$ , " ,&7a &0i'i"a" $

4i!&%a 4!vi4a'5 4!a$+0+7a 3+,0!i+!5 4a!a5 2+4a5 1+72!+ - 7a7a.A 3,a! " ,&, v$0aa, 3a!a ' 7("i4+5 , 7&- 3+4+ &0i'i)a"a5 -a 6&

, "i*4i' 3a!a ' 3a4i$05 - !,340+ "' 7a$+ " 'a a$,0,ia "2"i,3+$!, " va!i+, i73'7$0+, 3a!a ,& ,0a2i'i"a" - 4+$0!+'. La 3+,i>4i#$ , '+%!a 4+$ a-&"a " &$ ,+3+!0 + 4a2)a' *i%&!a >;;.

Va!ia$0, " 'a 3+,i4i#$ " F+'!

• S7iF+'! :.

• F+'! 'va"+ :.

o!i"ione! para pa"iente! pei%tri"o!La a0$4i#$ " 'a a,i,0$4ia " $*!7!a "&!a$0 ' 0!a$,+3!a0+!i+"2 4$0!a!, $ 'a 3!+044i#$5 "*$,a - 7i$&4i+,a a0$4i#$5 "2i"+ a 'a7a-+! "3$"$4ia " ,0 0i3+ " 3a4i$0.

E' +20iv+ 3!i$4i3a' "2 4$0!a'i)a!, $ i"$0i*i4a!5 3'a$a! - 3!+>

3+!4i+$a! 4&i"a"+, 6& 4&2!a$ 'a, $4,i"a", ,34*i4a, "' 3a4i$0 3"i/0!i4+ 4+$ 'a i$0$4i#$ " *a4i'i0a! 6& 'a i$0!v$4i#$ 6&i!!%i4a0!a$,4&!!a ,i$ i$4i"$0, - 3!+0%!'+ " 3+,i2', ',i+$,.

D2i"+ a '+ a$0!i+!5 0+"a, 'a, 3+,i4i+$, ",4!i0a, - ,&, va!ia$0, ,+$0i', 0a72i($ 3a!a 'a 4i!&%a $ 3a4i$0, 3"i/0!i4+,. S !4+7i$>

i#ura 811. *osición de semi2oler1 por lo -eneral se coloca una almohadilla bao las piernas.




"a ' &,+ " ,/2a$a, $!+''a"a,5 ,+3+!0, - 3a+, " a4&!"+ 4+$ ' 0a>7a+ - 3,+ " ,0+, 3a4i$0,.

D2 $*a0i)a!, 6& , "2 0$! 7a-+! 4&i"a"+ $ ' $*!7+

3"i/0!i4+ 4&a$"+ , ' 3+$ $ 3+,i4i#$ + , ' 7+vi'i)a5 -a 6& <i,0$!3+!0, " a44i"$0, 0a', 4+7+ 7&0i'a4i#$ 6& va$ "," &$a *a'a$%1a,0a <0!7i"a", 4+73'0a,5 a,*i<ia + 7&!0 3+! a3'a,0a7i$0+.

Criterio! )una*entale!para po!i"ionar al pa"iente

• Evi0a! 4+73'i4a4i+$, !,3i!a0+!ia,5 3a!a '+ 4&a' "2 4+73!+2a!,6& ' 4&''+5 0#!a< - a2"+7$ ,0($ 'i2!, " 4+73!,i#$5 4+$ '+ 6&, %a!a$0i)a &$a a"4&a"a *&$4i#$ !,3i!a0+!ia.

• Evi0a! 4+73'i4a4i+$, 4a!"i+va,4&'a!, 72+'ia,5 0!+72+,i, "!i>va"a, "' a'$0a7i$0+ "' Q&+ ,a$%&$+ "2i"+ a 'a a$,0,ia. L+,*a40+!, 6& '+, 4+$"i4i+$a$ ,+$ "&!a4i#$ 3!+'+$%a"a " 'a i$0!>v$4i#$5 "a" - 3,+ "' 3a4i$0.

• C+$0!+'a! 'a 4a$0i"a" - *!4&$4ia " 'a, 3!*&,i+$, i$0!av$+,a,.

•

Evi0a! a' 7/<i7+ 'a 3!,i#$ ,+2! $!vi+, 3!i*(!i4+, - 'a 3+,i4i#$*+!)a"a " 'a, <0!7i"a", "&!a$0 3!i+"+, 3!+'+$%a"+,5 3&, ,*a40i2' 3!+v+4a! 3(!"i"a, ,$,i0iva, - 7+0+!a, 6& 3&"$ ",7> 2+4a! $ ',i+$, %!av,.

• A4+'41+$a! ,i73! 6& ,a 3+,i2' 0+"+, '+, a44,+!i+, " 'a7,a 6& ,0($ $ 4+$0a40+ "i!40+ 4+$ 'a 3i' "' $*!7+ 3a!a 3!+0%!'+ " 7a$!a a"4&a"a.

• S&0a! 3!*40a7$0 'a, <0!7i"a", ,&3!i+!, i$*!i+!, 3a!avi0a! &$a 3+,i2' ',i#$.• Evi0a! a' 7/<i7+ 'a 3!,i#$ ,+2! 3i'5 $!vi+, - va,+, ,a$%&$+,

3+! 3!,i#$ 74/$i4a "i!40a. E' 6&i3+ 6&i!!%i4+ $+ "2 a3+-a!>, ,+2! ' $*!7+ - , i73+!0a$0 ,0a! a' 0a$0+ " $+ 4+'+4a!'7a0!ia' 3,a"+ $4i7a.

T+"a 3+,i4i#$ 6& , 4+$0!a3+$ + 6& +2'i%a a &$a 3+,0&!a "i*!$>0 a '+ a430a2' "," &$ 3&$0+ " vi,0a a$a0#7i4+ %$!a a*44i+$,

0a', 4+7+• A'0!a4i+$, $ 'a 4i!4&'a4i#$.• A'0!a4i+$, $ 'a !,3i!a4i#$. • A'0!a4i#$ " '+, !Q+,.




• A'0!a4i#$ - 0$,i#$ $ '+, #!%a$+,. •A'0!a4i#$ $ '+, $!vi+, 4!a$a',.

• A*40a4i#$ "' 3'<+ 4!vi4a'.

• A*40a4i#$ "' 3'<+ 2!a6&ia'.

U$a v) 6& ' 3a4i$0 1a ,i"+ a$,0,ia"+ , !,3+$,a2i'i"a" "0+"+ ' 6&i3+ 6&i!!%i4+ 4+'a2+!a! 4&a$"+ , !6&i!a 7+vi'i)a!'+ - 3!+0%!'+ " '+, *40+, $+4iv+, " 'a 3+,i4i#$5 3+! '+ 6& "2$ vi>0a!, 3+,i4i+$, <0!7a,. A,i7i,7+5 "2 7+v!, a' 3a4i$0 4+$ 'a7a-+! ,&avi"a" - '$0i0&" 3+,i2'. T+"+ ' 3!,+$a' i$v+'&4!a"+ $ 'aa0$4i#$ a' 3a4i$0 "&!a$0 ' 0!a$,+3!a0+!i+ "2 !4+!"a! 6& <i,0

7a-+! "2i'i"a" - v&'$!a2i'i"a" a a'0!a4i+$, 7/, 3!+*&$"a, - 6&5 3+!0a$0+5 ' $*!7+ $+ 0i$ 4a3a4i"a" 3a!a 4+73$,a! '+, 4a7> 2i+, 3+,0&!a',.

A 7$&"+ '+, *40+, a"v!,+, " 'a 3+,i4i#$ ,+$ '$0+, $ ,& i$i4i+- $+ , 7a$i*i,0a$ 4'$i4a7$0 $i " 7a$!a i$7"ia0a5 3+! '+ 6& "2 3!,0a!, ,34ia' a0$4i#$ a 'a v+'&4i#$ "' 3a4i$0 "&!a$0 ' 3+,+3!a0+!i+ i$7"ia0+.

$eia! e !e#uriaA40&a'7$0 'a 3!/40i4a " $*!7!a , 2a,a $ 4+$+4i7i$0+, 4a"a v)7/, a73'i+, - 3!+*&$"+,5 a40i0&", 3!+*,i+$a', - a30i0&", 3a!a 3!,0a!4&i"a"+, " $*!7!a " #30i7a 4a'i"a".

La &2i4a4i#$ 4+!!40a "' 3a4i$0 6&i!!%i4+ , &$a 7/, " 'a,7'0i3', +4&3a4i+$, " 'a $*!7!a "&!a$0 'a 0a3a 0!a$,+3!a0+!ia5 3+! '+ 6& "2 ,! 4+$,4i$0 " 'a 4+!!40a a3'i4a4i#$ " 'a, 0(4$i4a, -

3!+4"i7i$0+, 3a!a vi0a! 3+,i2', 4+73'i4a4i+$, "!iva"a, "' ",>4+$+4i7i$0+ " '+, 74a$i,7+, " 'a 7,a 6&i!!%i4a5 " 'a, 3!+3ia, 3+,i4i+$, - ,&, va!ia$0,5 " 'a a$a0+7a5 - " 'a, 7"i"a, " ,%&!i"a"0a$0+ 3a!a ' 3a4i$0 4+7+ 3a!a ' 6&i3+ 6&i!!%i4+. E$0! "i41a, 7>"i"a, , 4&$0a$ 'a, ,i%&i$0,

• I"$0i*i4a4i#$ "' 3a4i$0 i$7"ia0a7$0 a$0, " i$i4ia! ' 3!+>4"i7i$0+ a$,0(,i4+5 ,i ,& ,0a"+ " 4+$4i$4ia '+ 3!7i0 $ 4a,+4+$0!a!i+5 ' 3!,+$a' "2 a&<i'ia!, 4+$ 'a i$*+!7a4i#$ " '+,

772!0, - 3&',!a,5 a, 4+7+ "' <3"i$0 4'$i4+.• C+$*i!7a! ' ,i0i+ 6&i!!%i4+.• A,%&!a! 'a 7,a 4+$ *!$+ 3a!a vi0a! a44i"$0,. • N+ "a! ,+'+ a' 3a4i$0 $ $i$%$ 7+7$0+.




• C+$0a! 4+$ &$ 7$i7+ " 4&a0!+ 3!,+$a, 3a!a 'va$0a! + 7+v! a&$ 3a4i$05 ,+2! 0+"+ 4&a$"+ , $4&$0!a i$4+$,4i$0.

• U$a v) a$,0,ia"+ ' 3a4i$05 $+ , ' "2 7+v! ,i$ 'a a&0+!i)a>

4i#$ "' a$,0,i#'+%+.• E, !,3+$,a2i'i"a" "' a$,0,i#'+%+ 3!+0%! 'a 4a2)a "' 3a4i$0

0+"+ ' 0i73+ - "a! ,+,0($ "&!a$0 'a 7+vi'i)a4i#$. D2 7+v!, a' 3a4i$0 7&- ",3a4i+ 3a!a 3!7i0i! 6& ' ,i,07a 4i!4&'a0+!i+ ,a&,0.

• D&!a$0 'a 4i!&%a 'a $*!7!a i$,0!&7$0i,0a "2 !4+!"a! $0+"+ 7+7$0+ 'a 3+,i4i#$ $ 6& , $4&$0!a ' 3a4i$0 3a!a vi>0a! !4a!%a!, ,+2! ('5 $+ 4+'+4a! +20+, $4i7a " ('5 04(0!a.

• E' 7("i4+ 0i$ 'a !,3+$,a2i'i"a" " 3!+0%! i$7+vi'i)a! 0+"a*!a40&!a.

• V!i*i4a! 6& $+ , +2,0!&-a$ + ",4+$40$ 4a0(0!,5 v$+4'i,i, -7+$i0+!, "&!a$0 ' 7+vi7i$0+.

• N+ <0$"! $i$%&$a 3a!0 "' 4&!3+ "' 3a4i$0 7/, a''/ " '+, 2+!", " 'a 7,a.

• N+ "a! $ 4+$0a40+ $i$%&$a 3a!0 "' 4&!3+ 4+$ 'a, 3a!0, 70/>

'i4a, + ,&3!*i4i, ,i$ 3!+044i#$.• P!+0%! 'a, 0a2'a, 3a!a '+, 2!a)+, 3a!a vi0a! 'a 1i3!<0$,i#$5 a,4+7+ ',i+$, 7&,4&'a!, + $!vi+,a,.

• E<3+$! ' 4&!3+ '+ 7$i7+ $4,a!i+ 3a!a 3!v$i! 1i3+0!7ia -!,30a! 'a i$"ivi"&a'i"a" "' 3a4i$0.

• N+ 4!&)a! '+, 0+2i''+, $i 'a, 3i!$a, "' 3a4i$0 3a!a vi0a! +4'&,i#$$ '+, va,+, ,a$%&$+, - $!vi+,.

• Si ' 3a4i$0 , 4+'+4a"+ $ "42i0+ v$0!a'5 ' 0#!a< "2 'i2!a!,

" 3!,i#$ 3a!a *a4i'i0a! ,& !,3i!a4i#$.• E$ 3+,i4i#$ 'a0!a'5 "2 4+'+4a!, &$a a'7+1a"a $0! 'a, 3i!$a,"' 3a4i$0 3a!a 3!v$i! 'a 3!,i#$ " va,+, - $!vi+,.

• E, i73+!0a$0 ,+'i4i0a! +!i$0a4i#$ + a-&"a 4&a$"+ $+ , 0$%a 'a,%&!i"a" " "a! 'a 3+,i4i#$ 4+!!40a a' 3a4i$0.

• Di,3+$! ' 6&i3+ $4,a!i+ 3a!a *a4i'i0a! ' 3!+4"i7i$0+.• V!i*i4a! - 4+73!+2a! '+, "i,3+,i0iv+, 3a!a ,%&!i"a" "' 3a4i$0. •B!i$"a! &$a 2&$a 74/$i4a 4+!3+!a'5 '+ 6& 1a4 7/, ,%&!+ '

0!a2a+ "' 6&i3+ - %$!a &$ 7"i+ a"4&a"+ 3a!a ' 3a4i$0.E, i73+!0a$0 ,a'a! 6& 'a, 3a!0i4&'a!i"a", " 'a 04$+'+%a 6&

1a " a3'i4a!, a 3a4i$0, 4+$ 3!+2'7a, " ,a'&" 6&i!!%i4+, !6&i!&$a *+!7a4i#$ 7&- ,34*i4a5 - 6& ,#'+ 4+$ 'a 3!/40i4a 4+$,0a$0 -




' ,0&"i+ , 3+,i2' 6& 'a $*!7!a a"6&i!a 'a, ",0!)a, $4,a!ia, 3a!a a40&a! 4+$ 'a !a3i") - *i4i$4ia 6& ' 3!7i0a$ 4+$0!i2&i! " 7a>$!a "i!40a $ 'a a0$4i#$ 4+!!40a "' 3a4i$0 6&i!!%i4+5 4+$ '+ 6&

4+$0!i2&- a 4!a! &$ a72i$0 " ,%&!i"a" 3a!a 0+"+,.

:ilio#ra)ía

Antolo(%a de enfermer%a &uir'r(ica. H+,3i0a' G$!a' " M(<i4+. 9::;.

Di!,$ L H. E$*!7!a 7"i4+>6&i!!%i4a. W "i4i#$. E"i0+!ia' E',>vi! M+,2-. E,3aa. 9::.F&''! R J. #nstrumentación &uir'r(ica. W "i4i#$. E"i0+!ia' Pa$a7!i4a>

$a. 3/%. @. 9::.

$

a

pí

t

u

lo

9

ro"ei*iento! e!pe"iale!



en la !ala -uirr#i"a

L+, 7i4!++!%a$i,7+, 2a40!ia,5 vi!&,5 1+$%+, 3!+v+4a$ i$*44i+$, $' ,! 1&7a$+5 " 7+"+ 6& , $4&$0!a $ &$a ,i0&a4i#$ v&'$!a2'4&a$"+ ,0/ $ &$ /72i0+ 1+,3i0a'a!i+.

D2i"+ a' ",4&2!i7i$0+ " '+, a$0i,(30i4+,5 J+,31 Li,0! 4+$0!i> 2&-# $ %!a$ 7"i"a a "i,7i$&i! 'a, 7&!0, 3+! i$*44i#$ 4+$0!a"a, $' 6&i!#*a$+5 4&a$"+ a"vi!0i# 6& (,0a, !a$ 4a&,a"a, 3+! 3a!04&'a,

3!,$0, $ ' ai!5 - $*a0i)# 6& 'a *+!7a " 4!a! &$ a72i$0 7/,a,(30i4+ !a 7"ia$0 'a 4+'+4a4i#$ " $2&'i)a"+!, " /4i"+ 4a!2#'i4+*$+'. D,3&(, " Li,0! - "2i"+ a 'a 3!,$4ia " i$*44i+$, $ 'a,i$,0i0&4i+$, " ,a'&" 0a$0+ 'a, i$v,0i%a4i+$, 4+7+ '+, %!a$", 3!+>%!,+, $ 7i4!+2i+'+%a 1a$ 4+$0i$&a"+ $ 4&!,+. La, a&0+!i"a", ,a$i>0a!ia, 7&,0!a$ &$a ,34ia' 3!+4&3a4i#$ a' !,340+5 3&, ,0 3!+2'>7a !3!,$0a &$ i$4!7$0+ $ ' %a,0+ " '+, !4&!,+, &0i'i)a"+, 3a!a 'aa0$4i#$ " ,0a, 4+73'i4a4i+$, -5 7/, i73+!0a$0 a$5 "a ,4&'a, $

' 3a4i$05 'a, 4&a', i$4'&,+ 3&"$ 3!+v+4a! ,& 7&!0.E' 6&i!#*a$+ , &$ /!a " 4+$,0a$0 3'i%!+ 0a$0+ 3a!a ' 3!,+$a'

6& a1 'a2+!a 4+7+ 3a!a ' 3a4i$0 "2i"+ a' !i,%+ " i$*44i+$,5 6&!3!,$0a$ &$a a'0a 0a,a " i$4i"$4ia.

La 3!,$4ia $ ,0 ,i0i+ " 3!,+$a' 6&i!!%i4+5 7a$+ " 7a0>!ia' - 6&i3+5 a, 4+7+ " 7a$i3&'a4i#$ - 0!/$,i0+ " +0!+, 3a4i$0,5+2'i%a a a"+30a! 7"i"a, " 3!+044i#$ 4+$0!a ,0a, v$0&a'i"a",5 4+$+20+ " "i,7i$&i! 'a 3!+2a2i'i"a" " i$*44i+$, 3+,6&i!!%i4a,.

D2i"+ a 0+"+ '+ a$0!i+!5 , i73+!0a$0 !a'i)a! &$a 3!/40i4a 6&i>!!%i4a !,3+$,a2' $4a7i$a"a a 0+7a! 'a, 3!4a&4i+$, " 3!+04> 4i#$$ 0+"a 4i!&%a 3a!a 3!v$i! 'a, i$*44i+$, 4a&,a"a, 3+! 4+$0a>7i$a4i#$.

113




E,0a, 3!4a&4i+$, ,34ia', i$4'&-$ ' 7a$+ " "+, 3!+4"i>7i$0+, 4+$+4i"+, 4+7+ !ala containada - tiepo !%ptico$

La a430a4i#$ " ,0 7a$+ " 3!+4"i7i$0+, 3+! 3a!0 "' 3!>,+$a' " $*!7!a , $4&$0!a ",4!i0+ $ &$ ,0&"i+ 6& , !a'i)# $' H+,3i0a' G$!a' " M(<i4+ - $ ' 4&a' , !*i! 6& ' 3!,+$a'a",4!i0+ a 'a, /!a, 6&i!!%i4a, 7a$a ' 0i73+ ,(30i4+5 a&$ 4&a$"+ $+, 1a "0!7i$a"+ ,& 7a%$i0&" - a'4a$4 $ 'a 3!v$4i#$ " 'a,i$*44i+$, "&!a$0 ' 0!a$,+3!a0+!i+. Si$ 72a!%+5 , $4,a!i+ 1a4!7$4i#$ " 'a 3!/40i4a *!4&$0 " ,0a 0(4$i4a $ 7&41a, i$,0i0&4i+$,"' ,40+! ,a'&" $ M(<i4+5 0a$0+ 32'i4a, 4+7+ 3!iva"a,5 4+$ 'a ,+'ai$0$4i#$ " 4+$0!i2&i! a "i,7i$&i! 'a 3+,i2i'i"a" " 6& , 3!,$0 &$ai$*44i#$.

La 3!/40i4a 4+$,0a$0 " ,0+, 3!+4"i7i$0+, 1a %$!a"+ ' 3'a$>0a7i$0+ " 1i3#0,i,5 'a, 4&a', 3+"!a$ ,! ,0&"ia"a, " 7a$!a 4+$>0i$&a - va'i"a"a, " 7+"+ 4i$0*i4+ 3+! ' 3!+3i+ 3!+*,i+$a' " $*!>7!a5 a 0!av(, " &$a <1a&,0iva i$v,0i%a4i#$.

>ala "onta*inaa ?!<pti"a@Con"eptoE,0 3!+4"i7i$0+ 3!+%!a7a"+ + " &!%$4ia , !a'i)a $ 'a ,a'a 6&i>

!!%i4a5 $ 3a4i$0, 3+!0a"+!, " a%$0, i$*44i+,+,5 " a'0+ !i,%+ "4+$0a7i$a4i#$5 6& 3+$ $ 3'i%!+ 'a a,3,ia "' 6&i!#*a$+5 a, 4+7+ 'a,%&!i"a" " '+, 3a4i$0, - "' 3!+3i+ 6&i3+ " ,a'&".

O(etivo!• Evi0a! i$*44i+$, 4!&)a"a,.

• Ci!4&$,4!i2i! '+, 7i4!++!%a$i,7+, 3a0#%$+, a' /!a 6& , $>4&$0!a 4+$0a7i$a"a.

• I73"i! 'a 3!+3a%a4i#$ " '+, 7i4!++!%a$i,7+,. • D,0!&i! a' a%$0 4a&,a'.

• P!+0%! a' 6&i3+ 6&i!!%i4+ "' a%$0 4a&,a'.• R"&4i! a' 7/<i7+ ' !i,%+ " i$*44i#$ " 3a4i$0, a 6&i$, ,

', 3!a40i4a 4i!&%a $ ,a'a, 4+$0i%&a,.• E,0a$"a!i)a! ' 3!+4"i7i$0+ 6& 1a2!/ " ,%&i!, $ 'a ,a'a 4+$>

0a7i$a"a.



$apítulo N :*rocedimientos especiales en la sala 4uir,r-ica 115

Ciru#ía! en -ue !e eter*ina *ane(o

e !ala "onta*inaa• Ci!&%a i$0,0i$a' + !40a' 4+$ i$0!!&34i#$ "' 0!/$,i0+ i$0,0i$a'.• C+'44i+$, 3&!&'$0a,.• T&2!4&'+,i, 4+$ a40ivi"a" "' 3!+4,+ i$*44i+,+.• Fa,4i+0+7a, 3+! ,0a*i'+4+4+,.• P!+4,+, ,(30i4+, a2"+7i$+3!i$a',.• A73&0a4i+$, 3+! %a$%!$a %a,+,a.

• A!0!i0i, ,(30i4a.• C'&'i0i, 3+! 2a40!ia,.• H!i"a, <3&,0a, 3+0$4ia'7$0 i$*40a"a,.• \&7a"&!a, i$*40a"a,.• Ga$%!$a %a,+,a.• Pa4i$0, ,!+3+,i0iv+, 4+$ VIH.• Pa4i$0, 4+$ vi!&, " 13a0i0i, B - C.• O,0+7i'i0i,.

• S30i47ia,.• E$*!7"a", v$(!a,.• Ra2ia.• M$i$%i0i,.• T+"+ 3!+4"i7i$0+ 6& , 4+$,i"! i$*40a"+.

E' 6&i3+ 6&i!!%i4+ , !,3+$,a2' " 7a$0$! &$a 4+7&$i4a4i#$*40iva " 0a' *+!7a 6& , $+0i*i6& $ 0i73+ - *+!7a ,i 'a 4i!&%a!6&i! ,! 7a$a"a 4+7+ 4+$0a7i$a"a. L+ i"a' , i$*+!7a! a 'a $>

*!7!a * " ,!vi4i+5 3a!a 6& ''a a ,& v) 3!v$%a - "i,0!i2&-a a' 3!,+$a' !6&!i"+ 3a!a ,0 3!+4"i7i$0+. La $*!7!a 6&i!!%i4a"2 "0!7i$a! - 4+$0!+'a! ' 7a$+ " 'a ,a'a 4+$0a7i$a"a.

+e"ur!o u*ano ne"e!ariopara e!to! pro"ei*iento!A 4+$0i$&a4i#$ , 'i,0a ' 7$i7+ " 3!,+$a' $4,a!i+ 3a!a ,0 3!+>

4"i7i$0+.• Ci!&a$+ - a-&"a$0, '+ 7$i7+ !6&!i"+.• U$a $*!7!a i$,0!&7$0i,0a.• D+, $*!7!a, 4i!4&'a$0, &$a i$0!$a - &$a <0!$a.• U$ a$,0,i#'+%+.




+e"ur!o! *ateriale!E, $4,a!i+ 4+$0a! 4+$ '+, ,i%&i$0, a"i0a7$0+, a$0, " 73)a! 'a

4i!&%a.• B+',a, " 3'/,0i4+ " a4&!"+ 4+$ 'a NOM>:@>ECOL>SSA>9::9.• S+'&4i+$, a$0i,(30i4a, -+"+3+vi"+$a ,3&7a - ,+'&4i#$5 4'+!>

1<i"i$a5 + 'a, ,+'&4i+$, a$0i,(30i4a, "i,3&,0a, 3+! 'a i$,0i0&4i#$ 3a!a ,0+, 4a,+,.

• Hi3+4'+!i0+ " ,+"i+ "' a' @. • G'&0a!a'"1"+ a' 9.

• D0!%$0 $)i7/0i4+.• Ta30, a$0i7i4!+2ia$+, ,i , 4&$0a 4+$ ''+,.• C+$0$"+!, " 7a0!ia' 3&$)+4+!0a$05 '6&i"+, - Q&i"+, 4+!3+>

!a', " a4&!"+ 4+$ 'a NOM>:@>ECOL>SSA>9::9. • B&"i$!a, 4+$ 0a3a %!a"+ 7("i4+. • C3i''+,.• B&'0+ " !+3a 6&i!!%i4a ",41a2' 4a73+,5 ,/2a$a,5 04.. • L$0, 3!+040+!a,.• R+3a ",41a2' 3a!a ' 3a4i$0 - 3a!a ' 3!,+$a'.

$eia! #enerale!L+ i"a' , a,i%$a! &$a ,a'a ,34ia' 3a!a ,0 0i3+ " 3!+4"i7i$0+,.

Si ' 3!+4"i7i$0+ $+ , &!%$05 3!+ -a , 1a 3!+%!a7a"+5 "2 *4>0&a!, a' *i$a' "' 0&!$+5 " 0a' 7a$!a 6& , !a'i4 'a ",i$*44i#$ ,> 34*i4a " 'a ,a'a 6& *& &0i'i)a"a.

E$ 4a,+ " ,! 4i!&%a &!%$05 ,i73! "2 a,i%$a!, &$a ,a'a ,>

34ia' 3a!a ,0 0i3+ " 3!+4"i7i$0+,.E, i73+!0a$0 ,&,3$"! ' ai! a4+$"i4i+$a"+ - ' ,i,07a " <>

0!a44i#$ a$0, " i$i4ia! ' 3!+4"i7i$0+. D2 v!0!, 1i3+4'+!i0+ ",+"i+ a' $ *!a,4+ " a,3i!a4i#$ ,0 0!a2a+ '+ 3&" !a'i)a! ' 3!>,+$a' " ,!vi4i+, %$!a', + i$0$"$4ia5 ,&3!vi,a"+ 3+! 'a $*!7!a" 6&i!#*a$+.

E' 3!,+$a' "2 &0i'i)a! !+3a ",41a2'. Si , 3+,i2' , 4+'+4a$0a30, a$0i7i4!+2ia$+, a 'a $0!a"a " 'a ,a'a 6&i!!%i4a $ 4a,+ " 6&

'a i$,0i0&4i#$ $+ 4&$0 4+$ ,0+, a!04&'+, 3&" i73!+vi,a!, -,&,0i0&i!'+, 3+! 'i$)+, 1&7"4i"+, 4+$ 4'+!+. Ta72i($ , $4,a!i+4+'+4a! 3!+040+!, " 3'/,0i4+ a 'a 4a7i''a "' 3a4i$0.




T<"ni"a e e(e"u"in

E, i73+!0a$0 6& ' 6&i3+ 6&i!!%i4+ !a'i4 ,& 0!a2a+ ,i73! 4+$a3%+ a 'a, $+!7a, " 'a 0(4$i4a a,(30i4a5 7+0iva"+, 3+! 'a 4+$4i$4ia6&i!!%i4a.

un"ione! e la! en)er*era! "ir"ulante!A 4+$0i$&a4i#$ , 'i,0a$ a'%&$a, " 'a, 3!i$4i3a', *&$4i+$, - +2'i%a4i+>

$, " 'a, $*!7!a, $ ,0 3!+4"i7i$0+ - $ "i*!$0, 7+7$0+, "'

7i,7+.Enerera! circulante!

• R0i!a! " 'a ,a'a 6&i!!%i4a 0+"+ ' 7+2i'ia!i+ 6& $+ ,a $4,a!i+.• V!i*i4a! ' *&$4i+$a7i$0+ " a,3i!a"+!5 '/73a!a,5 7,a 6&i!!%i>

4a5 04.• S''a! 4+$ 4i$0a a"1,iva 'a, 3&!0a, " 'a ,a'a 6&i!!%i4a. • C+'+4a! avi,+ 4+$ 'a '-$"a SALA CONTAMINADA.• C+'+4a! 2+',a, " 3'/,0i4+ !+a, RPBI $ 'a, 4&20a, " 3a0a"a.

• C+'+4a! "+, 2+',a, " 3'/,0i4+ !+a, RPBI $ 'a 3&!0a &$a "$0!+- +0!a *&!a " 'a ,a'a 6&i!!%i4a "+$" , !a'i)a!/ ' 3!+4"i>7i$0+.

• R4i2i! i"$0i*i4a! a' 3a4i$0 - ' <3"i$0 4+$*+!7 a '+ ,0a> 2'4i"+ $ 'a N+!7a O*i4ia' M<i4a$a NOM>;SSA;>;.

Enerera 'uir(rgica @in!truenti!ta)

a) urante la ciruga

• S+'i4i0a! 2&'0+ 6&i!!%i4+ ",41a2'.• S+'i4i0a! i$,0!&7$0a' - 7a0!ia' " 4+$,&7+ ' 7$i7+ i$"i,3$>

,a2'.• Ra'i)a! a40ivi"a", " !&0i$a 3a!a 0+"a 4i!&%a. • Ma$+ " 0i73+ ,(30i4+ "&!a$0 'a 4i!&%a.

#) 3l inal de la ciruga @dentro de la !ala 'uir(rgica)

• V!i*i4a! 6& 'a !+3a " 0'a &0i'i)a"a $ 'a 4i!&%a , 4+'+6& $

2+',a !+a !+0&'a"a a"4&a"a7$0 4+$ 'a '-$"a 4+$0a7i$a"a.• C!!a! 4+$0$"+!, ",41a2', " '6&i"+, - Q&i"+,5 - 3+$!'+,

$ 2+',a "+2' 3a!a ,& !0i!+. Si , &,a$ '+, 0!a"i4i+$a',5 4+'+4a! '+,'6&i"+, i$a40iv+, $ "+2' 2+',a !+a 2i$ 4!!a"a.

• S3a!a! ' i$,0!&7$0a' 'i73i+5 6& $+ , &0i'i)#5 "' ,&4i+.




• D3+,i0a! ' i$,0!&7$0a' 'i73i+ 6& $+ , &0i'i)# $ &$a 2&"i$!a4+$ ",i$*40a$0.

• D3+,i0a! ' i$,0!&7$0a' ,&4i+ $ &$a 2&"i$!a 4+$ a2#$ $)i7/>

0i4+ + 4'+!+ "i'&i"+.• C3i''a! - $&a%a! i$,0!&7$0a' ,0!i40+ &,+ " %&a$0, - '$0,. • E$0!%a! ' i$,0!&7$0a' -a 'i73i+ a 'a 4i!4&'a$0 <0!$a.• A' a2a$"+$a! 'a ,a'a5 !0i!a!, 2a0a5 %&a$0,5 %+!!+5 4&2!2+4a, -

2+0a,5 3a!a $0+$4, 4+'+4a!, " i$7"ia0+ v,0i7$0a $&va ",>41a2' - 'i73ia.

• V!i*i4a! 6& 0+"+ ' 3!,+$a' 6& 3a!0i4i3# $ ' 3!+4"i7i$0+1a%a '+ 3!+3i+.

• N+0i*i4a! a' *i$a' "' 3!+4"i7i$0+ 3a!a 6& 3!,+$a' " i$0$"$>4ia !a'i4 'a ",4+$0a7i$a4i#$ - ' a,+ " 'a ,a'a.

Enerera circulante interna

a) urante la ciruga

• Vi%i'a! 6&5 &$a v) i$i4ia"+ ' 3!+4"i7i$0+ $+ ,a'%a + $0! 6&i> 3+5 7a0!ia' + 3!,+$a' " 'a ,a'a 6&i!!%i4a5 7a$0$i$"+ ,& 3!+3ia,%&!i"a" - 'a " 0+"+,.

• Ra'i)a! a40ivi"a", 3!+3ia, " 'a $*!7!a 4i!4&'a$0.• E*40&a! 'ava"+ 74/$i4+ - a$0i,3,ia " 'a !%i#$ 6& 1a2!/ "

+3!a!,.• S+'i4i0a! '+, i73!vi,0+, a 'a $*!7!a 4i!4&'a$0 <0!$a.• N+0i*i4a! 4+$,0a$07$0 '+, 3+!7$+!, "' ,0a"+ "' 3a4i$0 a

'a 4i!4&'a$0 <0!$a.• Ra'i)a!5 " 7a$!a 4+$&$0a 4+$ 'a $*!7!a i$,0!&7$0i,0a5 '

4+$0+ " %a,a, - 4+73!,a,.

• E*40&a!5 &$0+ 4+$ 'a $*!7!a 6&i!!%i4a5 ' i$v$0a!i+ "' i$,>0!&7$0a'.

• Vi%i'a! - 7a$0$! '+, ",41+, $+ i$*44i+,+, '+, " '+, i$*44i+>,+,5 vi0a$"+ "i,3!,i#$ " 0<0i', &,a"+,.

• U$a v) *i$a'i)a"a 'a 4i!&%a5 *ia! ' a3#,i0+ " 'a 1!i"a 6&i!!%i4a- "!$a,.

• C+'+4a! 2a0a - !+3a 'i73ia a' 3a4i$0.• E$0!%a! 3a4i$0 a 'a $*!7!a 4i!4&'a$0 <0!$a.

• Ra'i)a! ",4+$0a7i$a4i#$ "' i$,0!&7$0a' "$0!+ " 'a ,a'a 6&i>!!%i4a $ 4++!"i$a4i#$ 4+$ 'a $*!7!a 6&i!!%i4a.

• Vi%i'a! 6& ' 6&i3+ 6&i!!%i4+ "3+,i0 'a !+3a - '+, ",41+, $'+, 4+$0$"+!, 4+!!,3+$"i$0,.




• S+'i4i0a! 772!0, a 'a $*!7!a 4i!4&'a$0 <0!$a 3a!a !+0&'a!'a, 2+',a, " ",41+ - 4+$0$i"+.

• Da! 'a ,a'a $ 4+$"i4i+$, 3a!a 6& , !a'i4 'a ",4+$0a7i$a4i#$- a,+ <1a&,0iv+.

• A' a2a$"+$a! 'a ,a'a "2 ",3+a!, " 2a0a5 %&a$0,5 %+!!+5 4&2!> 2+4a - 2+0a,5 3a!a $0+$4, 4+'+4a!, " i$7"ia0+ 0+"a 'a v,0i>7$0a ",41a2' - 'i73ia.

Nota: La $*!7!a 4i!4&'a$0 i$0!$a5 a' i%&a' 6& 'a $*!7!a 6&i!!>%i4a5 "2 3!7a$4! "&!a$0 0+"+ ' 3!+4"i7i$0+ "$0!+ " 'a ,a'a

6&i!!%i4a.Enerera circulante eterna

• P!+v! " 7a0!ia' - 6&i3+ "&!a$0 'a 4i!&%a.• E'a2+!a! 1+a " $*!7!a - " 4+$,&7+.• R4i2i! 'a 3i)a 3a0+'#%i4a5 4+'+4a!'a $ "+2' 2+',a - 'a2+!a! 'a

0i6&0a.• Di,3+$! 2a0a,5 %+!!+,5 2+0a, - 4&2!2+4a, ",41a2', a 'a ,a'i"a

"' 3!,+$a' " 'a ,a'a 6&i!!%i4a.• E'a2+!a! 772!0, 3a!a 2+',a, " !+3a - 2a,&!a5 4+$ a3%+ a 'a$+!7a ,0a2'4i"a 4+!!,3+$"i$0.

• T!a,'a"a! a' 3a4i$0 a' 3+,+3!a0+!i+ i$7"ia0+5 4+$ a4a0+ a 'a,7"i"a, " ai,'a7i$0+.

• R4i2i! " 7a$+, " 'a $*!7!a i$,0!&7$0i,0a ' i$,0!&7$0a' 3a!a &$ ,%&$"+ 3!+4,+ " ",i$*44i#$.

• C+$*i!7a! 6& , !a'i4 'a ",4+$0a7i$a4i#$ - ' a,+ <1a&,0iv+

" 'a ,a'a 6&i!!%i4a.Nota: La $*!7!a 4i!4&'a$0 <0!$a "2 3!7a$4! "&!a$0 0+"+

' 3!+4"i7i$0+ *&!a " 'a ,a'a 6&i!!%i4a5 3!+ &$0+ a 'a 3&!0a "$0!a"a " 'a 7i,7a.

+e"o*ena"ione! #enerale!• U$a v) i$i4ia"+ ' 3!+4"i7i$0+ 6&i!!%i4+5 6&"a 3!+1i2i"+ $>

0!a! + ,a'i! " 'a ,a'a 6&i!!%i4a 3a!a ''+5 'a, 3&!0a, "2$ 3!7a>$4! 4!!a"a, "&!a$0 0+"a 'a +3!a4i#$.

• Si $+ , 4&$0a 4+$ 4+$0$"+!, ",41a2',5 ' 4+$0$i"+ " '+,*!a,4+, " ,&44i#$ "2 "i,3+$!, $ ,i,07a, " ",a%_5 3!via",a40iva4i#$.




• N+0i*i4a! +3+!0&$a7$0 ' 3!+4"i7i$0+ a' C+7i0( " i$*44i+$,$+,+4+7ia',.

• E' 3!,+$a' " i$0$"$4ia "2 !0i!a! $ *+!7a +3+!0&$a ' ",>

41+ 2i+'#%i4+ i$*44i+,+.• E' &,+ " 2+',a, 3a!a ",41+ "2 ,%&i! '+ ,0a2'4i"+ 3+! 'a

NOM>:@>ECOL>SSA>9::9.• D2$ <0!7a!, '+, 4&i"a"+, $ ' 7a$+ " 7a0!ia' 3&$)+4+!>

0a$0 &0i'i)a"+ $ 'a, 4i!&%a,.• E' <3"i$0 $+ "2 i$0!+"&4i!, $ 'a ,a'a 6&i!!%i4a5 3&, !3!>

,$0a &$a *&$0 " 4+$0a7i$a4i#$.• La ,a'a , 4'a&,&!a"a "&!a$0 4i!0+ 0i73+5 '+ 4&a' "3$" "' 0i3+

" ,+'&4i#$ &0i'i)a"a 4+7+ a$0i,(30i4+.• E' 3!,+$a' 6& 1a 3a!0i4i3a"+ $ &$a 4i!&%a 4+$0a7i$a"a "25

i$va!ia2'7$05 0+7a! &$ 2a+ " !%a"!a a$0, " ,a'i! " 'a &$i>"a" 6&i!!%i4a.

C&a'6&i! 7i72!+ "' 6&i3+ 6& 0$%a 4+$0a40+ "i!40+ 4+$ 'a,a$%! "' 3a4i$0 $ 7&4+,a,5 3i' 4+$ 1!i"a,5 04. "2 !a'i)a! "i$7"ia0+ '+ ,i%&i$0

• S&,3$"! 'a a40ivi"a".• E<3!i7i! 'a 1!i"a 3a!a 6& ,a$%!.• Lava!, 4+$ a%&a - a2#$.• A4&"i! 4+$ &$ 7("i4+ "' "3a!0a7$0+ " 3i"7i+'+%a.

E, i73+!0a$0 6& 0+"+ i$"ivi"&+ 6& , ""i6& a' 4&i"a"+ " 'a,a'&"5 3!+ ,+2! 0+"+ ' 6&i3+ 6&i!!%i4+5 , a3'i6& 'a va4&$a 4+$0!a 'a13a0i0i, - 'a va4&$a a$0i00/$i4a.

Tie*po !<pti"oE,0a 3!/40i4a 4+$,0a$0 - !&0i$a!ia , ''va a 4a2+ 4+$ *!4&$4ia $ 0+"a,'a, &$i"a", 6& 4&$0a$ 4+$ &$ 6&i!#*a$+5 - a40&a'7$0 , 1a "i*&$"i"+$ $&7!+,a, i$,0i0&4i+$, 32'i4a, - 3!iva"a, ""i4a"a, a' 4&i"a"+ " 'a,a'&" $ M(<i4+. La, !*!$4ia, 2i2'i+%!/*i4a, a' !,340+ ,+$ ,4a,a,,i$ 72a!%+5 <i,0 ' 3'a$ " ,0&"i+, "' 4&!,+ 3+,0(4$i4+ " $*!7!a

6&i!!%i4a "' H+,3i0a' G$!a' " M(<i4+5 $ ' 4&a' , a,i%$a$ ;: 1+!a, 3a!a !vi,a! ,0 07a. E, 2/,i4a7$0 " ,0a 7a$!a 4+7+ , 1a"i*&$"i"+ 'a 70+"+'+%a 6& 1a2!/ " 73'a!, $ 4a,+, " 4i!&%a,(30i4a.



$apítulo N : *rocedimientos especiales en la sala 4uir,r-ica 121

E$ &$ i$*+!7 0i0&'a"+ Ma$+ - *&$"a7$0a4i#$ 4i$0*i4a "'0i73+ ,(30i4+ 3+! ' 3!,+$a' " $*!7!a $ '+, 6&i!#*a$+, 4$0!a',"' H+,3i0a' G$!a' " M(<i4+ O.D.5 'a2+!a"+ $ 9::5 , !*i! 6& '

3!,+$a' " $*!7!a 6& 'a2+!a $ "i41a /!a '+ 4+$+4 - a3'i4a ,&,4+$+4i7i$0+, a' !,340+5 6& "!iva$ $ ' 2i$,0a! "' 3a4i$0.

E' 7a$+ "' 0i73+ ,(30i4+ , &$a 0(4$i4a 6& !a'i)a 'a $*!>7!a " 6&i!#*a$+ 4+$ 2a, $ 4+$+4i7i$0+,5 1a2i'i"a" - ",0!)a. La!a'i)a4i#$ " ,0a 0(4$i4a 3!+3+!4i+$a 7a-+! ,%&!i"a" $ 'a 3!/40i4a a'6&i3+ " ,a'&" - 4+$0!i2&- a "i,7i$&i! ' !i,%+ " i$*44i+$, a,i>7i,7+5 !"&4 ' 0i73+ " ,0a$4ia "' 3a4i$05 '+ 6& !"&$"a $7$+! 4+,0+ 3a!a ' $*!7+ - 'a i$,0i0&4i#$. D2i"+ a 0+"+ '+ a$0!i+!5 ," ,&7a i73+!0a$4ia a3'i4a! 'a, $+!7a, " 'a 0(4$i4a a,(30i4a $ 0+"+7+7$0+.

Con"eptoP!+4"i7i$0+ 6& , ''va a 4a2+ "&!a$0 'a i$0!v$4i#$ 6&i!!%i4a5

4&a$"+ &$ #!%a$+ + 0i"+ ,0/ i$*40a"+ + ,(30i4+5 4&a$"+ 4+$0i$ Q+> !a 2a40!ia$a $+!7a' - ' 4&a' a' i$4i"i!'+ 3&" 4+$0a7i$a! '+, 0i"+,4i!4&$"a$0,.

O(etivo!• Evi0a! 'a "i,7i$a4i#$ " 3!+4,+, i$*44i+,+, a 0i"+, & #!%a$+,

$+ 4+$0a7i$a"+,.• Evi0a! 'a, 4+$0a7i$a4i+$, 0!a$,+3!a0+!ia,.• Di,7i$&i! ' !i,%+ " 7+!2i'i"a" "' 3a4i$0.

• Evi0a! 'a "i,7i$a4i#$ " 4('&'a, 4a$4!%$a, a 0i"+, ,a$+,.

ro"ei*iento! -uirr#i"o! ini"ao!para el *ane(o el tie*po !<pti"oE,0+, 3!+4"i7i$0+, "2$ a3'i4a!, " 7a$!a %$!a' $ 0+"a 4i!&%a

6& 3!,$0 3+,i2i'i"a" " 4+$0a7i$a4i#$5 -a ,a 3+! i$*44i#$ + 3+!

Q+!a 2a40!ia$a $+!7a'.• R,44i#$ i$0,0i$a'.• D,2!i"a4i#$ " a2,4,+.• T+7a " 2i+3,ia, " %a$%'i+, 'i$*/0i4+,.




• R,44i#$ " 0&7+!, 4a$4!%$+,.• Hi,0!40+7a a2"+7i$a'.• A3$"i440+7a.

• R,44i#$ a2"+7i$+3!i$a'.• C+'4i,040+7a 4+$ !vi,i#$ " va, 2i'ia!,.• Ga,0!40+7a,.

T<"ni"a e e(e"u"inA 4+$0i$&a4i#$ , "'i$a $ ;; 3a,+, 'a a"4&a"a 0(4$i4a $ ,0 3!+>

4"i7i$0+.;. La $*!7!a 6&i!!%i4a , 4a')a "+2' %&a$0 a' i$i4i+ " 'a 4i!&%a.9. E, $4,a!i+ 4+'+4a! 4a73+ a"i4i+$a' 3a!a 3!+044i#$ $ 'a 3a!0

i$*!i+! " 'a ,/2a$a *$,0!a"a !%i#$ 3+"/'i4a "' 3a4i$0.. La $*!7!a ,'44i+$a '+, i$,0!&7$0+, a"4&a"+, ,%$ ' 7+>

7$0+ " 'a 4i!&%a - '+, 4+'+4a ,+2! 'a 7,a " Ma-+. E' i$,0!&>7$0a' a1 4+'+4a"+ , 3&" ,! 7a$a"+ "i!40a7$0 3+! 'a$*!7!a i$,0!&7$0i,0a 4+$ a72a, 7a$+,.

. C+'+4a! 3i$)a " F+!,0! a$i''+, $ 'a *&$"a " Ma-+5 "i!i%i$"+'+, a$i''+, 1a4ia 'a 7,a !40a$%&'a! + " !i#$5 'a 4&a' 6&"a!/ a'ai!. E,a 3i$)a 3!7i0 0+7a! ' i$,0!&7$0a'5 7a0!ia' + ,&0&!a " 'a7,a !40a$%&'a! + " !i#$. E,0a 7,a "2 7a$i3&'a!, '+ 7$+, 3+,i2' - ,i73! 3+! 7"i+ " 'a 3i$)a " a$i''+, 3a!a vi> 0a!4+$0a7i$a! ' i$,0!&7$0a' " 'a 7,a !40a$%&'a!. N+ "2$ 0+4a!,'a, 3&$0a, " 'a 3i$)a 4+$ '+, %&a$0, + 4+$ ' i$,0!&7$0a' 4+$ '6& , 0!a2aa $ 'a 7,a " Ma-+. Si ,0+ +4&!!i,5 "2 4a72ia!,

'a 3i$)a.?. E' 4+$0+ " %a,a, - 4+73!,a, 6& , $4&$0!a$ $ 'a 7,a !4>

0a$%&'a! + " !i#$ , "2 1a4! 4+$ a-&"a " 'a 3i$)a " a$i''+,.. E' #!%a$+ + 3i)a 6&i!!%i4a 6& , 4+$,i"!a 4+$0a7i$a"a "2

,a'i! "' 4i!4&i0+ 6&i!!%i4+ $ 4&a$0+ , !0i! " 'a 4avi"a"5 - ,!$0!%a"a a 'a $*!7!a 4i!4&'a$0.

@. A' 0(!7i$+ "' 0i73+ ,(30i4+ , 3!+4" a 3!+0%! 'a i$4i,i#$ 6&i>!!%i4a 4+$ &$a 4+73!,a 'i73ia. E' i$,0!&7$0a' 6& 1a 6&"a"+4+$0a7i$a"+ i$4'&-$"+ 'a 3i$)a " a$i''+, , 4+'+4a - $v&'v$ ' 4a73+ " 'a 7,a " Ma-+ - (,05 a ,& v)5 , $v&'v $ '4a73+ 6& 3!via7$0 , "i,3&,+ $ 'a !%i#$ 3+"/'i4a - , $>0!%a a 'a $*!7!a 4i!4&'a$05 3!vi+ 4+$0+ " %a,a, - 4+73!,a,.



$apítulo N : *rocedimientos especiales en la sala 4uir,r-ica 123

. U$a v) 6& ' i$,0!&7$0a' ,a' "' 4i!4&i0+5 'a $*!7!a 4i!4&>'a$0 "2 !a'i)a! &$ 4+$0+ 3a!a v!i*i4a! 6& $+ 6&" $a"a "'7i,7+ $ 4avi"a".

. La $*!7!a i$,0!&7$0i,0a , !0i!a '+, %&a$0, 4+$0a7i$a"+,54+$,!va$"+ ' ,%&$"+ 3a!.

;:. La $*!7!a i$,0!&7$0i,0a 4a72ia %&a$0, a' 4i!&a$+ - a '+, a-&>"a$0, &0i'i)a$"+ 'a 0(4$i4a 4!!a"a.

;;. La $*!7!a 4+'+4a 4a73+ 'i73i+ ,+2! 'a 7,a " Ma-+ 3a!a i$,>0a'a! $&va7$0 ' i$,0!&7$0a' - a"i0a7$0+, -5 $ 4a,+ $4,a>!i+5 '40!+4a&0!i+5 a,3i!a"+!5 04(0!a5 3a!a ' 4i!! " 'a a3+$&>!+,i,5 0i"+ 4'&'a! ,&24&0/$+ - 3i'. Si , 0+7a 'a "4i,i#$ " $+

4!!a! 3+! 3'a$+, - "a! 2+',a " B+%+0/5 $ , 7+7$0+ 0a72i($0!7i$a ' 0i73+ ,(30i4+.

Nota iportante: E' 0i73+ ,(30i4+ i$i4ia 4&a$"+ , i$4i" ' #!%a$+

6& , 4+$,i"!a 4+$0a7i$a"+ - 0!7i$a 4&a$"+ , "a ' '0i7+ 3&$0+ $' 3!i0+$+.

re"au"ione!• La $*!7!a "2 !vi,a! ' 3!+%!a7a " 4i!&%a.

• La 4i!&%a , i73!"4i2'5 ,+2! 0+"+ 'a " &!%$4ia5 3+! '+ 6&"2 va'+!a!, ' "ia%$#,0i4+ 3!+3!a0+!i+ 3a!a 3!v$i! 0+"+ '+$4,a!i+ - vi0a! 0i73+, 3!"i"+,.

• A' 0(!7i$+ " 'a 4i!&%a5 ' i$,0!&7$0a' "2 ,! ,+70i"+ a 'ava"+7a$&a'5 ,i , 3+,i2' 4+$ &$a ,+'&4i#$ " 1i3+4'+!i0+.

E$ a+, !4i$0, 'a $*!7!a 1a v+'&4i+$a"+ - 4+$0i$&a"+a"+30a$"+ 7"i"a, 6& 4+$"&4$ a' 7/<i7+ !$"i7i$0+ - *i4a4ia5 "0a' *+!7a 6& ,0+ ' 3!7i0 4&2!i! 4a"a v) " 7+! 7a$!a 'a,$4,i"a", " ,a'&" " 'a 3+2'a4i#$. S& 0!a2a+ "2 ,0a! +!i$0a"+ a",a!!+''a! a40ivi"a", $4a7i$a"a, a' *+7$0+ " 'a 3!v$4i#$ " 'a,i$*44i+$, $ ' 1+,3i0a'. P+! ''+ , $4,a!i+ 1a4! 1i$4a3i( $ '+i73+!0a$0 " ",4!i2i! ,0+, 3!+4"i7i$0+,5 6& ,i 2i$ , 4i!0+ 0+>"ava $+ 4&$0a$ 4+$ &$ ,&,0$0+ '+ 2a,0a$0 a73'i+5 , ,+$ 4+$+4i"+, -

3!a40i4a"+, 4+$ *!4&$4ia 3+! 'a 4+7&$i"a" " $*!7!a $ &$a %!a$ 3a!0 " M(<i4+.




:ilio#ra)ía

M4a$+%!a7a. H+,3i0a' G$!a' " M(<i4+. ;.B!av+ P B 0 a'. Ma$+ - *&$"a7$0a4i#$ 4i$0*i4a "' 0i73+ ,(30i4+

3+! ' 3!,+$a' " $*!7!a $ '+, 6&i!#*a$+, 4$0!a',. H+,3i0a'G$!a' " M(<i4+ O.D. 9::.

H+%,0+$ R 0 a'. )undamentos de la pr-ctica de enfermer%a$ T!4!a "i>4i#$. M4G!a>Hi'' I$0!a7!i4a$a E"i0+!,. 3. ??. 9::.

$a

pítulo 10Tie*po! -uirr#i"o!)una*entale!

n!tru*entalE' "i,+ "' i$,0!&7$0a' 6&i!!%i4+ +2"4 a '+, !6&!i7i$0+, " 'a,"iv!,a, 7a$i+2!a, "&!a$0 'a +3!a4i#$5 " a1 'a "i*!$4ia 6& ,+2,!va $ '+ !*!$0 a *+!7a5 3,+ - 0a7a+. A,5 "i41+, i$,0!&7$0+,

,34ia'i)a"+, va!a$ ,%$ ' ,i0i+ a' 6& , ",a a44"!5 -a 6& "24+$,i"!a!, 6& 'a *&!)a 6& , 3!4i,a 3a!a 0!a2aa! $ 1&,+ $+ , 'a7i,7a 3a!a 1a4!'+ $ 7,4&'+, +5 3+! +0!a 3a!05 ,+$ 1!!a7i$0a, 6&"2$ *a4i'i0a! - 1a4! 3+,i2' 0!a2aa! 4+$ 'a "'i4a")a - <a40i0&"i73!,4i$"i2', a' !a'i)a! 7a$i+2!a, $ 36&+, va,+, - $!vi+,.

La *a2!i4a4i#$ "' i$,0!&7$0a' 0a72i($ va!a " a4&!"+ 4+$ 'a 4a,a6& '+ 3!+"&4. La a'a4i#$ ,0/ $ *&$4i#$ " 'a "&!a2i'i"a"5 'a4a3a4i"a" *&$4i+$a' - ' 3!+3#,i0+ "' i$,0!&7$0a'. La 7a-+!a " ,0a,

1!!a7i$0a, ,0/$ 141a, " a4!+ i$+<i"a2'5 6& , &$a a'a> 4i#$ "



1i!!+5 4!+7+ - 4a!2+$+. Si$ 72a!%+5 3&"$ 4+$0$! +0!+, '7$0+,4+7+ $6&'5 7a$%a$,+5 ,i'i4i+5 7+'i2"$+ - a)&*!5 6& a-&"a$ avi0a! 'a 4+!!+,i#$ 3!+v+4a"a 3+! ' 4+$,0a$0 4+$0a40+ 4+$ ,+> '&4i+$,5,a$%!5 '6&i"+, - Q&i"+, 4+!3+!a',5 a, 4+7+ '+, 7(0+"+, ",0!i'i)a4i#$ a 6& ,+$ ,+70i"+,5 - 7+!a$ 'a !,i,0$4ia a 'a 0$,i#$.

S&, 4a!a40!,0i4a, "2$ ,0a! a3%a"a, a 'a N+!7a O*i4ia' M<i4a$a NOM>:>SSA;>;5 6& ,0a2'4 'a, ,34i*i4a4i+$, ,a$i0a!ia, "'+, i$,0!&7$0+, 6&i!!%i4+, - 7a0!ia', 70/'i4+, " a4!+ i$+<i"a2'54&-+ +20iv+ 3!i$4i3a' , !"&4i! a' 7$i7+ ' !i,%+ " &0i'i)a! '7$>0+, i$a3!+3ia"+, $ 'a *a2!i4a4i#$ "' i$,0!&7$0a'5 a"7/, ,34i*i4a0a72i($ 'a, a'a4i+$, - ' 3+!4$0a $ 6& "2$ ,! 'a2+!a"a,.

E$ 'a a40&a'i"a" , 3+,i2' a*i!7a! 6& @? " '+, i$,0!&7$0+, 6&i>!!%i4+, ,+$ " a4!+ i$+<i"a2'5 -a 6& 'a, 4a!a40!,0i4a, " ,0 70a'

'+ 1a4$ "&!a2' - *&$4i+$a'.

125





$apítulo ;B : 7iempos 4uir,r-icos fundamentales 127

E, i73+!0a$0 7$4i+$a! 6& ,0 i$,0!&7$0a' , &0i'i)a 0a72i($ $!'a4i#$ 4+$ ' 3'a$+ 6&i!!%i4+ $ 6& , 0!a2aa. P+! ''+5 4&a$"+ ,0!a2aa $ 3'a$+, ,&3!*i4ia', , "4i!5 a$0, " ''%a! a 4avi"a"5 ,

&0i'i)a 0+"+ ' i$,0!&7$0a' 4+!0+ -5 &$a v) 6& , 1a 0$i"+ a44,+ a 'a4avi"a"5 , 73'a 0+"+ 0i3+ " i$,0!&7$0a' 'a!%+5 6& , ' i"#$+ 3&, 3!7i0 ''%a! 4+$ 7a-+! *a4i'i"a" a 'a, ,0!&40&!a, 6& , $4&$> 0!a$ a7a-+! 3!+*&$"i"a". E, $4,a!i+ $*a0i)a! 6& 'a $*!7!a i$,>0!&7$0i,0a "2 4a72ia! ' i$,0!&7$0a' 4+!0+ 3+! ' 'a!%+ $ ' 7+>7$0+ a"4&a"+5 " a1 'a i73+!0a$4ia " 4+$+4! 'a, 4a!a40!,0i4a,%$!a', - 'a *&$4i#$ ,34*i4a $ !'a4i#$ 4+$ ' 0i73+ 6&i!!%i4+.

Tie*po! -uirr#i"o!"orte o di%re!i!. S "$+7i$a a, a 'a ,3a!a4i#$ " 0i"+, + 3'a>

$+,5 - a 'a i$4i,i#$ 70#"i4a " 3a!0, 2'a$"a,.La 3!i$4i3a' 4a!a40!,0i4a "' i$,0!&7$0a' " 4+!0 , 6& !,&'0a ,!

*i'+,+ - 4+!0a$0. E$0! ' i$,0!&7$0a' " 4+!0 *i%&!a$ ' 2i,0&!5 ''40!+2i,0&!5 '+, +,0#0+7+, 3a!a 4+!0a! 1&,+5 'a, 0i!a, - 0+"+ 0i3+ "

1!!a7i$0a 6& 0$%a *i'+ $ ,&, 1+a, + 3&$0a. La *i%&!a ;:>; i'&,0!a '+,7a$%+, " 2i,0&! - ' 4&a"!+ ;:>; 4+!!'a4i+$a ' 7a$%+ 4+$ 'a 1+a.E' 3!+4"i7i$0+ 3a!a 7+$0a! ' 2i,0&! 4+$,i,0 " 7a$!a *&$"a>

7$0a' $ 0!, 3a,+,

• T+7a! 'a 1+a " 2i,0&!5 " 3!*!$4ia 4+$ &$ 3+!0aa%&a, $&$4a4+$ 'a, 7a$+,.

i#ura 101. Man-os de bisturí.




Cuaro 101. Relación entre n,meros de man-o # hoa de bisturí.

Man-o de bisturí

0,mero D0,mero C

0,mero 0,mero I

&oa de bisturí

0,meros ?B a ?D

0,meros ;;% ;C # ;

• Fia! 'a 1+a a' 7a$%+ ",'i)a$"+ 'a 1$"i"&!a "$0!+ " 'a, 7&,4a," (,0.

• A,%&!a!5 4+$ &$a 'i%!a 0!a44i#$5 6& 'a 1+a 1a-a 6&"a"+ 3!*4>0a7$0 i$,!0a"a.

$i=era!. La, 1+a, " ,0 i$,0!&7$0+ va!a$ $ !a)#$ " ,& +2>0iv+. La, 1a- !40a,5 4&!va, + $ /$%&'+5 !+7a, + 4+$ 3&$0a5 4+$ !a7a,4+!0a, + 'a!%a,. Ta72i($ <i,0 va!i"a" 4+$ !,340+ a ,& &0i'i"a" 'a, 1a- 3a!a 4+!0a! + "i,4a! 0i"+, 0i!a, " M0)$2a&7 `*i%&!a ;:>95 " i!i,5" P+00,5 3a!a 4+!0 " 7a0!ia' 0a' 4+7+ ,&0&!a5 %a,a + a3#,i0+, 0i!a "Ma-+ !40a + 4&!va.

E' 0i3+ " 0i!a - 2i,0&! 6& 1a2!/ " &0i'i)a!, ,0a!/ "0!7i$a"+ 3+! 'a '+4a'i)a4i#$ "' 0i"+ 6& , i$4i"i!/.

recaucione!. L+, 2+!", *i'+,+, , 3!+0%$ "&!a$0 'a 'i73i)a5,0!i'i)a4i#$ - a'7a4$a7i$0+5 - 4+$ 7a-+! !a)#$ 4&a$"+ , 7a$a$

i#ura 102. 7ieras de Metzenbaum.




$ 'a, 7a,a, a&<i'ia!, "&!a$0 'a 4i!&%a5 %&a!"/$"+'+, 3+! ,3a!a"+ 4+$&$ 7a$+ 7&- 4&i"a"+,+.

/i!e""inP!+4"i7i$0+ 6& 3!7i0 "ivi"i! - ,3a!a! 70#"i4a7$0 'a, ,0!&4>0&!a, a$a0#7i4a, 4+$ *i$, 0!a3(&0i4+,. E<i,0$ va!ia, *+!7a, " "i,4>4i#$

i!ecci+n roa. E$ (,0a , &0i'i)a$ 1!!a7i$0a, ,i$ 3&$0a + *i'+

• D"+ $%&a$0a"+5 + 0a72i($ !*!i"a 4+7+ "i,44i#$ "i%i0a'.• P&41i0+ 0+!&$"a " a'%+"#$ 4+$ %a,a 7&- 36&a 7+$0a"+ $

&$a 3i$)a 4&!va K''- + R+41,0! ,0a "i,44i#$ 3!+"&4 "a+ 7>$i7+ a' ,3a!a! '+, 0i"+,.

• S 3&" &0i'i)a! 0a72i($ ' 7a$%+ " 2i,0&! i$v!0i"+ + &$a 0i!a4!!a"a.

i!ecci+n cortante. E$ ,0a "i,44i#$ , $4,a!i+ 73'a! &$ i$,>0!&7$0+ 4+!0a$0 "2i"+ a 6& 'a, ,0!&40&!a, ,0/$ !+"a"a, 3+! 0i"+!,i,0$0.

Ca2 7$4i+$a! 6& 3a!a !a'i)a! ,0 3!+4"i7i$0+ , $4,a!i+&0i'i)a! 'a, 3i$)a, " "i,44i#$5 " 7a$!a 6& 3&"a 0+7a!, ' 0i"+ +,0!&40&!a $ 6& , ,0/ 0!a2aa$"+.

In!truento! para di!ecci+n. Pi$)a, " "i,44i#$ 4+$ "i$0, - ,i$"i$0, C&,1i$%5 !&,a5 Ma!0i$5 A",+$ - " 2a-+$0a5 $0! +0!a, *i%&!a;:>.

recaucione!. La, 3i$)a, " "i,44i#$ ,i$ "i$0, , &0i'i)a$ 3a!a0i"+, - #!%a$+, "'i4a"+,5 - 'a, 3i$)a, " "i,44i#$ 4+$ "i$0, , &,a$

3a!a ,&0a! 3i' - a3+$&!+,i,.

'e*o!ta!iaMa$i+2!a 6& , ''va a 4a2+ 4+$ a-&"a " &$a 3i$)a 3a!a $&0!a'i)a! 'a17+!!a%ia - +4'&i! '+, %!a$", - 36&+, va,+,5 a *i$ " vi0a! 3(!"i"a" ,a$%!. S &0i'i)a $ %$!a' 3a!a ' 4'a73+ " '+, va,+, ,a$%&$+, +'i$*/0i4+,5 3a!a 'i%a!'+, + 4+a%&'a!'+, 3+,0!i+!7$0. Ta72i($ 0i$ 3+!+20+ 'a 3!$,i#$ - 7+vi'i)a4i#$ " 0i"+, 2'a$"+,.

La, 3a!0, " &$a 3i$)a ,+$ 7a$"2&'a + 7+!"a)a5 a!0i4&'a4i#$5 4aa" 0!a2a5 4&!3+ + 7a$%+5 4!7a''!a - a$i''+,. La, 7a$"2&'a, 3!$,a$' 0i"+5 - a' 4!!a! 6&"a$ 4a,i &$i"a, &$a 4+$ +0!a5 3!7a$> 4$,0a2', 7"ia$0 &$ $%!a$a +4&'0+ - ,+$ 4+$0!+'a"a, 3+! a$i''+,.




4uir,r-ica

A

:

i#ura 103. A% pinzas de disección1 3% pinzas Adson.

*rocedimientos para realizar hemostasiaH7+,0a,ia 073+!a' + 0!a$,i0+!ia. S& *i$a'i"a" , "0$! " 7a$!a

i$7"ia0a ' ,a$%!a"+5 - , !a'i)a 7"ia$0 4+73!,i#$ "i%i0a'5 , "4i!5 3!,i+$a$"+ ' va,+ ,a$%!a$0 "i!40a7$0 4+$ &$ ""+.

gito-digital. A44i#$ 4+$,i,0$0 $ 0+7a! ' va,+ $0! '+, ""+, -4+73!i7i! " 7a$!a "i!40a a3+-a$"+ &$a 4+73!,a + %a,a $ ' ,i0i+ ",a$%!a"+.

"opre!i+n indirecta. E$ ,0 3!+4"i7i$0+ , &0i'i)a &$a 3i$)a"i,a"a e/ profeso 3a!a ''+5 'a 4&a' 3!$,a ' va,+ ,a$%!a$0 - "0i$ 'a17+!!a%ia.

Heo!ta!ia deinitia. S !a'i)a &$a 'i%a"&!a &0i'i)a$"+ &$a ,"a'i2! + 7+$0a"a " 4a'i2! a"4&a"+ a 'a ,0!&40&!a "' 0i"+.

$ran!ii+n. S &0i'i)a &$a ,&0&!a 0!a&7/0i4a5 , "4i!5 4+$ a%&a. S&,a 3a!a 3"4&'+,5 va,+, 7&- %!a$", + 0i"+, 7&- va,4&'a!i)a"+,5 -4&a$"+ $+ , '+%!a i"$0i*i4a! ' va,+ ,a$%!a$0 3a!a ai,'a!'+ - 3i$)a!'+.



$apítulo ;B :7iempos 4uir,r-icos fundamentales 131

"era para <ue!o. E$ ,0 4a,+ , 1a4 17+,0a,ia $ 'a ,&3!*i4i"' 1&,+ ,a$%!a$0 7"ia$0 ' 73'+ " 4!a 3!+4,a"a " a2a.

Heo!ta!ia t%ricael%ctrica. E$ ,0 3!+4,+ , 73'a ' '4>0!+4a&0!i+5 6& 3!+"&4 ,&*i4i$0 4a'+! 3a!a 4+!0a! - 4+a%&'a! " 7a>$!a ,i7&'0/$a.

/nstrumentos para hemostasiaLa '+$%i0&" - ,0!&40&!a " 'a 3i$)a "2 ,0a! $ !'a4i#$ 4+$ ' ,i0i+ $6& , 0!a2aa ,i$ 72a!%+5 a'%&$a, 3i$)a, ,0/$ "i,a"a, 3a!a &0i'i)a!>

, $ ,i0i+, 7&- 4+$4!0+,5 4+7+ , ' 4a,+ " 'a, 3i$)a, i$0,0i$a', "P(a$ + 'a, 3i$)a, va,4&'a!, a0!a&7/0i4a,.E<i,0$ "iv!,a, 3i$)a, 17+,0/0i4a,5 4&-a, !a7a, 3&"$ ,! !4>

0a,5 4&!va, + $ /$%&'+5 - 'a, ,0!a, 1+!i)+$0a',5 "ia%+$a', + '+$%i0&>"i$a',5 4+$ 3&$0a !"+$"a"a + 4+$ &$ "i$0. La '+$%i0&" " 'a, !a7a, -" '+, 7a$%+, va!a.

La, 3i$)a, 4+$ 3&$0a *i$a , &0i'i)a$ 3a!a va,+, - ,0!&40&!a, "'i>4a"a, - 36&a,. La, !a7a, 'a!%a, - *&!0, , 73'a$ $ ,0!&40&!a,

"$,a,5 %!a$", - " 0i"+ %!&,+ '+, 7a$%+, 'a!%+, , &0i'i)a$ $ ,>0!&40&!a, - 4avi"a", 3!+*&$"a, 3. .5 K''-5 K+41!5 F+!,0!5 Ha',0" -Sa0i$,-5 $0! +0!a, *i%&!a ;:>.

A

:

i#ura 104. A% pinzas ell#1 3% pinzas &alsted o mos4uito.






"4i!5 &$a v) 4+'+4a"+ ' ,3a!a"+!5 , "a a1 " 7a$!a 3!7a$$05!0i!/$"+, &$a v) 4+$4'&i"a 'a i$0!v$4i#$.

E$0! ,0+, ,3a!a"+!, , $4&$0!a$ ' " =i0'a$!5 " B47a$5

" G+,,0 OZS&''iva$5 OZC+$$+! - " Fi$+41i0+ *i%&!a ;:>.Pa!a !0!a! + ,+,0$! ,0!&40&!a, a$a0#7i4a, + 0i"+ 4i!4&$"a$0

6& , $4&$0! $ ' ,i0i+ 6&i!!%i4+ , $4,a!i+ 1a4!'+ 4+$ a-&"a "a'%&$a, 3i$)a, 6& 0i$$ &,0a7$0 ,0a *&$4i#$ - 6& , &0i'i)a$ $*+!7a ,i7&'0/$a 4+$ ' i$,0!&7$0a' " ,3a!a4i#$. Ta' , ' 4a,+ " 'a, 3i$)a, " a$i''+,5 Ba24+4 - D&va'5 $0! +0!a, *i%&!a ;:>@. A'%&$a, ",0a, 3i$)a, ,+$ &0i'i)a"a, 3a!a ,0!&40&!a, "'i4a"a,5 4+7+ $ ' 4a,+ "'1%a"+5 -a 6& 'a 7a$"2&'a " ,0a 3i$)a $+ 4a&,a "a+ a' 0i"+.

A

:

i#ura 106. A% separador 2inochieto1 3% separador $rotto.




A

:

i#ura 107. A% pinza de anillos1 3% pinza de 3abcocQ.

>utura ?!ínte!i!@E,0 3!+4"i7i$0+ 4+$,i,0 $ a3!+<i7a! '+, 0i"+, ,44i+$a"+, 4+$ &$a*ia4i#$ #30i7a 1a,0a 6& , 4+73'0 ' 3!+4,+ " 4i4a0!i)a4i#$. Di41a,7a$i+2!a, 0i$$ 3+! *i$a'i"a" &$i! " $&v+ '+, 0i"+, - !,0a> 2'4! '&,+ " 4+$0i$&i"a"5 3a!a '+ 4&a' , 73'a$ 3+!0aa%&a,5 a%&a, - ,&0&!a,54&-a, 4a!a40!,0i4a, *&!+$ !*!i"a, $ ' 4a30&'+ .

n!tru*ental para !uturaortaagu=a!. C+7+ i$"i4a ,& $+72!5 ,0 +20+ , &0i'i)a 3a!a

,+,0$! 'a, a%&a, 6&i!!%i4a, 4&!va,5 - , 7&- ,i7i'a! a 'a, 3i$)a, "17+,0a,ia ,& "i*!$4ia !a"i4a 2/,i4a7$0 $ 6& 'a, !a7a, ,+$ 4+!> 0a,- *i!7,5 3+! '+ 6& $+ ,0!+3a$ ' 7a0!ia' " ,&0&!a. S& 0a7a+ ,0/ $!'a4i#$ 4+$ ' " 'a a%&a. S&, !a7a, ,+$ !40a,5 3!+ '+, 1a- 4&!> v+, + $/$%&'+ ,&, 7a$%+, 3&"$ ,! 'a!%+, 3a!a *a4i'i0a! 'a i$,!4i#$ " 'aa%&a $ ,i0i+, 3!+*&$"+,.

L+, 3+!0aa%&a, *i%&!a ;:> , "i*!$4ia$ 3+! ' 0i3+ " ,0!a +7+!"a)a " ,&, !a7a,. A,5 1a- 3+!0aa%&a, " ,0!a 4&a"!i4&'a"a + 'i,a,%$ 'a ,34ia'i"a" " 6& , 0!a05 - "," '+, 7&- *i$+, 4+7+ '+,



$apítulo ;B :7iempos 4uir,r-icos fundamentales 135

i#ura 108. *ortaa-uas.

6& , &0i'i)a$ $ 4i!&%a +*0/'7i4a - 7i4!+4i!&%a 1a,0a '+, 6& , 7> 3'a$ 3a!a ,&0&!a! 4+$ a'a72! 4+7+ $ ' 4a,+ " 'a 4i!&%a " 0#!a<.

rapadora! o engrapadora!. E<i,0$ "+, 0i3+, " ,0+, a!0*a40+,'a, !&0i'i)a2', - 'a, ",41a2',.

E$ ' 4a,+ " 'a, !&0i'i)a2',5 ,& 3!i$4i3a' ",v$0aa , 6& "2$",a!7a!, 3a!a ,& 'i73i)a - ,0!i'i)a4i#$5 - v&'v$ a a!7a!, "$0!+"' 4a73+ 6&i!!%i4+ a$0, " &0i'i)a!'a, $ 'a 4i!&%a. Mi$0!a, 6& 'av$0aa 7/, ,i%$i*i4a0iva " 'a, ",41a2', , 6&5 4+7+ $+ , $4,a>

!i+ a!7a!'a, $i ",a!7a!'a,5 ,0/$ 'i,0a, 3a!a ,! &0i'i)a"a, $ 4&a'6&i!7+7$0+.

La, %!a3a, ,0/$ 'a2+!a"a, " a4!+ i$+<i"a2'5 0i0a$i+ + 7a0!ia'!a2,+!2i2'5 - , 7+$0a$ $ 'a $%!a3a"+!a 3a!a !a'i)a! 'a ,&0&!a.

E$ 'a a40&a'i"a" <i,0$ 7(0+"+, $+ i$va,iv+, " ,&0&!a, a 2a, " 3%a7$0+, 0a', 4+7+ ' O40i'>4ia$+a4!i'a0+5 '+, 7+$#7!+, 4ia>$+a4!'i4+,5 04. Si$ 72a!%+5 3+! ,&, 4a!a40!,0i4a, ' 7a0!ia' , 0+!$a6&2!a"i)+ 4&a$"+ , &,a ,+2! )+$a, 4+$ 3'i%&, + a!!&%a,5 '+ 6&

'i7i0a ,& &,+ 4+7+ a"1,iv+ 0i,&'a!.

Otro! in!tru*ento!

/ilata"in !oneoE,0 0i3+ " i$,0!&7$0+, ,+$ 73'a"+, 4&a$"+ , !6&i! 3$0!a!

&$a '&) $a0&!a' 4+'("+4+5 &!0!a5 ,#*a%+5 04. + $ ' 4a,+ " &$a * ,0&>'a "!iva"a " a'%$ 0i3+ " 3a0+'+%a5 $ 4&-+ 4a,+ '+, "i'a0a"+!, ,+$73'a"+, 3a!a a&7$0a! 'a '&).

N+ "2 +'vi"a!, 6& 0a72i($ <i,0 i$,0!&7$0a' ,34*i4+ 3a!a4a"a ,34ia'i"a". A,5 $&7!+,+, i$,0!&7$0+, ,+$ &0i'i)a"+, 4+7+a"i0a7$0+, 3a!a 1a4! 6& +0!+ i$,0!&7$0+ *&$4i+$ " 'a 7a$!a




4uir,r-ica

a"4&a"a5 4+7+ $ ' 4a,+ "' 7a!0i''+ 4&a$"+ "2 4+!0a!, 1&,+5 3a!a'+ 4&a' "2$ &0i'i)a!, $ *+!7a ,i7&'0/$a.

Da"a 'a i73+!0a$4ia - !,3+$,a2i'i"a" 6& ' 3!,+$a' " $*!>7!a 0i$ 4+7+ 3a!0 "' 6&i3+ 6&i!!%i4+ $ ' 7a$+ "' i$,0!&>7$0a'5 , 3!i7+!"ia' ,&2!a-a! 6& 'a i$v!,i#$ 6& 'a, i$,0i0&4i+$, ",a'&" 1a4$ $ ' i$,0!&7$0a' 6&i!!%i4+ !3!,$0a &$ a'0+ 4+,0+. P+! '+a$0!i+!5 , 3!4i,+ 1a4! &$ &,+ 4+!!40+ - a"4&a"+ " "i41+ i$,0!&>7$0a'5 !,30a! 'a, i$"i4a4i+$, "' *a2!i4a$0 3a!a ,& 'i73i)a - vi0a!,& 7a$+ 2!&,4+5 -a 6& ,0+ 3+"!a %$!a! %a,0+, "2i"+, a ,& !3a>!a4i#$ + !3+,i4i#$. A"7/,5 7a$0$! ' i$,0!&7$0a' $ 4+$"i4i+$,#30i7a, !3!,$0a ,%&!i"a" 0a$0+ 3a!a ' 3!,+$a' " ,a'&" 4+7+ 3a!a ' 3a4i$05 6& ,i%$i*i4a 'a !a)#$ " ,! - " ,0a! " 'a $*!7!a.

E, 3!4i,+ 4+7$0a! 6& 0+"+ ' i$,0!&7$0a' "2 %&a!"a! &$ +!> "$$ 'a 41a!+'a $ 'a 4&a' , 3!3a!a - " a4&!"+ 4+$ 'a i$0!v$4i#$6&i!!%i4a 6& 1a2!/ " !a'i)a!,5 -a 6& ,0+ *a4i'i0a 'a, *&$4i+$, " 'a$*!7!a i$,0!&7$0i,0a "&!a$0 ' 0!a$,+3!a0+!i+ a' 7a$a! 'a, 7,a,a&<i'ia!, " !i#$ + !40a$%&'a! - 7,a " Ma-+. N+ "2 +'vi> "a!,6& 4+$ *!4&$4ia , !6&i!$ i$,0!&7$0+, 7&- ,34*i4+, 6& 3&"$$+ 1a''a!, $ 'a, 41a!+'a, 3!via7$0 3!3a!a"a,5 - '+, 4&a', ,"i,3+$$ $ 2&'0+, i$"3$"i$0,.

P+! '0i7+5 4a2 !*!i! 6& 4&a$"+ , 3!3a!a ' i$,0!&7$0a' 3a!a,! ,0!i'i)a"+5 'a, 4!7a''!a, " 4a"a 3i$)a "2$ 6&"a! ,3a!a"a, "0a' *+!7a 6& ' va3+! 3$0! $ *+!7a a"4&a"a $ 4a"a 3a!0 " 'a, 3i$)a,. A,i7i,7+5 , " ,&7a i73+!0a$4ia 4+$0a! ' i$,0!&7$0a' 6& ,&0i'i)a!/ $ 'a 4i!&%a 4+$ +20+ " a,%&!a! 6& a' *i$a' " (,0aa2,+'&0a7$0 $i$%$ i$,0!&7$0+ 6&" $ 'a 4avi"a". É,a, - +0!a, ,> 34i*i4a4i+$, , v!/$ $ 4a30&'+, 3+,0!i+!,.

:ilio#ra)ía

B!!- - K+1$. T0cnicas de &uirófano" ;:W "i4i#$5 E"i0+!ia' E',vi!5 Ma>"!i"5 E,3aa5 33. ;::95 9::?.

H!$/$") A G. T0cnicas &uir'r(icas en enfermer%a. E"i0+!, " T<0+,M<i4a$+,5 M(<i4+5 3. :?5 9::.

H&!0a T F. Manual de instrumentación &uir'r(ica5 M4G!a>Hi'' I$>0!a7!i4a$a5 M(<i4+5 3. 5 ;.

N+!7a O*i4ia' M<i4a$a NOM>:>SSA;>;.



$

a

pí

t

u

l

o

11

Colo"a"in *ane(oe *e!a! auxiliare!

D,73a! 0+"a, 'a, *&$4i+$, i$1!$0, a' /!a 6&i!!%i4a5 +30i7i>)a$"+ 'a a0$4i#$ a' $*!7+ - 7a<i7i)a$"+ ' 7a$+ " '+, i$,&7+, -6&i3+,5 !6&i! "' 0!a2a+ 4++!"i$a"+ $0! '+, "i,0i$0+, 7i72!+, "'

6&i3+ a *i$ " $+ "&3'i4a! 'a, 0a!a,5 3!+ ,+2! 0+"+ 3a!a ,0a2'4! &$ 3'a$ 7"ia$0 ' 4&a' ' 3a4i$0 !4i2a &$a a0$4i#$ 4+$0i$&a - ,i$"iv!%$4ia,.

D2i"+ a '+ a$0!i+!5 , $4,a!i+ ,a'a! 6& $ &$a ,a'a 6&i!!%i4a, !6&i! " 4&a$"+ 7$+, "+, $*!7!a,5 , "4i!5 &$a 6&i!!%i> 4ai$,0!&7$0i,0a - &$a 4i!4&'a$0. Si$ 72a!%+5 - 4+7+ , !*i!i# $ +0!+,4a30&'+,5 $+ "2 +'vi"a!, 6& ' $7!+ " 3!,+$a' $4,a!i+ ,0/ $*&$4i#$ "' 0i3+ " 3!+4"i7i$0+ 6& , !a'i)a. A,5 3!+4"i> 7i$0+,

,34ia', 4+7+ ,a'a 4+$0a7i$a"a !6&!i!/$ &$ 7a-+! $> 7!+ " 3!,+$a'.

P+! '+ a$0!i+!5 , i73!,4i$"i2' 'a 3a!0i4i3a4i#$ " 3!,+$a' "$*!7!a 4+$ $0!$a7i$0+ 0#!i4+ - 3!/40i4+5 a'0a7$0 4a'i*i4a"+ -,34ia'i)a"+ $ 3!+4"i7i$0+, - 0(4$i4a, 6&i!!%i4a,5 4+$ '+ 6& ,a,%&!a!/ ' 4+!!40+ 7a$+ " 'a 0(4$i4a ,0(!i'5 "' i$,0!&7$0a'5 a44>,+!i+,5 - , ,0a2'4!/ &$ +!"$ $ ' 7a$+ - 3!3a!a4i#$ " 'a, 7,a,



a&<i'ia!, " !i#$5 !40a$%&'a! - " Ma-+.

T<"ni"a e!t<rilT(!7i$+ 6& a'&" a 0+"+, '+, 3!+4"i7i$0+, 4&-a *i$a'i"a" , 3!,!>va!5 7a$0$! - vi0a! 'a 4+$0a7i$a4i#$ "' 7a0!ia'5 6&i3+ i$,&7+,&0i'i)a"+, "&!a$0 'a 4i!&%a5 '+ 4&a' i73i" 'a 3!+3a%a4i#$ " 7i4!++!>%a$i,7+, "&!a$0 3!+4"i7i$0+, i$va,iv+, 0a72i($ 1a4 !*!$4ia a 'a,0(4$i4a, &0i'i)a"a, 3a!a 'a 3!3a!a4i#$ " 'a, 7,a, a&<i'ia!, "&!a$> 0 '0!a$,+3!a0+!i+.

137




E' +!"$ - 4+$0!+' " 'a, 7,a, a&<i'ia!, , &$a *&$4i#$ 6& !a'i)a'a $*!7!a 6&i!!%i4a5 - , ,& !,3+$,a2i'i"a" 3!3a!a!'a, 2a+ ,0!i4>

0a, $+!7a, " ,0!i'i"a".A' 3!3a!a! 'a, 7,a, a&<i'ia!, "2$ 0$!, $ 4&$0a '+, 3!i$4i>

3i+, &$iv!,a', " 'a 0(4$i4a a,(30i4a5 " 0a' *+!7a 6& , *+!7 - 7a$>0$%a &$ 4!4&'+ ,0(!i' 7i$0!a, "&!a ' a40+ 6&i!!%i4+. E,0a )+$a 0a7> 2i($ ''a7a"a 4i!4&i0+ 6&i!!%i4+ 4+73!$" ' /!a "+$" , 3!a40i4a 'a4i!&%a5 - ,0/ *+!7a"a 3+! 'a, 7,a, a&<i'ia!, " !i#$ + !40a$%&'a!57,a " Ma-+ - 'a 7,a 6&i!!%i4a. E,0 4i!4&i0+ vi0a 'a 4+$0a7i$a4i#$"' 4a73+ ,0(!i' "&!a$0 'a i$0!v$4i#$ 6&i!!%i4a.

T<"ni"a a!<pti"aT(!7i$+ 6& , !*i! a 'a, !%'a, - $+!7a, 6& "2$ ,%&i!, a' 3!+> 3+!4i+$a! a0$4i#$ a' $*!7+. La, '-, "' 6&i!#*a$+ 3!7i0$ a,%&>!a! &$a a0$4i#$ '+ 7/, 'i73ia 3+,i2' - 'i2! " 'a 3!,$4ia " 7i4!+>

+!%a$i,7+, 3a0#%$+,.

+e#la! e la t<"ni"a a!<pti"a/a! per!ona! con #ata , guante! e!t%rile! de#en antener!e den-

tro del circuito e!t%ril. E$ ,0 4i!4&i0+5 ' 3a4i$0 , ' 4$0!+ "' 4a7> 3+ 6& , 4+$,i"!a 4+7+ 0a'5 *+!7a"+ 0a72i($ 3+! 6&i$ 3+!0a v,0i>7$0a ,0(!i'5 'a, 7,a, a&<i'ia!, - $ %$!a' 0+"+ '+ 6& , 4+$,i"!a

,0(!i' 3+! 0a$0+5 ,0a /!a $+ "2 ,! a2a$"+$a"a 3+! ' 3!,+$a' 2a+$i$%&$a 4i!4&$,0a$4ia.

"oner!aci+n nia en el tran!cur!o de la ciruga. U$a 4+$v!>,a4i#$ <4,iva a&7$0a 'a 3+,i2i'i"a" " i$*44i+$, 3+! 4+$0a7i$a>4i#$ " 'a 1!i"a "2i"+ a' Q&,1 6& , %$!a a' 1a2'a!. Ca2 !4+!"a!6& 'a ,a'iva 4+$0i$ %!a$ 4a$0i"a" " 2a40!ia,.

&oiiento nio en el tran!cur!o de la ciruga. D2 vi0a!,' 0!/$,i0+ 3,a"+ "&!a$0 'a 4i!&%a5 a, 4+7+ ' 7+vi7i$0+ <4,iv+ "'

3!,+$a' i$v+'&4!a"+ $ 'a +3!a4i#$5 -a 6& ,0+ 3&" *av+!4! 'a$0!a"a " 2a40!ia, 3+! ' 3+'v+ %$!a"+ 3+! ' 7+vi7i$0+.

El per!onal no e!t%ril de#e eitar pa!ar !o#re la! !upericie! e!-t%rile!. C+$vi$ !4+!"a! ,i73! 6& 'a 3!,+$a $+ ,0(!i' "2 vi0a!,+2!3a,a! '+, '7i0, " 'a, 7,a, a&<i'ia!, + " Ma-+. A' a2!i! '+,



$apítulo ;; :$olocación # maneo de mesas au(iliares 139

2&'0+, ,0(!i', 3a!a 4+'+4a!'+, $ &$a ,&3!*i4i ,0(!i'5 'a 7a$+ - 2!a)+" 6&i$ '+, +*!4 3&" ,0a! 3!+0%i"a 3+! &$ "+2') " 'a 7i,7a

$v+'0&!a -5 " ,0a 7a$!a5 3&" 4+'+4a!'+, $ 'a, 7,a, + $0!%a!'+,"i!40a7$0 a 'a i$,0!&7$0i,0a.

&antener!e !iepre de rente al capo e!t%ril. L+, 7i72!+, "'6&i3+ 6&i!!%i4+ $&$4a "2$ "a! 'a ,3a'"a a' 4i!4&i0+. C&a$"+ 3+!a'%&$a !a)#$ !6&i!a$ 4a72ia!, " '&%a!5 '+ 1a!/$ %i!a$"+ ,3a'"a 4+$,3a'"a. E' !,0+ "' 3!,+$a' $+ ,0(!i' $&$4a "2 4!&)a!, $0! "+,/!a, ,0(!i', + $0! "+, 7i72!+, "' 6&i3+.

El e'uipo utiliado para la ciruga de#e !oeter!e a e!terilia-ci+n. T+"+ ' i$,0!&7$0a' 3a!a 'a 4i!&%a "2 ,0a! 4+73'0a7$0 'i2!" 7i4!++!%a$i,7+,5 3+! '+ 6& , "2 v!i*i4a! 'a a3'i4a4i#$ "' 3!+4"i7i$0+ 4+!!40+.

E!t%ril con e!t%ril. E' 3!,+$a' 6& , 4+$,i"!a ,0(!i' , ' $i4+6& 3&" 0+4a! +20+, - 7a0!ia', ,0(!i',5 a, 4+7+ 'a 1!i"a 6&i>!!%i4a. E' 3!,+$a' $+ ,0(!i' ,+'a7$0 3+"!/ 0+4a! '+ $+ ,0(!i' ,i$72a!%+5 3+"!/ 4+'a2+!a! 3!+v-$"+ 7a0!ia' ,0(!i' 4+$ &$a 0(4$i4a"0!7i$a"a.

roce!o! de e!teriliaci+n dudo!o!. C&a$"+ , ,+,341a " 'av!a4i"a" $ 'a *41a " 4a"&4i"a"5 73a6&, !+0+,5 7a$41a"+, + 4+$4&a'6&i! +0!+ "*40+5 , "2 4+$,i"!a! 6& ,0/ 4+$0a7i$a"+ -5 3+!0a$0+5 $+ "2 ,! &0i'i)a"+.

&e!a! auiliare! e!t%rile! !+lo en la !upericie. La ,&3!*i4i " 'a,7,a, a&<i'ia!, 6& , !4&2!$ 4+$ ,/2a$a - 4a73+, ,0(!i', , '+ 6&, 4+$,i"!a 4+7+ 0a' 3+! 0a$0+5 , i73+!0a$0 $+ "a! 4+'%a$"+i$,0!&7$0+, + ,&0&!a, $ '+, 2+!",.

/a! #ata! !on e!t%rile! !+lo por delanteJ <a!ta la cinturaJ , uno! 7a 8 c por arri#a del codo. La 3a!0 3+,0!i+! + "+!,+ " &$a 2a0a $&$>4a "2 ,! 4+$,i"!a"+ 4+7+ ,0(!i'. La, 7a$+, ,i73! "2$ 7a$0>$!, 3+! a!!i2a " 'a 4i$0&!a5 - $&$4a 4+'+4a!'a, 2a+ 'a, a<i'a,.

El #orde de cual'uier ena!e 'ue contenga aterial e!t%ril node#e con!iderar!e e!t%ril. S "2 vi0a! 6& '+, 2+!", " '+, $va,,1a%a$ 4+$0a40+ 4+$ ' 7a0!ia' 6& 4+$0i$ a,5 ,i , 0!a0a " ,+'&4i+>$,5 'a 0a3a "2 4+$,i"!a!, 4+$0a7i$a"a &$a v) 6& , 1a a2i!0+.

&antener un contacto nio con lo! ateriale! e!t%rile!. Ma$i> 3&'a! " 7a$!a 4+$,0a$0 - <4,iva ' 7a0!ia' 6& , 4+$,i"!a ,0(!i' 3&" 4a&,a! 'a 4+$0a7i$a4i#$ "' 7i,7+.

/a <uedad e! un edio de containaci+n. Si ' a%&a 1a4 4+$>0a40+ 4+$ &$a ,&3!*i4i ,0(!i' 4+7+ $ ' 4a,+ " 'a ,/2a$a 6& !>




4uir,r-ica

4&2! 'a 7,a a&<i'ia! a!!a,0!a 2a40!ia,5 -a 6& 'a, 7,a, $+ ,0/$,0(!i', - ,+$ &$a 3+,i2' 4a&,a " 4+$0a7i$a4i#$. C&a$"+ , 4+'+4a &$a

41a!+'a + 6&i3+ 4a'i$0 ,+2! &$a ,&3!*i4i ,0(!i'5 0a72i($ <i,04+$0a7i$a4i#$ "2i"+ a 6& , 3!+"&4 va3+! 3+! 4+$"$,a4i#$.

$e!a! auxiliare!

Con"epto

S+$ 7&2', *a2!i4a"+, 4+$ a4!+ i$+<i"a2'5 7i,7+, 6& 3+,$ ''a$>0a, 3a!a *a4i'i0a! ,& &,+ - 7a$+ "$0!+ " 'a ,a'a 6&i!!%i4a.

O(etivoDi,0!i2&i! ' i$,0!&7$0a' - ' 6&i3+ $ 'a 7,a " a4&!"+ 4+$ '+,

0i73+, 6&i!!%i4+, 3a!a *a4i'i0a! 'a, *&$4i+$, "&!a$0 'a 4i!&%a 7a$>0$! a"7/, &$a 0(4$i4a a,(30i4a ,%&!a 6& vi0 a' 7/<i7+ 'a 4+$0a>

7i$a4i#$ " 7a0!ia' i$,0!&7$0a' a' 1a4! ,0+5 $ 4+$,4&$4ia5 ,i73i" 'a 4+$0a7i$a4i#$ " 'a 1!i"a 6&i!!%i4a. P!7i05 a"7/,5 '+>4a'i)a! 4+$ !a3i") ' i$,0!&7$0a' - 7a$0$! &$ 4+$0!+' ,0!i40+ ,+2!,0 '0i7+5 a, 4+7+ "' 7a0!ia' 0<0i'.

E<i,0$ 0!, 0i3+, " 7,a, a&<i'ia!,

;6 Mesa rectan-ular

E,0/ 3!+vi,0a " &$ $0!3a+ 3a!a 4+'+4a! 7a0!ia'5 i$,0!&7$0a' ,0(!i'a"i4i+$a'5 ,+'&4i+$,5 04(0!a *i%&!a ;;>;.

?6 Mesa de riJónP+, *+!7a ,7i4i!4&'a! - , ' "$+7i$a a, 3+! ' 3a!4i"+ 6& 0i$4+$ 'a *+!7a " ,0 #!%a$+ *i%&!a ;;>9.

La, "+, 7,a, ",4!i0a, ,#'+ , "i*!$4ia$ $ 'a *+!7a5 -a 6& "&>!a$0 ' a40+ 6&i!!%i4+ 4&73'$ 'a 7i,7a *&$4i#$.

rocediiento. N+ <i,0 &$ +!"$ 3!*40a7$0 ,0a2'4i"+ $ 'a 3!3a!a4i#$ " 'a, 7,a, a&<i'ia!, ,i$ 72a!%+5 , i73+!0a$0 "a! $4'a!+ 6& 4a,i ,i73! 1a- 4+i$4i"$4ia $ 6& "2 +!"$a!, $ *&$>4i#$ " '+, 0i73+, 6&i!!%i4+,. Ta72i($ 4a2 $*a0i)a! 6& ' H+,3i0a'G$!a' " M(<i4+5 4+7+ 3i+$!+ $ 'a 3!3a!a4i#$ - $0!$a7i$0+ "




i#ura 111. Mesa rectan-ular.

%!a$ $7!+ " $*!7!a, $ ' 3a,5 1a 7a!4a"+ 'a, 3a&0a, a ,%&i!!,340+ a 'a 3!3a!a4i#$ " 'a, 7,a, a&<i'ia!,.

D i%&a' 7a$!a5 "2 0$!, 3!,$0 6& 'a 3!i$4i3a' !,3+$,a2'" 3!3a!a!5 +!"$a! - 4+$0!+'a! 'a 7,a , 'a $*!7!a i$,0!&7$0i,0a5 -'a $*!7!a 4i!4&'a$0 4+'a2+!a $ 0+"+ 7+7$0+ 3!+3+!4i+$a$"+ '7a0!ia' - ' 6&i3+ $4,a!i+,. E$ +0!+ 4a30&'+ " ,0a +2!a , ,34i>*i4a$ 'a, *&$4i+$, " ,0a, $*!7!a, "&!a$0 ' 0!a$,+3!a0+!i+.

Pa!a 6& 'a 7,a ,a *&$4i+$a' "&!a$0 'a +3!a4i#$5 "2 "ivi"i!,$ 0!4i+, 7"ia$0 'a &0i'i)a4i#$ " '+, 7i,7+, 4a73+, $ 6& , $>4&$0!a$ $v&'0+, 'a !+3a - ' 6&i3+ *i%&!a ;;>. A *i$ " "'i7i0a!'+, 0!4i+, '+, 3a,+, a ,%&i! ,+$

i#ura 112. Mesa de riJón.




A

:

C

i#ura 113. Apertura de bulto 4uir,r-ico% previo a la operación.



$apítulo ;; : $olocación # maneo de mesas au(iliares 143

• C+'+4a! ' 2&'0+ " !+3a ,+2! 'a 7,a !40a$%&'a! + " !i#$. • R0i!a! 'a 3!i7!a $v+'0&!a 4a73+ "+2' " *+!7a 7a$&a'.• A&<i'i/$"+, " &$a 3i$)a " 0!a,'a"+ + Ba" Pa!!5 , !0i!a - <>

0i$" 'a ,/2a$a5 !,30a$"+ '+, 3!i$4i3i+, 2/,i4+, " 'a 0(4$i4aa,(30i4a5 3a!a 4&2!i! 3!*40a7$0 'a 7,a " <0!7+ a <0!7+.

$ercio derec<o. E' 0!4i+ "!41+ *i%&!a ;;> 3&" "'i7i0a!,4+$ 'a ,%&$"a $v+'0&!a " 'a, 2a0a, ,i (,0a, ,+$ a"i4i+$a', + 4+$a'%$ 4a73+ 6& v$%a i$4'&i"+ $ ' 7i,7+ 2&'0+ " !+3a. S+2! 'a, 2a0a, "2 4+'+4a!, &$a 4+73!,a + 0+a''a ,4a"+ " 7a$+,. A40+ ,>%&i"+5 'a i$,0!&7$0i,0a , 4+'+4a 'a 2a0a - '+, %&a$0, ,0(!i',5 3!vi+

'ava"+ 6&i!!%i4+ " 7a$+, - 4+$ 0(4$i4a 4!!a"a. A 4+$0i$&a4i#$ ,$4a!%a!/ " 3!3a!a! 'a, 7,a, 4+$ 0(4$i4a ,0(!i' - " 4+'+4a! 0+"a 'a!+3a ,0(!i' $4,a!ia 3a!a 'a 4i!&%a. La !+3a ,#'+ , 4+'+4a a6& $ *+!7a 3!+vi,i+$a' - $ ' +!"$ $ 6& ,!/ &0i'i)a"a. M/, 0a!"5 $ ,0 ,i0i+ ,4+'+4a!/ ' i$,0!&7$0a' " !0+!$+5 a, 4+7+ 0+"+ 0i3+ " 7a0> !ia' 6&, 4+$,i"! ,&4i+.

E, !4+7$"a2' 1a4! &$a !*!$4ia $ 'a ,6&i$a i$*!i+! i)6&i!>"a 3a!a 4+'+4a! $ "i41+ ,i0i+ ' 3!i7! 2i,0&! &$a v) 6& (,0 1a ,i"+

&0i'i)a"+. E$ 'a 3a!0 i$*!i+! " ,0 0!4i+ , 7a$a 0+"+ ' i$,0!&7$>0a' " !0+!$+ + 6& , 4+$,i"!a ,&4i+ "&!a$0 'a 4i!&%a.$ercio edio. E' 0!4i+ 7"i+ *i%&!a ;;>? , "'i7i0a 4+$ a&<i'i+ "

&$ 4a73+ ,0(!i'5 6& 0a72i($ 3&" v$i! i$4'&i"+ $ ' 2&'0+ " !+3a.

i#ura 114. 7ercio derecho.




i#ura 115. 7ercio medio.

E$ 'a 3a!0 ,&3!i+! , 4+'+4a$ !4i3i$0, 4+$ ,+'&4i+$, 3a!a i!!i>%a4i#$5 0&2+, 3a!a a,3i!a4i#$5 "i,3+,i0iv+, 3a!a '40!+4a&0!i+5 ,+$"a,5 !i$%a,5 a%&a,5 4a0(0!,5 04. La 3a!0 i$*!i+! , "a 'i2! 3a!a +4&3a!' ,3a4i+ - 3!3a!a! a"i0a7$0+, 0i', "&!a$0 'a 4i!&%a.

$ercio i'uierdo. E' 0!4i+ i)6&i!"+ *i%&!a ;;> , "'i7i0a 4+$ 'a7i,7a 4+73!,a "+$" vi$ $v&'0+ ' i$,0!&7$0a' 6& 'a $*!7!a6&i!!%i4a 0+7a 3!via7$0 " 'a 41a!+'a " Ma-+5 + a' i%&a' 6& 4+$ '+,+0!+, 0!4i+,5 3&" +4&3a!, a'%&$a 4+73!,a 6& , 1a-a i$4'&i"+ $ ' 2&'0+.

E$ 'a 3a!0 ,&3!i+! i)6&i!"a5 - $ ,$0i"+ " i)6&i!"a a "!41a5 ,4+'+4a$ " 7a$!a ,4&$4ia' 'a, 3i$)a, " 4a73+ + Ba41a&,. A,i>7i,7+5 3&" a!7a!, &$ 'i2!+ ''a7a"+ a, 3+!6& , 1a4$ va!i+,"+2'4, 4+$ &$a 4+73!,a "+$" , 4+'+4a$ $ +!"$ " &,+ 'a, ,&0&>!a,. D2a+ " ,0a 4+73!,a + 'i2!+ , 4+'+4a$ '+, 3+!0aa%&a,5 i$7>"ia0a7$0 ",3&(, 'a, %a,a, - 'a, 4+73!,a, " ,3+$a! "+2'a"a,5 "7a$!a 6& !,&'0 */4i' vi,&a'i)a!'a, - 4+$0a!'a,5 ,+2! 0+"+ 3a!a ''va!&$ 4+!!40+ 4+$0!+' " ''a,.

E$ 'a 3a!0 7"ia "' 7i,7+ 0!4i+ , &2i4a ' i$,0!&7$0a' *i$+5 - $'a 3a!0 i$*!i+! , 4+'+4a$ 0+"a, 'a, 3i$)a, $ *&$4i#$ " '+, 0i73+,6&i!!%i4+, 4+!05 "i,44i#$5 17+,0a,ia5 04.5 "a$"+ a' *i$a' 0+"+ '




A

:

i#ura 116. A% 7ercio iz4uierdo. 3% !ivisión de la mesa rectan-ular en

tercios.

i$,0!&7$0a' " ,34ia'i"a". E, 3!4i,+ a,%&!a!, " 4+'+4a! 'a, 3i$)a,4+$ 'a, 3&$0a, "i,0a', $ !'a4i#$ a 'a &2i4a4i#$ " 'a $*!7!a 6&i!!>%i4a5 + 2i$ 4+$ 'a, 3&$0a, 1a4ia a!!i2a.

La 7,a !40a$%&'a! + " !i#$ , 4+'+4a 3!*!$07$0 $ 'a 3a!>0 3+"/'i4a "' 3a4i$05 3&, " ,0a 7a$!a 'a $*!7!a i$,0!&7$> 0i,0a 3&" 0$! a44,+ 4+$ !a3i") a' 7a0!ia' - a' 6&i3+ 6& $+ ,

$4&$0!a$ " 7a$!a i$7"ia0a $ 'a 7,a " Ma-+.

C6 Mesa de Ma#oE, i73+!0a$0 !4+!"a! 6& ,0a 7,a 0i$ &$ ,+'+ ,+3+!0 + 3a0a5 '+6& 3!7i0 4+'+4a!'a 3+! $4i7a "' 3a4i$0 - ,i$ 1a4! 3!,i#$ "2i>




"+ a 6& ,0/ 3!+vi,0a " &$ 0+!$i6&0 3a!a %!a"&a! 'a a'0&!a - &$ 7a!4+$ "+$" , 4+'+4a 'a 41a!+'a 4+$ ' i$,0!&7$0a' ,0(!i'. E, 0i' 3a!a7a$a! ' i$,0!&7$0a' !6&!i"+ $ 4a"a 3a,+ " 'a 4i!&%a.

E$ 'a 7a-+!a " '+, 3!+4"i7i$0+, 6&i!!%i4+, 'a 7,a " Ma-+"2 &2i4a!, " 7a$!a +3&,0a a 'a &2i4a4i#$ "' 4i!&a$+5 " 0a' *+!>7a 6& 6&" a &$ $iv' i$*!i+! "' ,i0i+ "+$" 1a2!/ " !a'i)a!, 'a4i!&%a - $+ "2 0+4a! $ $i$%$ 7+7$0+ a' 3a4i$0.

La $*!7!a 73'a ,& 3!+3i+ 4!i0!i+ 3a!a +!"$a! 'a 7,a "Ma-+5 0$i$"+ 3!,$0 'a 0(4$i4a 6&i!!%i4a a !a'i)a!. Si$ 72a!%+5 3a!a &$a 3!3a!a4i#$ *i4a) - 4+$ ' +20iv+ " 6& ' 3!+4"i7i$0+ ,",a!!+'' " 7a$!a <i0+,a5 , $4,a!i+ !Q<i+$a! 3a,+ a 3a,+ 'a

,4&$4ia "' 3!+4"i7i$0+5 '+ 6& 3!7i0 ''va! 'a a44i#$ " 7a$!a4+$&$0a 4+$ ' !,0+ "' 6&i3+ 6&i!!%i4+ "&!a$0 ' 0!a$,+3!a0+!i+.

rocediiento. C+'+4a! &$a *&$"a " Ma-+5 7i,7a 6& ,0/ 4+$0>$i"a %$!a'7$0 $ ' 2&'0+ " !+3a 6&i!!%i4a. C+7+ i$"i4a ,& $+7> 2!5 , &$a *&$"a 'a!%a 3a!4i"a a 'a " 'a, a'7+1a"a,5 - , "+2'a $*+!7a " a4+!"#$ 3a!a *a4i'i0a! ,& ",'i)a7i$0+ 1a4ia 'a 41a!+'a - 'a!4+ " 'a 7,a. La *&$"a " Ma-+ 3&" $+ ,0a! "i,3+$i2' $ 0+"a, 'a,i$,0i0&4i+$, " ,a'&"5 $ 4&-+ 4a,+ , 4+'+4a$ ,+2! 'a 7,a 4+73!,a,

"+2',5 " 0a' *+!7a 6& , a,%&! 4&2!i! 3!*40a7$0 'a 7,a5 4!a$>"+ a, &$a 2a!!!a *40iva. A' 4+'+4a!'a5 'a $*!7!a 6&i!!%i4a "2 3!+0%!, " $+ 4+$0a7i$a! ,&, %&a$0,.

O0!a *+!7a " v,0i! ,0a 7,a , 0+7a! 'a 41a!+'a ,0(!i' - 4+'+4a!'a"$0!+ " 'a *&$"a5 3a!a $0+$4, ",'i)a! " i$7"ia0+ a72a, 3+! ' a!4+" 'a 7,a5 3!+0%i$"+ ,i73! 'a ,0!i'i"a" " '+, %&a$0, 4+$ &$a!*!$4ia a 'a 3!+3ia *&$"a 4&a$"+ , 4+'+4a.

A 4+$0i$&a4i#$ , 'a2+!a &$a 2+',a 4+$ &$ 4a73+ "+2'5 6& ,i!v4+7+ ,%&$"a 2a!!!a5 'a 4&a' 6&"a a' 2+!" " 'a 7,a - 3!#<i7a a 'a$*!7!a i$,0!&7$0i,0a5 " 0a' *+!7a 6& ,i!va 3a!a '+, ",41+, ",&0&!a,5 73a6&5 04. N&$4a "2$ 4+'+4a!, a1 %a,a, + 4+73!,a,. La,"a 'i2! 6& , &0i'i)a , 4+'+4a"a a '+ 'a!%+5 a4+7+"/$"+'a 3+!4a'i2!, $0! ,0a 2+',a - 'a *&$"a " Ma-+ 3a!a 6& 'a, 3&$0a, 6&"$ a'a vi,0a - 3&"a$ 0+7a!, 4+$ !a3i") - *a4i'i"a".

U$a v) 6& , 0!7i$a " v,0i! 'a 7,a5 , a4+7+"a ' i$,0!&>7$0a'. A,5 - 0+7a$"+ 4+7+ !*!$4ia 'a 2+',a 6& 6&"a 1a4ia 'a $>*!7!a5 + " "i,0a' a 3!+<i7a'5 , i$i4ia 'a 4+'+4a4i#$ "' i$,0!&7$0a'0a72i($ 3+! 0i73+, 6&i!!%i4+, 4+!05 "i,44i#$5 17+,0a,ia5 04.a"7/,5 "2 i$i4ia!, 4+$ i$,0!&7$0a' 4+!0+. E' i$,0!&7$0a' 'a!%+ ,,&2 a 'a 7,a " Ma-+ 4&a$"+ , a44" a 4avi"a" 3+! ,&3&,0+5 '






A

:

C

/

i#ura 117. *rocedimiento para vestir la mesa de Ma#o.

"a - &$a v) 6& , ' 1a$ !a'i)a"+ 'a a$0i,3,ia - ' 'ava"+ 74/$i4+ "'a 3i'5 , 4+'+4a$ '+, 4a73+, ,0(!i',5 3!+4"i7i$0+ 0a72i($ 4+$+4i"+4+7+ v,0i! a' 3a4i$0. E,0 3a,+ , 1a4 4+$ 'i$)+, + 4a73+,5 '+,4&a', 3&"$ ,! " 0'a + 7a0!ia' ",41a2'.



$apítulo ;; : $olocación # maneo de mesas au(iliares 149

E, i73+!0a$0 !4+!"a! 6& ,0 3!+4"i7i$0+ va!a " &$a i$,0i0&>4i#$ a +0!a ,i$ 72a!%+5 2a,0a 4+$ !,30a! 'a, !%'a, " a,3,ia 4&a$"+, 4+'+4a$. A,i7i,7+5 $ 4i!&%a, 3+4+ 4+7&$, , !4+7i$"a 4+$,&'>

0a! ' 7a$&a' " 3!+4"i7i$0+, " 'a i$,0i0&4i#$ 3a!a 4+$+4! 'a 0(4$i4a6& 1a2!/ " ,%&i!,.

O(etivoC!a! &$ 4a73+ 6& ,i!va " 2a!!!a " 3!+044i#$ 4+$0!a 'a 4+$0a7i>

$a4i#$ - 1&7"a" " 'a 1!i"a 6&i!!%i4a5 a"7/, " 4&2!i! 'a, )+$a,4i!4&$"a$0, 7"ia$0 'a 4+'+4a4i#$ " 4a73+, - ,/2a$a, ,0(!i',.Ta72i($ , 2&,4a 'i7i$a! ' 3a,+ " 7i4!++!%a$i,7+, $0! 'a, )+$a,,0(!i', - 'a, $+ ,0(!i',5 *a40+! " ,&7a i73+!0a$4ia 3a!a 3!v$i! i$>*44i+$,.

E<i,0 "iv!,i"a" " 'i$)+, 6&i!!%i4+, ,i$ 72a!%+5 "2$ 4&2!i!4i!0a, 4a!a40!,0i4a, 3a!a 4&73'i! 4+$ ,& *&$4i#$ ,&,0a$0iva. P+! '+ %>$!a' , a430a 6& ,0($ *a2!i4a"+, 4+$ &$a 0'a ''a7a"a 7&,'i$a.

Cara"terí!ti"a! e lo! "a*po! -uirr#i"o!C+$,i"! a'%&$+, " '+, !a,%+, 7/, ,+2!,a'i$0, " '+, 4a73+, 6&i>

!!%i4+,.3lta re!i!tencia a la <uedad. E,0+ 3!7i0 4+$,!va! ' 4a73+ '+

7/, ,4+ 3+,i2' - vi0a ' 3a,+ " 7i4!++!%a$i,7+, $+4iv+,.3lta re!i!tencia a de!garro!. L+ a$0!i+! i73i" 'a !&30&!a " 'a,

*i2!a, -5 $ 4+$,4&$4ia5 *!$a 'a 3$0!a4i#$ " 7i4!+2i+,.

No de!<ilar!e. C&a$"+ 'a 0'a , ",1i'a5 'a, *i2!a, " a'%+"#$ 3&>"$ 3!+"&4i! 3!i0+$i0i, %!a$&'+7a0+,a + *+!7a! (72+'+, $ 'a, a!0> !ia,.3ntie!t4tica. E,0a 4a!a40!,0i4a 'i7i$a ' !i,%+ " &$a 41i,3a.oro!a. E,0+ 4+$0!i2&- a 'i7i$a! 'a a4&7&'a4i#$ " 4a'+! - 4+$>

,!va! &$ 7"i+ ,0a2' - a3!+3ia"+ 3a!a 'a 073!a0&!a 4+!3+!a' "' 3a4i$0.

L+, 4a73+, 6&i!!%i4+, , 'a2+!a$ $ "iv!,+, 0a7a+,5 '+, 4&a',, !*i!$ a 4+$0i$&a4i#$.

• "opre!a de capo @60 K 90 c). Ca73+ 6&i!!%i4+ $ *+!7a!40a$%&'a! 6& ,i!v 3a!a a2,+!2! '6&i"+, $ %!a$ 4a$0i"a" - 3a!a4+'+4a!'+, a'!""+! "' ,i0i+ " 'a i$4i,i#$.




• S4#ana !iple o !encilla @1.20 K 1.80 ). Ta72i($ , ' 4+$+44+7+ ,/2a$a " 3i,5 - , 4+'+4a $ '+, 3i, + 4a2)a "' 3a4i$054&2!i$"+ !%i+$, 4+73'0a,.

• S4#ana <endida o ene!trada @2.50 K 1.80 ). C&$0a 4+$ &$ +!i*i>4i+ $ ' 4$0!+5 4&-+ 2+!" ,0/ !*+!)a"+. C+$ ,0a ,/2a$a , 4&2! 3+! 4+73'0+ a' 3a4i$0 - 'a 7,a " +3!a4i+$,.

• E<i,0$ 0a72i($ 4+73!,a, *$,0!a"a,5 ''a7a"a, a, 3+! ,&, "i>7$,i+$, ,+$ " 7&41+ 7$+! 0a7a+5 - 0a72i($ 0i$$ &$ +!i>*i4i+ 3a!a 'a, 4i!&%a, " 4&''+5 +"+5 04(0!a.

+e#la! para la "olo"a"in e "a*po!La 4+'+4a4i#$ " 4a73+, - ,/2a$a, %&a!"a !'a4i#$ 4+$ ' 0i3+ " 4i>

!&%a5 3+! '+ 6& "2 3+$!, ,34ia' 4&i"a"+ a' &0i'i)a!'+,5 -a 6& 'a1!i"a + ,i0i+ " i$4i,i#$ "2 6&"a! ,i73! $4&a"!a"+ 3+! (,0+,5 4+$'+ 6& , !,0a2'4!/ " 7a$!a a"4&a"a 'a 2a!!!a $0! '+ ,0(!i' - '+,&4i+.

• L+, 4a73+, "2$ "+2'a!, 3a!a ,+70!'+, a ,0!i'i)a4i#$5 " 0a'

7a$!a 6& a' &0i'i)a!'+, 3&"a$ ,! ","+2'a"+, 4+$ *a4i'i"a" ,+> 2! ' 4a73+ +3!a0+!i+.• U$a v) 4+'+4a"+ &$ 4a73+ -a $+ "2 7+v!,5 3&, ,0+ 3+"!a

4+$0!i2&i! a ,& 4+$0a7i$a4i#$.• E, i73+!0a$0 4+!!+2+!a! 6& 0+"+, '+, 4a73+, ,0($ a4+7+"a"+,

$ 'a ,4&$4ia a"4&a"a $ ' 2&'0+ " !+3a 6&i!!%i4a.• Ta$0+ 'a $*!7!a i$,0!&7$0i,0a 4+7+ ' 4i!&a$+ - '+, a-&"a$0,

0i$$ 'a !,3+$,a2i'i"a" " 7a$0$! 'a 4a"$a ,0(!i' - " 6& $+

1a-a !!+!, $ 'a 0(4$i4a a' 4+'+4a!'+,.• M$i7a 7a$i3&'a4i#$ " '+, 4a73+,.• V!i*i4a! 6& '+, 4a73+, , 4+'+6&$ $ )+$a, ,4a,.• L+, 4a73+, "2$ 'va$0a!, '+ ,&*i4i$0 3a!a i73"i! 6& 0+6&$

)+$a, $+ ,0(!i',.• Ma$0$! 'va"+ ' 4a73+ 1a,0a 6& ,0( &,0+ ,+2! ' /!a5 - '&>

%+ 2aa!'+ 1a,0a "+$" 3!7a$4!/.

E$ 4&a$0+ a 'a 4+'+4a4i#$ " 4a73+, 3a!a 4i!&%a a2"+7i$a' "2$

+2,!va!, '+, ,i%&i$0, a,340+,• P+$! ,i73! $ 3!/40i4a 'a 0(4$i4a a,(30i4a.• C+'+4a! 'a ,/2a$a " 3i, $ 'a )+$a "$+7i$a"a 3+"/'i4a5 6& va

" 'a ,$*i,i, "' 3&2i, 1a4ia a2a+. Pa!a ''+ , 3a,a a' a-&"a$0 &$+




" '+, <0!7+, " 'a ,/2a$a ,i$ "a!'a 4a!5 - $0! a72+, 'a ",>"+2'a$5 7a$0$i($"+'a 0$,a 1a,0a 6& ,0( 4+73'0a7$0 a2i!0a5

'&%+ " '+ 4&a' , 1a4 &$ 36&+ "+2') $ ' 2+!" - *i$a'7$0, ' "a 4a! $ ' ,i0i+ a"4&a"+. E$ +4a,i+$, 'a $*!7!a $+ 3a!0i4i3a "i!40a7$0 $ ,0a a40ivi"a"5 3+! '+ 6& ,& *&$4i#$ , 2/,i4a7$0 3!+3+!4i+$a! 'a ,/2a$a ,i$ ","+2'a!'a.

• C+'+4a! 4&a0!+ 4a73+, a'!""+! "' ,i0i+ 6&i!!%i4+ i$7"ia>0+ "+, 'a0!a',5 "!41+ i)6&i!"+5 &$+ ,&3!i+! - +0!+ i$*!i+!5,i73! 4+$ ' 2+!" "+2'a"+ 1a4ia 'a '$a " i$4i,i#$. E,0a /!a ,"$+7i$a $4&a"!a7i$0+5 - '+, 4a73+, "2$ a,%&!a!, 4+$ 3i$)a," 4a73+ Ba41a&,5 4+'+4a! &$+ + "+, 3&$0+, " ,&0&!a ,"a5 + 2i$ %!a3a,. La $*!7!a , $4a!%a " 3!+3+!4i+$a! ,0+, 4a73+, -'a, 3i$)a,5 a&$6& $+ "2 +'vi"a! 6& 3&" 3a!0i4i3a! "i!40a7$0$ ,& 4+'+4a4i#$.

• Fi$a'7$0 , 4+'+4a 'a ,/2a$a 1$"i"a + *$,0!a"a5 4&-a a2!0&!a, ,i0a $ ' ,i0i+ " i$4i,i#$ 6& 3!via7$0 , $4&a"!# 4+$ '+,4a73+,. E,0a ,/2a$a 0a72i($ 4+$+4i"a 4+7+ ,/2a$a " 3!+4"i>

7i$0+, , 'a '0i7a $ 4+'+4a!,. D i%&a' 7a$!a5 ,0 3!+4>"i7i$0+ , !a'i)a 4+$ a3+-+ "' a-&"a$05 $ 4a,+ " 6& a, ,!6&i!a.

• U$a v) !a'i)a"+ 0+"+ '+ a$0!i+! , 1a 4+$4'&i"+ 4+$ ' v,0i"+"' 3a4i$05 0!a, '+ 4&a' "2 3!+4"!, " i$7"ia0+ a 4!!a! '4i!4&i0+ 3a!a i$i4ia! 'a 4i!&%a.

E<i,0$ 4a73+, ",41a2', 6& 0i$$ a"1,iv+5 ' 4&a' , 4+'+4a$ 4+$0a40+ "i!40+ 4+$ 'a 3i'5 a 0!av(, " '+, 4&a', , i$4i" 4+!0a$"+

"i!40a7$0 $ 'a 4a3a " 3'/,0i4+ a"1,iva.E$ ' 4a,+ " 'a 4i!&%a " 4&''+5 , "+2'a$ "+, 4a73+, $ *+!7a

0!ia$%&'a! 7i,7+, 6& , $0!%a$ 4+$ "+, 3i$)a, " 4a73+ 3a!a 4&> 2!i! 'a 4a2)a "' 3a4i$0 a 7a$!a " 0&!2a$05 -a 6& $ ,0 4a,+ '+6& 0i$ 6& 6&"a! 3!*40a7$0 <3&,0+ ,5 3+! ,&3&,0+5 ' 4&''+.Pa!a 4+'+4a! ' !,0+ " 'a !+3a 6&i!!%i4a $ ,0 0i3+ " 4i!&%a , ,i%&'a 0(4$i4a -a ",4!i0a.

A&$6& $+ , 3+,i2' ",4!i2i! 3a,+ a 3a,+ 4a"a 0(4$i4a 3a!a 'a 4+>

'+4a4i#$ " '+, 4a73+, " &$a 4i!&%a ,34*i4a5 4+7+ -a , 4+7$0#5,a 4&a' *&! ' 3!+4"i7i$0+ 73'a"+5 'a $*!7!a $+ "2 +'vi"a!$&$4a a3'i4a! 'a, !%'a, " a,3,ia5 '+ 6& !"&$"a!/ $ &$a a0$4i#$ "4a'i"a" a' 3a4i$0 - a vi0a! i$*44i+$,5 4+$ '+ 4&a' 'a i$,0i0&4i#$ - ' 3!+3i+ 3a4i$0 , v!/$ 2$*i4ia"+, - vi0a!/$ a&7$0a! 4+,0+,.




4uir,r-ica

:ilio#ra)ía

A!41&$"ia G A. Educación &uir'r(ica" E"i0+!ia' F!a$4i,4+ M($") C!>va$0,5 M(<i4+5 3. 999.

B!!- - K+1$. T0cnicas de &uirófano5 ;:W "i4i#$5 E"i0+!ia' E',vi!5 Ma>"!i"5 3. ;::95 9::?.

M4a$+%!a7a. Curso de enfermer%a &uir'r(ica5 H+,3i0a' G$!a' "M(<i4+5 ;.

$a

p

í

tu

l

o

12

+opa -uirr#i"a



+opaLa v,0i7$0a5 a0&$"+ + !+3a5 ,+$ 0+"a, a6&''a, 3!$"a, 6& , *a2!i>4a$ + 4+$*44i+$a$ 4+$ 7a0!ia', " +!i%$ $a0&!a' 4+7+ ,"a5 'a$a5

$0! +0!+, + " 7a0!ia', ,i$0(0i4+, 4+7+ ' 3+'i(,0! - '+, " +!i%$v%0a' 4+7+ ' a'%+"#$. La !+3a , 0i'5 ,+2! 0+"+ 3a!a 3!+044i#$ "'*!+5 4a'+! - 3a!a 4&i"a! ' 3&"+! " 'a, 3!,+$a,. E$ &$ ,$0i"+ a7> 3'i+5' 4+$430+ " !+3a 0a72i($ i$4'&- 0+"+ 0i3+ " 2a0a,5 'i$)+,54+73!,a, - ,/2a$a, 6& , &0i'i)a$ $ 'a, i$,0i0&4i+$, " ,a'&"5 ,+$ 3!$"a, 6& , *a2!i4a$ 4+$ 4a!a40!,0i4a, ,34ia',5 3a!a &0i'i)a!'a, $ 3!+4"i7i$0+, 7("i4+>6&i!!%i4+, - , ', 4+$+4 4+$ ' $+72! "ropa 'uir(rgica.

+opa -uirr#i"aLa !+3a 6&i!!%i4a , 0+"a a6&''a 3!$"a 6& , ",0i$a 3a!a $v+'v!6&i3+,5 i$,0!&7$0a' - !+3a 3!+3ia7$0 2a0a,5 4+73!,a,5 4a73+,04.5 7i,7a 6& 3&" ,! " 0'a + ",41a2'.

E,0+, 2&'0+, " !+3a 6&i!!%i4a , &0i'i)a$ "&!a$0 &$a 4i!&%a. La

!+3a 6& 4+$0i$$ a' ,! 4+'+4a"a a40a 4+7+ 2a!!!a - 3!+0% a' 3a>4i$05 !"&4 'a 0!a$,7i,i#$ " 2a40!ia, " &$ /!a a +0!a5 3!,!va a' 3!,+$a' " 'a ,a$%! - 0+"+ 0i3+ " ,4!4i+$, 3!+3ia, "' 3a4i$0 - a(,0 "' 3!,+$a' " ,a'&" ,+2! 0+"+ 4+$,0i0&- &$a 2a!!!a * ,i4a -,0(!i' ,+2! 'a 4&a' , 3&" 0!a2aa! 4+$ ,%&!i"a". C!a &$a "*$,a*40iva 3a!a !"&4i! 'a 3+,i2i'i"a" " i$*44i+$,. E$ ,0 ,$0i"+ , $>4,a!i+ !,a'0a! 6& 4&a$"+ &$a i$*44i#$ $+,+4+7ia' , 1a4 3!,$0 "a'%$ 7+"+ , "0!7i$a $+ ,#'+ 'a ,a'&" "' i$"ivi"&+5 0a72i($ ,

153




1a4 3a0$0 'a 4a'i"a" " 'a a0$4i#$ 6& 3!,0a &$a i$,0i0&4i#$ 3+! '+ 6&' 6&i3+ 6&i!!%i4+5 $ 3a!0i4&'a! ' 3!,+$a' " $*!7!a5 "2

4+$,i"!a! 'a 7a-+!a " 'a, 3!4a&4i+$,5 " 0a' 7a$!a 6& '+, 4+,0+, $+, 'v$ 3a!a ' 3a4i$0 $i 3a!a 'a i$,0i0&4i#$ 3+! 'a 3!,$4ia " a'%$0i3+ " i$*44i#$ 6& 3&"a "!iva!, "' i$a"4&a"+ 7a$+ " 'a !+3a6&i!!%i4a.

O(etivoE' 3!+3#,i0+ " 'a !+3a 6&i!!%i4a ,0(!i' , 'a " +2,0!&i! + "i,7i$&i! '

!i,%+ " 0!a$,7i,i#$ " 7i4!++!%a$i,7+, "," ' 6&i3+ 6&i!!%i4+5 ' 3!+3i+ 3a4i$05 1a,0a 'a 1!i"a 6&i!!%i4a.

+opa e!e"ale o e!"artaleE$ ' 4a,+ " 'a !+3a ",41a2' 3a!a 4i!&%a , i73+!0a$0 ,&2!a-a! 6&

, 3&" $4+$0!a! $ ' 7!4a"+ 4+$ 4a!a40!,0i4a, 7&- ,34*i4a,5 "a4&!"+ 4+$ ' 3!+4"i7i$0+ "' 4&a' , 0!a0 '+, *a2!i4a$0, " ,0 0i3+

" !+3a 4+$,i"!a$ "," 'a )+$a a i$0!v$i! 1a,0a 'a 3+,i4i#$ 6&a"+30a!/ ' 3a4i$05 i$4'&,+ ' &,+ " ,0 0i3+ " !+3a 3&" ''%a! a4+$0!a!!,0a! ' &,+ <4,iv+ " 'i$)+, - 4+73!,a,5 -a 6& , !3'$0 a'+, Q&i"+, - '6&i"+,.

La !+3a ",41a2' 3+! '+ %$!a' , i73!7a2'5 ,i$ 72a!%+5 ,1a +2,!va"+5 ,+2! 0+"+ $ 3!+4"i7i$0+, 3!+'+$%a"+, $ '+, 4&a',1a- <4,+ " 7a$+ " Q&i"+,5 6& (,0+, , '+%!a$ 3!7a! ,0a 2a!!>!a. A,i7i,7+ a'%&$a, 7a!4a, 4+$+4i"a, a,%&!a$ 6& ,&, 3!+"&40+, ,+$

i%$*&%+,5 , "4i!5 6& $ 4a,+ " a4&7&'a4i#$ " 4a'+!5 $+ 3!+"&4$''a7a, ,i$+ 6& , *&$"$5 '+ 4&a' !3!,$0a &$a 7"i"a " ,%&!i"a",i%$i*i4a0iva $ '+, 4$0!+, 1+,3i0a'a!i+,. S+$ 3!$"a, 1i3+a'!%($i4a, -'i2!, " '/0< $ ,& 0+0a'i"a"5 $0! +0!a, " ,&, 4a!a40!,0i4a,.

Si$ 72a!%+5 , 3!4i,+ 7$4i+$a! 6&5 " a4&!"+ 4+$ 'a <3!i$>4ia5 0a' v) $+ ,a$ 7&- *&$4i+$a',5 -a 6& $ +4a,i+$, ,&, ,/2a$a,54a73+, - *&$"a, $+ !$$ 'a, ,34i*i4a4i+$, !,340+ " 'a, 7"i"a,6& "2$ 0$!5 ,+2! 0+"+ 3a!a 4&2!i! a' 3a4i$0 i$,0!&7$0a'5 - "

,0a 7a$!a '+%!a! &$a 2a!!!a *i4a).R,340+ " ,& 4+73+,i4i#$5 'a 'i0!a0&!a !*i! 6& , &$a 7)4'a

" : " 4'&'+,a - : " 3+'i0i'$+ a'%&$a, *i!7a, " *a2!i4a$0,i73+!0a$0, a*i!7a$ 6& ,0+, 3!+"&40+, -a ,0/$ 'i2!, " 4'&'+,a5 '+6& vi0a 'a 0a'a " /!2+',5 a"7/, " 6& "i,7i$&- ' 3,+ - 'a 4a$0i>



$apítulo ;? :Ropa 4uir,r-ica 155

"a" " !,i"&+,5 '+ 4&a' 3!+v+4a &$ ,4a,+ ",3!$"i7i$0+ " *i2!a, -4+$0!a!!,0a 'a 3+,i2i'i"a" " i$*44i#$.

E$ ,0 ,$0i"+ , $4,a!i+ !Q<i+$a! $ 6&5 ,i 2i$ $+ 1a- &$a0a'a <4,iva " /!2+', 4+7+ !,&'0a"+ " 'a *a2!i4a4i#$ " ,0 0i3+ " 3!$"a,5 , 1a- &$ 4i!0+ %!a"+ " 4+$0a7i$a4i#$ 3+! ' 3+'i0i'$+ 6& ,&0i'i)a 3a!a 'a2+!a!'a,. A, 6& , i73+!0a$0 4+$,i"!a! 6& 'a, - '+,$*!7!+, 0a72i($ "2$ 4+73!+70!, a 1a4! &,+5 $ 'a 7"i"a " '+ 3+,i2'5 " 04$+'+%a, 6& $+ va-a$ $ "0!i+!+ "' 7"i+ a72i$0.Ha4!'+ a, ', 3!7i0 "a! &$ 4&i"a"+ 1+',0i4+5 -a 6& ,& 7a-+! 3!>+4&3a4i#$ 1+- "a "2 ,! $+ ,#'+ ' i$"ivi"&+5 ,i$+ 0a72i($ ' 4&i"a"+"' 7"i+ a72i$0 6& !+"a a 'a 3!,+$a.

La !+3a ",41a2' 3+! '+ %$!a' $+ , &0i'i)a $ 'a, i$,0i0&4i+$, ",a'&"5 ,+2! 0+"+ $ ' ,40+! 32'i4+ $ M(<i4+5 3&, , 4+$,i"!a 6&%$!a a'0+, 3!4i+,. Si$ 72a!%+5 , 1a$ +20$i"+ !*!$4ia, !,340+ "&$ a$/'i,i, " 4+,0+, " 'a !+3a 6&i!!%i4a ",41a2' $ 4+$0!a,0 4+$!+3a !&0i'i)a2' + " 0'a. E$ 9::?5 ' "+40+! Ji7($) Nava!!0 - ,&6&i3+ " 4+'a2+!a"+!, ''v# a 4a2+ $ &$ 1+,3i0a' $ E,3aa &$ ,0&>"i+ $ ' 4&a' , 4+$4'&-# 6& 9 " 'a !+3a ",41a2' , 7/, !$0a2'6& 'a " !&,+. N+ +2,0a$05 , "2 4+$,i"!a!5 ,%$ '+, a&0+!,5 6&,0 !,&'0a"+ 3&" va!ia! " a4&!"+ 4+$ 'a ,0!&40&!a5 *&$4i+$a7i$> 0+- a'%&$a, +0!a, 4a!a40!,0i4a, " '+, 4$0!+, 1+,3i0a'a!i+,.

+opa -uirr#i"a reutili=ale o e telaE$ 'a a40&a'i"a" <i,0$ !*!$4ia, "' ",a!!+''+ " &$a $+!7a &!+>

3a5 'a ;@?5 4&-+ 00&'+ 1a4 !*!$4ia a 'a, 2a0a,5 3a+, - 0!a, "

&0i'i)a4i#$ 6&i!!%i4a5 3a!a 3a4i$0,5 3!,+$a' 4'$i4+ - 6&i3+$ E$ ''a ,7$4i+$a$5 $0! +0!a, 4+,a,5 'a 0$"$4ia a ",a3a!4! " 7a$!a%!a"&a' 'a 3!,$4ia "' 7a0!ia' 0<0i' " a'%+"#$ "$0!+ "' 6&i!#*a$+5-a 6& ,0+ "i,7i$&- $ %!a$ 7"i"a 'a, i$*44i+$, "' ,i0i+ +3!a0+!i+6& !"&$"a$ $ 7$+!, 4+73'i4a4i+$, 3+,+3!a0+!ia, 3a!a ' 3a4i$0.

E$ M(<i4+5 $ ' Diario 7ficial de la )ederación 6& , 3&2'i4# $' 7, " $+vi72! " 9::@5 , 1a2'a " &$ 3!+-40+ " $+!7a PROY> NMX>A>::9>INNTEX>9::@5 $ ' 6& , ,0/ 0!a2aa$"+ a 3a!0i! ""i41+ a+ $ (' , 3!0$" ",4!i2i! 'a, $+!7a, - 4a!a40!,0i4a, 6&"2 4&73'i! ,0 0i3+ " !+3a - 6& 3+! ,&3&,0+ "2 $4a7i$a!,0a72i($ a !"&4i! ' &,+ " 7a0!ia', " 0'a " a'%+"#$ $ 'a, 2a0a,5,/2a$a,5 3a+, 6& ,+$ &0i'i)a"+, "&!a$0 &$a 4i!&%a 3a!a ' 3a4i$0 - '6&i3+ 6&i!!%i4+.




4uir,r-ica

A 3,a! " ,0a 0$"$4ia &$ %!a$ $7!+ " 4$0!+, 1+,3i0a'a!i+,4+$0i$a 1a4i$"+ &,+ " 'a !+3a 6&i!!%i4a !&0i'i)a2' + " 0'a5 3+! ''+

, 3!i7+!"ia' a2+!"a! a'%&$+, a,340+, a' !,340+. La, 2a0a,5 3a> +,5'i$)+, - 4a73+, 6&i!!%i4+, " 0'a5 "2$ 0$! 'a, ,i%&i$0, 4a>!a40!,0i4a,.

• D2$ ,0a! 141a, " a'%+"#$5 3+3'i$a5 'i$+5 4+$ &$a "$,i"a" "0i"+ " 9: - ;: 1i'+,7. •

I73!7a2'.• Fa2!i4a"a " 7a0!ia' 6& $+ 3!+"&)4a '40!i4i"a". •

A73'i+,5 3a!a *a4i'i0a! ' 7+vi7i$0+. • D&!a2',.• R,i,0$0 a ,&,0a$4ia, 6&7i4a,.• C+'+!, 0$&, 4+7+ ' a)&' + v!" 3a,0'5 ,0+ !"&4 *40+ " 'a

'&) 2!i''a$0 ,+2! 'a 0'a. • A2,+!2$0. • E4+$#7i4a.• F/4i' " 'i73ia! - 7a$i3&'a!.

:ulto -uirr#i"oU$ 2&'0+ 6&i!!%i4+ *i%&!a ;9>; , &$ 3a6&0 6& 4+$0i$ !+3a ">,41a2' + " 0'a5 ,0!i'i)a"+ 4+$ va3+! + 4+$ %a, " #<i"+ " 0i'$+

i#ura 121. 3ulto 4uir,r-ico.



$apítulo ;? : Ropa 4uir,r-ica 157

6& , &0i'i)a 3a!a 4!a! &$ 4i!4&i0+ ,0(!i'5 "&!a$0 'a 4i!&%a $0! ' 3a4i$05 'a 1!i"a 6&i!!%i4a - ' 3!,+$a' " ,a'&". S&, 4a!a40!,0i4a,,+$ 'a, ,i%&i$0,

• D+2' 4&2i!0a.• P,+ $+ 7a-+! a ?.? %.• N+ "2 0$! "i7$,i+$, 7a-+!, a : [ : [ ?: 47.• C+'+4a! ,i73! 4i$0a 0,0i%+ 'a 7a!4a $ $%!+ " ,0a 4i$0a i$"i4a

6& ' 2&'0+ 4&73'i# 4+$ ' 3!+4,+ " ,0!i'i)a4i#$.• R%i,0!+ " *41a - 0&!$+ " ,0!i'i)a4i#$.• S&*i4i$07$0 a&,0a"+ 3a!a 3!7i0i! 3!7a2i'i"a" a' va3+!.

E,0+, 2&'0+, 3&"$ 3!7a$4! a'7a4$a"+, 1a,0a 3+! : "a,5,i73! - 4&a$"+ ' 73a6& $+ 1a-a ,&*!i"+ !+0&!a, + 'a 4i$0a 0,0i%+ $+, $4&$0! 3!,$05 "2 4+'+4a!, $ ,i0i+, 'i73i+, - ,i$ 1&7> "a".

E' 2&'0+ " !+3a 6&i!!%i4a %&a!"a &$ +!"$ "0!7i$a"+ 3a!a vi> 0a! &$a <4,iva 7a$i3&'a4i#$ a 'a 1+!a " 4+'+4a! 'a !+3a a' 3a4i$0 -5 $4+$,4&$4ia5 3!"! ,& ,0a0&, " ,0!i'i)a"+.

Oren el ulto -uirr#i"oE$ 'a "iv!,i"a" " &$i"a", 1+,3i0a'a!ia, 0a72i($ , $4&$0!a &$a "i>

v!,i"a" $ 'a 7a$!a " 3!3a!a! '+, 2&'0+, " !+3a 6&i!!%i4a - va!ia>4i+$, " &$a i$,0i0&4i#$ a +0!a. Si$ 72a!%+5 $+ , "2 3!"! " vi,0a' 3!i$4i3i+ 2/,i4+ " a4+7+"a! 'a !+3a a 'a i$v!,a " 'a *+!7a $ 6& ,vi,0 a' 3a4i$05 , "4i!5 6& 'a ,/2a$a 1$"i"a5 7i,7a 6& , &0i'i)a a'*i$a'i)a! ' v,0i"+ "' 3a4i$05 , 'a 3!i7!a 6& , 4+'+4a 4&a$"+ ,,0/ a!7a$"+ ' 2&'0+ - a, " 7a$!a ,&4,iva 1a,0a 4+73'0a! 'a !+3a

$4,a!ia 3a!a ' 3!+4"i7i$0+.

+opa -uirr#i"a ne"e!ariapara ar*ar un ulto -uirr#i"o

3ataH41a " 0'a " a'%+"#$ + ",41a2'5 4+$ &$a a2!0&!a - 4i$0a, $ 'a

3a!0 3+,0!i+! 3a!a a$&"a!,5 4+$ ' 30+ + 341+ "+2'5 ''a7a"+ 7a!>,&3ia' 3a!a 6& 'a 0!a$,3i!a4i#$ $+ 3!7 'a 0'a5 4+$ 7a$%a, 'a!%a, - 3&+, '/,0i4+, 6& *a4i'i0a$ 4&2!i!'+, 4+$ '+, %&a$0,.




A&$6& , ,0!i'i)a 0+"a 'a 2a0a5 'a )+$a 6& 4&2! 'a ,3a'"a $+ ,4+$,i"!a ,0(!i'5 $i 3+! "2a+ "' $iv' " 'a 4i$0&!a &$a v) 6& , 1a4+'+4a"+.

A' 1a4! ' "+2'a"+ " ,0a 3!$"a *i%&!a ;9>9 ,i73! , "20$! 3!4a&4i#$ " 1a4!'+ 3+! ' !v(,5 4+$ '+ 6& , vi0a 6& a' 4+'+>4a!, 3i!"a ,& ,0!i'i"a".

SábanasS+$ 'a2+!a"a, " 0'a " a'%+"#$ + 4+$ 7a0!ia' ",41a2'.

S4#ana ene!trada o <endida. Ti$ 'a 4a!a40!,0i4a " 3+,! &$

+!i*i4i+ 4+$ ' 3!70!+ !*+!)a"+5 " 0a' 7a$!a 6& 3!7i0a &$a 7> +! 4&2i!0a "' ,i0i+ 6&i!!%i4+ - a' 7i,7+ 0i73+ ,i!va 3a!a a2,+!2! 0+"+0i3+ " Q&i"+, - '6&i"+, "&!a$0 &$a 4i!&%a *i%&!a ;9>.

S4#ana cerrada o de pie!. S &0i'i)a 3a!a 3!+0%! '+, 3i, "' 3a>4i$0 - , 4+'+4a a$0, " '+, 4a73+, 6&i!!%i4+,5 0i$ &$a, 7"i"a,a3!+<i7a"a, " 9.: [ 9.:: 75 ,& 4+'+4a4i#$ va!a " a4&!"+ 4+$ '%&,0+ "' 4i!&a$+.

S4#ana ce4lica. E, &$a ,/2a$a 4!!a"a *i%&!a ;9> - , &0i'i)a $

'a 3a!0 ,&3!i+! "' 3a4i$0 $ "i!44i#$ a 'a 4a2)a.

$ampos o compresas sencillasC+$*44i+$a"a, 4+7+ 0+"a 'a !+3a5 -a ,a " 0'a + ",41a2',5 , &0i>'i)a$ &,0+ $ ' 3!70!+ " 'a 1!i"a 6&i!!%i4a5 4+7+ 3!i7!+, + ,>%&$"+, 4a73+,. P+! '+ %$!a' ,+$ " ;.:: [ ;.:: 7.

$ampos o compresas doblesS 4+$*44i+$a$ 4+$ "+2' 0'a5 , &0i'i)a$ 3a!a $v+'v! i$,0!&7$0a'- !+3a5 '+ 6& 3!7i0 "a! &$a 7a-+! ,%&!i"a" a' 6&i3+ 4&a$"+ ,,+70 a 3!+4,+ " ,0!i'i)a4i#$ '+, 1a- " va!ia, 7"i"a, 6& va$"," ' ;.9: [ ;.9: 7 1a,0a '+, 9: [ 9: 475 "3$"i$"+ "' 7a0!ia'6& , 73a6&0a. E,0+, 4a73+, 0a72i($ ,+$ 0i', 3a!a v,0i! 'a, 7,a,a&<i'ia!,.

2unda de Ma#oS7a$0 a &$a *&$"a 4+7$ 3a!a a'7+1a"a5 3!+ 7/, 'a!%a - 4+$ &$a" ,&, 4a!a, " "+2' 0'a 3a!a !*+!)a! 'a 3!+044i#$ "' i$,0!&7$0a',0(!i' 6& , 7a$a $ 'a 7,a " Ma-+.




A

:

C

/



i#ura 122. !oblado adecuado de una bata.




i#ura 123. Sábana hendida.

$ompresas de esponear o de vientreC+$*44i+$a"a, 4+$ va!ia, 4a3a, " 0'a 4+$+4i"a 4+7+ 7a$0a " 4i>'+5 4+$ &$a 4i$0a $ &$+ " ,&, <0!7+,5 " 3!*!$4ia " 7a0!ia'

!a"i+3a4+5 3a!a ,& */4i' '+4a'i)a4i#$ ,i!v$ 3a!a a2,+!2! '+, '6&i"+, -Q&i"+, 6& , %$!a$ "&!a$0 'a i$0!v$4i#$ 6&i!!%i4a.

i#ura 124. Sábana cerrada.




/iver!o! ulto! e ropaD a4&!"+ 4+$ 'a 4i!&%a + 3!+4"i7i$0+ 6& 1a " *40&a!,5 '+, 2&'>

0+, " !+3a 6&i!!%i4a 0i$$ a'%&$a, va!ia4i+$,.

3ulto de ropa para ciru-ía menor• ; 4a73+ "+2' ;.9: [ ;.9: *&$4i+$a 4+7+ $v+'0&!a.• ; 4a73+ ,$4i''+ : [ : 47.• ; ,/2a$a 1$"i"a + *$,0!a"a.• 4a73+, ,$4i''+, ;.9: [ ;.9: 7.

• 2a0a, 6&i!!%i4a,.

3ulto de ropa para ciru-ía ma#or• ; 4a73+ "+2' ;.9: [ ;.;: 7 *&$4i+$a 4+7+ $v+'0&!a.• ; ,/2a$a 4!!a"a 4&2! 'a 7,a " !i#$ + !40a$%&'a!.• 9 4a73+, ,$4i''+, : [ : 47.• 4a73+, ,$4i''+, ;.9: [ ;.9: 7.• ; ,/2a$a " 3i,.

• ; *&$"a " Ma-+ 3a!a 4&2!i! 'a 7,a " Ma-+.• ; ,/2a$a 1$"i"a + *$,0!a"a.

E' $7!+ " 4a73+, ,$4i''+, 6& 4+$0i$ &$ 2&'0+ ,0/ $ *&$>4i#$ "' 0i3+ " 4i!&%a. E$ ' 6&i!#*a$+ " $&!+'+%a "' H+,3i0a' G>$!a' " M(<i4+5 3+! 73'+5 ,&'$ &0i'i)a!, 7/, " '+, 6& ,0/$ 4+$>0$i"+, $ ' 2&'0+ ",4!i0+.

La, 2a0a, 6&i!!%i4a, 0a72i($ , 7a$a$5 4+$ *!4&$4ia5 $ 2&'0+,a3a!05 3!+ $+ , "2 ",4a!0a! ' $4+$0!a! 2&'0+, $ '+, 6& -a ,$4&$0!$ i$0%!a"a,.

3ulto de ropa para parto• ; 4a73+ "+2' ;.9: [ ;.9: 7 *&$4i+$a 4+7+ $v+'0&!a.• ; ,/2a$a %i$4+'#%i4a 4+$ "+, 3i!$!a, - &$a *$,0!a4i#$ $0!

''a,.• ; 2a0a 6&i!!%i4a.

L+, 2&'0+, " !+3a ",4!i0+, ,+$ '+, 2/,i4+, $+ , "2 +'vi"a! 6&a 3a!0i! " ,0+, 2&'0+, , 1a4$ 'a, 7+"i*i4a4i+$, 3!0i$$0, !,340+"' 4+$0$i"+ - $ *&$4i#$ " 'a ,34ia'i"a" 6&i!!%i4a " 'a 4&a' , 0!a0.




T<"ni"a para "olo"a"ine la ropa el pa"ienteLa 4+'+4a4i#$ " !+3a ,0(!i' a' 3a4i$0 ,/2a$a, - 4a73+, !a"i4a $ 'a4+7+"+ +!"$a"+ " '+, 7i,7+, 4+$ ' +20iv+ " ,0a2'4! &$ /!a,0(!i' 6& ,i!va 4+7+ 2a!!!a - " ,0a 7a$!a 3!+0a5 $ 'a 7"i"a "'+ 3+,i2'5 a' 3a4i$0 " &$a 3+0$4ia' 4+$0a7i$a4i#$ " 'a 1!i"a6&i!!%i4a.

La !+3a "2 4+'+4a!'a ' 4i!&a$+ !,3+$,a2' - ' 3!i7! a-&"a$> 05''%a$"+ a 3a!0i4i3a!5 $ +4a,i+$,5 'a $*!7!a i$,0!&7$0i,0a5 "

a4&!"+ 4+$ 'a )+$a "+$" , va a *40&a! 'a i$4i,i#$5 !,30a$"+ ,i7> 3! 'a, $+!7a, " 'a 0(4$i4a a,(30i4a.

A' 4+'+4a! 'a !+3a , 3!4i,+ 0$! ,34ia' 4&i"a"+ $ 1a4! ' 7>$i7+ " 7+vi7i$0+,5 3&, , $4&$0!a ,0!a0(%i4a7$0 "+2'a"a5 -a ,a$ *+!7a " a4+!"#$5 3+! 7i0a", - 4+$ !*!$4ia, 6& 3!7i0$ ,a2! 4+$ a$0i4i3a4i#$ 'a *+!7a 4+!!40a " 0+7a!'a "' 2&'0+. D ,0a 7a$!a ,vi0a &$a 7a$i3&'a4i#$ <4,iva "&!a$0 ' 3!+4"i7i$0+ 6&i!!%i4+ -, i73i" 6& ",3!$"a 3'&,a 6& , "i,3!, - , 4+$> vi!0a $ &$a

*&$0 " 4+$0a7i$a4i#$.E$ '+, 3!+4"i7i$0+, 3a!a 4i!&%a %$!a' 'a !+3a , 4+'+4a 3+! '+

!%&'a! " 'a ,i%&i$0 7a$!a

;. Pa!a 4+'+4a! 'a !4#ana pod4lica + " 3i,5 "2 0+7a!, 4+$ a7> 2a, 7a$+,5 4+$ 'a i$0$4i#$ " &2i4a! 4+$ !a3i") 'a 3a!0 7"ia 3+!"+$" , $4&$0!a "+2'a"a5 , +*!4 &$ <0!7+ a' 4i!&a$+ - '+0!+ '+ 0+7a ' 3!i7! a-&"a$0 + 2i$ 'a $*!7!a 'a ,/2a$a ,4+'+4a $ 'a 3a!0 i$*!i+!5 a' 2+!" "' ,i0i+ "' /!a a i$4i"i!5

1a4i$"+ &$ 3'i%& + !*!$4ia 1a4ia a"$0!+5 "a$"+ 4a! ,&,<0!7+, a '+, 'a"+,.

9. C&a$"+ , 4+'+4a$ capo! $ a2"+7$5 0#!a< + ,3a'"a5 , "2$0+7a! 3+! 'a !*!$4ia - 4+$ ,0a 7i,7a5 'a $*!7!a 6& i$,0!&>7$0a 3!+0% ,&, %&a$0,5 "a$"+ &$ 36&+ %i!+ a ,&, 7&4a, 3a!a 6& a' 7+7$0+ " +*!4! ' 4a73+ a' 4i!&a$+ $+ 1a%a$ 4+$>0a40+ %&a$0 4+$ %&a$0 *i%&!a ;9>?. E, i73+!0a$0 !4+!"a! 6& ,4+'+4a$ 4&a0!+5 "+, a '+, 'a"+, 3!+<i7a' - "i,0a'5 &$+ $ "i!4> 4i#$4*/'i4a - 3+! '0i7+ &$+ $ "i!44i#$ 3+"/'i4a.

. La !4#ana ene!trada , 4+'+4a 0+7a$"+ 'a, 7i,7a, 3!4a&4i+$,6& 4+$ 'a ,/2a$a 4!!a"a + " 3i,5 &2i4a$"+ 'a *$,0!a4i#$ &,0+$ ' ,i0i+ " i$4i,i#$ *i%&!a ;9>.




i#ura 125. Manera correcta de ofrecer el campo al ciruano.

. P+! '0i7+5 , 4+'+4a$ copre!a! de e!pon=ear + " vi$0! $ '+, 2+!", "' ,i0i+ a i$4i"i!5 &$a a 4a"a 'a"+.

D ,0a 7a$!a , *i$a'i)a 4+$ ' 3!+0+4+'+ 3a!a 'a v,0i7$0a "' 3a4i$0 - , 3!+4" a i$i4ia! 'a 4i!&%a 3!+3ia7$0.

Colo"a"in e ropa en extre*iae!?!uperiore! o in)eriore!@E' a-&"a$0 + 2i$ 'a $*!7!a i$,0!&7$0i,0a ,+$ !,3+$,a2', " 6&

'a <0!7i"a" $ 4&,0i#$ "' 3a4i$0 , 7a$0$%a 'va"a. S 4+'+4a&$a ,/2a$a 4!!a"a + 3+"/'i4a 3+! a2a+ "' 3a4i$0 - , "a 4a! 4+$

,&avi"a" 'a <0!7i"a"5 ",3&(, , 4+'+4a &$ 4a73+ i$*!i+! - +0!+ ,&> 3!i+!5 " 0a' 7a$!a 6& 'a <0!7i"a" 6&" !+"a"a 3+! '+, 4a73+,57i,7+, 6& , *ia$ 4+$ 3i$)a,. S 3&" 4&2!i! 'a <0!7i"a" 4+$ +0!+4a73+ - 4+'+4a! &$a v$"a ,0(!i'5 3+! '0i7+ , 3a,a 'a <0!7i"a" a0!av(, " 'a a2!0&!a " 'a ,/2a$a 1$"i"a. D ,0a 7a$!a , 3&" "a!i$i4i+ a 'a i$0!v$4i#$ 6&i!!%i4a.

Colo"a"in e ropa para "iru#ía

e "ae=a "uelloS 4+'+4a &$a ,/2a$a 3+"/'i4a a' 2+!" "' ,i0i+ a i$4i"i! 1a4i$"+ &$

3'i%& + !*!$4ia 4+$ 'a 7a$+ 1a4ia a"$0!+. La $*!7!a i$,0!&>





$apítulo ;? :Ropa 4uir,r-ica 165

'a 2a, "' 0!i/$%&'+ - "+, $ ' v(!0i4 "' 0#!a<5 &$+ a 4a"a 'a"+. S4+$0i$a 4+$ 'a 4+'+4a4i#$ " 'a ,/2a$a 1$"i"a - , 3!+4" a 'a i$0!>

v$4i#$ 6&i!!%i4a.

Colo"a"in e ropa para "iru#ía#ine"ol#i"aU$ 3&$0+ i73+!0a$0 6& "2 7a$0$!, $ 7$0 a' i$i4ia! , 6&5 $

,0 4a,+5 ' 3a4i$0 , $4&$0!a $ 3+,i4i#$ " 'i0+0+7a5 7i,7a 6& -a

, ",4!i2i# 4+$ "0a'' $ 4a30&'+, a$0!i+!,.S 3!+4" a 'a 4+'+4a4i#$ " &$ 4a73+5 4+$ &$a !*!$4ia 6&

3!7i0a 4&2!i! '+, %&a$0, "' 4i!&a$+ - 6& (,0 '+ 3&"a 4+'+4a! 3+!"2a+ " 'a )+$a %'0a "' 3a4i$0. S 4+'+4a &$a ,/2a$a 4*/'i4a +4!!a"a a 3a!0i! " 'a ,$*i,i, "' 3&2i, 3a!a 4&2!i! a2"+7$ - 0#!a<.

E$0+$4, , "i,3+$ 'a ,/2a$a %i$4+'#%i4a5 0+7a$"+ 'a, 7a-+!, 3!4a&4i+$, 3a!a vi0a! 4+$0a7i$a4i#$ a' i$0!+"&4i! '+, 7i72!+, i$>*!i+!, a 'a, 3i!$!a,5 4&i"a$"+ 6& 'a *$,0!a4i#$ " 'a ,/2a$a 6&"

,i0&a"a $ 'a !%i#$ %$i0a'.La, 0(4$i4a, ",4!i0a, $+ ,+$ 'a, $i4a, 6& <i,0$5 3!+ , 'a, 2/>

,i4a,5 " 7+"+ 6& 'a, $*!7!a, i$,0!&7$0i,0a, 'a, "2$ 4+$+4! a 'a 3!*44i#$5 3&, ''+ ', 3!7i0 a$0i4i3a! ,&, i$0!v$4i+$, "&> !a$0 'a4i!&%a. Ca2 !*!i! 6& 'a 0(4$i4a 3a!a 'a 4+'+4a4i#$ " 'a !+3a "3$"$ %!a$ 7"i"a "' 0i3+ " 4i!&%a -5 $ 4+$,4&$4ia5 <i,0$ va!ia4i+$,.Ta72i($ +2"4 $ 7&41+ a 'a, 3!*!$4ia, "' 4i!&a$+ !,3+$,a2'.

repara"in e lo! ulto! e ropaCa2 a1+!a $*a0i)a! 'a i73+!0a$4ia 6& 0i$ &$a 4+!!40a 3!3a!a4i#$ "'+, 2&'0+, " !+3a 6&i!!%i4a5 -a 6& " $+ %&a!"a! ' +!"$ a"4&a> "+<i,0 'a 3+,i2i'i"a" " 6& ' i$i4i+ " 'a 4i!&%a , 4+$vi!0a $ &$v!"a"!+ 4a+,5 7i,7+ 6& !3!4&0i!a $ &$ 7a-+! 0i73+ 6&i!!%i4+ - 3+$"!a $ !i,%+ a' 3a4i$0. Ta72i($ , ,0a!a$ i$vi!0i$"+ 7a-+!,

!4&!,+, 0a$0+ 1&7a$+, 4+7+ 7a0!ia', $ &$ 7i,7+ 3!+4"i7i$0+. P+! '+ a$0!i+! , $4,a!i+ 6& ' 3!,+$a' a,i%$a"+ e/ profeso 3a!a 'a'a2+!a4i#$ " '+, 6&i3+, - 2&'0+, " !+3a 6&i!!%i4a ,i%a 'a, ,i%&i$0,i$"i4a4i+$, *i%&!a, ;9>@ - ;9>.




A

:

C

/

i#ura 127. Armado de un bulto de batas.




A

:

C

i#ura 128. Armado de un bulto de ropa.

+e"o*ena"ione!• C&2!i! ' 3'+ 4+$ %+!!+ + 0&!2a$0.

• U0i'i)a! 4&2!2+4a,.• Lava!, 'a, 7a$+,5 3!vi+ a 'a 'a2+!a4i#$ " '+, 2&'0+,.• N+ 4+$,&7i! $i$%$ 0i3+ " a'i7$0+ + 22i"a $ 0a$0+ , 1a4 'a

3!3a!a4i#$ " '+, 2&'0+,.• S'44i+$a! 'a !+3a5 v!i*i4a! 6& $+ 0$%a !+0&!a,5 7a$41a, + ,

$4&$0! ",%a,0a"a.




• R0i!a! " 'a !+3a 0+"+ 0i3+ " 3'&,a - !,0+, " 4i$0a, a"1,iva,.• V!i*i4a! 6& 'a !+3a , $4&$0! ,4a 3+! 4+73'0+5 a$0, " a!7a!

'+, 2&'0+,.

• Evi0a! 6& , 4ai%a + 0i!a!'a a' ,&'+5 $ 4a,+ " ,! a, "2!/ $via!>, $&va7$0 a' 4i4'+ " 'ava"+.

• A,%&!a!, " "a! ,i73! &$a !*!$4ia vi,i2'5 ,0+ *a4i'i0a ,&7a$+ $ ' 4a73+ 6&i!!%i4+5 - vi0a 6& , 4+$0a7i$.

• C+'+4a! 4i$0a 0,0i%+ $ 'a $v+'0&!a <0!$a i$0!$a.• C+'+4a! 0a!0a + !#0&'+ i$"i4a$"+ ' 4+$0$i"+ "' 2&'0+ - *41a "

,0!i'i)a4i#$.• U0i'i)a! ,i73! 4a73+, "+2', 3a!a $v+'v! '+, 6&i3+, " !+3a

i$,0!&7$0a'.• A$&"a! '+, 2&'0+, *i!77$05 ,0+ vi0a 6& ' 6&i3+ 3i!"a ' +!>

"$5 3!+ ,+2! 0+"+ 6& 3i!"a ,& ,0!i'i"a".• C+$0a! 4+$ &$ 7a$&a' " 3!+4"i7i$0+ 3a!a a!7a! ' 2&'0+ "

!+3a 6&i!!%i4a.

E' 4&a"!+ ;9>; 7&,0!a 'a, 7"i"a, a3!+<i7a"a, " 'a !+3a 6&i!!>%i4a5 a&$6& "2 0$!, $ 4&$0a 6& va!a$ " i$,0i0&4i#$ a i$,0i0&>

4i#$5 $ 0a$0+ $+ , 7i0a &$a $+!7a +*i4ia' 6& !%&' ,& 'a2+!a4i#$.

Cla!i)i"a"in e la ropa !u"iaU$a v) 6& , 1a 4+$4'&i"+ 'a 4i!&%a , "2 0$! ,34ia' 4&i"a"+ $' 7a$+ " 'a !+3a5 ,+2! 0+"+ 4&a$"+ , 0!a0a " 4i!&%a, a'0a7$04+$0a7i$a"a,5 3+! '+ 6& , !4+7i$"a a%!&3a!'a, " a4&!"+ 4+$ '!i,%+ " 4+$0a7i$a4i#$.

Cuaro 121. Medidas apro(imadas de la ropa 4uir,r-ica.

Ropa 4uir,r-ica

Sábana simple

$ampos dobles

2unda de Ma#o

Sábana

hendida

Sábana de

riJón

$ampos sencillos

Medidas apro(imadas

? [ ;.B m

; [ ; m% NB [ NB cm

; [ DB cm

?.B [ ?.B m

?.B [ ;.I m

; [ ; m% NB [ NB cm






• 3lto rie!go. T+"a !+3a 6& , 1a-a i73!%$a"+ " Q&i"+, 4+!3+!a>', " 3a4i$0, 4+$ $*!7"a", i$*40+4+$0a%i+,a,.

• &ediano rie!go. R+3a 6& , 1a-a i73!%$a"+ " Q&i"+, 4+!3+!a>

', " 3a4i$0, 6& $+ *&!+$ "ia%$+,0i4a"+, " a'%&$a $*!7> "a"i$*40+4+$0a%i+,a.

• Ba=o rie!go. R+3a 6& $+ , i73!%$# 4+$ '6&i"+, - Q&i"+, 4+!> 3+!a',5 3+! '+ %$!a' , 'a !+3a 6& , &0i'i)a "&!a$0 ' 'ava"+74/$i4+ - 'a a,3,ia5 a, 4+7+ 'a 6& &0i'i)a ' a$,0,i#'+%+ 3a!a,&, 3!+4"i7i$0+,.

E' 3!,+$a' " $*!7!a 0i$ 'a !,3+$,a2i'i"a" " v!i*i4a! 6& 'a

!+3a , ,3a! a"4&a"a7$05 ,+2! 0+"+ 3a!a vi0a! i$*44i+$, 4!&>)a"a, "2 ,0a! 7&- a0$0+ 3a!a 6& ' 3!,+$a' " i$0$"$4ia 1a%a ,0a,3a!a4i#$ - 0!a$,3+!0a4i#$ a"4&a"a " 'a !+3a. La !+3a , "2"3+,i0a! $ 2+',a, " 3'/,0i4+5 " 3!*!$4ia5 - ,''a"a, "2i"a7$0 3a!a vi0a! 'a "i,7i$a4i#$ " 7i4!++!%a$i,7+,5 " i%&a' 7a$!a "20!a,'a"a!, a' '&%a! " ,& ",0i$+ *i$a' $ 4a!!+, 4!!a"+,.

La 3'a$a4i#$ - 3!+%!a7a4i#$ " 4a"a a40+ 6&i!!%i4+ !3!,$0a &$a%!a$ !,3+$,a2i'i"a" 3a!a 'a, $*!7!a, 6& 3a!0i4i3a$ $ ' 7i,> 7+5

3!+ 0a72i($ "2 !3!,$0a! &$a +3+!0&$i"a" 3a!a !4! 0+"+, ,&,4+$+4i7i$0+,5 1a2i'i"a", - ",0!)a, $ 3+, " +0+!%a! ' 7a-+! 2$*i4i+ a' 3a4i$05 6& , 'a !a)#$ " ,! - ,0a! " 4a"a $*!7!a $&$ 6&i!#*a$+. E$ vi,0a " 0+"+ ''+5 $+ "2 7i$i7i)a!, 'a i73+!0a$4ia" 'a 3!3a!a4i#$ " 'a !+3a 6&i!!%i4a.

:ilio#ra)ía

G&!!!+ S J&v$0i$a. Manual Enfermera Circulante5 E"i4i+$, C&(''a!5G&a"a'aa!a5 Ja'i,4+5 M(<i4+5 ;@5 3. ;;.

J+a$$a R&01 F&''!. #nstrumentación 8uir'r(ica5 a ".5 E"i0+!ia' Pa$>a7!i4a$a5 M(<i4+5 &'i+ 9::5 3. @9:.

P!+-40+ " N+!7a O*i4ia' M<i4a$a 3&2'i4a"+ $ ' Diario 7ficial de

la )ederación ' 9@ " $+vi72! " 9::@ PROY>NMX>A>::9>INNTEX>9::@.

N+!7a E&!+3a A!7+$i)a"a ;@? $4+$0!a"a $ 1003,a'&"3!v$0iva.4+72i$"<.313^3a%i$ab!4c!+3a6&i!&!%i4a.107'4+7a$"+b",c!4+7$"a4i+$,



$apítulo

"

$D!

*I1

*T+

TE7

17




7ransoperatorio mediato

La3,+ 6& 4+!!,3+$" a' 7+7$0+ $ 6& ' 3a4i$0 , !4i2i"+ $ '0!a$,*! 3+! 'a $*!7!a 4i!4&'a$0 - 4+$4'&- 1a,0a 6& , !a'i)a 'ai$4i,i#$.

7ransoperatorio inmediatoI$i4ia "," 6& , !a'i)a 'a i$4i,i#$5 1a,0a 6& , "a"+ ' '0i7+ 3&$0+" ,&0&!a5 3a!a ' 4i!! " 'a 1!i"a 6&i!!%i4a.

o!operatorioT!a$,4&!! "," 6& ' 3a4i$0 ,a' " 'a ,a'a - ''%a a 3i,+ & 1+,3i0a'i>

)a4i#$. La $*!7!a !a'i)a &$a ,!i " a44i+$, $4a7i$a"a, a 6& ' 3a4i$0 !4&3! ,& *&$4i#$.

*osoperatorio mediato

La3,+ 6& va "," 6& ' 3a4i$0 a2a$"+$a 'a ,a'a 6&i!!%i4a - 3!>7a$4 $ ' /!a 2'a$4a !4&3!a4i#$ + 3+,+3!a0+!i+ 1a,0a 6& ,"4i" ,& 0!a,'a"+ a 3i,+ & 1+,3i0a'i)a4i#$5 0+"a v) 6& ,&, 4+$,0a$0,vi0a', , $4&$0!$ ,0a2',.

*osoperatorio inmediatoD&!a$0 ,0 3!i+"+ ' 3a4i$0 , 0!a,'a"a"+ a 3i,+ & 1+,3i0a'i)a4i#$5 3a!a " a1 ,! "a"+ " a'0a &$a v) 6& , +2,!v *!a$4a !4&3!a4i#$.

E$ 4&a'6&i!a " '+, 0!, 7+7$0+, ",4!i0+,5 'a $*!7!a 0i$ &$a0!a,4$"$0a' 3a!0i4i3a4i#$ 3a!a 'a 3!3a!a4i#$ "' 3a4i$0 6& , ,+70a 4i!&%a.

&n)er*ería -uirr#i"aE$ ' 1+,3i0a' 7+"!$+ 'a $*!7!a , 1a 4+$v!0i"+ $ &$ '7$0+i73!,4i$"i2' "2i"+ a 6& 4++!"i$a - "i!i% 0i73+, - 7+vi7i$0+, "0+"a 'a ,0!&40&!a 1+,3i0a'a!ia. E$ ,34*i4+ "$0!+ "' /!a 6&i!!%i4a0i$ a ,& 4a!%+ $+ ,#'+ ' 4+$0!+' " &$a "iv!,i"a" " 3!,+$a' 3!+>*,i+$a'5 0(4$i4+ - a"7i$i,0!a0iv+ 4+$ i73+!0a$0, *&$4i+$, a'!""+! "' 3a4i$0 , ''a 6&i$ i$0!vi$ !,340+ " ,& 7a$+5 -a ,a " 7a$!a"i!40a + i$"i!40a "&!a$0 ,0+, 0!, 7+7$0+, *&$"a7$0a',



$apítulo ;C : 2unciones de la enfermera circulante 173

, 'a $4a!%a"a " 4&i"a! " 7a$!a 4+$0i$&a - 3!7a$$0 a' i$"ivi"&+6& , ,+70 a 4i!&%a. E$ 4+$,4&$4ia5 ,+$ 'a, a44i+$, i$0!v$>4i+$, " 'a $*!7!a 'a, 6& "0!7i$a$ ' 4+!!40+ 4&!,+ " &$a i$>

0!v$4i#$ 6&i!!%i4a - " ,0a 7a$!a , 4+$vi!0 $ %a!a$0 " &$aa0$4i#$ " 4a'i"a".

E, 3+,i2' $0+$4, "*i$i! 6& &$a $*!7!a 6&i!!%i4a *+!7a 3a!> 0"' 3!,+$a' " ,a'&" 3!+*,i+$a' 4+$ 3!+%!,iva <i%$4ia " ,0&"i+, ",34ia'i)a4i#$5 6& !4i2i# &$a i$,0!&44i#$ a4a"(7i4a 4+$4!0a "' /!a$ 4&,0i#$. E, &$a 3!+*,i+$a' 6& 0i$ 4+7+ 3!i7+!"ia' !,3+$>,a2i'i"a" !4! &$ 4!i0!i+ a$a'0i4+ - 3!+3+,i0iv+ 3a!a 3+"! 3!+-40a!'a, +2,!va4i+$, 6& 4+$,i"! 4+$v$i$0, a' !,340+ " ,&, *&$4i+>

$, "3$"i$0, i$0!"3$"i$0,5 7a$0i$ &$a 4+$0i$&a i$6&i0&"i$0'40&a'5 " i$v,0i%a4i#$ - 3a!0i4i3a4i#$ $ "iv!,a, a40ivi"a", 4i$>0*i4a, "2 ,0a! ,i73! 4+$,4i$0 " 6& ,& ",73+5 ,& ,0!i40a"i,4i3'i$a - 4+$4i$4ia 6&i!!%i4a ,+$ 'a 4'av "' (<i0+ -5 ,+2! 0+"+5 "'a ,%&!i"a" $ &$a 4i!&%a. E' +20iv+ 4+7$ " 'a $*!7!a , 3!+> 3+!4i+$a! &$ 4&i"a"+ *i4i$05 7a$0$i$"+ 'a, 4+$"i4i+$, a,(30i4a,i"a', $ 0+"+ 7+7$0+. E, &$ /!a " 'a $*!7!a 6& 4+73!$" 'aa,i,0$4ia a$0,5 "&!a$0 - ",3&(, " 'a 4i!&%a 3!i+3!a0+!i+ $ 'a 6&

, a3'i4a$ - !a'i)a$ 0(4$i4a, - 3!+4"i7i$0+, ,34*i4+, $ 'a, "i>*!$0, ,34ia'i"a", 4i!&%a %$!a'5 +!0+3"ia5 +0+!!i$+'a!i$%+'+%a5+*0a'7+'+%a5 $0! +0!a,.

Cara"terí!ti"a! e la en)er*era -uirr#i"a• G!a$ !,i,0$4ia *,i4a - 7$0a'.

• B&$a ,a'&".

• Sa2! 0!a2aa! 2a+ 3!,i#$.• D2 ,! a2i!0a - Q<i2'.• S#'i"a *+!7a4i#$.• Ca3a4i"a" " &i4i+ 4!0i4+ - a$a'0i4+.• Ha2i'i"a" - ",0!)a 0(4$i4a.• A'0+ $iv' (0i4+.• Ca3a) " 2!i$"a! 2&$ 0!a0+ - " ,0a! 4+$,4i$0 " 'a, $4,i"a",

i$7"ia0a, "' 3a4i$0.

• C+$+4! a 'a 3!*44i#$ 'a, $+!7a, " ,%&!i"a".• C+$+4! a,340+, '%a', 6& i73'i4a ' 0!a2a+ $ &$ 6&i!#*a$+.• T!a2a+ $ 6&i3+.• B&$a, !'a4i+$, i$0!3!,+$a',.








4uir,r-ica

>#=etio 2• E' 6&i3+ &0i'i)a!/ 7(0+"+, 6& ,a2 6& 3!vi$$ '+, "a+, 6& ,

"!iva$ " 'a a"7i$i,0!a4i#$ " 'a a$,0,ia5 a' 0i73+ 6& 3!+0%$a' 3a4i$0 "' "+'+!.

>#=etio • E' 6&i3+ , 3!3a!a!/ 4+$ *i4a4ia 3a!a ' 4a,+ " 6& , 3!+"&)4a

&$a 3(!"i"a " 'a *&$4i#$ !,3i!a0+!ia + "' a44,+ a 'a va a(!a5 -!4+$+4!/ ,a, ,i0&a4i+$,.

>#=etio A

• E' 6&i3+ , 3!3a!a!/ 3a!a ' 4a,+ " 6& , 3!+"&)4a &$a 3(!"i"a4+$,i"!a2' " ,a$%!5 - !4+$+4!/ ,a, ,i0&a4i+$,.

>#=etio 5• E' 6&i3+ vi0a!/ 3!+v+4a! !a44i+$, a'(!%i4a, + !a44i+$, a"v!>

,a, a */!7a4+, 6& , ,a2 6& ,&3+$$ &$ !i,%+ i73+!0a$0 3a!a ' 3a4i$0.

>#=etio 6• E' 6&i3+ &0i'i)a!/ ,i,07/0i4a7$0 7(0+"+, !4+$+4i"+, 3a!a 7i>

$i7i)a! ' !i,%+ " i$*44i#$ " 'a 1!i"a 6&i!!%i4a.>#=etio 7• E' 6&i3+ vi0a!/ "a! 3+! a44i"$0 %a,a, + i$,0!&7$0+, $ 'a 1>

!i"a 6&i!!%i4a.>#=etio 8

• E' 6&i3+ %&a!"a!/ i"$0i*i4a!/ 4+$ 3!4i,i#$ 0+"a, 'a, 7&,0!a,6&i!!%i4a,.

>#=etio 9

• E' 6&i3+ , 4+7&$i4a!/ 4+$ *i4a4ia i$0!4a72ia!/ i$*+!7a4i#$*&$"a7$0a' ,+2! ' 3a4i$0 3a!a 6& 'a +3!a4i#$ , ",a!!+'' "7a$!a ,%&!a.

>#=etio 10• L+, 1+,3i0a', - ,i,07a, " ,a'&" 32'i4+, ,0a2'4!/$ &$a vi%i>

'a$4ia ,i,07/0i4a " 'a 4a3a4i"a"5 ' v+'&7$ - '+, !,&'0a"+, 6&i>!!%i4+,.

Ta', +20iv+,5 a' i%&a' 6& va!i+, " '+, 4a30&'+, 4+$0$i"+, $

' 3!,$0 7a$&a'5 1a4$ 4+$,0a$0 !*!$4ia a' 0!a2a+ 6& !a'i)a '6&i3+ " ,a'&"5 4+7+ ' 7("i4+5 'a $*!7!a5 a$,0,i#'+%+,5 a"7i$i,>0!a0iv+,5 04.5 4a"a &$+ " ''+, ,$4ia', 3a!a ' (<i0+ " 'a 4i!&%a5 -a6& $+ , "2 +'vi"a! 6& a' *i$a' " &$a +!$a"a " 0!a2a+5 'a !,3+$>,a2i'i"a" a' i%&a' 6& ' 0!a2a+ , 4+73a!0i"a.




un"ione! e la en)er*era-uirr#i"aLa *&$4i#$ " 'a $*!7!a 6&i!!%i4a $+ , 'i7i0a a 'a, a40ivi"a", "!&0i$a "$0!+ " 'a ,a'a 6&i!!%i4a5 0i$ !,3+$,a2i'i"a", $ ' /!a 3!+3!a0+!ia5 ,a'a " !4&3!a4i#$ + 3+,+3!a0+!i+5 4$0!a' " 6&i3+, -,0!i'i)a4i#$ CEYE - /!a " 'ava"+ " i$,0!&7$0a'5 $0! +0!a,.

D2i"+ a '+ a$0!i+! , 6& $+ 1a- 6& 3!"! " vi,0a 6& i$"> 3$"i$07$0 "' !+' 6& ' 0+6& a,&7i!5 -a ,a $ 'a CEYE5 4+7+$*!7!a 4i!4&'a$05 i$,0!&7$0i,0a5 ,a'a " !4&3!a4i#$5 04.5 ,i73!

"2 !a'i)a! ,&, a40ivi"a", $ 6&i3+5 " ,0a 7a$!a 3!+3i4ia &$ !i0>7+ " 0!a2a+ 7/, !/3i"+ - 4++!"i$a"+5 4+$,i%& +30i7i)a! '+, 0i73+, -5$ 4+$,4&$4ia5 , '+%!a &$ 7+! 0!a0a7i$0+ 3a!a ' $*!7+ 4+$a*44i+$, 6&i!!%i4a,.

La *&$4i#$ 6& ' 4+!!,3+$"a ",73a! ,!/ a,i%$a"a 3+! 'a$*!7!a *a "' ,!vi4i+5 -a 6& , ''a 6&i$ , $4a!%a " 1a4! 'a"i,0!i2&4i#$ "' 0!a2a+ " a4&!"+ 4+$ ' $7!+ " 4i!&%a,5 "i,3+>$i2i'i"a" " 'a, ,a'a,5 3!+5 ,+2! 0+"+5 ,%$ 'a, 1a2i'i"a", - ",0!)a,

"' 3!,+$a'.A 4+$0i$&a4i#$ , ",0a4a 'a 3a!0i4i3a4i#$ " 'a $*!7!a "$0!+ "

'a ,a'a 6&i!!%i4a5 6& , 4$0!a $ "+, *&$4i+$, ,34*i4a,5 &$a 4+7+$*!7!a i$,0!&7$0i,0a - 'a +0!a 4+7+ $*!7!a 4i!4&'a$0. A72a,*&$4i+$, ,+$ !,3+$,a2i'i"a" - 'a, 3&" ",73a! &$a $> *!7!a6&i!!%i4a $ 7+7$0+, "i*!$0,.

&n)er*era "ir"ulanteLa 3a'a2!a 4i!4&'a! ,i%$i*i4a a$"a! + 7+v!, a'!""+! "5 i!5 v$i!5

4+!!! + 3a,a! &$a 4+,a " &$a, 3!,+$a, a +0!a,. E$ ,0 ,$0i"+ , 6& '0!a2a+ " 'a 4i!4&'a$0 , ",a!!+''a "$0!+ " 'a ,a'a 6&i!!%i4a.

La $*!7!a 4i!4&'a$0 ,5 $0+$4,5 'a $4a!%a"a " 3!+v! 7a>0!ia' - 6&i3+ $4,a!i+ a$0,5 "&!a$0 - ",3&(, "' a40+ 6&i!!%i4+ 3!+3ia7$05 a,i,0 " 7a$!a 3!7a$$0 a' 6&i3+ 6& , 4+$,i"!a,0(!i'5 ''va$"+ - 0!a-$"+ '+, ,&7i$i,0!+, $4,a!i+, - '+, 6& , ,+'i>

4i0$5 , $4a!%a 0a72i($ " 4!a! - 7a$0$! &$ 7"i+ ,%&!+ 3a!a '",a!!+''+ " 'a 4i!&%a. E, &$ $<+ " 4+7&$i4a4i#$ $0! ' 6&i3+ 6&i>!!%i4+ 4+$ ' !,0+ " '+, ,!vi4i+, " 'a &$i"a" 6&i!!%i4a - "' 7i,7+1+,3i0a'. D2 4+$0!+'a! - 4++!"i$a! 'a 7a-+!a " 'a, a40ivi"a", "$0!+




4uir,r-ica

" 'a ,a'a &$a $*!7!a 4i!4&'a$0 *40iva , a,%&!a " "i,3+$!5 4+$a$0i4i3a4i#$5 " '+, a!04&'+,5 ,&7i$i,0!+,5 i$,0!&7$0+, - 6&i3a7i$0+

3a!a ' a40+ 6&i!!%i4+5 a"7/,5 "2 0$! 'a 4a3a4i"a" " +20$!'+, 4+$!a3i").

D 3!i7!a i$,0a$4ia 'a, a40ivi"a", " 'a $*!7!a 4i!4&'a$0 i$,0!&7$0i,0a , ''va$ a 4a2+ " 7a$!a 4+$&$0a5 a, 'a 3!3a!a4i#$ "'a ,a'a a$0, "' i$%!,+ "' 3a4i$0 4+$,i,0 $ 'a, ,i%&i$0, a40ivi>"a",

• R0i!a! 0+"+ 7a0!ia' - 6&i3+ 6& $+ ,a$ $4,a!i+, "$0!+ " 'a

,a'a 6&i!!%i4a.• C+$ &$ 3a+ 17"+5 " 3!*!$4ia 4+$ ,+'&4i#$ ",i$*40a$05'i73ia! ' 3+'v+ " '/73a!a,5 7,a, a&<i'ia!,5 4a7i''a, - 2a$4+,.

• V!i*i4a! 6& ' ,&'+5 3a!", - 041+, , $4&$0!$ 'i73i+, - 'i> 2!, " ,&4i"a".

• V!i*i4a! ' 4+!!40+ *&$4i+$a7i$0+ " '/73a!a,5 0+7a, " +<%$+- a3a!a0+, '40!+7("i4+, $4,a!i+, 3a!a 'a 4i!&%a.

• C+$*i!7a! '+, 3!+4"i7i$0+, - +!"$ $ 6& '+, 3a4i$0, va$ a

,! i$0!v$i"+,.• V!i*i4a! 6& ' 4a!!+ " a$,0,ia 4&$0 4+$ ' 7a0!ia' - 6&i3+$4,a!i+, 4/$&'a, " R&,1 - G&"' " "i*!$0, 4a'i2!,5 'a!i$>%+,4+3i+,5 7a,4a!i''a,5 %a,a,5 7i4!+3+!. La "+0a4i#$ " '+, 7>"i4a7$0+, a$,0(,i4+,5 $ 'a 7a-+!a " '+, 4$0!+, 1+,3i0a'a!i+,,i73! , !,3+$,a2i'i"a" "' 7("i4+ a$,0,i#'+%+5 3+! ,! (,0+,4+$0!+'a"+,.

• Ta$0+ 'a $*!7!a 4i!4&'a$0 4+7+ 'a i$,0!&7$0i,0a , "2$ $>

4a!%a! " ,+'i4i0a!5 $ 4+$&$0+5 ' i$,0!&7$0a' - 6&i3+ !6&!i"+,.E, 7&- i73+!0a$05 -a 6& a' *i$a' " 'a 4i!&%a a72a, ,+$ 'a, !,> 3+$,a2', "' 7i,7+.

un"ione! e la en)er*era "ir"ulante

Antes de la ciru-ía 5preoperatorio inmediato6• S+'i4i0a a' 3a4i$0 3+! $+72! - a3''i"+ a 'a $*!7!a "' 3!>

+3!a0+!i+5 '+ !4i2 $ ' 0!a$,*! - v!i*i4a5 a' 7i,7+ 0i73+5 6& '<3"i$0 0$%a 'a "+4&7$0a4i#$ !6&!i"a ,+'i4i0&" " 4i!&%a5,0&"i+, " 'a2+!a0+!i+5 1+a " 4+$,$0i7i$0+ i$*+!7a"+5 $+0a7("i4a5 1+a " $*!7!a5 04(0!a.

• La $*!7!a 4i!4&'a$0 , 3!,$0a 4+$ ' 3a4i$0.






i#ura 131. Enfermera 4ue cuida de la adecuada posición del paciente.

• V!i*i4a 'a 3!+044i#$ " '+, ++, "' 3a4i$0 4+$ %a,a 17"a + 2i$ 4+$ a'%$ 0i3+ " 3+7a"a +4&'a!.

• C+$40a5 4+$0!+'a - v!i*i4a ' 4+!!40+ *&$4i+$a7i$0+ " '+, ,i,>07a, '(40!i4+, " a,3i!a4i#$5 '40!+2i,0&!5 '/73a!a,5 $0! +0!+,*i%&!a ;>9.

• Ra'i)a ' 'ava"+ 6&i!!%i4+ - a$0i,3,ia " 'a !%i#$ a +3!a! *i%&!a;>.

• C+'+4a 3'a4a " '40!+4a&0!i+5 - v!i*i4a 6& ,0( $ &$ ,i0i+ 'i73i+- ,4+.

• E$ 4a,+ $4,a!i+ 4+'+4a ,+$"a " F+'-5 $a,+%/,0!i4a5 04(0!a.

• A-&"a a 'a $*!7!a i$,0!&7$0i,0a a 4+'+4a!, 2a0a ,0(!i' v,>0i!,.

• C+'a2+!a 4+$ 'a $*!7!a i$,0!&7$0i,0a 3a!a 4+'+4a! 2a0a ,0(!i'v,0i! a '+, 4i!&a$+, - a-&"a$0,.

• C+'a2+!a 4+$ 'a i$,0!&7$0i,0a a2!i$"+ '+, 2&'0+, 6&i!!%i4+, $>4,a!i+, - , '+, 3!+3+!4i+$a. M/, a"'a$0 , ",4!i2i!/ 'a *+!7a4+!!40a " a2!i! '+, 2&'0+, 6&i!!%i4+,.

• C+$0!+'a ' 7a0!ia' " ",41+ 6& , 3!+"&4 "&!a$0 '+, 3!> 3a!a0iv+,5 0$i$"+ ,34ia' 4&i"a"+ " v!i*i4a! 6& 'a, 4&20a,'a0!a', 6&"$ 3+! 4+73'0+ va4a, a$0, "' i$i4i+ " 'a 4i!&%a 3!+3ia7$05 '+ 4&a' ' 3!7i0 ''va! &$ 4+$0!+' a"4&a"+ " 'a,4+73!,a, - %a,a,.






A

:

C

i#ura 133. Lavado 4uir,r-ico # antisepsia de la re-ión a operar. 5contin,a6






• C&2! a' 3a4i$0 4+$ &$a ,/2a$a 'i73ia - ,4a5 3a!a vi0a! 'a 1i3+>0!7ia.

• V!i*i4a 6& , 1a-a 'a2+!a"+ 'a $+0a 7("i4a 3+,+3!a0+!ia5 4+$ 'a,

i$"i4a4i+$, 7("i4a, 4+!!,3+$"i$0,.• C+73!&2a ' ,0a"+ " 4+$4i$4ia "' 3a4i$0.• Si ' 3a4i$0 ,0/ ",3i!0+5 va'+!a ,& %!a"+ " 4+$4i$4ia.• C+'a2+!a 3a!a 3a,a! a' 3a4i$0 " 'a 7,a 6&i!!%i4a a 'a 4a7i''a. •Ra'i)a ' 2a'a$4 " '6&i"+, - '40!#'i0+,.• E$ 4+$&$0+ 4+$ ' a$,0,i#'+%+ ''va a' 3a4i$0 a 'a &$i"a" "

!4&3!a4i#$ 3+,+3!a0+!ia.• E$0!%a <3"i$0 4+73'0+ - +!"$a"+ a 'a $*!7!a "' 3+,>

+3!a0+!i+.• E$0!%a a 'a $*!7!a " ,a'a " !4&3!a4i#$ a' 3a4i$05 "a$"+

&$ 2!v !,&7$ " '+ 7/, ,i%$i*i4a0iv+ "&!a$0 ' 0!a$,+3!a0+!i+.• V!i*i4a 6& ' 3a4i$0 6&" 4#7+"+ $ 'a 4a7i''a5 v!i*i4a$"+ "

$&v+ ' ,0a"+ " '+, "!$a,5 a3#,i0+ " 'a 1!i"a - a44,+, va,>4&'a!,.

• R%!,a a 'a ,a'a - ",41a " 7a$!a 4+!!40a ' 7a0!ia' $+ !&0i>

'i)a2'.• C+'a2+!a 4+$ 'a i$,0!&7$0i,0a 3a!a "a! +!"$a"a - 'i,0a 'a ,a'a6&i!!%i4a 3a!a ' ,i%&i$0 3!+4"i7i$0+.

• E$ 4+$&$0+ 4+$ 'a i$,0!&7$0i,0a 3!3a!a ' i$,0!&7$0a' - 6&i3+6& , $va a ,0!i'i)a4i#$.

U$a " 'a, a40ivi"a", ,&,0a$0iva, $ ' 0!a$,+3!a0+!i+ - 6& 7!>4 ,34ia' 7$4i#$ , 'a 'a2+!a4i#$ " 'a 1+a " $*!7!a5 $ 'a 6&, a$+0a$ '+, "a0+, 7/, !'va$0,5 "," ' i$%!,+ "' 3a4i$0 a 'a ,a'a

" 4i!&%a 1a,0a ' %!,+ "' 7i,7+.E$ ''a , !%i,0!a i$*+!7a4i#$ 4+7+ $+72! 4+73'0+ "' 3a4i$>

05 $7!+ " <3"i$05 3!+4"i7i$0+5 '+, 3+!7$+!,5 i$4'&-$"+"," 'a, ,+'&4i+$, &0i'i)a"a, 3a!a ' 'ava"+ 74/$i4+ - 'a a$0i,3,ia50i3+ " a$,0,ia5 i$,0a'a4i#$ " ,+$"a, - 4a0(0!,5 04. S 1a4 &$a 2!>v ",4!i34i#$ " 'a 0(4$i4a 6&i!!%i4a5 , !%i,0!a 'a 4&$0a i$i4ia' - *i$a'" %a,a, - 4+73!,a,.

D2 a$+0a!, ' $+72! 4+73'0+ " 'a $*!7!a 6& i$,0!&7$> 0a

- " 'a $*!7!a 6& 4i!4&'a. E, i73+!0a$0 !*!i! 6& 'a, a$+0a4i+> $,6& , 1a4$ $ ,0a 1+a !,3+$"$ a' 3!+0+4+'+ ,0a2'4i"+ 3+! 4a"a4$0!+ 1+,3i0a'a!i+5 ,i$ +'vi"a! 6& !3!,$0a &$ "+4&7$0+ '%a' 6&"2 3!7a$4! $ ' <3"i$0 "' 3a4i$0.



$apítulo ;C :2unciones de la enfermera circulante 185

Apertura e ulto! -uirr#i"o!

Ya , 4+7$0# ,+2! 'a i73+!0a$4ia 6& !3!,$0a 7a$0$! &$ a7> 2i$0 '+ 7/, a,(30i4+ 3+,i2'5 3+! '+ 6& , $4,a!i+ 6& 'a $*!7!a"' 6&i!#*a$+ 4&$0 4+$ 'a 1a2i'i"a" - ",0!)a 3a!a a2!i! '+, "i*!$> 0, 2&'0+, 6&i!!%i4+, 6& , &0i'i)a$ "&!a$0 ' 0!a$,+3!a0+!i+5 - " ,0a7a$!a 4+$0!+'a! 'a 3+,i2i'i"a" " 4+$0a7i$a4i#$5 3+! '+ 6& ,$4,a!i+ 1a4! &$a 2!v ",4!i34i#$ " 'a 0(4$i4a 3a!a a2!i! &$ 2&'0+,0(!i'.

7'cnica para la aperturade bultos est'rilesE$ 'a *i%&!a ;> , 7&,0!a 'a 0(4$i4a a"4&a"a 6& "2 ,%&i! 'a $>

*!7!a 3a!a a2!i! 2&'0+, ,0(!i',.

• C+'+4a ' 2&'0+ ,+2! &$a 7,a a&<i'ia!5 4+$ 'a, !*!$4ia, a 'a vi,0a.

• La $*!7!a , 4+'+4a *!$0 a' 2&'0+5 vi,&a'i)a$"+ 'a 4i$0a 0,0i%+.

• R0i!a! 'a 4i$0a 0,0i%+.• T+7a 'a !*!$4ia 7/, vi,i2' - 'a ",3'i%a + <0i$" $ ,$0i"+

+3&,0+ a ''a.• S ",3'i%a$ + <0i$"$ 0a72i($ 'a, !*!$4ia, 'a0!a', ,i$ 4!&>

)a! 'a, 7a$+, ,+2! ' 2&'0+.• P+! '0i7+ , 0+7a 'a !*!$4ia 3!+<i7a' - , <0i$"5 6&"a$"+

" ,0a 7a$!a <3&,0+ ' 4+$0$i"+ ,0(!i' "' 2&'0+.

E, i73+!0a$0 a4'a!a! 6& 3a!a <0$"! 'a ,%&$"a 4&2i!0a "' 2&'0+5 'a $*!7!a "2 a&<i'ia!, " &$a 3i$)a " 0!a,'a"+ 3a!a vi0a!4+$0a7i$a! ,& 4+$0$i"+.

7'cnica para la apertura de bultosest'riles pe4ueJosLa *i%&!a ;>? i'&,0!a 4#7+ 'a $*!7!a "2 a2!i! 2&'0+, ,0(!i', "

7$+! 0a7a+.• T+7a! ' 2&'0+ 4+$ &$a 7a$+.• C+$ 'a +0!a 7a$+ , ",3'i%a$ 'a, !*!$4ia, $ ' +!"$ a$0,

",4!i0+.• S <3+$ ' 4+$0$i"+ ,0(!i'.




A

:

C

i#ura 134. 7'cnica para abrir bultos est'riles.




i#ura 135. 7'cnica para la apertura de bultos est'riles pe4ueJos.

S 3!+4" a 3!+3+!4i+$a!'+ a 'a $*!7!a i$,0!&7$0i,0a + 2i$ ,4+'+4a5 "/$"+'+ 4a! 4+$ ,&avi"a" a &$+, ;: 47 a3!+<i7a"a7$0 $ 'a7,a ,0(!i'.

Pa!a '+, 2&'0+, 6& vi$$ ,0(!i', " *a2!i4a4i#$ , ",3!$" &$+" ,&, <0!7+, 7"ia$0 0!a44i#$ - a, , 3&" <3+$! - 4+'+4a! '7a0!ia' ,0(!i' $ 'a 7,a a&<i'ia! $ a'%&$+, 4a,+, 0a72i($ , 3&"a&<i'ia! 4+$ &$a 0i!a 3a!a 4+!0a! &$+ " ,&, <0!7+, - " ,0a 7a$!a",'i)a! ' 4+$0$i"+ "' 3a6&0 1a4ia 'a 7,a ,0(!i'.

La 3!i$4i3a' *&$4i#$ " 'a $*!7!a 4i!4&'a$0 , *av+!4! &$ a7> 2i$0 " 4+7+"i"a"5 4+$ +!"$ - 'i73i)a5 !a'i)a! &$a 7i$&4i+,a +2>,!va4i#$ 3a!a ,a0i,*a4! 'a, $4,i"a", - !6&!i7i$0+, "' 3a4i$0"&!a$0 ,& ,0a$4ia $ ' /!a +3!a0+!ia5 a, 4+7+ 0a72i($ "' 6&i3+ ",a'&". D2 !%i,0!a! '+, "a0+, 4'$i4+, $4,a!i+, 3a!a !a'i)a! &$a4+!!40a va'+!a4i#$5 3'a$i*i4a4i#$ - !a!6&i)a4i#$ " ,&, a40ivi"a", 6&' 3!7i0a$5 3+! '0i7+5 +0+!%a! 4&i"a"+, i$"ivi"&a'i)a"+,.

C+7+ , vi"$05 'a, a40ivi"a", " 'a $*!7!a 4i!4&'a$0 ,+$7'0i3', - 7&- va!ia"a,5 6&i)/, a0i$" 1a,0a "+, a40ivi"a", a &$ 7i,>7+ 0i73+5 6& ,i 2i$ %&a!"a$ &$a ,4&$4ia '#%i4a5 $+ , ",a!!+''a$ $&$ 3!*40+ - "0!7i$a"+ +!"$.





in!tru*enti!ta

Ya , 7$4i+$# 6& 'a $*!7!a 6&i!!%i4a ",73a va!ia, *&$4i+>$, 4!&4ia', "&!a$0 ' 3!i+3!a0+!i+5 &$a " ''a, , 'a 6& !a'i)a4+7+ i$,0!&7$0i,0a. E$ ,0 4a30&'+ , 1a4 &$a 2!v ",4!i34i#$ ",0a 'a2+!.

La *&$4i#$ ,$4ia' " 'a $*!7!a i$,0!&7$0i,0a ,0/ $ ' 0!a$,>+3!a0+!i+5 ,i$ 72a!%+5 'a !a'i"a" , 6& 4&73' 4+$ *&$4i+$, 4+$> &$0a, $ '+, 0!, 7+7$0+, *&$"a7$0a', " 'a 4i!&%a &$0+ 4+$ '!,0+ "' 6&i3+ " ,a'&". E, i73+!0a$0 !*!i! 6& 'a, a40ivi"a", " 'a,

$*!7!a, 4i!4&'a$0 i$,0!&7$0i,0a , ,0!&40&!a$ " 0a' *+!7a 6&&$a v) 6& i$i4ia ' 3!+4"i7i$0+5 'a 3a!0 ,0(!i' a6&''a 6& 7a$a'a $*!7!a i$,0!&7$0i,0a - 'a $+ ,0(!i' 6& 4+$"&4 'a 4i!4&'a$0 0i$$ 6& *40&a!, " 7a$!a ,i7&'0/$a5 3!+ ,i$ 0!a,> 3a,a! ,a'$a i7a%i$a!ia 6& "2 7a!4a!, $0! ' 0!a2a+ 6& 4a"a &$a " ''a,4&73'.

&n)er*era in!tru*enti!taSi , 3a!0 " 'a "*i$i4i#$ " 6& &$ i$,0!&7$0+ , &$ a3a!a0+ + 7/6&i>$a " 'a 4&a' , 3&" ,!vi! 3a!a !a'i)a! a'%$ 0!a2a+ - 6& i$,0!&7$>0a!5 4&-+ ,i%$i*i4a"+ , "i,3+$! + 3!3a!a!5 $0+$4, , *a40i2' "*i$i! a'a $*!7!a i$,0!&7$0i,0a 4+7+ a6&''a 6& i$,0a'a - a4+$"i4i+$a 'i$,0!&7$0a' - 6&i3+ ,0(!i' $4,a!i+ 3a!a 'a i$0!v$4i#$5 6& 0i$4+7+ +20iv+ 3!i$4i3a' 4+$,!va! 'a ,%&!i"a"5 *i4i$4ia i$0%!i"a" "'4a73+ "&!a$0 0+"a 'a 4i!&%a5 a"7/, " ,! 0a72i($ &$ 7i72!+ ,0(!i'

"' 6&i3+.E$ 2a, a '+ a$0!i+!5 'a, 4a!a40!,0i4a, 6& 7/, "2$ 3!va'4! $

''a 4&a$"+ !a'i)a ,0a a40ivi"a" ,+$ !,i,0$4ia *,i4a5 1a2i'i"a" 7a>

189




$&a'5 0+'!a$4ia a 0!a2aa! 2a+ 3!,i#$5 &$ a73'i+ 4+$+4i7i$0+ " 'a0(4$i4a a,(30i4a - 'a 6&i!!%i4a ,0+ '0i7+ ' 3!7i0 ,0a! ,i73! &$

3a,+ a"'a$0 " 'a, $4,i"a", "' 4i!&a$+ -5 3+! 4+$,4&$4ia5 "' 3!+3i+ 3!+4"i7i$0+5 "2 ",a!!+''a! ,& 0!a2a+ 4+$ 3!4i,i#$5 a"> 7/," 7a$0$! &$a ,0!41a 4+7&$i4a4i#$ 4+$ 'a $*!7!a 4i!4&> 'a$0. E,i73+!0a$0 !4+!"a! 6& "&!a$0 ' 3!+3!a0+!i+ 7"ia0+ i$7"ia0+<i,0 &$a 4+!!,3+$,a2i'i"a" " 'a, $*!7!a, 4i!4&'a$0 i$,0!&7$0i,0a 3a!a ,+'i4i0a! - 3!3a!a! '+ $4,a!i+ " a4&!"+ 4+$ ' 0i3+" 4i!&%a 6& , 3!+%!a7a. D!iva"+ " 'a vi,i0a 3!+3!a0+!ia 6& a72a,"2$ !a'i)a! a' 3a4i$05 +!%a$i)a$ - "i,3+$$ '+, i$,&7+, 7/,a"4&a"+, a' 0i3+ " 3!+4"i7i$0+. A&$ 4&a$"+ 'a, a40ivi"a", " 4a"a&$a 3&"$ ,0a! ",4!i0a, - "'i7i0a"a, $ ' 7a$&a' " 3!+4"i7i$> 0+,"' 4$0!+ 1+,3i0a'a!i+5 , $4,a!i+ $*a0i)a! 6& ' (<i0+ $ 7&41+"3$" " 'a 4++!"i$a4i#$ 6& a72a, 7a$0i$$.

U$a v) 6& , 0!7i$# " 6&i3a! 'a ,a'a5 6& ' 3a4i$0 ,0/ $ 3!+4,+ " 3!3a!a4i#$ i$"&44i#$ a$,0(,i4a5 'ava"+ - a$0i,3,ia5 'a$*!7!a i$,0!&7$0i,0a "2 i$i4ia! 'a 3!3a!a4i#$ "' 4a73+ ,0(!i'

7,a, a&<i'ia!,5 - " ,0a 7a$!a 3!3a!a!, 3a!a 'a ''%a"a "' 4i!&> a$+ - a-&"a$0,.

un"ione! e la en)er*erain!tru*enti!ta

Antes de la ciru-ía

5transoperatorio mediato6• V!i*i4a 3!+%!a7a4i#$ " 4i!&%a &$ "a a$0, " 6& (,0a , va-a a!a'i)a!.

• V!i*i4a 6& 'a 'i73i)a " 'a ,a'a 6&i!!%i4a , 1a-a !a'i)a"+ "a4&!"+ 4+$ '+, 3!+0+4+'+, ,0a2'4i"+,.

• E'a2+!a 0a!0a + va' 3a!a ,+'i4i0a! a 'a ,&2CEYE ' i$,0!&7$0a'$4,a!i+ $ 4+$&$0+ 4+$ 'a $*!7!a 4i!4&'a$0.

• C+'+4a 2&'0+ " !+3a i$,0!&7$0a' $ 'a 7,a 4+!!,3+$"i$0.

• S 3!,$0a 4+$ ' 3a4i$05 - ' 1a4 ,a2! " 6&( *+!7a 3a!0i4i3a!/"&!a$0 'a 4i!&%a.

• R*i! a'%&$a, i$,0!&44i+$, a' 3a4i$0 3a!a ' 3+,+3!a0+!i+ i$>7"ia0+5 " a4&!"+ 4+$ ' 0i3+ " 3!+4"i7i$0+.

• R,&'v "&"a, $ 'a 7"i"a " ,&, 3+,i2i'i"a",.



$apítulo ;D : 2unciones de la enfermera instrumentista 191

!urante la ciru-ía5transoperatorio inmediato6

• P!vi+ 'ava"+ " 7a$+, "' 7("i4+5 a2! '+, 2&'0+, 6&i!!%i4+, &$av) 6& ' a$,0,i#'+%+ i$i4ia 7a$i+2!a, 3a!a 'a i$"&44i#$ a$,>0(,i4a.

• C+$ a-&"a " &$a 3i$)a " 0!a,'a"+ 4+'+4a a 'a vi,0a 4+73!,a,5'a 2a0a - %&a$0,. La, 4+73!,a, + 0+a''a, ' ,!vi!/$ 3a!a 1a4! ',4a"+ " 'a, 7a$+,.

• S 4+'+4a5 ,i73! 6& ,a 3+,i2'5 %a*a, 3!+040+!a, 3a!a '+, ++,. •S !a'i)a 'ava"+ " 7a$+, 6&i!!%i4+ v(a, 4a30&'+ .

• P!+4" a' ,4a"+ " 7a$+,5 0+7a$"+ 'a 4+73!,a + 0+a''a ,0(!i'"' ,i0i+ $ 6& 'a 4+'+4#5 3!+4&!a$"+ $+ 2aa! 'a, 7a$+, 7/, a''/ "'a 4i$0&!a5 7a$0$i($"+'a, $ 3+,i4i#$ v!0i4a'.

• P!+4" a 4+'+4a!, 'a 2a0a 6&i!!%i4a 4+$ 0(4$i4a 4!!a"a.La 2a0a5 4+7+ -a , 4+7$0#5 ,0/ "+2'a"a " a"$0!+ 1a4ia

a*&!a5 a, , 3&" ,+,0$! 3+! 'a 2a$"a "' 4&''+ - "a! 6& ,",3'i%& 3+! %!av"a"5 , "4i!5 "/$"+'a 4a!5 ,i$ ,+'0a!'a 3+!

4+73'0+5 4&i"a$"+ " 6& $+ 0+6& ,&3!*i4i, $+ ,0(!i',.U$a v) 6& , $4&$0!a 4+73'0a7$0 ",3'%a"a5 , 2&,>4a$ 'a, 4i)a, " 'a, 7a$%a, - , 3!+4" a i$0!+"&4i! $ ''a, &$ 2!a)+ a 'a v) $ 4a,+ " 6& $+ ,a 3+,i2' a$&"a! + a2!+41a! 'a 2a0a " 7a$!a i$7"ia0a 3+! 3a!0 " 'a $*!7!a 4i!4&'a$05 'a$*!7!a i$,0!&7$0i,0a "+2'a '+, 2!a)+, 'i%!a7$0 3a!a 0!a44i+>$a! - *ia! 7/, 'a 2a0a 1a4ia ' 4&!3+5 - " ,0a 7a$!a 4+$0i$&a! 4+$,& a40ivi"a".

E$ 4a,+ " ,! 3!&"$0 , ,+'i4i0a a-&"a a 'a $*!7!a 4i!4&>'a$0 3a!a 1a4! 0!a44i#$ 3+! 'a 3a!0 " 'a ,3a'"a " 'a $*!7!ai$,0!&7$0i,0a5 ,i$ 3!7i0i! 6& 'a, 7a$+, " ,0a '0i7a a,+7$ 3+! ' 3&+ " 'a 2a0a *i%&!a ;>;.

P+! '0i7+ , a7a!!a 'a 2a0a 3+! 'a ,3a'"a5 4+$ 'a, 4i$0a, 6&vi$$ 4+'+4a"a, a0!/,5 4&i"a$"+ " 6& 4a"a &$a 6&" 2i$ a$&>"a"a 3a!a 6& $+ , 4+$vi!0a $ &$ a%$0 4+$0a7i$a$0.

• S 4+'+4a$ %&a$0, ,0(!i', 4+$ 0(4$i4a 4!!a"a.

La 4+'+4a4i#$ " '+, %&a$0, !3!,$0a &$a 7"i"a 6& a,%&>!a 'a 0(4$i4a ,0(!i'5 ,& 4+!!40a 4+'+4a4i#$ - 7a$i3&'a4i#$ 3!vi$i$*44i+$,. E, 3!4i,+ $*a0i)a! 6& 'a 4+'+4a4i#$ " '+, %&a$0, $+,&,0i0&- " $i$%&$a 7a$!a ' 'ava"+ " 7a$+,.




4uir,r-ica

A

:

C

/

i#ura 141. Enfermera 4ue se coloca la bata 4uir,r-ica con t'cnica cerrada.

U$a v) 6& 'a $*!7!a i$,0!&7$0i,0a 0!7i$# " 4+'+4a!, 'a 2a0a5 "25 " i$7"ia0+5 4+'+4a!, '+, %&a$0,5 4+$ 0(4$i4a 4> !!a"a.Pa!a ''+ "2 1a4! ' ,i%&i$0 3!+4"i7i$0+ *i%&!a ;>9

T+7a! ' 3a6&0 " %&a$0,5 - 4&i"a! " $+ ,a4a! 'a, 7a$+, "$0! '+, 3&+, " 'a 2a0a5 , "4i!5 'a, 7a$+, "2$ ,0a! 4&2i!0a, 3+! '+, 3&+, $ 0a$0+ , 7a$i3&'a$ '+, %&a$0, 1a,0a ,& 4+'+4a4i#$.



O2,!va! 'a $v+'0&!a - '+4a'i)a! ' %&a$0 "!41+5 !+0&'a"+4+$ 'a '0!a R ri(th5 - ' i)6&i!"+5 !+0&'a"+ 4+$ 'a '0!a L left 5



$apítulo ;D :2unciones de la enfermera instrumentista 193

A

:

C

/

i#ura 142. *rocedimiento mediante el cual la enfermera instrumentista se



coloca los -uantes con t'cnica cerrada.




4+'+4a!'+, $ 'a 7,a a&<i'ia! " 0a' 7a$!a 6& 'a 2a, 6&" 1a4ia'a $*!7!a i$,0!&7$0i,0a5 0+7a!'+, 3+! 'a !*!$4ia5 4+'+4a!'+,,+2! ' 3&+ 4!!a"+5 0!a0a$"+ " 6& ' ""+ 3&'%a! 4+i$4i"a 4+$ '

3&'%a! "' %&a$05 " 7a$!a 6& ' 3&+ " 'a 7a$%a " 'a 2a0a - 'a 2a, "' %&a$0 4+i$4i"a$ - a, , ",'i4 ' %&a$0 3a!a 4&2!i! 'a7a$+ 3+! 4+73'0+. D i$7"ia0+ 0+7a! ' +0!+ %&a$0 - 4+$ 'aa-&"a " 'a 7a$+ 6& -a ,0/ $%&a$0a"a 4+'+4a! ,0 '0i7+.

P+! '+ %$!a'5 "&!a$0 ' 3!+4"i7i$0+ '+, %&a$0, $+ 6&"a$ 3!*40a7$0 4a')a"+,5 3+! '+ 6& "2$ ,! a&,0a"+,5 &$a v) 6&a72a, 7a$+, ,0($ $%&a$0a"a,.

U$a v) 4+'+4a"+, '+, %&a$0, 'a, 7a$+, ,+$ ,0(!i',5 3+! '+

6& a 3a!0i! " ,0 7+7$0+5 'a $*!7!a i$,0!&7$0i,0a ,#'+ 3&>" 0+4a! +20+, 3+! i%&a' ,0(!i',.

• repara la! e!a! auiliare! 4+$ ' i$,0!&7$0a' - 7a0!ia' !6&>!i"+ v(a, 4a30&'+ ;9. La $*!7!a i$,0!&7$0i,0a 0i$ 2a+ ,&!,3+$,a2i'i"a" 7a$0$! a' 7/<i7+ 'a a,3,ia "&!a$0 0+"+ ' 3!+>4"i7i$0+5 3!+ $ ,34ia' $ 'a 3!3a!a4i#$ " 'a, 7,a, a&<i'ia>!, 3a!a a,%&!a!, " ''+ "2 ,%&i! 'a, ,i%&i$0, i$,0!&44i+$,;. E$ 'a 7,a ,0(!i' ,#'+ , &0i'i)a$ 7a0!ia', ,0(!i',.

9. La 2a0a , ,0(!i' ,#'+ $ 'a 3a!0 *!+$0a' "' 341+ 1a,0a "+$"0+3 4+$ ' $iv' " 'a 7,a - 'a, 7a$%a, "," ' 4+"+ 1a,0a '+, 3&+,5 3+! '+ 6& 'a $*!7!a $+ "2 2aa! ,&, 2!a)+, 7/, a''/" ,0+, '7i0,5 a, 4+7+ $+ <0$"!'+, $ &$ !a"i+ $+ 7a-+! a''a!%+ " ,&, 2!a)+,.

. La $*!7!a i$,0!&7$0i,0a 4+$ v,0i7$0a ,0(!i' , 7a$0i$4!4a " '+, 4a73+, ,0(!i', - '+, " 'a, *!a$a, $+ ,0(!i',.

. La, 7,a, - '+, 4a73+, ,0(!i', '+ ,+$ ,#'+ $ 'a ,&3!*i4i.

• P!3a!a! ,+$"a " F+'- 4+$ a"i0a7$0+,5 $ 4a,+ " 6& ' 3!+4>"i7i$0+ '+ !6&i!a. D2 0$! $ 7$0 6& $+ , 'a $*!7!ai$,0!&7$0i,0a 6&i$ 'a 4+'+4a5 ,i$+ 'a $*!7!a 4i!4&'a$0.

• E$ 4+$&$0+ 4+$ 'a $*!7!a 4i!4&'a$0 *40a 4+$0+ i$i4ia' "%a,a, - 4+73!,a,5 v!i*i4a$"+ 6& ' i$,0!&7$0a' 0a72i($ ,0(4+73'0+.

• C+'+4a 2a0a - %&a$0, a' 4i!&a$+ - a-&"a$0,.• I$i4ia 'a 4+'+4a4i#$ " 'a !+3a ,0(!i' a' 3a4i$0 v,0i"+ "' 3a4i$>

0 , 3!4i,+ !4+!"a! 6& $ +4a,i+$, 'a $*!7!a i$,0!&7$0i,> 0a4+'a2+!a $ 'a 4+'+4a4i#$ " 'a, ,/2a$a,.

• E$ 4+$&$0+ 4+$ 'a $*!7!a 4i!4&'a$05 a4!4a 'a, 7,a, " Ma-+- !40a$%&'a! 1a4ia "+$" , $4&$0!a ' 3a4i$0 3a!a 4!!a! '




4i!4&i0+ ,0(!i'. E, i73+!0a$0 a,%&!a!, " $+ 4+$0a7i$a! '+, ,i> 0i+,,0(!i',.

• J&,0+ ",3&(, " 4!!a! ' 4i!4&i0+ 'a $*!7!a i$,0!&7$0i,0a 4+>

'+4a 'a 4/$&'a Ya$a! a 'a 7a$%&!a "' a,3i!a"+!5 4+'+4a '4>0!+4a&0!i+ + 2i,0&! a!7#$i4+ 4+$ ,&, a"i0a7$0+,5 - v!i*i4a ,&4+!!40+ *&$4i+$a7i$0+. T+"+, '+, a"i0a7$0+, , *ia$ 4+$ &$a 3i$)a " 4a73+5 ,+2! 'a, ,/2a$a,5 4&i"a$"+ 6& '+, <0!7+, $+4ai%a$ 7/, a''/ "' 4i!4&i0+ ,0(!i'.

La $*!7!a i$,0!&7$0i,0a "2 v!i*i4a! 6& 'a 7,a " Ma-+,0( ,i73! ,+2! ' 3a4i$05 3!+ ,i$ 3!,i+$a!'+5 " ,0a 7a$!a 6&>

"a *!$0 a ,0a 7,a 'a 2+',a " ",41+ 6&"a *!$0 a ''a - ' 4i!&> a$+ "' +0!+ 'a"+. E, "4i!5 4i!&a$+ - $*!7!a i$,0!&7$0i,0a 6&"a$*!$0 a *!$0 - 4+$ &$a a73'ia vi,i#$ "' 4a73+ +3!a0+!i+.

E' i$,0!&7$0a' 6& , 3+$ $ 'a 7,a " Ma-+ , 4+'+4a 4+$ '+,a$i''+, " 'a 3i$)a 1a4ia 'a i$4i,i#$5 '+ 4&a' 3!7i0 6& 'a $*!7!a0+7 4+$ %!a$ *a4i'i"a" 'a 3i$)a - 'a 3!+3+!4i+$ a' 4i!&a$+ $ &$ ,+'+7+vi7i$0+.

E, 3!4i,+ !4+!"a! 6& "&!a$0 ' a2+!"a , 4+'+4a " 3!i7!a

i$,0a$4ia $ 'a 7,a " Ma-+ ,#'+ i$,0!&7$0a' 4+!0+.

n!tru*enta"in -uirr#i"aT+"a 4i!&%a i$i4ia " a4&!"+ 4+$ '+, 0i73+, 6&i!!%i4+, -a ",4!i0+,5 ,"4i!5 4+$ ' 4+!0 3a!a 1a4! 'a i$4i,i#$. E<430+ 'a 4i!&%a " +*0a'>7+'+%a $ "+$" ' 3!i7! 0i73+ , 'a ,3a!a4i#$ , 4+$0i$a 4+$17+,0a,ia 3a!a "0$! ' ,a$%!a"+ 6& ' 4+!0 1a 3!+v+4a"+5 ",3&(,

, 1a4 "i,44i#$ - ,3a!a4i#$ " 'a, ,0!&40&!a, a$a0#7i4a, 4+$ 'a i$>0$4i#$ " 7a$i3&'a!'a, - *40&a! ' a40+ 3!i$4i3a'5 6& , 'a i$0!v$>4i#$ 6&i!!%i4a 3+! '0i7+5 , 1a4 'a !4+$,0!&44i#$ + ,&0&!a.

La *&$4i#$ " 'a $*!7!a 4+7+ i$,0!&7$0i,0a $ ,0 7+7$0+ "'a 4i!&%a5 !a"i4a ,+2! 0+"+ $ 3!+3+!4i+$a! a' 4i!&a$+ ' i$,0!&> 7$0+i"a' - 3!4i,+ 3a!a *40&a! 'a i$0!v$4i#$ " a4&!"+ 4+$ ' 0i73+ "'6& , 0!a0.

E, 3+! ''+ 6& 'a $*!7!a 1a " 0$! 4+$+4i7i$0+ %$!a' " 'a

0(4$i4a 6&i!!%i4a - 4+73!$,i#$ ,34*i4a "' 3!+4"i7i$0+ $ ,5 a *i$" a$0i4i3a!, a 'a, $4,i"a", - !6&!i7i$0+, " 'a 7i,7a. P+!,&3&,0+5 ' 4i!&a$+ $ * ",a 0$! 'a 4!0)a " 6& !4i2 ' i$,>0!&7$0+ 4+!!40+ $ ' 7+7$0+ 3!4i,+.




4uir,r-ica

A *i$ " ''va! a 4a2+ ,0a 0!a,4$"$0a' 7i,i#$5 0a72i($ , $4>,a!i+ 6& 'a $*!7!a i$,0!&7$0i,0a ,0( *a7i'ia!i)a"a $+ ,#'+ 4+$ 'a

0(4$i4a5 0a72i($ , i73+!0a$0 6& 4+$+)4a ' '$%&a 7a$&a' 6& ,&0i'i)a "&!a$0 ' 3!+4"i7i$0+.

Ben#ua(e *anualurante la "iru#íaA 4+$0i$&a4i#$ , 'i,0a$ a'%&$a, " 'a, ,a', 6& $+ !6&i!$ " +!>

"$ v!2a' 3a!a 6& , 4&73'i7$0 'a ,+'i4i0&" "' 4i!&a$+ 3+! 3a!0 "'a $*!7!a i$,0!&7$0i,0a

• Pa'7a " 'a 7a$+ 1a4ia a!!i2a 3!i7! 2i,0&! + 3i$)a.• Ma$+ 4+$ ""+ $"i4 - 7"i+ 1a4i$"+ 7+vi7i$0+, " &$0a! -

,3a!a! 0i!a.• Ma$+ 73&a"a5 1a4i$"+ 7+vi7i$0+, " ,&0&!a 3+!0aa%&a,5

4+$ ,& !,340iv+ 1i'+ - a%&a.

• Ma$+ 4+$ ""+, $"i4 - 3&'%a! 1a4i$"+ 7+vi7i$0+, " &$0a! -,3a!a! 3i$)a " "i,44i#$.• Ma$+ <0$"i"a 4+$ 'a 3a'7a 1a4ia a2a+ ,"a 'i2!.

A' 7a!%$ " 'a *+!7a $ 6& ' 4i!&a$+ ,+'i4i0 ' i$,0!&7$0a'5 'a$*!7!a "2 "/!,'+ ,i73! 4+$ 7+vi7i$0+, *i!7, - ,%&!+,5 ",0a *+!7a (' 0i$ 'a 4!0)a " 6& ' i$,0!&7$0+ *& 4+'+4a"+ $ ,&,7a$+,5 ,i$ 6& 0$%a 6& a3a!0a! 'a vi,0a " 'a )+$a +3!a0+!ia.

La $*!7!a i$,0!&7$0i,0a "2 0+7a! ,i73! ' i$,0!&7$0a' 3+!

'a a!0i4&'a4i#$ v! 3a!0, " &$a 3i$)a5 " 0a' 7a$!a 6& '+, a$i> ''+, -'a 3&$0a 6&"$ 'i2!,5 $0!%a!'+ 4+$ &$ 7+vi7i$0+ *&!0 - *i!> 75 '4i!&a$+ '+ !4i2 3+! '+, a$i''+, - '+ &0i'i)a " 7a$!a i$7"ia0a ,i$ 3!"! 0i73+.

T<"ni"a e in!tru*enta"inE' ",a!!+''+ " 'a 0(4$i4a 6&i!!%i4a ,i%& &$a ,4&$4ia 7/, + 7> $+,

'#%i4a a, , 0i$5 3+! 73'+5 6& 4&a$"+ , "040a &$ va,+ 6&,a$%!a , "2 3!+3+!4i+$a! &$a 3i$)a 17+,0/0i4a ,%&i"a "' 2i,0&!'(40!i4+ - " &$a 'i%a"&!a + ,&0&!a5 - a' *i$a' , !6&i! &$a 0i!a "1i'+, $ +0!+, 4a,+,5 4+7+ 4&a$"+ , 3!+4" a !a'i)a! &$a a$a,0+7+>,i,5 , 3!+3+!4i+$a 3i$)a5 4+!05 ,&0&!a - a' *i$a' 4+!0 " 1i'+,. D2i"+ a






&$ 3+!0aa&%a,5 - 3i$)a " "i,44i#$5 $0!%a a' a-&"a$0 0i!a "1i'+,.

• D i$7"ia0+5 a' 0(!7i$+ "' 4i!! " 'a 1!i"a5 4+$ &$a %a,a 1&7>

"4i"a 4+$ ,+'&4i#$ ,0(!i'5 'i73ia ' ,i0i+ - ,&, a'!""+!, - 4+'+4a,+2! (,0a &$ a3#,i0+ ,0(!i' ,4+.

$ane(o e pun=o"ortante!Pa!a 3!v$i! a44i"$0, !,340+ "' 7a$+ " 3&$)+4+!0a$0, , i7>

3+!0a$0 6& 'a $*!7!a i$,0!&7$0i,0a ",i%$ &$a )+$a ,34*i4a 3a!a "a! - !4+%! ,0a, 1!!a7i$0a,5 4+$ ' +20iv+ " vi0a! 3a,a!>'+, " 7a$+ a 7a$+ $*!7!a i$,0!&7$0i,0a>4i!&a$+>i$,0!&7$0i,> 0a,0a )+$a 3&" "'i7i0a!, a,i%$a$"+ &$a 4+73!,a5 2&"i$!a + /!a $'a 7,a " Ma-+5 $ "+$" , "a$ - 0+7a$ " ,0a 7a$!a , vi0a$a44i"$0,. E, $4,a!i+ 4+7&$i4a! a' 4i!&a$+ 'a )+$a 6& , 1a",i%$a"+ 3a!a ,0 *i$.

Al )inali=ar la "iru#ía

?po!operatorio in*eiato@Si$ 4+$0a7i$a!, $i 4+$0a7i$a!5 'a $*!7!a i$,0!&7$0i,0a !0i!a 'a,

7,a, " i$,0!&7$0a' a, 4+7+ 7a0!ia' - 4a73+, 6&i!!%i4+,5 4&i"a$>"+ 6& $+ 6&" $a"a5 $ ,34ia' 3&$)+4+!0a$0,. D2 !4+!"a! 6&"&!a$0 ' 3+,+3!a0+!i+ i$7"ia0+ ' 3a4i$0 ,0/ 7&- ,&,430i2' - 3&" 3!,$0a! " ,2i0+ 3a!+ 4a!"ia4+5 'a!i$%+,3a,7+ + 2i$ 17+>!!a%ia5 - a' 7a$0$! ' i$,0!&7$0a' ,0(!i' , vi0a 6& 1a-a 0i73+,

3!"i"+, $ 4a,+ " &$a &!%$4ia5 -a 6& ' i$,0!&7$0a' 6& 6&"a ,+> 2! 'a 7,a 3&" ,! &0i'i)a"+ 3a!a &$a i$0!v$4i#$ &!%$0 $ 0a$0+ ,"i,3+$ " +0!+,. C+'+4a &$ 4a73+ + ,/2a$a 'i73ia a' 3a4i$0 3a!a4&2!i!'+5 0$i$"+ ,34ia' 4&i"a"+ $ $+ !0i!a! + 7+v! ' a3#,i0+ 6&a$0, , 4+'+4#.

U$a v) !v!0i"+ $ ,& 0+0a'i"a" a' 3a4i$0 " 'a a$,0,ia5 i$i4ia a",4+$40a! '+, a3a!a0+, '40!+7("i4+,. Ta72i($ 'a $*!7!a i$,0!&>7$0i,0a 'i73ia ' <4"$0 " ,+'&4i+$, - ,4!4i+$,5 4+'+4a a3#,i>

0+,5 !,!v+!i+, 3a!a "!$a, - 0+"a 4'a, " 4&i"a"+, 6& !6&i!a 'a1!i"a.

L+, +20+, 3&$)+4+!0a$0,5 4+7+ a%&a, - 1+a, " 2i,0&!5 "2$",41a!, $ '+, 4+$0$"+!, 3a!a 0a' *i$ - ,!/ '+ 3!i7!+ 6& 1a%a 'a






4uir,r-ica

" 6& 3&"a$ 6&"a! "$0!+ " 'a 4avi"a" '+ 6&5 3+! ,&3&,0+5 3&" 3+$! $ 3'i%!+ 'a vi"a "' 3a4i$05 a"7/, "' 7a-,4&'+ 3!+2'7a

'%a' $ ' 6& , v!a i$v+'&4!a"+ 0+"+ ' 6&i3+ " ,a'&". Pa!a 1a4!&$ 4+!!40+ 4+$0!+' " %a,a, - 4+73!,a,5 0a$0+ 'a $*!7!a 4i!4&'a$04+7+ 'a i$,0!&7$0i,0a "2$ ,%&i! 'a, !%'a, ,i%&i$0,

;. Ma$a!5 " 3!*!$4ia5 3a6&0, 4+$ &$ 7$i7+ " ? - 7/<i7+

" ;: %a,a,5 $ 0+"+ 4a,+ ,%&i! 'a i$,0!&44i#$ "' 7a$&a' " 3!+>4"i7i$0+ " 4a"a i$,0i0&4i#$.

9. E' !%i,0!+ $ 'a 1+a " $*!7!a " 'a 4a$0i"a" " 0<0i', a &0i>

'i)a! "2 1a4!, " *+!7a 7&- 4'a!a5 ,i$ 0a41a"&!a, $i 2+!!+$,. N&$4a "a! ' !%i,0!+ 3a!a &$ 7+7$0+ 3+,0!i+!5 7/, 2i$5 "21a4!, ",3&(, " 6& , ,&7i$i,0!$ 7/, %a,a, + 4+73!,a,5 a,4+7+ i$,0!&7$0a'. La $*!7!a i$,0!&7$0i,0a "2 +2,!> va! 6&, 1a%a " 7a$!a i$7"ia0a. E$ 4a,+ " +7i0i! ' !%i,> 0!+ a 4a&,a" &$a &!%$4ia <0!7a "2 ,! "+4&7$0a"+. D i%&a' 7a$!a ,i' 4i!&a$+ + ' !,0+ "' 6&i3+ !41a)a & +7i0 ' 4+$0+ " 0<0i',5'a 4a&,a "2 ",4!i2i!, a "0a'' $ 'a 1+a " $*!7!a.

. La $*!7!a i$,0!&7$0i,0a 1a4 ' 4+$0+ i$i4ia' a 'a vi,0a " 'a4i!4&'a$05 ,3a!a &$a a &$a 'a, %a,a, + 4+73!,a,5 <0$"i($"+'a," 7a$!a +!"$a"a5 3a!a vi0a! 6& 3&"i!a$ 6&"a! 3%a"a,.

. La $*!7!a i$,0!&7$0i,0a ,+'i4i0a a3+-+ " 'a 4i!4&'a$05 3a!av!i*i4a! ' $7!+ " %a,a, + 4+73!,a,5 4a"a 6& '+ 4+$,i"!a$$4,a!i+5 $ ,34ia' $ '+, 7+7$0+, -a ",4!i0+,5 i$*+!7a$ a'4i!&a$+5 ,+2! 0+"+ 4&a$"+ a$0, "' 4i!! , "040 'a *a'0a "a'%$ 0<0i' + i$,0!&7$0+.

?. N&$4a &0i'i)a! ' 7a!,&3ia' " 'a 2a0a 3a!a %&a!"a! %a,a,.. C+$*i!7a! - $*a0i)a! 'a 4&$0a " 0<0i', i$,0!&7$0a' 4&a$"+ ,

a44" a #!%a$+, 1&4+,.@. La $*!7!a i$,0!&7$0i,0a 4+$*i!7a $ v+) a'0a a' 6&i3+ 'a

4&$0a a' i$i4i+ " 'a 4i!&%a - a' *i$a' " 'a 7i,7a. E,0+ '+ 1a4 0!a,4+$*i!7a! ' 4+$0+ 4+$ 'a $*!7!a 4i!4&'a$0.

. E$ 4a,+ " 6& a' *i$a'i)a! ' 3!+4"i7i$0+ 6&i!!%i4+ , "040'a 3(!"i"a " 7a0!ia' 0<0i' + i$,0!&7$0a'5 , $+0i*i4a " 7a$!a

i$7"ia0a a' 4i!&a$+ 3a!a "0$! ' 3!+4"i7i$0+5 $ 0a$0+ ,'+4a'i)a '+ 6& *a'0a. D2 0+7a!, &$a !a"i+%!a* a 3a!a v!i*i4a!6& ' 7a0!ia' <0!avia"+ $+ , $4&$0! $ 4avi"a". E,0 0i3+ "i$4i"$0 i$va!ia2'7$0 , !%i,0!a $ 'a 1+a " $*!7!a.




. E, $4,a!i+ v!i*i4a! 6& 'a, %a,a, - 4+73!,a, 6& , &0i'i)a$ $ '/!a 6&i!!%i4a 4+$0$%a$ 7a0!ia' !a"i+3a4+ !a-0<.

S "2 $*a0i)a! 6& 'a 4+7&$i4a4i#$ "&!a$0 ' 3!i+3!a0+!i+5 3!+ $ ,34*i4+ "&!a$0 ' 0!a$,+3!a0+!i+5 , &$ *a40+! "4i,iv+ 3a!a''va! a 2&$ 3&!0+ 'a 4i!&%a5 3+! '+ 6& 'a $*!7!a i$,0!&7$0i,0a"2 7a$0$!'a $ 0+"+ 7+7$0+ $+ ,#'+ 4+$ 'a $*!7!a 4i!4&'a$05,i$+ 4+$ 0+"+ ' 6&i3+ 6&i!!%i4+.

uturo e la en)er*ería -uirr#i"aE$ &$ a!04&'+ 3&2'i4a"+ $ 'a I$0!$0 , 7$4i+$a 6& &$ 6&i3+ "4i$0*i4+, "' I$,0i0&0+ P+'i0(4$i4+ Na4i+$a' !*i!$ 6& , ,0/ ",a>!!+''a$"+ &$a $*!7!a 4i2!$(0i4a i$,0!&7$0i,0a5 3a!a a,i,0i! a' 4i>!&a$+ "&!a$0 'a i$0!v$4i#$ ' +20iv+ 3!i$4i3a' , $+ <3+$! a ,0 3!,+$a' a $*!7"a", i$*40+4+$0a%i+,a, 4+7+ ' VIH - 'a 13a0i0i,5$0! +0!a,. C+7$0a$ 6& 3+"!a !a'i)a! 'a, 7i,7a, *&$4i+$, 6& &$a$*!7!a5 a &$a 7a-+! v'+4i"a"5 4+$ 7+vi7i$0+, 3!4i,+, -5 $ ,3>

4ia'5 $+ 3!,$0a!a "a0+, " *a0i%a.C+$ ,0 0i3+ " a"'a$0+, 6&"a " 7a$i*i,0+ 6& '+, ava$4, 04>$+'#%i4+, a&7$0a$ " 7a$!a a4'!a"a - 3!7i0$ *a4i'i0a! - a%i'i)a! '0!a2a+ 6& 'a $*!7!a !a'i)a $ '+, "i*!$0, !+', 6& ' 4+!!,3+$>" a,&7i!5 $+ ,#'+ $ ' /!a 6&i!!%i4a5 ,i$+ $ '+, "i*!$0, ,4$a!i+,$ 6& , ",73a5 a"7/, " 6& ,0+, ava$4, !3!4&0$ " 7a>$!a *av+!a2' $ 'a a0$4i#$ 6& , +0+!%a a '+, 3a4i$0,. N+ +2,0a$05, 3!4i,+ !4+!"a! 6& 'a $*!7!a , &$a 3!+*,i#$ 7i$$07$0

1&7a$i,0a5 6& i73'i4a &$ a'0+ %!a"+ " 4+$+4i7i$0+5 !,3+$,a2i'i"a" - &i4i+ 4!0i4+5 &$0+ 4+$ &$a 2&$a 3!/40i4a - 0!a2a+ $ 6&i3+.

P+! '+ 0a$0+5 'a <3!i$4ia -5 ,+2! 0+"+5 ' a4!4a7i$0+ " ,07i72!+ "' 6&i3+ " ,a'&" 4+$ ' 3a4i$0 ,+$ *a40+!, i$,&,0i0&i2',.A, 6& a&$6& , 2&$+ 1a4! &$ &,+ !a)+$a"+ " 'a 04$+'+%a5 $&$4a"2 "a!, " 'a"+ 'a a0$4i#$ 3!,+$a'i)a"a 1&7a$+>1&7a$+ 6&!6&i! ' 3a4i$0 $ 4&a'6&i! 7+7$0+ - 7/, 0+"ava 4&a$"+ , ,+>70i"+ a a'%$ 3!+4"i7i$0+ 6&i!!%i4+.

E$ 4+$,4&$4ia5 'a $*!7!a !6&i! 4a"a "a " &$ 7a-+! 4+>$+4i7i$0+ - 4a3a4i0a4i#$ 3a!a 4+$0i$&a! a"6&i!i$"+ 1a2i'i"a", -",0!)a, $ ,0 4a73+5 " 7+"+ 6& ' 3!7i0a$ 4!4! a 'a 3a! " 'a04$+'+%a.




4uir,r-ica

:ilio#ra)ía

Diccionario enciclop0dico. E"i0+!ia' E,3a,a Ca'35 E,3aa 9::9 3. ;@.F&''! R. J+a$$a. #nstrumentación 8uir'r(ica$ *rincipios y *r-ctica5 E"i>

0+!ia' Pa$a7!i4a$a5 W ".5 M(<i4+5 3. @9:5 9::9.Ma!0$) D&2+i, Sa'va"+!. 2ases del Conocimiento 8uir'r(ico" E".

M4G!a>Hi''. M(<i4+ 3. 95 ;@.E$*!7!a 4i2!$(0i4a $0!a a' 6&i!#*a$+ $ 1003.7a%i,0!i+.

4+7.7<a!41iv+9::7a!)+107$*!7!ac!+2+0cIPN.1075

4+$,&'0a"+ ' ;? " *2!!+ " 9:;;.

$apítulo 15

n!tru*ental -uirr#i"o

E, $4,a!i+ i$,i,0i! $ 6& 'a $*!7!a , &$ i$0%!a$0 i73!,4i$"i> 2'"' 6&i3+ 6&i!!%i4+. C+7+ -a , 1a ",4!i0+ $ 4a30&'+, 3!vi+,54&73' 4+$ *&$4i+$, ,&,0a$4ia', "&!a$0 ' 3!i+3!a0+!i+5 , 6&i$ ,

$4a!%a " a4+$"i4i+$a! ' $0+!$+5 ,&7i$i,0!a! 0+"+ 0i3+ " 7a0> !ia' -6&i3+5 !a'i)a a40ivi"a", 4+7+ 4i!4&'a$0 + i$,0!&7$0i,0a5 04. A"7/," ,0a 7&'0i3'i4i"a" " a40ivi"a", , 0a72i($ 'a !,3+$,a2' " 'a+!%a$i)a4i#$5 4'a,i*i4a4i#$ - 7a$0$i7i$0+ "' i$,0!&7$0a' 6&i> !!%i4+.

E$ ,$4ia5 ,& *&$4i#$ $ !'a4i#$ 4+$ ' i$,0!&7$0a' , 'a " *+!>7a! &%+, + 6&i3+, 6& i$4'&-a$ 0+"+, '+, i$,0!&7$0+, $4,a!i+, 3a!a '+, 3!+4"i7i$0+, a !a'i)a! "&!a$0 'a 4i!&%a.

A ,0 !,340+5 - 4+7+ -a , 1a ",4!i0+ a' 0(!7i$+ " &$ 3!+4>

"i7i$0+ 6&i!!%i4+5 'a, $*!7!a, 4i!4&'a$0 i$,0!&7$0i,0a ,+$ 'a,










' 3!i7!+ ' i$,0!&7$0a' - '&%+ 4+$ ' 4a73+ "+2'5 1a4! &$a $v+'>0&!a 6& 4&2!a 3+! 4+73'0+ 'a 41a!+'a.

A' +!%a$i)a! ' i$,0!&7$0a' , 0+7a $ 4+$,i"!a4i#$ 'a ,34ia'i>

"a"5 -a 6& "3$"i$"+ "' #!%a$+ + ,i,07a a' 4&a' , !6&i!a a44,a!5,!/$ 'a, 4a!a40!,0i4a, - 4a$0i"a" " 3i$)a, 6& 3a!a ''+ , !6&i!. A4+$0i$&a4i#$ , a$a'i)a$ a'%&$a, " 'a, ,34ia'i"a", 7/, i73+!0a$0, -a'%&$a, ,&%!$4ia, 3a!a 4+$*+!7a! '+, 6&i3+,.

&!pe"ialiae! -uirr#i"a!

Ciru#ía #eneralLa 4i!&%a %$!a' 0!a0a 0+"+ 0i3+ " 3!+2'7a, %a,0!+i$0,0i$a', 6&

!6&i!$ " i$0!v$4i#$5 i$4'&- 1%a"+5 ,0#7a%+5 2a)+5 3/$4!a,51!$ia, " 3a!" a2"+7i$a'5 4+$,i"!a 0a72i($ 3!+4"i7i$0+, $ !4> 0+5%'/$"&'a 7a7a!ia - 0i!+i",.

D ,0 7+"+ a2a!4a i$0!v$4i+$, 4+7+ a3$"i440+7a5 4+'>4i,040+7a5 'a3a!+0+7a5 %a,0!40+7a5 %a,0!+,0+7a5 3i'+!+0+7a5 4+>

'+,0+7a5 !,44i#$ a2"+7i$+3!i$a'5 ,3'$40+7a5 3a$4!a0i4+->-&$+,0+7a5 a$a,0+7+,i, i$0,0i$a', =1i33'5 %a,0!+--&$+,0+7a51!$ia " 1ia0+5 17+!!+i"40+7a5 0i!+i"40+7a5 $0! +0!a,.

/nstrumental re4uerido en ciru-ía -eneralina!. K''-5 A''i,5 Ba41a&, 4a73+5 R+41,0!5 Ha',0" 7+,>

6&i0+5 Ba24+45 D&va'5 F+!,0! a$i''+,5 "i,44i#$ 4+$ - ,i$ "i$0,5

Mi<0!5 K+41!5 Ra$"a'5 C!i'5 L+v'a45 C'a73 i$0,0i$a',5 " 3!,i#$5 3a!a 4/'4&'+,5 Pa-!,5 04(0!a.

ortaagu=a!. D "i*!$0, 7"i"a,."4nula! de a!piraci+n. Ya$a!5 P++'5 $0! +0!a,.Separadore!. Fa!a2&*5 Ri41a!",+$5 Ba'*+&!5 Dav!,5 Ha!!i$%0+$5

G'3i5 =i0'a$!5 =+'7a$5 ,3a!a"+! 0i!+i"+ G!$5 La1-5 B4>7a$5 "i'a0a"+!, " Ba,5 $0! +0!+,. I$,0!&7$0+, !40a', 4+7+%a$41+, 3a!a 4!i30a5 ,3+ !40a'5 4/$&'a " a,3i!a4i#$ !40a'5 3i$)a "

2i+3,ia5 04(0!a.$i=era!. M0)$2a&7 - Ma-+.E' 4+!0 0i!a, , 3!3a!a $ 3a6&0, i$"3$"i$0,5 7i,7+,

6& , i$0%!a$ a' 6&i3+ 1a,0a ' 7+7$0+ 7i,7+ " 'a 4i!&%a. D






• ;: 3i$)a, " R+41,0! Pa$• 9 3i$)a, " Ba24+4• 9 3i$)a, Sa0i$,-

• 3i$)a, " 4,0i4+• 3i$)a, " F+!,0! a$i''+,• 9 3i$)a, " "i,44i#$ 4"• 9 3i$)a, " "i,44i#$ ,"• 9 3i$)a, D&va'• 3+!0aa%&a,• ; 4/$&'a " Ya$a!• 9 ,3a!a"+!, " Fa!a2&*

• ,3a!a"+!, " Dav!,• 9 ,3a!a"+!, " Ha!!i$%0+$• ; ,3a!a"+! " Fi$+41i00+• 9 7a$%+, " 2i,0&! $7. • ; 7a$%+ " 2i,0&! $7. @• ; !i#$ 2&"i$!a " a4!+ i$+<i"a2' " ; ::: - ?:: 7'

Especialidad de estóma-oO• ,3a!a"+!, " Dav!, " "i*!$0, 0a7a+,• ; ,3a!a"+! " Ba'*+&! " 44a'va• 9 ,3a!a"+!, " Ha!!i$%0+$• 3i$)a, Pa-!• 9 3i$)a, " "i,44i#$ 4" - ," " 9 47• ; 4/$&'a " P++' 47a$"!i'• 9 3i$)a, D&va' " 9: 47

• ; 3+!0aa%&a, " Ma-+ " 9 47

Ciru#ía e ortopeiaLa 4i!&%a " +!0+3"ia 0i$ 4+7+ 3!i$4i3a' +20iv+ ' 0!a0a7i$0+ 6&i>

!!%i4+ " '+, "*40+, "' ,i,07a 7&,4&'+,6&'(0i4+ a!0i4&'a4i+$,5'i%a7$0+,5 0$"+$,5 4a!0'a%+5 !3a!a4i#$ " *!a40&!a,5 $0! +0!+,.

La, i$0!v$4i+$, 6& ,0 !&2!+ i$4'&- ,+$ 4i!&%a, " !"&44i#$a2i!0a - *ia4i#$ <0!$a + i$0!$a5 !"&44i#$ 4!!a"a - *ia4i#$ i$0!$a +<0!$a5 3!+4"i7i$0+, $ 2!a)+5 7a$+5 4'av4&'a5 !+"i''a5 4a"!a5 0i2ia5 3!+$(5 0+2i''+5 3i5 $0! +0!+,.






• P!#0,i, " 3!&2a• S3a!a"+!, " S+*i'"• G&2ia !40a - a$%&'a"a

• E<0!a40+! " 4a2)a *7+!a' 0i!a2&)#$• S3a!a"+!, B47a$• S3a!a"+! " a!4+ 4+$ 3,a• S3a!a"+!, " Hi22,• G&2ia, !40a, - a$%&'a"a, •

Ga$41+ 3a!a 1&,+ • P!#0,i," 3!&2a

• T&2+ 3a!a v$0+ 7"&'a!• S3a!a"+!, " !a,0!i''+• F!,a $ T

E4uipo de ciru-ía de ortopedia para menisco# li-amentoO

• Ti!a, 3a!a 4a!0'a%+

• Ma$%+, " 2i,0&! *i$+,• Pa,a"+! " 0$"#$• S3a!a"+!, " =i0'a$!• S3a!a"+!, G'3i• S3a!a"+!, B'+&$05 M-!, !+"i''a• S3a!a"+!, " !a,0!i''+• Ma!0i''+• Ga$41+ 3a!a 1&,+

• G&2ia,• L%!a,• O,0#0+7+,• B!2i6&• P!*+!a"+! 7a$&a' •

Bi,0&! 3a!a 4a!0'a%+• Pi$)a " 7$i,4+,• C&!0a, 'a!%a, - 4+!0a, •

I$,!0a"+! " %!a3a,• G&a 3a!a %!a3a,• E<0!a40+! " %!a3a,• D,0+!$i''a"+!



$apítulo ; : /nstrumental 4uir,r-ico 211

E4uipo de ciru-ía de ortopedia para osteosíntesisO• ; ",a!7a"+!

• ; ",a!7a"+! 70/'i4+ 1<a%+$a'• ; 7a41&'+ $ T 41i4+• ; 7a41&'+ $ T %!a$"• @ 2!+4a, " "iv!,+, 0a7a+, •;<3'+!a"+! • ; av''a$a"+!• ; %&a• ; 3+!0a%&a• ; 3'a4a %&a a$%&'a"a

• ; ''av 1<a%+$a'• 9 4+73!,+!, " M_''!• ; ''av 3a!a 7a41&'+ 4+$ 4a7i,a

Ciru#ía #ine"ol#i"aS+$ i$0!v$4i+$, 6& , !a'i)a$ $ ,0!&40&!a, "' a3a!a0+ !3!+"&4>

0+! *7$i$+5 4+7+ 0!+5 +va!i+,5 v&'va5 va%i$a5 0!+73a, " Fa'+3i+ -

"7/,. E$0! ''a, , 4&$0a$ $0+$4, 1i,0!40+7a a2"+7i$a' + 3+! vava%i$a'5 ,a'3i$%++*+!40+7a5 ,a'3i$%40+7a5 6&i,0 " +va!i+ %'/$"&'a" Ba!01+'i$5 *,0&'a v,i4+va%i$a' + !40+va%i$a'5 4i,0+4' + !40+4'5v&'v40+7a5 4,/!a5 4+$i)a4i#$ "' 4&''+ &0!i$+5 04(0!a.

/nstrumental re4uerido en ciru-ía-inecoló-ica

ina!. Ha$-5 M&,&< M&))+05 P+))i5 3i$)a *&!0 3a!a a!0!ia&0!i$a5 Hi,0!+'av+5 $0! +0!a,.

Separadore!. Ri41a!",+$5 Fa!a2&*5 OZS&''iva$>OZC+$$+!.+rcep!. D Si73,+$5 " La&* 3a!a 3#'i3+, &0!i$+,.>tro!. Va'va, " D+-$ " "i*!$0, 0a7a+,5 ,3+, ,3(4&'+,

" "i*!$0, 0a7a+,5 "i'a0a"+!, &0!i$+, " H%a!5 1i,0!#70!+.

E4uipo de ciru-ía -inecoló-ica para histerectomía

abdominalO• ; !i#$ " a4!+ i$+<i"a2' " ; ::: 7'• ; !i#$ " a4!+ i$+<i"a2' " ?:: 7'




• 9 va,+, " a4!+ i$+<i"a2'• 9 3i$)a, " F+!,0! a$i''+, !40a,• ; 3i$)a " F+!,0! a$i''+, 4&!va

• ; 3+!0aa%&a, 'a!%+• 9 3+!0aa%&a, 7"ia$+• ? 3i$)a, " R+41,0! 4&!va, •

? 3i$)a, " Ha$- 4&!va,• ? 3i$)a, " Ba24+4• ;: 3i$)a, " A''i,• ? 3i$)a, " A''i, 'a!%a,

•;: 3i$)a, " K''- 4&!va,

• ;: 3i$)a, " K''- !40a,• 3i$)a, " Ba41a&, 4a73+• 9 3i$)a, " "i,44i#$ 4+$ "i$0,• 9 3i$)a, " "i,44i#$ ,i$ "i$0,• 9 3i$)a, " "i,44i#$ 'a!%a,5 4+$ - ,i$ "i$0,• ; 3i$)a " "i,44i#$ !&,a• 9 ,3a!a"+!, Fa!a2&*

• 9 7a$%+, " 2i,0&! $7. • ; va'va " Ea,07a$• ; 4/$&'a Ya$a!• ; ,3a!a"+! OZS&''iva$>OZC+$$+!• va'va,5 ,&3!a32i4a, i$*!a32i4a,

E4uipo de ciru-ía -inecoló-ica

para salpin-oclasiaO• ; !i#$ " a4!+ i$+<i"a2'• 3i$)a, " Ba41a&, 4a73+• 9 3i$)a, " K''- " ; 47• 9 3i$)a, " K''- !40a, " ;9 47• 9 3i$)a, " A''i, " ; 47• ; 3i$)a " F+!,0! a$i''+, !40a• 9 3i$)a, "i,44i#$ 4+$ - ,i$ "i$0, " ;? 47

• 9 3+!0aa%&a, H%a! " 9: 47• 9 ,3a!a"+!, Fa!a2&*• 9 ,3a!a"+!, Ri41a!",+$• ; 7a$%+ " 2i,0&! $7.




E4uipo de ciru-ía -inecoló-ica para cesáreaO

• 9 !i+$, " a4!+ i$+<i"a2' " ?:: 7'

• ; Qa$!a " a4!+ i$+<i"a2'• 3i$)a, " F+!,0! a$i''+, !40a,• ; 3i$)a " F+!,0! a$i''+, 4&!va• 9 3i$)a, R+41,0! 4&!va, " 9: 47• 9 3+!0aa%&a, 7"ia$+,• ? 3i$)a, " A''i,• ? 3i$)a, " K''- 4&!va,• 3i$)a, " K''- !40a,

• 3i$)a, " Ba41a&, 4a73+• 9 3i$)a, " "i,44i#$5 4+$ - ,i$ "i$0,• ; 3i$)a !&,a• 9 ,3a!a"+!, " Fa!a2&*• 9 7a$%+, " 2i,0&! $7. • ; va'va " Ea,07a$• ; 4/$&'a Ya$a!

• ; ,3a!a"+! " Ba'*+&!• ; va'va ,&3!a32i4a

Ciru#ía uro#enital

E$ ,0 0i3+ " i$0!v$4i+$, , !a'i)a$ 3!+4"i7i$0+, 3a!a 4+!!> %i!a*40a4i+$, $ ' a3a!a0+ !3!+"&40+! *7$i$+ + 7a,4&'i$+ 6&

i$v+'&4!a$ #!%a$+,5 4+7+ ' !i#$5 &!(0!,5 vi%a - &!0!a. L+, 3!+4>"i7i$0+, 3&"$ ,! a2i!0+, + 4!!a"+,. E$ '+, a2i!0+, , 1a4 &$ai$4i,i#$ 3a!a <3+$! 'a )+$a5 $ '+, 4!!a"+, $+ , <3+$ ' ,i0i+5 ,#'+, vi,&a'i)a 3+! 7"i+ " &$ a3a!a0+ ''a7a"+ 4i,0+,4+3i+ 4+$ ' 4&a' , 3&" <a7i$a! - 1a4! "ia%$#,0i4+ 1a,0a 'a 7i,7a 4i!&%a.

A'%&$+, 73'+, " 'a, i$0!v$4i+$, 6& , a%!&3a$ $ ,0 !&> 2!+ ,+$ $*!40+7a5 $*!+,0+7a5 0!a,3'a$0 !$a'5 3i'+'i0+0+7a5 &!>0!+'i0+0+7a5 4i,0+0+7a5 3!+,0a040+7a5 4i!4&$4i,i#$5 1i3+,3a"ia,5

i73'a$0 3$ia$+5 +!6&i40+7a5 +!6&i"+3<ia5 va,40+7a5 1i"!+4'4>0+7a.

Ta72i($ , !a'i)a$ 3!+4"i7i$0+, "ia%$#,0i4+, 3+! 4i,0+,4+3ia54+7+ !,44i#$ 0!a$,&!0!a' " 'a 3!#,0a0a.




4uir,r-ica

/nstrumental re4uerido en ciru-ía uro-enital

ina!. C'a73 " Ma-+5 " H!!i45 " =!01i7>C&''$5 04.5 3a!a 4+!"#$ ,3!7/0i4+5 04(0!a.

Separadore!. Pa!a vi%a5 " J&"">Ma,,+$5 3a!a 3!#,0a0a5 " Y+&$%'a0!a'5 a$0!i+! - 2i*&!4a"+5 " T1+7,+$>=a'!. S+$"a &!0!a' " O0i,5"i'a0a"+!, 3a!a 4&''+ v,i4a' Mi''i$5 04(0!a.

E4uipo de ciru-ía uro-enital para histerectomíava-inalO

• 9 !i+$, " a4!+ i$+<i"a2' ?:: - ; ::: 7'• 9 va,+, " a4!+ i$+<i"a2'• 3i$)a, " Ba41a&, 4a73+• ;: 3i$)a, " A''i, ; 47• ;: 3i$)a, " K''- 4&!va, ; 47• ? 3i$)a, " K''- !40a, ; 47• ? 3i$)a, " R+41,0! 4&!va, 9: 47• 9 3i$)a, " F+!,0! a$i''+, !40a,

• ; 3i$)a " F+!,0! a$i''+, 4&!va• 9 3i$)a, " P+))i• 9 3i$)a, " Ha$-• 9 3i$)a, " "i,44i#$ 4+$ "i$0, 9: 47• 9 3i$)a, " "i,44i#$ ,i$ "i$0, 9: 47• 9 3+!0aa%&a, H%a! 9: 47• 9 7a$%+, " 2i,0&! $7. • 9 ,3a!a"+!, Fa!a2&*

• va'va, " D+a-a$• ; va'va Ea,07a$

E4uipo de ciru-ía uro-enital para colposuspensiónO• 9 !i+$, " a4!+ i$+<i"a2' " ?:: - ; ::: 7'• ;: 3i$)a, " Ba41a&, 4a73+• ;: 3i$)a, " K''- 9 47• ;: 3i$)a, " R+41,0! ; 47

• ;: 3i$)a, " A''i, ; 47• 9 3i$)a, " P+))i ; 47• 9 3i$)a, " "i,44i#$ 4+$ - ,i$ "i$0,• 9 3i$)a, " M&,&< M&))+0• 9 7a$%+, " 2i,0&! $7.




• 9 va'va, va%i$a', ,&3!i+! i$*!i+!• 9 3+!0aa%&a, " ; 47

E4uipo de ciru-ía uro-enital para nefrolo-íaO• ;: 3i$)a, " 4a73+• ;: 3i$)a, " K''-• ;: 3i$)a, " A''i,• 9: 3i$)a, " R+41,0! •

9 3i$)a, " Ra$"a' • 9 3i$)a, " Ba24+4• 3i$)a, " 4,0i4+

• 3i$)a, " F+!,0! a$i''+,• 9 3i$)a, "i,44i#$ 4+$ "i$0,• 9 3i$)a, "i,44i#$ ,i$ "i$0,• 3+!0aa%&a,• 9 7a$%+, " 2i,0&! $7. • ; 7a$%+ " 2i,0&! $7. @• 9 ,3a!a"+!, Fa!a2&*• ; 4/$&'a " Ya$a!

• ? ,3a!a"+!, " Dav!,• ; ,3a!a"+! " Fi$+41i00+• 9 !i+$, " a4!+ i$+<i"a2' " ?:: - ; ::: 7'

Ciru#ía "aria"aÁ!a " 'a 4i!&%a +4&3a"a "' 0!a0a7i$0+ " a*44i+$, "' 4+!a)#$5

3!i4a!"i+5 %!a$", va,+, - ,i,07a va,4&'a! 3!i*(!i4+. E' 3!i$4i3a' +2>

0iv+ " ,0a 4i!&%a , 4+!!%i! + 7+!a! ' *&$4i+$a7i$0+ 4a!"ia4+.Pa!a !a'i)a! ,0a 4i!&%a , !6&i! " &$ a2+!"a 4+7$ ''a7a"+

,0!$+0+7a5 ' 4&a' 4+$,i,0 $ 1a4! &$a i$4i,i#$ $ 'a '$a 7"ia "'0#!a<5 - " ,0a 7a$!a +20$! 'a <3+,i4i#$ - vi,&a'i)a4i#$ " 'a4avi"a" 0+!/4i4a5 3!+ ,+2! 0+"+ "' 4+!a)#$. C+$ 2a, $ '+ a$0!i+! ,6& , "2 i$4'&i! 6&i3+ 3a!a !,44i#$ 4+,0a' $ 0+"a 4i!&%a a 4i> '+a2i!0+. A'%&$+, 3!+4"i7i$0+, 6& 73'i*i4a$ '+ a$0!i+! ,+$ ' 4i!!"' 4+$"&40+ a!0!i+,+5 4+!!44i#$ " 'a 4+a!0a4i#$ " 'a a+!0a 0+!/4i4a5!,44i#$ " a$&!i,7a, " a+!0a a,4$"$05 ",4$"$05 bypass 4a!"i+3&'7+$a!5 a$%i+3'a,0ia " a!0!ia 4+!+$a!ia5 !73'a)+ " v/'v&'a,a#!0i4a - 7i0!a'5 4i!! " 4+7&$i4a4i#$ i$0!v$0!i4&'a! i$0!> a&!i4&'a!54+!!44i#$ " 00!a'+%a " Fa''+05 04(0!a.




4uir,r-ica

E$ ' 4a,+ " 'a 4i!&%a va,4&'a! 3!i*(!i4a5 , !a'i)a $ a!0!ia, -v$a, 6& $+ , &2i4a$ $ ' 4+!a)#$5 4&-+ *i$ , 4+!!%i! + 7+!a! 'a

4i!4&'a4i#$ ,a$%&$a. E$0! ''a, , 4&$0a$ $"a!0!40+7a 4a!+0> "a5!,44i#$ "' a$&!i,7a " a+!0a a2"+7i$a' - bypass a+!0+*7+!a'5bypass *7+!+3+3'0+5 72+'40+7a5 "!iva4i#$ 3+!0+4ava5 'i%a"&!a "'a v$a 4ava5 ,a*$40+7a5 04(0!a.

/nstrumental re4uerido en ciru-ía cardiacaE$0! +0!+,5 , "2$ i$4'&i! '+, ,i%&i$0, i$,0!&7$0+, 4'a73 "

C++'- 3a!a 4+a!0a4i#$5 4'a73 " D2a- a$%&'a"+5 4'a73 " G'+v!5 3i$)a 0+!/4i4a " R&7'5 4'a73 " F+%a!0- Hi"!+%!i35 Q2+<0!a40+!,i$0!$+5 <0!$+5 3i$)a C'a73 B&''"+% G'+v! " "i*!$0, 7"i"a,54&!va, - !40a,5 0i!a " P+00, S7i01 a4+"a"a " :5 ? - 9?5 3i$)aC'a735 B&''"+% G'+v! Sa0i$,- - ,3a!a"+! Fi$+41i00+.

E4uipo de ciru-ía cardiaca para venodisecciónO

• 9 3i$)a, " Ba41a&, 4a73+ " ;? 47

• ; 3i$)a " Ha',0" 7+,4+ 4&!va " ; 47• ; 3i$)a " Ha',0" 7+,4+ !40a " ; 47• 9 3i$)a, " K''- 4&!va, " ; 47• 9 3i$)a, " A''i, " ; 47• ; 3+!0aa%&a, " H%a! !40+ " ; 47• ; 3i$)a " "i,44i#$ 4+$ "i$0, " ; 47• ; 3i$)a " "i,44i#$ ,i$ "i$0, " ; 47• Ma$%+ " 2i,0&! $7.

Especialidad de cardiolo-ía para ciru-ía ma#orO

• ; 3i$)a " "i,44i#$ " D2a- %!a$" !40a• ; 3i$)a " "i,44i#$ " D2a- %!a$" 4&!va• ; 3i$)a " "i,44i#$ " D2a- 7"ia$a 4&!va• ; 3i$)a a+!0+a2"+7i$a' " 4+2!a• ; 3i$)a " a+!0a 0+!/4i4a• ; 3i$)a " C++'- 4&a"!a"a

• ; 3i$)a " S72• 9 3i$)a, " Sa0i$,-• 9 3i$)a, " Mi<0!• ; 3i$)a " G'+v! 4&!va• ; 3i$)a " G'+v! !40a








• ; 3i$)a 3!+040+!a " "&!a• ; ,i!!a " Gi%'i• ; a%&a v$0!i4&'a!

E4uipo para laminectomíaO• ; 2&"i$!a %!a$"• 9 3i$)a, " "i,44i#$ " A",+$ 4+$ - ,i$ "i$0,• ;: 3i$)a, " Ba41a&, 4a73+ •

;: 3i$)a, " A''i,• ;: 3i$)a, " K''- !40a,• 9: 3i$)a, " K''- 4&!va,

• ,3a!a"+!, " =+'7a$• 3+!0aa%&a,• 9 ,3a!a"+!, " =i0'a$!• ; ,3a!a"+! " S1'"+$• ; ,3a!a"+! " Hi22,• 4&41a!i''a, 3a!a 1&,+• ; ,3a!a"+! " B47a$• ; 3i$)a " "i,4+ !40a - a$%&'a"a

• ; 7a!0i''+• ; '%!a 4+!0a$0• 3i$)a, " K!!i,+$• 4i$4', !40+,• 4i$4', a4a$a'a"+, •

; %&2ia " F&'0+$• ; %&2ia a$%&'a"a •

; %&2ia " L,''

• 4/$&'a, " a,3i!a! 4+$ "+, 7a$"!i',• 9 ,3a!a"+!, " !a)• 9 "i,40+!, " A",+$5 4&!v+ - !40+• ; 4i)a''a• 9 3i$)a, " "i,44i#$ " 2a-+$0a• 9 3i$)a, " "i,44i#$ 4+$ - ,i$ "i$0,• 9 7a$%+, " 2i,0&! $7. • ; 7a$%+ " 2i,0&! $7.

• ; "i,40+! " F!a)i! •;,+$"a a4a$a'a"a• ; va,+ 70/'i4+• ; 3i$)a " R+41,0!




E4uipo para derivación ventriculoperitonealO• ; 2&"i$!a 70/'i4a

• 3i$)a, " Ba41a&, 4a73+• 3i$)a, " A''i,• ;: 3i$)a, " Ha',0" 4&!va, 7+,4+• ;: 3i$)a, " K''- 4&!va, •

9 3+!0aa%&a, 'a!%+,• ; 3+!0aa%&a, 7"ia$+• 9 ,3a!a"+!, " =i0'a$! 7"ia$+,• ; ,3a!a"+! " 7a,0+i", i$*a$0i'

• ; 0!3a$a"+! " H&",+$• 4&41a!i''a, 3a!a 1&,+• 9 3i$)a, " "i,44i#$ " 2a-+$0a %!a$" - 7"ia$a• 9 3i$)a, " "i,44i#$ 4+$a ,i$a• 9 3i$)a, " "i,44i#$ " A",+$ 4+$ "i$0, - ,i$ "i$0, •

; "i,40+! " F!a)i! • 7a$%+, " 2i,0&!• ; a%&a v$0!i4&'a! $7.

• va,+, 70/'i4+,• 4/$&'a, " a,3i!a4i#$ 4+$ 7a$"!i'• ; 3i$)a &0!i$a• 9 ,3a!a"+!, " Fa!a2&*• ; 0&$'i)a"+!• ; "i,40+! " a7%"a'a,

Ciru#ía o)tal*ol#i"aS+$ 4i!&%a, $ "+$" , 0!a2aa " 7a$!a "i!40a $ ' %'+2+ +4&'a!

$ (,0a, , 0!a0a " 4+!!%i! 7a'*+!7a4i+$, 4+$%($i0a,5 0!a&7a0i,7+, +a'%&$a $*!7"a"5 i$4'&-$"+ 3/!3a"+,5 7,4&'+, +4&'a!, - ,i,07a'a%!i7a'.

A'%&$+, 73'+, " ,0a, i$0!v$4i+$, ,+$ !3a!a4i#$ " $0!+> 3i#$ - 40!+3i#$5 <0!a44i#$ " 30!i%i#$5 !,44i#$ "' 'va"+! "' 3/!>

3a"+5 !,44i#$ " !40+ 'a0!a' - 7"ia'5 "a4!i+!!i$+4i,0+,0+7a5 0!a,> 3'a$0 " 4#!$a5 $&4'a4i#$ - vi0!40+7a5 a, 4+7+ ",3!$"i7i$0+ "!0i$a.



$apítulo ; :/nstrumental 4uir,r-ico 221

/nstrumental re4uerido en ciru-ía

oftalmoló-icaE, i73+!0a$0 a4'a!a! 6& ' i$,0!&7$0a' 3a!a ,0 0i3+ " 4i!&%a ,7&- "'i4a"+ "2i"+ a 'a a$a0+7a "' ++5 a"7/,5 " a4&!"+ 4+$ '0i3+ " 3!+4"i7i$0+ , 3&" &0i'i)a! &$ 7i4!+,4+3i+ 3a!a ,0!&40&!a,"7a,ia"+ 36&a, - 6& $+ 3&"$ ,! vi,&a'i)a"a, a ,i73' vi,0a.

ina!. Ca,0!+vi+ ,&0&!a5 " Bi,1+3 Ha!7a$5 " !'+!+5 "D,7a!!, 3a!a 41a'a)i#$5 " Ba!!a6&! 3a!a 3,0aa5 " G!a* 3a!a i!i,.

uerat+too!. D Ja%!5 " Ca,0!+vi+."uc<illa!. D Bav! - 4&41i''a, " G!a* 3a!a 4a0a!a0a.anc<o!. D T-!'' 3a!a i!i, - " Ja7,+$ 3a!a 7,4&'+.Separadore!. D M4P1!,+$5 " S0v$,+$5 " 3/!3a"+5 " R+>

,$2a&75 2'*a!#,0a0+ " C+$a-5 $0! +0!+,.>tro!. P+!0aa%&a, " Ca,0!+vi+ - " Ba!!a6&! ,+$"a, 'a%!i7a>

', " B+7a$5 ,a4a2+4a"+, " Ca,0!+vi+.

E4uipo de ciru-ía oftalmoló-ica para estrabismoO• ; !i#$ " a4!+ i$+<i"a2' " ?:: 7'• 9 3i$)a, " Ha',0" 7+,4+• 9 3i$)a, " Ba41a&, 4a73+• ; 3+!0aa%&a, *i$+• ; 4+73/,• ; 7a$%+ " 2i,0&! $7. • ; %a$41+ " *&%+

• ; 3i$)a " Bi,1+3• ; 3i$)a " 1i'+,• ; 2'*a!#,0a0+• 9 %a$41+, 4+$ +'iva• ; %a$41+ " 7,4&'+• 9 ,3a!a"+!, ",7a!!,

E4uipo de ciru-ía oftalmoló-ica

para dacriorrinocistectomíaO• ; 4/$&'a " a,3i!a4i#$ *i$a• ; ,3a!a"+! " S0v$,+$• ; 3i$)a " 2a-+$0a• "i,40+!, " 3!*i'




• 9 4i$4',• ? '%!a, 4&!va,• ; ,+$"a a4a$a'a"a

E4uipo de ciru-ía oftalmoló-ica para catarataO• ; !i#$ " a4!+ i$+<i"a2' ?:: 7'• 3i$)a, " Ba41a&, 4a73+• 3i$)a, " Ha',0" 7+,4+• ; 3+!0aa%&a, *i$+• ; 7a$%+ " 2i,0&! $7. • ; ,4'!#0+7+

• ; %a$41+ " *&%+• ; !3+,i0+! " i!i,• ; 4&41a!i''a " Davi'• ; 3i$)a " Bi,1+3• ; 3i$)a " "i,44i#$ *i$a• 9 ,3a!a"+!, " G!a*

Ciru#ía e *íni*a inva!inTa72i($ , 4+$+4 4+7+ $"+,4+3ia5 , "4i!5 6& , !73'a)a 'a vi>

,i#$ "i!40a "' ++ 3+! &$ ,i,07a " vi,&a'i)a4i#$ a "i,0a$4ia. S !a'i)a4+$ 'a a-&"a " a3a!a0+, " *i2!a #30i4a5 6& 3!7i0$ v! ' i$0!i+! "&$a 4avi"a" & #!%a$+ 1&4+ (,0 , i$,!0a a 0!av(, " 'a 3a!" a2"+7i>$a' 3+! 7"i+ " 36&+, +!i*i4i+,5 + 2i$ 3&" i$0!+"&4i!, a 0!av(, "'+, +!i*i4i+, $a0&!a', "' 4&!3+5 4+7+ 2+4a5 a$+ - va%i$a.

E$ 4a,i 0+"a, 'a, ,34ia'i"a", 6&i!!%i4a, , 3+,i2' 1a4! 4i!&%a" 7$i7a i$va,i#$ %i$4+'+%a5 &!+'+%a5 0!a&7a0+'+%a5 4i!&%a %$>!a'5 " +0+!!i$+'a!i$%+'+%a5 04.5 3+! 0a$0+5 'a, 0(4$i4a, ,+$ 7'0i3', -va!ia"a,. E$0! 'a, i$0!v$4i+$, 6& , !a'i)a$ 4+$ ,0 7(0+"+ ,0/$'a, ,i%&i$0, a3$"i440+7a 3+! 'a3a!+,4+3ia5 4+'4i,040+7a 'a3a>!+,4#3i4a5 !,44i#$ 0!a$,&!0!a'5 <0i!3a4i#$ " 6&i,0, !$a', - 'i$*a>"$40+7a.

/nstrumental re4uerido en ciru-íade mínima invasiónE$ ' 4a,+ " 6& 'a i$0!v$4i#$ ,a $ ' ,i,07a #30i4+5 , !6&i!4+$0a! 4+$




• M+$i0+! " 0'vi,i#$• C/7a!a " vi"+• d30i4a + 'a3a!+,4+3i+

• Fi2!a #30i4a• F&$0 " '&) *!a

E' i$,0!&7$0a' " a44,+ $ &$a 4i!&%a " 7$i7a i$va,i#$ i$4'&-

• A%&a " V!,,• Di,0i$0a, va!i"a", " 0!#4a!,• I$,0!&7$0+, " "i,44i#$5 17+,0a,ia - 4+!0 " ? 77• I$,0!&7$0+, " a%a!!

• I$,0!&7$0+, " 'i%a"&!a - ,&0&!a• I$,0!&7$0+, " 3&$4i#$ - 2i+3,ia• I$,0!&7$0+, " a,3i!a4i#$ i!!i%a4i#$• Ca2', 7+$+3+'a! - 2i3+'a!

La, 3i$)a, 3a!a ,0 0i3+ " 4i!&%a ,+$ 'a!%a, - , ', "$+7i$a 4+$' 3!*i+ $"+ 3. .5 $"+0i!a5 $"+3i$)a `" K''-5 A''i,5 Ba24+4504. *i%&!a ;?>9.

E' 3!+4"i7i$0+ 2/,i4+ 3a!a ' a2+!"a $ a2"+7$ , ' ,i%&i$0

;. N&7+3!i0+$+ i$0!+"&44i#$ " %a, a' a2"+7$ 3a!a i$,&Qa!.9. S 4+'+4a 0!#4a! - 4a7i,a a 0!av(, " 'a 3a!" a2"+7i$a'.. S !a'i)a ' 3!+4"i7i$0+ 3!+3ia7$0 a3$"i440+7a5 4+'4i,>

040+7a5 'i$*a"$40+7a5 04..

i#ura 152. /nstrumental para ciru-ía de mínima invasión.




. S 'i7i$a $&7+3!i0+$+.?. S ,&0&!a$ '+, 3&!0+, & +!i*i4i+, 6& , 1i4i!+$ 3a!a 4a"a &$+ "

'+, 0!#4a!,.

Tar(eta! el in!tru*ental en el 'o!pitalGeneral e $<xi"oS 1a$ !*!i"+ 1a,0a ,0 7+7$0+ a'%&$+, 6&i3+, 4+$ ' i$,0!&7$0a'

$4,a!i+ 3a!a 'a, 4i!&%a, 7/, 4+7&$, ,0a, !*!$4ia, , 1a$ 0+7a>"+ " 7a$!a 0<0&a' " 'a, 0a!0a, 6& ,+$ 4+'+4a"a, $ ' i$,0!&7$> 0a'

" '+, "i*!$0, 6&i!#*a$+, "' H+,3i0a' G$!a' " M(<i4+. Di41a,!*!$4ia, !3!,$0a$ &$a 4'a!a vi"$4ia " 6& a!7a! '+, 6&i3+,"3$"5 $ 7&41+5 " 'a, $+!7a, " 4a"a i$,0i0&4i#$. C+7+ , 1a 3+>"i"+ +2,!va!5 3+! '+ %$!a' , ' "a $+72! a' i$,0!&7$0a' " a4&!"+4+$ ,& *&$4i#$5 -a 6& !,&'0a 7/, */4i' a3!$"!'+ a,5 6& !*!i!'+ 3+!,& $+72! " 3a0$0 a&$6&5 " $&v+5 ,0+ "3$" " 4a"a i$,0i0&>4i#$. E' +20iv+ " a!7a! '+, 6&i3+, " &$a 7a$!a +!%a$i)a"a 4&a'>6&i!a 6& ,a 'a 6& , 'ia , *a4i'i0a! ' 0!a2a+ " 'a, $*!7!a, i$,>

0!&7$0i,0a - 4i!4&'a$0 "&!a$0 ' 0!a$,+3!a0+!i+ a *i$ " 6& '+%!$i"$0i*i4a! - &2i4a! 4a"a &$a " 'a, 3i)a,.

$anteni*iento el in!tru*entalE' i$,0!&7$0a' 6&i!!%i4+ 4+$,0i0&- &$a i73+!0a$0 i$v!,i#$ 3a!a 'a,i$,0i0&4i+$,5 3+! '+ 6& "2$ 1a4!, ,*&!)+, "i!i%i"+, a 4+$,!va! ,&va'+!5 '+ 6& ' %a!a$0i)a &$a 'a!%a vi"a 0i' - 7a$0i$ a' 7/<i7+ ,&

*&$4i+$a'i"a". S& 4+!!40+ - a3!+3ia"+ 7a$+ , 'a 4'av 3a!a ' (<i0+ "'a, 4i!&%a,5 '+ 6& 3!7i05 a' 7i,7+ 0i73+5 +0+!%a! &$a a0$4i#$ "4a'i"a" a '+, $*!7+,.

A'%&$a, !4+7$"a4i+$, %$!a', 3a!a 3!,!va! ' i$,0!&7$0a',+$

• Da! ' &,+ i$"i4a"+ a 4a"a i$,0!&7$0+.• Evi0a! "a!'+ 4a! + %+'3a!'+.• Li73ia!'+ 4+$,0a$07$0 "&!a$0 ,& &,+ - &,0+ a' 0!7i$a! 'a 4i>

!&%a.• Evi0a! 6& ' i$,0!&7$0a' 4+$ 3&$0a - " 4+!0 , "a $ ,0 4a,+

, 3&"$ 4+'+4a! 4a3&41+$, " 3'/,0i4+ $ 'a, 3&$0a, 3a!a 3!+0>%!'+.




• Da! a2i!0a, 'a, 4!7a''!a, 3a!a 6& ,a 3+,i2' !a'i)a! &$a 4+>!!40a 'i73i)a - ,0!i'i)a4i#$.

• R0i!a! 4+$ a%&a ' <4"$0 " "0!%$0 1a,0a 'i7i$a!'+ 3+!

4+73'0+.• S4a! a 'a 3!*44i#$ - 3!+4"! a ,& 3!3a!a4i#$ 3a!a 'a ,i%&i$0

i$0!v$4i#$.• L&2!i4a! 'a 4aa " 0!a2a - 4!7a''!a, 4+$ *!4&$4ia5 a,%&!/$"+,

" !0i!a! ' <4"$0 " '&2!i4a$0.• E$ ' 4a,+ " i$,0!&7$0+, " $"+,4+3ia5 "2$ ",7+$0a!, -

'ava!, 4+$ ,&7+ 4&i"a"+5 4+$ a%&a 0i2ia 4+$,&'0a! ,i73! 'a, !>4+7$"a4i+$, "' *a2!i4a$0 - a,%&!a!, " 6& , ,0!i'i4$ 4+$

%a, + 2i$ 7"ia$0 ",i$*44i#$ " a'0+ $iv'.

:ilio#ra)ía

F&''! R J. #nstrumentación &uir'r(ica$ *rincipios y pr-ctica5 E"i0+!ia'

Pa$a7!i4a$a W ".5 M(<i4+5 3. @9:5 9::9.H&!0a T+!!, F. Manual de instrumentación &uir'r(ica5 E". M4G!a>

Hi''>I$0!a7!i4a$a5 M(<i4+5 3. 5 ;.1003.1vi'.,i".4&i$,0!&7$0a'>6&i!&!%i4+&!+'+%i4+;.107'5 4+$>

,&'0a"+ ' " *2!!+ " 9:;;.P1i''i3, N. 2erry y 4ohn" T0cnicas de &uirófano5 ;:W ".5 E". M+,2-5 E',>

vi!5 Ma"!i"5 E,3aa5 3. ;::;5 9::?.





Eni"e al)a<ti"o

N+0a L+, $7!+, " 3/%i$a $ negrita! i$"i4a$ 4&a"!+5 - a6&''+, $ cursi

vas" *i%&!a,.

AÁ4i"+5 3!a4(0i4+5 9@

3+'i%'i4#'i4+ "<#$5 ?9A%&a, a0!a&7/0i4a,5 ?A%&a,5 4a!a40!,0i4a, " 'a,5 ?

4&!3+5 ?++ & +a'5 ? 3&$0a5 ?

Ai! 4a'i$05 9Ai!a4i#$5 9?5 25A'4+1+' 0'i4+ 4+7+ a$0i,(30i4+5 @A$,0,ia5 @

4a!!+ "5 A$,0,ia %$!a'5 <4i0a4i#$5 @;

i$"&44i#$5 @;i$1a'a0+!ia + $"+v$+,a5 @:

3a!0i4i3a4i#$ " $*!7!a5 @; 3'a$+ 6&i!!%i4+5 @;0(4$i4a " i$1a'a4i#$5 @;0(4$i4a i$0!av$+,a 0+0a'5 @;0(4$i4a #<i"+ $i0!+,+5 $a!4#0i4+,

- !'aa$05 @;A$,0,ia '+4a'5

2'+6&+ 3i"&!a' + ,3i$a'5 6&i3+ ",41a2' 3a!a 2'+6&+5

227

7a0!ia' - 6&i3+ 3a!a 2'+6&+5

3+! i$*i'0!a4i#$5 3!+4"i7i$0+ $*!7!a 4i!4&>

'a$05 @:,&3!*i4ia' + 0#3i4a5

A$0i,3,ia5 " 'a !%i#$ a2"+7i$a'5 'ava"+ 74/$i4+ -5 4+$ i$,0a'a>

4i#$ " ,+$"a v,i4a'5$ 1+72!,5 ;$ 7&!,5 :

3!+4"i7i$0+5 A$0i,(30i4+5 ;@

A3a!a0+, '40!+"+7(,0i4+,5 ;a,3i!a"+!5 2i,0&! a!7#$i4+5 2+72a " i$*&,i#$5 4a!a40!,0i4a, i"a', " &$ 7+>

$i0+!5 @4i!4&i0+ 2i3+'a!5 4i!4&i0+ 7+$+3+'a!5 4+'41#$ 0(!7i4+5 ?

'40!+4a&0!i+5 96&i3+ " !,&4i0a4i#$5 :7+$i0+! " ,i%$+, vi0a',5



228 : 8ndice alfab'tico

Á!a *,i4a "' 6&i!#*a$+5 a44,+!i+,5 ;/!a $%!a5 @

a,340+, '%a',5 ; 2a$4+, " a'0&!a5 ;;4a!a40!,0i4a,5 4+$,$0i7i$0+ i$*+!7a"+5 4&20a, " 3a0a"a5 ;;",4!i34i#$5 <3"i$0 4'$i4+5 9*+!7a - 0a7a+5 1+a " $*!7!a5 i'&7i$a4i#$5 ;;7a'a 3!/40i4a5 97,a a&<i'ia! + " !i#$5 ;97,a " Ma-+5 ;97,a Pa,0&!5 ;97,a 6&i!!%i4a5 ;9+20iv+5 @

3i,+5 041+ - 3a!"5

3&!0a,5 ;:!4+7$"a4i+$,5 ?073!a0&!a5 ;:0!i3i(5 ;9)+$a 2'a$4a5 )+$a %!i,5

A!%#$ 3'a,7a5 A!0!+,4+3ia5 A,3i!a"+!5

3!+4"i7i$0+5 ?A&0+4'av5 ;

!4+7$"a4i+$, a' 4+'+4a! 'a4a!%a $ '5 9;

:Ba40!i+,0/0i4+5 ;

Ba0a 6&i!!%i4a5 ;?@Bi,0&! a!7#$i4+5 B+72a " i$*&,i#$5 B!+$4+,4+3ia5 B&'0+ 6&i!!%i4+5 ;?

a3!0&!a "5 ;?+!"$ "'5 ;?@!+3a 6&i!!%i4a 3a!a a!7a! &$5

;?@B&'0+, " !+3a5 "iv!,+,5 ;;

3a!a 4i!&%a 7a-+!5 ;; 3a!a 4i!&%a 7$+!5 ;; 3a!a 3a!0+5 ;; 3!3a!a4i#$ " '+,5 ;?!4+7$"a4i+$,5 ;@

B&'0+, ,0(!i',5 0(4$i4a 3a!a 'a a3!>0&!a "5 ;?

CCa'+!5 17"+5 ;

,4+5 9Ca73+, + 4+73!,a,5 "+2',5 ;?

,$4i''a,5 ;?Ca73+, 6&i!!%i4+,5 a'0a !,i,0$4ia

a ",%a!!+,5 ;a'0a !,i,0$4ia a 'a 1&7"a"5 ;a$0i,0/0i4a5 ;4a!a40!,0i4a, " '+,5 ;4+'+4a4i#$ "5 ;@4+73!,a " 4a73+

: × : 475 ;$+ ",1i'a!,5 ;+20iv+5 ;

3+!+,a5 ;,/2a$a 1$"i"a + *$,0!a"a

9.?: × ;.: 75 ;?:,/2a$a ,i73' + ,$4i''a

;.9: × ;.: 75 ;?:Ca73+,5 !%'a, 3a!a 'a 4+'+4a4i#$

"5 ;?:C/$&'a -a$a!5 ?

Ca0%&0 ,i73' + 4!#7i4+5 ?;C$0!a' " 6&i3+, - ,0!i'i)a4i#$CEYE5 5 ;?

/!a 4+$0a7i$a"a -+ /!a $+4!0i4a5 ;





/ a&<i'i+ 4+$ %a,a 17"a5;

D42i0+ 'a0!a'5 3+,i4i#$ $5;:D,a!!+''+ 4i$0*i4+ " $*!7!a5 99D,*i2!i'a"+!,5 :

4a!!+ !++5 ;<0!$+, a&0+7a0i)a"+,5 ;<0!$+, 7a$&a', + " 3a'a,5 :<0!$+, ,7ia&0+7a0i)a"+,5 ;0i3+, "5 :

D,i$*40a$05 ;@Di,44i#$5 ;9

4+!0a$05 ;9

!+7a5 ;9

&E2&''i4i#$5 ;

E'40!+2i,0&!5 9E'40!+4a&0!i+5 9E$"+,4+3ia5 9E$*!7!a 4i!4&'a$05 ;;@5 ;@@

<0!$a5 ;;E$*!7!a 4i!4&'a$05 *&$4i+$, "

'a5 ;@;5 ;@a' *i$a' " 'a 4i!&%a5 ;a$0, " 'a 4i!&%a 3!+3!a0+!i+

i$7"ia0+5 ;@"&!a$0 'a 4i!&%a5 ;@7+7$0+, *&$"a7$0a', " 'a

4i!&%a5 ;@;+20iv+, ,$4ia', 3a!a 'a ,%&>!i"a" " 'a 4i!&%a5 ;@?

vi,i0a 3!+3!a0+!ia5 ;@E$*!7!a 4i!4&'a$0 i$0!$a5 ;;

"&!a$0 'a 4i!&%a5 ;;E$*!7!a i$,0!&7$0i,0a5 ;

*&$4i+$, " 'a5 ;a' *i$a'i)a! 'a 4i!&%a 3+,+3>

!a0+!i+ i$7"ia0+5 ;a$0, " 'a 4i!&%a 0!a$,+3!a>

0+!i+ 7"ia0+5 ;:

4+$0!+' "' 4i!4&i0+ ,0(!i'+3!a0+!i+5 ;

"&!a$0 'a 4i!&%a 0!a$,+3!a>

0+!i+ i$7"ia0+5 ;;*&0&!+ " 'a $*!7!a 6&i!!>%i4a5 9:;

'$%&a 7a$&a' "&!a$0 'a4i!&%a5 ;

7a$+ " 3&$)+4+!0a$0,5;

7a$0$! ,i73! ' +!"$ "'i$,0!&7$0a'5 ;

3!3a!a 'a, 7,a, a&<i'ia!,5;

!4+7$"a4i+$, i73+!0a$0,5;

!4&$0+ " i$,0!&7$0a' -%a,a,5 ;

0(4$i4a " i$,0!&7$0a4i#$5;

&0i'i)a! ' i$,0!&7$0+ 4+!!4>0+5 ;E$*!7!a 6&i!!%i4a5 4a!a40!,0i4a,

" 'a5 ;@*&$4i+$, " 'a5 ;@@

E$*!7!a 6&i!!%i4a i$,0!&7$0i,>0a5 ;;@5 ;@9

a' *i$a' " 'a 4i!&%a "$0!+ " 'a,a'a 6&i!!%i4a5 ;;@

"&!a$0 'a 4i!&%a5 ;;@E$v+'0&!a "' 7a0!ia' i$,0!&>

7$0a'5 !4+7$"a4i+$, 3a!a'i73i)a5 'ava"+ -5 9:

E6&i3+ 3a!a 4!a$+0+7a5 9;,34ia'i"a" " 4a!"i+'+%a5 9;

3a!a "!iva4i#$ v$0!i4&'+3!i0+>$a'5 99:

3a!a ,34ia'i"a" a!0!ia'5 9;@ 3a!a 'a7i$40+7a5 9; 3a!a v$+"i,44i#$5 9;



: 8ndice alfab'tico 231

E6&i3+ " 4i!&%a %i$4+'#%i4a5 3a!a4,/!a5 9;

3a!a 1i,0!40+7a5 9;;

3a!a ,a'3i$%+4'a,ia5 9;9E6&i3+ " 4i!&%a +*0a'7+'#%i4a5 3a!a

4a0a!a0a5 999 3a!a "a4!i+!!i$+4i,040+7a5 99; 3a!a ,0!a2i,7+5 99;

E6&i3+ " 4i!&%a &!+%$i0a'5 3a!a4+'3+,&,3$,i#$5 9;

3a!a 1i,0!40+7a va%i$a'5 9; 3a!a $*!+'+%a5 9;?

E6&i3+ " !,&4i0a4i#$5 :E,0!i'i)a4i#$5 ;@

3+! 4a'+! 17"+5 ; 3+! 7(0+"+, 6&7i4+,5 9 3+! va3+! a 3!,i#$5 ;0(4$i4a "5 ;@

E,0!i'i)a4i#$5 i$"i4a"+!, "' 4+$>0!+' " 'a5 9

2i+'#%i4+,5 9*,i4+,5 96&7i4+,5 9

E,0!i'i)a4i#$ 3+! 7(0+"+, *,i4+,5;

a'0a, 073!a0&!a, 4a'+!5 ;E,0!i'i)a4i#$5 3!+4,+ "5 9;

ai!a4i#$5 9?va4&a4i#$5 9?

<3+,i4i#$5 9;5 9? 3!3a!a4i#$5 9;!4+7$"a4i+$,5 995 9va4+5 9?

E,0!i'i)a"+!5 " ",3'a)a7i$0+%!avi0a4i+$a'5 ;

" 3!va4+5 ;0i3+, "5 9

F'+!a 2a40!ia$a5 !,i"$05 @

0!a$,i0+!ia5 @

F+!7a'"1"+ %a,+,+5 9 3!+4,+ " ,0!i'i)a4i#$5 9

F&$"a " Ma-+5 ;?

GG!7i4i"a5 ;

'H7+,0a,ia5 ;9

4!a 3a!a 1&,+5 ;;

4+73!,i#$ i$"i!40a5 ;:"*i$i0iva5 ;:"%i0+>"i%i0a'5 ;:i$,0!&7$0+, 3a!a5 ;;

3!+4"i7i$0+, 3a!a !a'i)a!5 ;:073+!a' + 0!a$,i0+!ia5 ;:0(!7i4a'(40!i4a5 ;;0!a$,*i<i#$5 ;:

H!i"a,5 4'a,i*i4a4i#$ "5 @4+$0a7i$a"a5 "*i$i4i#$5 @'i73ia5 'i73ia 4+$0a7i$a"a5 6&i!!%i4a5 @,&4ia5

Hi"!#%$+5 3'a,7a 3!#<i"+ "5 9@"i*&,i#$5 9@

i$-44i#$5 9@ 3!+4,+ " ,0!i'i)a4i#$5 9@va4+5 9@v$0i'a4i#$5 9@

H+a " $*!7!a5

I$,0!&7$0a4i#$ 6&i!!%i4a5 ;?

I$,0!&7$0a' 6&i!!%i4+5 ;9?5 9:4/$&'a, " a,3i!a4i#$5 9:5 9;4i!&%a 4a!"ia4a5 9;?4i!&%a " +!0+3"ia5 9:






!4+7$"a4i+$, !'a4i+$a"a,4+$ '5 :

,4a"+5 @

,%&$"+ 0i73+5 @,+'&4i+$, a$0i,(30i4a,5 @0!4! 0i73+5 @

Lava"+ 74/$i4+5 7a0!ia' - 6&i3+5@

3!+4"i7i$0+5 @Lava"+5 !4+7$"a4i+$, 3a!a5 9:Li73i)a5 ;@

!4+7$"a4i+$, 3a!a5 9:L&72+0+7a5 3+,i4i#$ "5 ;:@

$Ma$+ " 3&$)+4+!0a$0,5 ;Ma$%+, " 2i,0&!5 9;

Ma$0a " 4i'+5 ;:Ma0!ia' 3a!a ,0!i'i)a!5 3!3a!a4i#$

"5 9?M"i4a7$0+, 2/,i4+, i$"i,3$,a> 2',5 9

a$a'%(,i4+, - ,"a$0,5 a$0ia!!07i4+,5 9

2'+6&a"+!, 20a - a$0i1i3!0$>,iv+,5 9

4a!"i+va,4&'a!,5 96&i3+ " 'a!i$%+,4+3i+,5

6&i3+ " +<i%$a4i#$5 6&i3+, 3a!a i$*&,i#$5 !'aa$0, 7&,4&'a!,5 ,+'&4i+$, 4!i,0a'i$a,5

M,a5 " Ma-+5 ;?6&i!!%i4a5 !40a$%&'a!5 ;@

M,a, a&<i'ia!,5 ;:

4+'+4a4i#$ - 7a$+ "5 ;@4+$430+5 ;:7,a " !i#$5 ;:7,a !40a$%&'a!5 ;:!4+7$"a4i+$,5 ;@

M+7$0+, *&$"a7$0a', " 'a 4i!&>%a5 3+,+3!a0+!i+5 ;@;

3+,+3!a0+!i+ i$7"ia0+5 ;@9

3+,+3!a0+!i+ 7"ia0+5 ;@9 3!+3!a0+!i+5 ;@; 3!+3!a0+!i+ i$7"ia0+5 ;@; 3!+3!a0+!i+ 7"ia0+5 ;@;0!a$,+3!a0+!i+5 ;@;0!a$,+3!a0+!i+ i$7"ia0+5 ;@90!a$,+3!a0+!i+ 7"ia0+5 ;@9

M+$i0+! " ,i%$+, vi0a',5 4a!!+ " a$,0,ia5 "i,+ ,i73'5 @6&i3+ - 7a0!ia'5 @*/4i' 4+$*i%&!a4i#$5 @*/4i' " +3!a!5 @*!4&$4ia 4a!"ia4a5 *!4&$4ia !,3i!a0+!ia5 7+$i0+!i)a4i#$ 4a!"ia4a5

3!,i#$ a!0!ia'5

,a0&!a4i#$ " +<%$+5 0i3+, " a'a!7a,5 @

N N%'i%$4ia5 9

N&!+4i!&%a5 ;

Od<i"+ " 0i'$+5 9

O<%$+5 ,a0&!a4i#$ "5

Pi$)a,5 A",+$5 9<=

" a$i''+,5 ;

" Ba24+45 ;" "i,44i#$5 ;:" Ha',0" + " 7+,6&i0+5 ;;" K''-5 ;;

P+'i"i+<a$+$a5 ?






Sa'a 6&i!!%i4a5 4a!a40!,0i4a, "'a5

3!+4"i7i$0+, ,34ia', $ 'a5

;;!4+7$"a4i+$, %$!a',5 ;;

S3a!a4i#$ 7a$&a'5 a&0+7/0i4a5 ;9i$,0!&7$0+, 3a!a5 ;9

S3a!a"+!,5 " C!+00+5 9<<

" Fa!a2&*5 ;9" Fi$+41i0+5 ;" Ri41a!",+$5 ;9

S+'&4i+$, a$0i,(30i4a,5 @S&0&!a ,$0,i,5 ;

%!a3a"+!a, + $%!a3a"+!a,5 ;?i$,0!&7$0a' 3a!a5 ;+0!+, i$,0!&7$0+,5 ;?

S&0&!a,5 ?:a%&a5 ?4'a,i*i4a4i#$ " '+, 7a0!ia',

3+! a4a2a"+ - 7a$i3&'a4i#$5

??4'a,i*i4a4i#$ " '+, 7a0!ia', 3+!4+'+!5 ?

4'a,i*i4a4i#$ " '+, 7a0!ia',,%$ ,& ,0!&40&!a5 ??

7a0!ia' a2,+!2i2'5 $+ a2,+!2i> 2' - 0i73+ a3!+<i7a"+ "a2,+!4i#$5 ?9

$+72!, 4+7!4ia', " '+, 7a0>

!ia', 3a!a5 ??!4+7$"a4i+$, 3a!a ' 7a$+

" 'a,5 ?&,+ 6&i!!%i4+ " 'a,5 ?

TT(4$i4a a,(30i4a5 4+$v!,a4i#$

7$i7a $ ' 0!a$,4&!,+ " 'a4i!&%a5 ;' 2+!" " 4&a'6&i! $va, 6&

4+$0$%a 7a0!ia' ,0(!i' $+"2 4+$,i"!a!, ,0(!i'5 ;

' 6&i3+ &0i'i)a"+ 3a!a 'a 4i!&%a"2 ,+70!, a5 ;

,0(!i' 4+$ ,0(!i'5 ;

'a 1&7"a" , &$ 7"i+ " 4+$>0a7i$a4i#$5 ;

'a, 2a0a, ,+$ ,0(!i', ,#'+ 3+!"'a$05 1a,0a 'a 4i$0&!a5 -&$+, @ a 47 3+! a!!i2a "'4+"+5 ;

7a$0$! &$ 4+$0a40+ 7$i7+4+$ '+, 7a0!ia', ,0(!i',5;

7a$0$!, ,i73! " *!$0 a'4a73+ ,0(!i'5 ;

7,a, a&<i'ia!, ,0(!i', ,#'+ $'a ,&3!*i4i5 ;

7+vi7i$0+ 7$i7+ $ ' 0!a$,>4&!,+ " 'a 4i!&%a5 ;

3!,+$a' 6& $+ , 1a ,+70i"+a ,0!i'i)a4i#$ "2 vi0a!

3a,a! ,+2! 'a, ,&3!*i4i,,0(!i',5 ;

3!,+$a, 4+$ 2a0a - %&a$0,,0(!i', "2$ 7a$0$!,"$0!+ "' 4i!4&i0+ ,0(!i'5;

3!+4,+, " ,0!i'i)a4i#$ "&"+>,+,5 ;

!%'a, " 'a5 ;

T(4$i4a ,0(!i'5 ;@T(4$i4a 3a!a 4+'+4a4i#$ " 'a !+3a

"' 3a4i$05 ;94a73+, $ a2"+7$5 0#!a< +

,3a'"a5 ;94+73!,a, " ,3+$a! + "

vi$0!5 ;$ <0!7i"a", ,&3!i+!, +

i$*!i+!,5 ; 3a!a 4i!&%a " 4a2)a - 4&''+5 ; 3a!a 4i!&%a %i$4+'#%i4a5 ;?,/2a$a *$,0!a"a5 ;9,/2a$a 3+"/'i4a + " 3i,5 ;9







Documents

Manual.de.Enfermeria.Quirurgica.docx