7. Circulating and Scrub Nurse Duties Flashcards
What is asepsis?
absence of pathogenic microorganisms that cause infections - a surgically clean environment, not a sterile environment
What is sterile?
absence of all living microorganisms, including spores
along w/ aseptic techniques, most important practices to prevent infection
How can we maintain asepsis?
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
What is the sterile field?
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
What are the sterile parts of the surgical gown?
chest to lvl of sterile field, 2 “ above sleeve elbow to edge of cuffWha
What are the unsterile parts of surgical gown?
neckline, shoulders, bottom of cuff, lower portion of gown, back of gown
What are sterile surgical drapes?
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
How is sterility maintained?
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
What are the responsibilities of the surgical technician?
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
What is the role of the circulating nurse?
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
What do we need to check before opening items to be used in the surgical field
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
How do we open peel-away packs
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
How are linen wrapped packs opened by the circulating nurse?
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
How do we open a new gown and glove?
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
How do we open fluids to use in a sterile field?
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
What is the role of the scrub nurse
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
How do we move about the sterile field
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
How should the circulating nurse handle and pass instruments?
Double wrap: outer wraps unfolded and then offered to scrub nurse
Peel-packs: be aware of non-sterile portions and avoid touching it - dropping the equipment or contaminating equipment requires flash sterilization procedure
Keep table organized
Instruments laid out so ring handles closest to scrub nurse - where u stand dictates which direction instrument should be
What is the role of the scrub nurse?
Assist in procedure ex. tissue retraction, hemostasis, any other assistance
Having a scrub nurse inc intraop efficiency, dec sx time, dec anes. time
What is the correct method of loading and passing a scalpel blade and handle?
needle holders are only instrument that should be used to place the blade onto and to remove the blade from the scalpel handle
How do we pass a scalpel
Technician holds scalpel handle w/ blade TOWARDS you, blade UPWARD
Thumb + index hold handle
Pronate (turn hand so blade DOWN)
as surgeon grabs, tech should continue to move forward (instead of back to avoid getting cut)
How do we pass ring-handled instruments
Remember: place FIRMLY into palm of waiting hand t dec chance of item dropped
First ratchet of ring handle instrument closed b4 instrument passed
Box lock should be held btw assistants thumb and index finger, shaft of instrument stabilized by remaining fingers of delivering hand
Ring handles should be facing the floor, tip towards ceiling
curved instruments should be facing the thumb(or midline) of surgeon
How do you pass non-ringed instrument
Hold instruments w/ tips facing the floor
other end of instruments should be firmly held w/ thumb + index while remaining fingers stabilize the instrument
How do we thread eyed needles?
remove suture from cassette
- circulating nurse removes cap from cassette, grabs suture and pulls straight up, exposing ~6” of suture
- Scrub nurse grasps suture below level initially exposed
- Assistant uses sterile operating scissors + cuts suture close to hand btw their hand and assist. nurse
- sterile then cuts suture close to cassette w/o contaminatinf the scissors
A needle holder to be placed about 2/3 into needles curve for secure and controlled handling
Suture should pass from inside of needle’s curve to outside - allows short end of suture to fall away from the outside curve of the needle, reducing the chance that it will pull out of the needle
load suture once though eye, then another time and pull tight
How do we load the needle holder?
know surgeon’s dominant hand
needle should be placed in needle holder so surgeon can use immediate w/o adjusting
tip of needle directed towards surgeon’s midlint, point orienteted towards their heart
r-handed = point of needle face left
L-handed = point of needle face right
How do we handle tissue?
healthy tissue needs to be handled appripriately to not cause trauma
unhealthy tissue also requires care so as not to compromise its viability further
Scrub nurse be aware of status of tissue in field, be familiar w/ appropriate methods of tissue retraction
Too much pressure = vascular tissue damage
Too little retraction surgeon may not see clearly and procedure may be compromised
Why is keeping tissues moist important?
systemic hydration should be achieved and maintained thru the infusion of IV fluids, but tissue must be kept moist topically as well - heat from lights and exposure to room air makes tissue vulnerable to adverse conditions
“moist tissue is happy tissue” - circulation is less compromised and tissue function remains intact
Why solution is thypically used to keep tissues moist?
isotonic solution or normo saline as a lavage fluid
depending on surgical procedure, an antibiotic may be added for topical application
A bowl on sterile field can be filled with warm isotonic sol.
- 1 guaze square can be soaked and then squeezed while suspended above the exposed tissues to drip lavage sol. onto tissues
_ important to avoid wiping/rubbing gauze sponge onto tissue directly
A bowl containing warm lavage sol. should be kept at back of instrument table, or on separate tray, so If you spill, no contam of sterile field
What are some ways of maintaining hemostasis
If vessels are cut, scrub nurse ready to pass required tools
Blotting or applying pressure to hemorrhaging site b4 surgeon places hemostat helps the surgeon place the clamp on vessel w/o including excessive tissue in hemostat
important to remember bleeding tissue should be blotted, no wiped
Can use absorbable gelatin or cellulose sponge and bone wax
also achieved thru electrocautery - assistant may cauterize tissue or a vessel or elevate hemostat that’s on vessel so surgeon can activate the cautery
How do we maintain hemostasis?
blood-soaked sponge count can serve as an estimate of blood loss
3x3 holds ~ 6ml blood
4x4 holds ~ 10ml of blood
only radiopaque sponges should be included in surgical packs
Why is instrument and sponge counts important
Instrument cound documents how many instruments present at beginning of procedure
B4 sx site closed, a 2nd found of instruments should be done
Most anesthetic logs have a space to record the initial sx instrument count and instrument and sharps count @ closure
circ. nurse helps sx assist. nurse keep track of how many instruments (if any) were removed from sterile field and how many sharps were used
Next perform spong count - initial qty in pack counted b4 use, then discarded into dedicated spong bowl or kick bucket
as sponges are discarded, circ. nurse can unfold znd count each sponge - important to unfold sponges in case two or more together
all sponge added to sterile field mus t be accounted for
What are suture related responsibilities
cutting a suture depending on type (absorbable or nonabsorbable) and placement( internal or external)
“running” a suture when the surgeon is placing a continuous pattern
recognizing suture pattern
What are some postoperative considerations and instructions
incision checked 1/d until suture remvoved
Complications include: dihiscence, herniation, evisceration, blood loss, sepsis
How do we surgically assist when working with equine patients?
instrument set up and handling - open packs during draping, arrangement of instruments + equipment on the table, abdominal sx - create pouch btw back legs for line/hose, instrument tray, clean instruments - wiping w/ wet 4x4 sponge, discard contam equipment
How is tissues of equines handled?
hollow organ sx - GI tract, colon
SI - discard ingesta-contam instruments, tissue easily dehydrated once out of body cavity, risks of damage, tissue hydration + care - 0.9% saline by pressurized bag or bulb syringe
Bone + joints: replace torn gloves immediately, frequent irrigation, suction/blotting, tissue retraction, fragment reduction, hohmann retractors
What are some retraction techniques for the abdomen of equine patients?
abdomen - retract abdominal wall by hand or balfour retractors
How do we perform hemostasis in equine patients?
Abdominal - suction (not hemostasis)
Large vessel - clamp and ligate w/ suture
Small vessel - hemostats and electrocautery
