Nursing Instructions
Hemorrhoidectomy for Thrombosed External Hemorrhoids
Patient Preparation
The patient is asked to undress from the waist down and given a drape to cover the waist and legs. The patient can be left seated on the examination table to speak with the physician. At the start of the procedure, the patient is rolled onto the left side and into the left lateral decubitus position. The knees are bent, and a drape covers the waist and legs. An absorbent pad is placed under the buttocks and the anal area.
Nonsterile Tray for Anesthesia
- Place the following items on a nonsterile drape covering a Mayo stand:
- Nonsterile gloves
- 1 inch of 4 X 4 gauze
- 4 X 4 gauze soaked with povidone-iodine solution
- 1 inch of 2 percent lidocaine jelly (Xylocaine) placed on the corner of the drape
- Ive's anoscope
- Mask (if desired)
- 10-mL syringe filled with 1 percent lidocaine with a 25-gauge, 1¼-inch needle
Sterile Tray for the Procedure
- Place the following items on a sterile drape covering a Mayo stand:
- Sterile gloves
- 2 inches of sterile 4 X 4 gauze
- 3 hemostats (mosquito clamps)
- No. 15 scalpel blade and blade handle
- Needle holder
- Adson forceps with teeth
- Iris scissors (for cutting sutures)
- Mayo or tissue-cutting scissors
- Allis clamp for holding tissue
- 4-0 Vicryl suture
Postprocedure Nursing Instructions
The anal area and buttocks can be cleansed with sterile saline or a gauze dampened with water to wipe away any blood or drainage. Soiled gauze and the absorbent pad are disposed of in an appropriate biohazard waste container.
Antibiotic ointment is applied to the surgical site, and 1 inch of clean gauze is placed over the site between the buttocks.
The patient may need assistance with placement of underwear while maintaining the gauze between the buttocks.
Disposable needles and suture needles are disposed of in appropriate sharps containers.
The instruments should be scrubbed, washed, rinsed and dried. The instruments should be placed in a clear sterilization packet, either individually or as a tray, and sterilized in the autoclave.
Adapted with permission from Zuber TJ. Office procedures. Baltimore: Lippincott Williams & Wilkins, 1999.
Copyright © 2002 by the American Academy of
Family Physicians.
This content is owned by the AAFP. A person viewing it
online may make one printout of the material and may use that printout only for
his or her personal, non-commercial reference. This material may not otherwise
be downloaded, copied, printed, stored, transmitted or reproduced in any
medium, whether now known or later invented, except as authorized in writing by
the AAFP. Contact afpserv@aafp.org for
copyright questions and/or permission requests.
