Unit 7: circulating and scrub nurse duties Flashcards
Asepsis means
Absence of pathogenic microorganisms that cause infection
A surgically clean enviro, not a sterile enviro
Sterile means
Absence of all living microorganisms, including spores
Along with aseptic techniques, most important practices to prevent infection
What is surgical conscience
Commitment of surgical personnel to adhere strictly to aseptic techniques
Bread in technique are immediately reported, addressed and corrected
What are the sterile fields
Any area covered with a sterile barrier (person, table, table cover, patient, gown, drape)
Scrubbed personnel: functions within sterile field
Maintained and monitored continuously by surgical team
Never left unattended
Where is the surgical gown sterile
Chest to level of the sterile field
2 inches above sleeve elbow to edge of cuff
Where are the drapes sterile
Sterile drapes: barriers b/w sterile and nonsterile areas
Covers entire animal, surgical table, equipment
Strike through contamination: liquids soaking through drape from sterile to unsterile area
How do you maintain sterility
Non sterile personnel should only tough non sterile items, they should never reach over a sterile field
What can the sterile person do to maintain sterility
Only touch sterile items or areas
Always face the sterile field
Neckline, back, armpit area not sterile
Hands stay above waist level
What are the responsibilities of the surgical tech
Do not distract the surgeon
Perform careful preplanning
Prepare everything needed for surgery
Assist as a surgical assistant if necessary
Asist as a circulating nurse if necessary
Monitor anaesthetised patients
Have a knowledge of the particular surgical procedure, instruments, and aseptic and sterile techniques
Anticipate the surgeons needs
What is the role of the circulating nurse
May be responsible for the final sterile prep of the patient
Assist sterile personnel with gowning
Opens packs and supplies
Assist with draping as needed
Is a runner for the surgical team
Before you open a pack, make sure someone is available to take the item or that the area is prepared (ie: instrument table) to receive the item
Packs must be opened properly to maintain a sterile field
What should you do before opening a pack
Confirm the following
No tears or hotels in the outer package
Check 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 contained
Once the package is opened, check the indicator strip if it is visible
Check the date written on the autoclave tape
How do you pass an open sterile pack to a sterile person
Open packs without contaminating their contents of the sterile field
Edges of all sterile wraps and packages are considered non sterile (1”)
Sterile person may lift the item straight out of the package without touching any edge of the package
The item may be tossed onto a sterile field
How do you open a peel pack
Hold packet only at the outer ends with both hands, grasp with the thumbs, slowly peel open
Open, dispense, and transfer by methods that maintain sterility and integrity of product
How do you open a linen wrapped pack to pass to a sterile person
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 are to open the final flap
How do you open gowns and gloves for a sterile person
Open on a veal, flat, dry surface in the surgery room
For gown: open distant flap first, then side flaps and nearest flap last
NEVER reach across the surgical pack
For gloves: unfold top and bottom edges of the paper wrap; place your hands under the side flaps and pull the packet open
How do you open fluids for use in a sterile field
Fluids should be poured carefully to prevent any spills onto the sterile field and to avoid splash block
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 fluids have been opened, the cap is considered contaminated and cannot be replaced onto the bottle so the remaining fluids must be discarded
What are the responsibilities of the scrub nurse
Final draping
Keeping track of instruments and performing sponge counts
Passing instruments to the surgeon
Keeping exposed tissue moist
Maintaining hemostasis
Assisting the surgeon as needed, including assisting with suturing
How do you move around 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
Un scrubbed personnel should always face the surgical field and not step b/w two sterile fields
Surgical scrub team should not change levels of position (e.g., from sitting to standing) during a procedure
There should be minimal talking and a limited number of non scrubbed in observers in the surgery room
Door should remain closed as much as possible
How do you pass packs from a non sterile person to a sterile person
Accepting sterile packs and equipment form the circulating nurse is a responsibility of the scrub nurse
For a double wrapped pack, the outer wraps should be properly unfolded by the circulating nurse and then offered to the scrub nurse
When taking a peel packed item form the circulating nurse, it is equally important that the scrub nurse be aware of the nonsterile portions of the packaging and avoid touching those areas
Dropping the equipment of contaminating the equipment would require a flash sterilization procedure
The scrub nurse is not only responsible for properly passing the instruments to the surgeon, but also maintaining the instrument table and ensuring the working order of the instrumentation throughout the procedure
The table should be organized for quick and easy access
Instruments should be laid out so that the ring handles (or shafts) of the instruments are closest to the scrub nurse
Where you stand in relation to the table and patient dictates which direction the instruments should face
What is the role of the scrub nurse
At other times the tech may be required to assist the surgeon with the procedure
Assisting in the procedure may entail tissue retraction, hemostasis, or any other assistance needed by the surgeon
A technician scrubbed in to assist with surgery will increase intraoperative efficiency, decrease surgery time, and decrease anaesthesia time, which all are beneficial to the health and outcome of the patient
How do you pass a scalpel
The technician holds the scalpel handle with the blade facing away from the hand and the pint toward the technician
The thumb and index finger hold the handle with the hand in a supinated position
Pronation of the technicians had follows as the handle is passed to the waiting surgeons hands
As the surgeon grapes the handle, the technician should maintain the forward momentum of the hand so as not to contact the cutting edge of the blade
How do you pass ring handled instruments
When passing an instrument, it is important to remember to place the instrument firmly in the palm of the waiting hand to decrease the chance that the instrument will be dropped
The first ratchet of a ring-handled instrument should be closed before the instrument is passed
The box lock should be held between the assistant thumb and index finger, with the shaft of the instrument stabilised by the remaining fingers of the delivering hand
The ring handle should be facing the floor and the tip of the instrument facing the ceiling
Curved instruments should have the curve facing the thumb (or midline) of the surgeon
How do you pass non ringed instruments
When passing an instrument without ring handles, hold the instrument with the tips facing the floor
The other end of the instrument should be held firmly with the thumb and index finger while the remaining fingers stabilize the instruments
How do you remove suture from a suture cassette
The circulating nurse removes the cap front the cassette, they then grab the exposed suture and pull it straight up, exposing about 6 inches of suture
The sterile assistant than grapes the suture below the level that was initially exposed
The assistant used sterile operating scissors to cut the suture close to their hand between their hand and the circulating nurses
A hand over hand motion is used to pull as much suture as needed
The sterile person then cuts the suture close to the cassette without contaminating the scissors
How do you load a needle with suture
A needle holder should be placed at about ⅔ into the needles curve for secure and controlled handling
The suture should pass from the inside of the needles curve to the outside – this allows the short end of the suture to fall away from the outside – this allows the short end of the suture to fall away fort eh outside curve of the needle, reducing the chance that it will pull out of the needle
How do you load a needle holder
Know which hand is the surgeons dominant hand
The needle should be placed in the needle holder so that the surgeon can use it immediately without having to adjust the needles position
The tip of the needle should be directed towards the surgeons midline with the point oriented towards their heart
Right handed surgeon – the point of the needle should face left
Left handed surgeon – the point of the needle should face right
How do you keep tissues moist
Systemic hydration should be achieved and maintained through the infusion of IV fluids, but the tissue must be kept moist as well
The heat from the lights and exposure to room air makes tissue vulnerable to adverse conditions
“Moist tissue is happy tissue”
The circulation is less compromised and tissue function remains intact
How do you lavage tissue
Generally an isotonic solution such as lactated ringers solution of 0.9% normal saline is used as a lavage
Depending on the surgical procedure, an antibiotic may be added to the solution for topical application
A bowl on the sterile field can be filled with aram isotonic solution
A single gauze square can be soaked in thai lavage solution and then squeezed while suspended above the exposed tissues to drip the lavage solution onto the tissues
It is important to avoid wiping or rubbing the gauze on the tissue directly
The bowl containing the warm lavage solution should be kept at the back of the instrument table, preferably on a separate tray, so that if spillage does occur there is no contamination of the sterile field
How do you maintain hemostasis
If vessels are cut, the scrub nurse should be ready to pass the necessary hemostat
Blotting or applying pressure to the hemorrhaging site before the surgeon places the hemostat helps the surgeon place the clamp on the vessel without including excessive tissue in the hemostat
It is important to remember that bleeding tissue should be blotted, not wiped
Other items available that you may see for controlling hemostasis, are absorbable gelatin or cellulose sponge and bone wax
Hemostasis can also be achieved using electrocautery
The assistant, at the direction of the surgeon, may cauterize tissue or a vessel or may elevate the hemostat that is on the vessel so that the surgeon can activate the cautery
How can you tell how much blood was lost while using gauze
The blood soaked sponge count can serve as an estimate of blood loss
A 3x3 inch sponge holds approx 6mL of blood
A 4x4 inch sponge holds approx 10mL of blood
Ideally, only radiopaque sponges should be included in surgical packs
When do you do a count and how
An instrument count documents how many instruments are present at the beginning of the procedure
Before the surgical site is closed, a second count of the instruments should be done
Most anesthesia logs have a space to record the initial surgical instrument count and sharps count at closure
The circulating nurse helps the surgical assistant keep track of how many instruments (if any) were removed front eh sterile field and how many sharps were used
Next, the surgical assistant should perform a sponge count
The initial quantity of sponges in the pack is counted before any sponges are sued
As the sponges are sued, they should be discarded in a dedicated sponge bowl or kick bucket
As the sponges are discarded, the circulating nurse can unfold and count each sponge
It is important to unfold the sponges in case two or more sponges are stuck together
All sponges, whether gauze squares or laparotomy pads subsequently added to the sterile field must be accounted for as well
Before the surgical site is closed, the sponges on the sterile field must be counted by the scrub nurse
The number of discarded sponges counted by the circulating nurse is added to the count by the scrub nurse
This number must equal the number of sponges documented as entering the sterile field
What are the scrub nurses responsibilites with suture
Cutting 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 patterns
How often should you check an incision site
At least once a day
What complications can happen with sutures
Dehiscence (separation of all layers of an incision or wound)
Herniation
Evisceration
Blood loss
Sepsis
Surgical assisting with instrument setup and handling of equine patients
Open packs during draping
Arrangement of instruments and equipment on the table
Abdominal surgery
Create pouch between back legs for line/hose
Instrument tray
Clean instruments
Wiping with a wet 4x4 sponge
Discard contaminated equipment
Surgical assisting with tissue handling of equine patients
Hollow organ surgery
Small intestine
- Discard ingesta-contaminated instruments
- Tissue becomes easily dehydrated once it is outside of the body cavity
- Risks of damage
- Tissue hydration and care
- Sterile saline via pressurised or bulb syringe
What do you need to do during LA bone and joint surgery
Replace torn gloves immediately
Frequent irrigation
suction/blotting
Tissue retraction, fragment reduction
Hohmann retractors
How do you help with hemostasis on equine patients
Abdominal surgery
- Sponge hemostasis dangerous - can stick to guts and go back in to abdominal cavity
- Suction
Large vessel
- Clamp and ligate with suture
Small vessel
- Hemostats
- Electrocautery
