7. Circulating and Scrub Nurse Duties

Question 2

What is asepsis?

Answer 2

absence of pathogenic microorganisms that cause infections - a surgically clean environment, not a sterile environment

Question 3

What is sterile?

Answer 3

absence of all living microorganisms, including spores
along w/ aseptic techniques, most important practices to prevent infection

Question 4

How can we maintain asepsis?

Answer 4

aseptic + sterile techniques
AORN’s “recommended practices for maintaining a sterile field”
aseptic technique used to maintain the absence of disease-causing organisms in the surgical enviro
Asepsis does not guarantee sterility
A surgical conscience requires acknowledging when a breach in asepsis or sterility has occurred and taking the necessary steps to address and correct it, even if no one else witnesses the breach

Question 5

What is the sterile field?

Answer 5

any area covered w/ a sterile barrier (person, table, table cover, patient, gown, grape)
Scrubbed personnel: functions within sterile field
Maintained and monitored continuously by sx team, never left unattended

Question 6

What are the sterile parts of the surgical gown?

Answer 6

chest to lvl of sterile field, 2 “ above sleeve elbow to edge of cuffWha

Question 7

What are the unsterile parts of surgical gown?

Answer 7

neckline, shoulders, bottom of cuff, lower portion of gown, back of gown

Question 8

What are sterile surgical drapes?

Answer 8

barriers btw sterile and non-sterile areas
Covers entire animal, sx table, equipment
Strike through contam: liquid soaking thru drape from sterile to unsterile area

Question 9

How is sterility maintained?

Answer 9

nonsterile personnel should only touch nonsterile items, never reach over sterile field
Sterile personnel can only touch sterile items or areas, always face sterile field, neckline/back/armpit area not sterile, hands stay above waist-below shoulders

Question 10

What are the responsibilities of the surgical technician?

Answer 10

Do no distract surgeon, perform careful planning, prepare everything needed for sx, assist as sx assistant if necessary, assist as a circulating nurse if necessary, monitor anesthetized patients, have a knowledge of particular sx procedure, instruments, and aseptic and sterile techniques, anticipate surgeon’s needs

Question 11

What is the role of the circulating nurse?

Answer 11

may be responsible for the final sterile pre of the patient
assist sterile personnel w/ owning
open packs and supplies
assists w/ draping as needed
is a runner for the sx team
b4 opening packs, ensuring someone can take them/area is prepared to receive item

Question 12

What do we need to check before opening items to be used in the surgical field

Answer 12

Check for tears or holes in the outer package
Check that the autoclave tape has changed color and is not torn
Check seal of the package to ensure it is secure
Check the package itself: if it looks worn, like it is opening or is over-handled, consider it contaminated
once page is opened, check indicator strip if visible, check date writing on autoclave tape
Open w/o contam contents or sterile field (1” of sterile wraps considered non-sterile)
Sterile person may lift item straight out of package w/o touching any edge of package or tossed onto fild

Question 13

How do we open peel-away packs

Answer 13

Hold packet only at outer ends w/ both hands, grasp w/ thumbs and slowly peel open
Open, dispense, and transfer methods that maintain sterility and integrity of product

Question 14

How are linen wrapped packs opened by the circulating nurse?

Answer 14

Will unwrap both layers of the linen pack
sterile supplies are opened by unwrapping the flap furthest away first, the sides next and the nearest flap last - never reach across or over a sterile area to open the final flap

Question 15

How do we open a new gown and glove?

Answer 15

Open on a clean, flat, dry surface in the surgery room
For gown: open distant flap first, then side flaps, and nearest flap last - NEVER reach across surgical pack
For gloves: unfold top and bottom edges of the paper wrap, place your hands under the side flaps and pull packet open

Question 16

How do we open fluids to use in a sterile field?

Answer 16

fluids should be poured carefully to prevent any spills onto the sterile field and to avoid splash-back
if possible, have the scrubbed in person hold the basin away from the field or place it at the edge of the sterile table
once the fluids have been opened, the cap is considered contaminated and cannot be replaced onto the bottle so the remaining fluids must be discarded

Question 17

What is the role of the scrub nurse

Answer 17

Final draping, keeping track of instruments and performing a sponge count, passing instruments to the surgeon, keeping exposed tissue moist, maintaining hemostasis, assisting the surgeon as needed including assisting w/ suturing

Question 18

How do we move about the sterile field

Answer 18

be aware of sterile and nonsterile areas in the surgery room
minimize movement within surgery room, as well as in and out of room
scrubbed personnel should not walk away from the sterile field
scrubbed personnel must change positions around the sterile field a safe distance apart, face to face or back-to-back
Unscrubbed personnel should always face the surgical field and not step btw two sterile fields
surgical scrub team should NOT change lvls of position (from sit to stand) during procedure
Minimal talking and limited # of non-scrubbed-in observers in the sx room
Door should remain closed as much as possible