Unit 3 Flashcards
List aspects of perioperative monitoring of the sterile field.
Observe for breaks in sterile technique
Correct breaks
Protect sterile field
Maintain sterile technique awareness.
List principles of back table organization
Orient back table to right or left side of room
And to procedure and/or surgeon preference
Minimize movement for efficiency and speed
Use principle of “body-in-a-box”
Move shoulders and arms, not entire body
Work in sections of table (3 sections)
Handle items once
Set an efficient pattern with a logical sequence
Repeat it case after case
Remain aware of total environment
Such as where the door is and which side of the room you’ll be on and who is in the room
State the 3-step basic sequence of back table organization.
Drapes
Stack in reverse order of use
Basin items (supplies)
Empty big basin and place small basins/pitcher near edge for transfer of solutions
Organize sharps
Organize countable items
Organize items for medication administration
Labels, pen, med cups, syringes, hypos – all together
Instruments
List principles of Mayo stand organization and set up.
First, orient tray to patient
May use rolled towel on Mayo (don’t hang rings over edge)
Place only items likely to be needed
Inspect each instrument
Placed in pairs or groups of alike instruments
For example: all scissors or all tissue forceps
Clamps closed on first ratchet
List items that must be included in surgical counts.
Sponges (all kinds)
Needles, blades, and other sharps
Instruments
When major cavity (abdominal/pelvic and thoracic) opened
Vessel loops, safety pins, ESU tip, ESU tip cleaner
State the times when surgical counts are performed.
Initial count (First count)
Before Mayo set up
And as items added intraoperatively
Before closure of body cavity (First closing count)
May do 2 counts if cavity within a cavit
E.g., at closure of uterus and closure of peritoneum (first and second closing counts)
At subcutaneous layer or skin (Final closing count)
Identify best practices for safe surgical counts.
Scrub & circulator count together, aloud
Scrub touch each item as it is counted
Circulator record immediately
Don’t interrupt counts
Keep not-yet-counted items away from counted items until completely counted
Relief persons verify complete count
Circulator’s duty to report counts correct to surgeon
Surgeon must acknowledge it verbally
Documenting varies/ may use RF tagged sponges
If pack is short or long, discard it and remove it from the room – do not try to work with it
If patient is in room, label and keep these in room separately
Don’t open dressings until final count is complete
State the appropriate surgical counting sequence.
Field (surgical site)
Tables: Mayo, back table and finish at
Floor (circulator)
List the sequence of steps taken when a closing count is incorrect.
Inform surgeon immediately Recount If still incorrect, inform surgeon again Check cavity Document all actions and findings May take x-ray to demonstrate presence or absence of item in body cavity
Identify (1 type each of) fenestrated, non-fenestrated, and accessory drapes.
Fenestrated:
Laparotomy drape
Laparoscopy, general
E.g.; laparoscopic cholecystectomy drape
Laparoscopy, gynecology
2 fenestrations; with leggings
Pediatric lap drape
Transverse laparotomy drape
Kidney, thorax, and also used for low abdomen
Thyroid sheet
Craniotomy drape
Perineal drape (aka. lithotomy drape)
C-section drape
Side pockets to catch fluid
Extremity drape
Carpal tunnel, ORIF ankle
Arthroscopy drape
Knee arthroscopy
Shoulder arthroscopy
Non-fenestrated drapes include:
½ and ¾ sheets (general coverage)
Table covers
When used as under drape for orthopedics
Lithotomy pack
(different from lithotomy drape); under-buttocks sheet; 2 leggings and top sheet
Split sheets; U-sheets
Accessory drapes:
Stockinette
FYI: Plain and barrier, various sizes; need Ace or Coban to secure it; used to drape extremities “free”; large for adult legs, regular for adult arms and kids
Microscope drapes
Laser arm drapes
C-arm drapes
Camera drapes
Used to cover video camera when camera is not sterile
X-ray cassette coversState principles and applications of draping
Organize drapes in order of use
Towels with 2” cuffed edge
Drapes are NOT passed over unsterile areas
Move to opposite side of OR bed to hand them PRN
4 towels and clips (PRN) in 1 trip
Handed one towel at a time
1 toward (nearest to sterile person), 1 superior, 1 inferior, 1 away
Drapes passed in folded position
Keep safe distance from unsterile area until drapedRemove protective covering of adhesive sections prior to handing
Placed on patient’s surgical site to unfold
Or held above patient and unfolded (such as first drape inferiorly)
Use sterile technique!
Sterile to sterile = sterile
Sterile gloves touch unsterile area = UNSTERILE!
Do NOT reposition drapes once placed
Cover with another drape PRN
Protect gloved hands with drape cuff
Contaminated drape removed by circulator
(unsterile to unsterile)
A drape dropped below table level is not sterile
Don’t drop (or raise) hands, either!
Non-perforating towel clips for cords
Summarize basic steps to drape the abdomen
Place sheet over lower body (“sheet below”)
4 towels and clips (clips optional) or sticky towels
Adhesive incise drape PRN
Place laparotomy drape
Summarize basic steps to drape the perineum
Place an under-buttocks drape
2-3 towels around perineum and clips
Different fold than for squaring off
Place leggings
Add lithotomy (fenestrated) sheet or top sheet
Summarize basic steps to drape the extremity
Sheet superiorly PRN; sheet under limb
May be a plastic table cover down
Place 2 U-sheets or split sheets; down & up
Place stockinette and coban or ace
Extremity sheet
Cut stockinette PRN, place adhesive incise drape PRN
Identify nerves most at risk for injury during positioning
Ulnar, radial, peroneal, facial, brachial plexus.
State patient safety concerns regarding surgical patient skin preparation.
Allergy; burn from warm prep solution; chemical burn; flammability; pooling of solution; incision marking visible.
State options for safely passing the scalpel.
Hand knife directly to surgeon and receive it back when used
Hand directly to surgeon and have him/her place it on the Mayo where you retrieve and place it back in location
No-hand technique with neutral zone
You place, surgeon picks up, replaces, you retrieve
No-hand technique with basin (caution)
List means that contribute to efficiency and order of the sterile field.
Position items for efficiency (one smooth move)
ESU tip cleaned after use and hand piece returned to holster
Bring clean sponges up first; then take dirty ones off
So you can do it all in one trip up and back!•Maintain order throughout for efficiency!!!
As surgeon sets used instruments on drapes
You retrieve them, clean them, replace them on your Mayo in the proper location•Sharps always placed in designated spot!
Suture
Is placed on Mayo when using
Placed on back table when not in use
Cut off strand only when fully used
Outline the process of patient transfer from OR bed to transport vehicle.
Gurney brought into room, placed beside OR bed and locked
Roller/slider placed on gurney
Patient’s IV moved, check Foley, etc.
Minimum 4 people to move, anesthesia leads
Place roller/slider under patient (log roll patient)
Move patient’s body in unison to gurney
Remove slider (again, log roll patient)
Put gurney side rails up, unlock gurneyTransfer patient to PACU
