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OPERATING ROOM TECHNIQUE BY: stella marie c.

jardenil Common Terminologies: Operating Room- a room or area in a hospital where patients are made ready for surgery, have surgery and recover from the effects of anesthesia needed for the surgery. Operation- any surgery performed to the patient. Sterile- free from microorganisms Sterile field- a specified area, as within a tray or on a sterile towel, that is considered free of organisms. Asepsis- free of germs Aseptic technique- any health care procedure in which added precautions are used to prevent contamination. Perioperative Refers to the management and treatment of the client during the three phases of surgery. 3 Phases of Surgery: Preoperative- before surgery Intraoperative- during surgery y Postoperative- after surgery Conditions requiring surgery: To correct anatomical or physiological defects To provide therapeutic interventions To preserve life To save a damaged organ or limb To remove a diseased part of the body Surgical procedures are classified according to: Urgency Purpose Extent Urgency: Emergency- requires immediate intervention to sustain life. Imperative- has to be done within a limited time span, usually within 24 hours. Example: bleeding hemorroids, obstructions, painful kidney stones, newgrowths Elective-operation that may or may not be absolutely necessary but which if done will add to patient s well being. Planned Elective Surgery- can be scheduled ahead of time. Example: Tonsillectomy, Cataract Extraction, polypectomy Purpose: Diagnostic-Determine the origin of presenting symptoms and extent of a disease process. Example: biopsy Exploratory- surgery is done for the purpose of estimating the extent of disease or injury as well as confirm a diagnosis.

Example: Exploratory Laparotomy, Pelvic Laparotomy Curative a) Ablative- refers to the removal of a damaged or a diseased organ. Example: Cholecystectomy, Appendectomy b) Reconstructive- correct a disease process or improve cosmetic appearance. c) Constructive- refers to the repair of an organ which has been defective from birth, to improve it s function and appearance. Example: Cheiloplasty, Palatoplasty Palliative- decrease the spread of the disease process to prolong life or to alleviate pain. Extent: a) Minor operations- superficial part of the body, minimally invasive procedure, less blood loss. Example: Circumcision, Excision of mass b) Major operations- invasive procedures, more blood loss Example: Kidney transplant, Modified Radical Mastectomy A patient can be admitted or can be an out patient. Preparation is still the same. Although the out patient can go home after the procedure. Preoperative - Refers to the time interval that begins when the decision is made for surgery until the client is transferred to the operating room. Preoperative Preparation: 1) Assessment 2) Psychological and physiological preparation 3) Preoperative teachings 4) Preoperative skin preparation 5) Preparation of the gastrointestinal tract Consent- refers to the provision of approval particularly and especially after thoughtful consideration. - 21 years old and above except if emancipated - Before giving of pre operative medications - No coercion Thumb mark if unable to write Preoperative Checklist - to guide a nurse in carrying out all preoperative procedures for a patient. - It is a list of things that should have been done to the patient before being brought to the operating room. Principles of Sterile Technique: 1) Only sterile items are used within the sterile field. 2) Gowns are considered sterile only from the waist to the shoulder level 3) Tables are sterile only at table levels 4) Persons who are sterile touch only sterile items or areas; persons who are not sterile touch only unsterile items or areas. 5) Unsterile persons avoid reaching over a sterile field; sterile persons avoid leaning over an unsterile area. 6) Edges of anything that encloses the sterile contents are considered unsterile.

7) Sterile field is created as close as possible to the time of use. 8) Sterile areas are continuously kept in view. 9) Sterile persons keep well within the sterile area 10) Sterile persons keep contact to sterile areas to a minimum. 11) Unsterile persons avoid sterile areas. 12) Destruction of the integrity of the microbial barriers results in contamination. 13) Microorganisms must be kept to an irreducible minimum. 3 zones: Unrestricted- personnel can enter in street clothes, receiving desk, holding area, locker rooms. Semi restricted- hallways and storage areas constitute the semi restricted area. Restricted- (germ free areas) OR rooms where sterile instruments are prepared. Surgical scrub - Is the removal of as many bacteria as possible from the hands and arms by chemical disinfection before participating in an operation. Purpose: - To help prevent the possibility of contamination of the operative wound by the bacteria on the arms and hands. Preparation prior to surgical scrub: Skin and nails clean, cuticles uncut Fingernails should not be long No nail polish worn Hands and forearms should be intact, no open lesions and cracked skin Remove jewelries Be sure hair and ears are covered by hair cap Adjust mask over nose and mouth Adjust eye wear Adjust water to comfortable temperature Surgical Scrub Procedure: Time method Counted brush stroke method Time method: - fingers, hands and arms are scrubbed by allotting a prescribed amount of time to each anatomical area or each step of the procedure. - Done 5-7 minutes Brush stroke method: - A prescribed number of brush strokes, applied in a circular motion in each surface of the fingers, hands and arms. Brush Stroke Method Hand washing: Make sure that you are properly attired.(scrub suit, scrub shoes, surgical cap and mask, protective eye gear). Fold the sleeves of your scrub suit Perform handwashing Start hand scrubbing 1) Finger nails 30 strokes 2) Divide the fingers into 4 planes each side 10 strokes

3) 4) 5) 6)

In between the fingers 10 strokes Divide the hand into 4 planes each plane 10 strokes Divide the arms into 3 parts, each part divide it into 4 planes, 10 circular strokes Elbow 2-3 strokes

Purposes of gowning: 1) To exclude skin as a possible contaminant and to create a barrier between sterile and unsterile areas. 2) To permit the wearer to come within the sterile field. 3) To carry out sterile techniques during an operative procedure. Procedure in drying of the hands: 1) When picking up the towel, do it with a swift efficient motion. 2) Take the towel at the middle, being careful not to contaminate the sterile gown under it. 3) Bend at the waist to help prevent the sterile towel from touching the unsterile gown while drying your hands and arms. 4) Dry hand to mid lower arm; then transfer dry end of towel to another hand. 5) Do not dry hand then arm and return to the same hand. 6) Discard towel in linen hamper. Procedure in gowning: 1)Reach down to the sterile package and lift the folded gown directly upward. 2) Step back away from the table, into a clear area. 3) Holding the folded gown, carefully locate the neckband or centerfold. Then gently shake the folds of the gown. 4) Slip both hands into the sleeves, holding the hands upward on level with the shoulder without touching the outside part of the gown with bare hands. 5)Circulating nurse reaches the inside part of the gown and ties the gown. Procedure in gowning a surgeon: 1) Give the towel to the surgeon, being careful not to touch the hand. 2) Unfold the gown, holding it at the neck band. 3) Keep the hands on the outer part of the gown under the protective cuff and shoulder area 4) Release the gown. The surgeon holds the arms outstretched while the circulating nurse pulls the gown onto the shoulders. Note: When gowned and gloved remember to use the back to back technique in transferring from one area to another if there is another sterile person beside you. Removing a gown: The gown is always removed before the gloves. It is pulled downward from the shoulders (arms in an x position), turning the sleeves inside out as it is pulled off the arms. Purposes of gloving: 1) To exclude the skin as a possible contaminant. 2) To create a barrier between sterile and unsterile areas.

3) To permit the wearer to handle sterile supplies or tissues of the operative wound. Gloving techniques: Close glove technique Open glove technique Close Gloving: - Used in major operations - Used together with a gown No bare skin is exposed

Procedure in close gloving: 1) Using the left hand, and keeping it within the cuff, pick up the glove, from the inner wrap of the glove package, by grasping the folded cuff. 2) Extend the right forearm with palm upward. place the palm of the glove against the palm of the right hand, grasping in the right hand. (thumb to thumb technique) 3) Grasp the back of the cuff in the left hand and turn it over the right sleeve and hand. (hand is still inside the sleeve). 4) Pull glove on over extended right fingers until it completely covers he stockinet cuff. 5) Do the same procedure on the other hand. Open Gloving: - Uses skin to skin glove to glove technique - Used in minor operations, in NSVD - No gown is used Aprons are used Procedure for open gloving: 1) With the left hand, grasp the cuff of the right glove on the fold. Pick up the glove and step back. 2) Insert the right hand into the glove and pull it on. 3) Slip the finger of the gloved right hand under the everted cuff of the left glove. 4) Insert hand into the left glove and pull it on. Changing gloves during operations: - If a glove becomes contaminated for any reason during an operative procedure, it must be changed immediately. Removing gloves: - Glove is removed after the gown. Gloves are turned inside out, using glove to glove then skin to skin technique. Anesthesia: -lack of normal sensation like pain. It is bought on by an anesthetic drug. It may be used in a local area on the entire area of the body. Anesthesiologist: -a doctor trained to give anesthetics and to support lungs, heart and blood flow systems during surgery. Intra operative: -Begins when the client is transferred to the OR and ends with the client s discharge from the OR. Types of Anesthesia: - General - Regional 1) Spinal

2) Epidural 3) Local 4) Sedation General: - Total unconscious state - Drug injected into the bloodstream or breathed into the lungs - Operations in major organs of the body - Example: Craniotomy - Regional: - -blocks nerve impulse conduction to a specific area or region of the body to decrease intractable pain or to produce an anesthetic field without the loss of consciousness. 1) Spinal

2) Epidural - Temporary decrease of sensation or loss of feeling and movement to the lower part of the body. - Example: Cesarean Section 3) Local - Direct giving of a local anesthetic agent to cause the loss of feeling in a small area of the body. - Example: circumsion 4) Sedation - A drug that causes a state of calmness or sleep, as by means of a sedative or pill. - Example: Close reduction of arm Common Positions for Surgery: 1) Supine 2) Prone 3) Lithotomy 4) Lateral 5) Modified Jacknife Prepping: - Done after the patient has been anesthetized and positioned on the operating table, skin of the operative site and extensive area surrounding it is mechanically cleansed again with an antiseptic agent immediately prior to draping. Draping: - Is the procedure of covering the patient and surrounding areas with a sterile barrier to create and maintain an adequate sterile field during operation. 2 teams: - Sterile team a) Surgeon b) Assistant Surgeon c) Scrub Nurse - Unsterile team a) Circulating Nurse Anesthesiologist Surgeon: - Explains the procedure to the patient - Secures consent - Performs the operation - Secures the dressing in place

Assistant Surgeon: - Assists the surgeon during operation (retracting, suctioning etc.) - May close the incision and helps with the placement of the dressing. Scrub Nurse: - Instrument nurse or suture nurse - Prepares the instruments needed for the surgery - Set s up the sterile field - Counts the instruments, packs, needles etc. - Serves the instruments and sutures to the surgeon - Assist in dressing - Cleans the patient after the operation - Cleans the instruments and the room after the operation Anesthesiologist: - Gives anesthesia to the patient - Monitors the patient during the operation (vital signs, airway etc.) Circulating Nurse: - Receives endorsement from the ward nurse - Prepares the things needed by the anesthesiologist - Assist in the induction of anesthesia - Inserts Foley catheter if needed - Positions the patient - Preps the patient - Takes note of the counting of instruments - Charting - Endorses the patient to the Recovery room - Endorses the specimen Layers of tissue: - Skin - Subcutaneous - Fascia - Muscle peritoneum - leans the room after the operation Common abdominal incisions: - Upper abdominal midline - Lower abdominal midline - Left lower transverse - Right lower paramedian - McBurney - Right horizontal flank - Right upper oblique - Left upper paramedian - Left lower oblique - pfannensteil Categories of Instruments: - Cutting and Dissecting - Clamping - Grasping

- Retracting - Needle holder - Cutting and Dissecting Instruments used to cut sutures skin etc. Example: Mayo scissors, metz, scalpel Clamping Instruments used to stop bleeding Instrument used to clamp organs like intestines Example: Curve hemostat, instetinal clamp Grasping Instruments used to grasp skin or organs of the body Example: Tissue forcep, allis - Retracting Instruments used to expose areas of the body Example: Richardson retractor, army navy retractor - Needle holder Instruments used to hold sutures Count instruments: 3 times -Before procedure starts -Before closure of the peritoneum -Before closure of the skin Report to the surgeon: Excuse me doc sponges, needles and instruments are complete for the first count. Postoperative: -closure of the wound to the time the patient has fully recovered from the effects of the anesthesia Monitor: -Vital signs -Circulation -Neurologic status -Wound dressing - Hydration - Genitourinary and gasrto intestinal function Post operative complications: - Shock - Pulmonary complications