DUTIES OF SCRUB NURSE

Before an operation

Ensures that the circulating nurse has checked the equipment Ensures that the theater has been cleaned before the trolley is set Prepares the instruments and equipment needed in the operation Uses sterile technique for scrubbing, gowning and gloving Receives sterile equipment via circulating nurse using sterile technique Performs initial sponges, instruments and needle count, checks with circulating nurse

When surgeon arrives after scrubbing

Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet. Then, assist in draping the patient aseptically according to routine procedure Place blade on the knife handle using needle holder, assemble suction tip and suction tube Bring mayo stand and back table near the draped patient after draping is completed Secure suction tube and cautery cord with towel clips or allis Prepares sutures and needles according to use

During an operation

Maintain sterility throughout the procedure Awareness of the patients safety Adhere to the policy regarding sponge/ instruments count/ surgical needles Arrange the instrument on the mayo table and on the back table

Before the Incision Begins

Provide 2 sponges on the operative site prior to incision Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon Hand the retractor to the assistant surgeon Watch the field/ procedure and anticipate the surgeons needs Pass the instrument in a decisive and positive manner Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge Always remove charred tissue from the cautery tip Notify circulating nurse if you need additional instruments as clear as possible Keep 2 sponges on the field Save and care for tissue specimen according to the hospital policy

Remove excess instrument from the sterile field Adhere and maintain sterile technique and watch for any breaks

End of Operation

Undertake count of sponges and instruments with circulating nurse Informs the surgeon of count result Clears away instrument and equipment After operation: helps to apply dressing Removes and siposes of drapes De-gown Prepares the patient for recovery room Completes documentation Hand patient over to recover room

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DUTIES OF CIRCULATING NURSE

Before an operation

Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table Make sure theater is clean Arrange furniture according to use

Place a clean sheet, arm board (arm strap) and a pillow on the OR table Provide a clean kick bucket and pail Collect necessary stock and equipment Turn on aircon unit Help scrub nurse with setting up the theater Assist with counts and records

During the Induction of Anesthesia

Turn on OR light Assist the anesthesiologist in positioning the patient Assist the patient in assuming the position for anesthesia Anticipate the anesthesiologists needs If spinal anesthesia is contemplated:

Place the patient in quasi fetal position and provide pillow Perform lumbar preparation aseptically Anticipate anesthesiologists needs After the patient is anesthetized

Reposition the patient per anesthesiologists instruction Attached anesthesia screen and place the patients arm on the arm boards Apply restraints on the patient Expose the area for skin preparation Catheterize the patient as indicated by the anesthesiologist Perform skin preparation

During Operation

Remain in theater throughout operation Focus the OR light every now and then Connect diatherapy, suction, etc. Position kick buckets on the operating side Replenishes and records sponge/ sutures Ensure the theater door remain closed and patient s dignity is upheld Watch out for any break in aseptic technique

End of Operation

Assist with final sponge and instruments count Signs the theater register Ensures specimen are properly labeled and signed

After an Operation

Hands dressing to the scrub nurse

Helps remove and dispose of drapes Helps to prepare the patient for the recovery room Assist the scrub nurse, taking the instrumentations to the service (washroom) Ensures that the theater is ready for the next case

Sutures
Definition:

A suture is a piece of thread-like material used to stitch or approximate tissues, and hold the wound together until healing takes place. any strand of material used to ligate bleeders or used to approximate tissue. any materials used to sew, sick or hold tissue together until healing process occurs.

Purpose of Suture:

to hold a wound together in good apposition until such time as the natural healing process is sufficiently well established to make the support from the suture material unnecessary and redundant.

Ligature or Tie refers to a suture material that is tied around a blood vessel to occlude the lumen. Two types of ligature or tie: 1. Free tie is a stand of material that is handed or given the surgeon or assistant to ligate a vessel. This stand is not threaded on a needle. 2. Stick tie or suture ligature the suture material is threaded either on a needle holder or on a right angle clamp before occluding a deep or large vessel. Atraumatic Suture a suture material prepared or manufactured with a needle attached to it. It is referred to as an eyeless needle or atraloc-swage on needle. Strand suture material prepared or manufactured without a needle attached to it. Continuous Suture a suturing technique wherein a surgeon start suturing at one point and ends at the other point without cutting the suture material. This may be referred to as a running stitch and also used to close the peritoneum and vessels because it provide a leakproof suture line. Interrupted Suture the suture is taken, tied and out separately. This technique is time consuming.

Subcuticular Suture a continuous suture is placed beneath epithelial layer of skin in short lateral stitches. It leaves a minimal scar formation. Buried Suture a suture placed under the skin, buried either continuous or interrupted suture. Burse String or Inverting Stitch a continuous suture is used as a draw string method to invert the loose ends or edges of tissue and tied the close the lumen. (for example, stamp of the appendix.) Traction Suture is used to hold tissue out of the way during the operation. Classification of Suture Material: 1. Absorbable Suture. An absorbable suture is made from material that can be absorbed (digested) by body cells and fluids. Rate of absorption depends on various factors, including type of body tissue, nutritional status of the patient, and the presence of infection. Absorbable suture is available prepackaged and presterilized in various sizes graded by diameter and length. Sizes range from number 12-0, which is the finest, to number 5, which is the heaviest. The length ranges from 12 to 60 inches. a.Plain gut. Plain indicates a surgical gut material that has not been treated to lengthen its absorption time in the tissue. This suture is absorbed more rapidly than treated suture. b. Chromic gut. Chromic surgical gut has been treated with chromic oxide so that it will delay its rate of digestion or absorption. c. Synthetic Absorbable Sutures i. Polyglactin 910 (Vicryl). ii. Polyglycolic Acid (Dexon). iii. Polydioxanone (PDS). 2. Nonabsorbable Suture. This suture material is not absorbed during the healing process. Nonabsorbable suture becomes encapsulated (enclosed in a capsule) with tissue and remains in the body until it is removed or cast off. Silk, nylon, cotton, linen, polypropylene, and corrosion-resisting steel wire are examples of nonabsorbable sutures. Sutures used for skin closure are usually removed before healing is complete. Suture Sizes:

Sutures are sized by the USP (United States Pharmacopoeia) scale The available sizes and diameters are: o 6-0 = 0.07 mm o 5-0 = 0.10 mm o 4-0 = 0.15 mm o 3-0 = 0.20 mm

o o o o

2-0 = 0.30 mm 0 = 0.35 mm 1 = 0.40 mm 2 = 0.5 mm

Suture characteristics:

Suture materials vary in their physical characteristics Monofilament sutures (e.g. polypropylene) are smooth The slide well in tissues but if handles inappropriately they can fracture Multifilament sutures (e.g. polyglactin) are braided They have a greater surface area They are easier to handle and knot well Some suture materials have a memory (e.g. polypropylene) Return to former shape when tension is removed

Catgut

Made from the submucosa of sheep gastrointestinal tract Broken down within about a week Chromic acid delays hydrolysis Even so it is destroyed before many wounds have healed

Silk

Strong and handles well but induces strong tissue reaction Capillarity encourages infection causing suture sinuses and abscesses

Vicryl

Tensile strength o 65% @ 14 days o 40% @ 21 days o 10% @ 35 days Absorption complete by 70 days

Polydioxone

Tensile strength o 70% @ 14 days o 50% @ 28 days o 14% @ 56 days Absorption complete by 180 days

Specifications for Suture Materials:

1. 2. 3. 4. 5. 6.

It must be sterile It must be uniform in tensile strength by size and material. It must be hypoallergenic and less tissue reactive. It must be safe on each type of tissue. It must be secure and tight when knotted. It must be appose and maintain the tied tissues together until it fully heal.

LAYERS OF THE ABDOMEN

Skin. It is the most prominent and always seen layer of the abdomen. The skin acts as a physical barrier against microorganisms. It also houses the sebaceous and sweat glands which helps by making our skin supple and moist, similar to the skin on the other parts of the body. Saggy abdominal skin is a result of the decrease of its elasticity; might be due to pregnancy, increasing age and obesity. Subcutaneous. This layer is commonly known as the fatty layer. Most of the stored fats in our body accumulate in this layer. It is also the target layer of the liposuction procedures. Though known for its unwanted function, it provides us heat during cold winter days. Fascia. If you have ever cooked a roast, you may have seen a silvery membrane on parts of the uncooked meat. That is fascia. This layer covers the abdominal muscles. It tends to constrict the muscles to aid in proper contraction of it. And also it is the toughest amongst all the layers. Muscle. The layer that contains the muscles. It is the layer that gives the six pack abs especially when certain exercises focuses on these muscle groups. Some groups of muscle in this layer are responsible for the shape of your abdomen and can be stretched with age and pregnancy. Peritoneum. It is the last layer of the abdomen. It protects and indirectly covers some important organs of our abdomen. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves. Though the function the abdomen is not that critical compared to your heart and brain, everyone must consider to take care of it. You do not need to go to the gym or spend a lot to surgical interventions for those inches. Walking or even doing some household chores will be enough to eliminate some fats and to strengthen those muscles and fascia. You could avoid having saggy skin on your abdomen by also doing these. Remember that the best way to get a six pack is to have it the natural way.