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Major Procedures Tray Retractors • 2 Ribbon/Malleable; (1) 1 1/2", (1) 2 1/2" • 3 Richardson; (1) small, (1) medium, (1) large • 2 Goulet • 2 Army Navy • 3 Deaver; (1) narrow, (1) medium, (1) wide Forceps • 2 Tissue w/o teeth; (1) 5 1/2", (1) 10" • 3 Tissue w/ teeth; (1) 5 1/2", (1) 8", (1) 10" • 2 Russian; (1) 7", (1) 10" • 6 De Bakey; (2) 6", (2) 7 3/4", (2) 9" • 2 Adson w/ teeth Scissors • 2 Straight Mayo 6 1/4" • 1 Curved Mayo 6 1/4" • 1 Metzenbaum 7" • 1 Wire Cutter Clamps • 10 Towel Clips 5 1/2" • 18 Curved Crile 5 1/2" • 6 Straight Crile 5 1/2" • 6 Straight Kocher 6 1/4" • 6 Allis 6" • 4 Babcock 6" • 4 Tonsil 7 1/2" • 2 Right Angle 8" • 6 Needle Holder; (2) 6", (2) 7", (2) 8" • 4 Sponge Forceps 10" • 2 Carmalt 8" Suction Tubes/Tips • 1 Poole • 1 Yankauer 10 3/8" Miscellaneous • 3 Knife Handles; (2) No. 3, (1) No. 7 • 1 Probe, Malleable • 1 Grooved Director

Neurologic Procedures Tray Retractors • 1 Mastoid • 2 Weitlaner • 1 Curved Weitlaner • 1 Adson Cerebellar • 2 Brain Spoons • 8 Malleable Brain Spatulas, double-ended • 2 Nerve Hooks; (1) sharp, (1) blunt • 2 Nerve Root • 2 Hoen Dura Separators • 2 Dura Hooks Forceps • 2 Adson w/ teeth • 2 Adson cup • 4 Cushing w/ teeth • 2 Cushing w/o Teeth • 2 Bayonet Scissors • 2 Straight Mayo • 1 Curved Mayo • 2 Metzenbaum • 1 Wire Cutter Clamps • 2 Curved Pean • 10 Curved Crile • 6 Curved Mosquito • 36 Hemostatic Scalp • 2 Allis • 2 Tonsil • 4 Needle Holder; (2) fine, (2) heavy • 12 Towel Clips Suction Tubes/Tips • 4 Frazier Miscellaneous • 3 Knife Handles • 1 Langenback Periosteal Elevator • 1 Freer • 2 Panfield Disectors, No. 1-5 • 2 Short Kerrison Rongeur, up • 1 Flat Kerrison Rongeur • 1 Kerrison Rongeur 30º, up • 1 Leksell Double Action Rongeur • 1 Small Double Action Rongeur • 1 Straight Pituitary Forceps • 1 Angled Pituitary Forceps, up • 3 Blunt Ventricular Needles • 1 Sharp Ventricular Needle • 4 Stylets • 4 Syringes, Luer-Lok

Minor/Basic Procedures Tray Retractors • 1 Ribbon/Malleable • 1 Richardson, small • 1 Weitlaner, sharp • 2 Goulet • 2 Army Navy • 1 Deaver, narrow • 2 Senn, sharp Forceps • 2 Tissue w/o teeth • 2 Tissue w/ teeth • 1 Russian • 4 De Bakey • 1 Adson w/o teeth • 2 Adson w/ teeth Scissors • 2 Straight Mayo • 1 Curved Mayo • 3 Metzenbaum • 1 Stevens Tenotomy • 1 Straight Iris • 1 Curved Iris Clamps • 10 Towel Clips • 12 Curved Mosquito • 2 Straight Mosquito • 12 Curved Crile • 4 Straight Kocher • 4 Allis • 2 Babcock • 2 Webster Needle Holder • 4 Needle Holder • 2 Sponge Forceps Suction Tubes/Tips • 1 Poole • 1 Yankauer • 1 Frazier, No. 10 Miscellaneous • 3 Knife Handles • 1 Probe, Malleable • 1 Grooved Director • 1 Medicine Cup

• • • • • • • • • • • • • • • AP Set I • 16 Kelly Curve Forceps • 16 Kelly Straight Forceps • 4 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 1 Sponge Holder • 1 Bobcock Tissue Forceps • 1 Metzenbaum • 2 Big Richardson • 1 Long Tissue Forceps w/o teeth • 2 Blade Holder; (1) No. 3, (1) No. 4 • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Mayo Scissors • 2 Small Ribbon Retractors • 2 Fritz/AP Retractors • 1 Adson Forceps w/ teeth • 1 Tissue Forceps w/ teeth • 2 Tissue Forceps w/o teeth AP Set II • 16 Kelly Curve Forceps • 16 Kelly Straight Forceps • 4 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 1 Sponge Holder • 1 Bobcock Tissue Forceps • 1 Metzenbaum • 2 Small Richardson • 1 Long Tissue Forceps w/o teeth

3 Pituitary Spoons 1 Perforator 2 Scalp Clip Appliers 4 Hemo Clip Appliers 1 Hand Drill w/ Key 1 Set Drill Bits 2 Gigli Saws w/ Handles 1 Saw Guide 1 Hudson Brace 1 Basin 4 Medicine Cups 10 Rubber Bands 1 Bayonet Bipolar Electrocoagulating Forceps and Cord 1 Neurological Sponge Tray Prongs For Skull Clamp

AP Set III (with Stainless Mayo Tray) • 16 Kelly Curve Forceps • 16 Kelly Straight Forceps • 4 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 1 Sponge Holder • 1 Bobcock Tissue Forceps • 1 Metzenbaum • 2 Big Richardson • 1 Long Tissue Forceps w/o teeth • 2 Blade Holder; (1) No. 3, (1) No. 4 • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Mayo Scissors • 2 Army Navy Retractors • 1 Adson Forceps w/ teeth • 1 Tissue Forceps w/ teeth • 2 Tissue Forceps w/o teeth AP Set IV (with Stainless Mayo Tray) • 16 Kelly Curve Forceps • 16 Kelly Straight Forceps • 4 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 1 Sponge Holder • 1 Bobcock Tissue Forceps • 1 Metzenbaum • 2 Medium Richardson • 1 Long Tissue Forceps w/o teeth • 2 Blade Holder; (1) No. 3, (1) No. 4 • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Mayo Scissors • 2 Army Navy Retractors • 1 Adson Forceps w/ teeth

AP Set V • 10 Mosquito Straight • 10 Kelly Curve Forceps • 10 Kelly Straight Forceps • 4 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders, long and short • 2 Sponge Holder • 3 Bobcock Tissue Forceps • 1 Metzenbaum • 2 Richardson • 3 Long Tissue Forceps; (1) w/ teeth, (2) w/o teeth • 3 Blade Holder; (1) No. 3, (2) No. 4 • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Mayo Scissors • 2 Army Navy Retractors • 2 Medium Deaver • 1 Abdominal Suction Tip • 2 Adson Forceps w/ teeth • 2 Tissue Forceps w/o teeth • 4 Mixter Forceps APR Set (Abdominal-Perineal Resection) w/ Stainless Tray • 10 Mosquito Straight • 10 Kelly Curve Forceps • 10 Kelly Straight Forceps • 10 Pean Forceps Curved • 7 Adson's Tip Forceps Curved • 3 Mixter's, long • 2 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders; (1) short, (1) long (gold-plated)

• • • • • • • •

2 Blade Holder; (1) No. 3, (1) No. 4 1 Stainless Bowl 1 Stainless Kidney Basin 1 Mayo Scissors 2 Army Navy Retractors 1 Adson Forceps w/ teeth 1 Tissue Forceps w/ teeth 2 Tissue Forceps w/o teeth

• •

1 Tissue Forceps w/ teeth 2 Tissue Forceps w/o teeth

• • • • • • • • • •

Ophthalmic Tray (Basic Eye Procedures) Scissors • 1 Blunt • 1 Curved Iris • 1 Stevens Tenotomy • 1 Suture Clamps • 2 Halsted Straight Mosquito • 1 Halsted Curved Mosquito • 4 Towel Clip Miscellaneous • 1 Irrigating Tip, No. 21 • 1 Knife Handle, No. 9 • 6 Medicine Cups Needles • (1) 23 Gauge • (2) 23 Gauge Retrobulbar • (2) 25 Gauge Retrobulbar Syringes • 2 5mL Luer-Lok • 5 2mL Luer-Lok

Vascular Procedures Tray Forceps • 6 De Bakey Scissors • 1 Potts Clamps • 2 De Bakey Multipurpose • 1 De Bakey Curved Aorta Aneurysm • 5 De Bakey Tangential Occlusion • 1 Hufnagel Ascending Aorta • 2 Angled De Bakey 90º • 1 Medium Curved Crawford Auricle • 1 Glover Coarctation, straight • 1 Glover Coarctation, angled • 1 Glover Patent Ductus, straight • 1 Glover Patent Ductus, angled • 1 Straight Glover • 2 Curved Glover • 2 Cooley Multipurpose, straight • 1 Cooley Multipurpose, curved • 1 Curved Cooley • 6 Cardiovascular Needle Holder

• •

1 Eyepad 2 Eyeshield; (1) metal, (1) plastic • 2 Serrefine Clamps Biopsy Set I • 4 Towel Clips • 6 Straight Forceps • 13 Curved Forceps • 2 Allis Tissue Forceps • 1 Curette • 1 Metzenbaum Scissors • 1 Mayo Scissors • 2 Blade Holder; (1) No. 3, (2) No. 4

Biopsy Set II • 4 Towel Clips • 6 Straight Forceps • 13 Curved Forceps • 2 Allis Tissue Forceps • 1 Curette • 1 Metzenbaum Scissors • 1 Mayo Scissors • 2 Blade Holder; (1) No. 3, (2) No. 4 • 1 Needle Holder

2 Sponge Holder 1 Metzenbaum 2 Long Tissue Forceps; (1) w/ teeth, (1) w/o teeth 3 Blade Holder; (1) No. 3, (1) No. 4, (1) No. 7 1 Stainless Bowl 1 Mayo Scissors 2 Big Deaver 1 Tissue Forceps w/ teeth 1 Tissue Forceps w/ teeth (heavy duty) 1 Tissue Forceps w/o teeth

Cholecystectomy Set • 2 Babcock Tissue Forceps • 1 Ovum Forceps • 2 Allis Tissue Forceps • 6 Kelly Curved • 6 Kelly Straight • 6 Towel Clips • 6 Mosquito Straight • 1 Mayo Scissors, long • 1 Metzenbaum Scissors, short • 3 Needle Holder; (1) long, (2) short • 4 Randall forceps • 2 Pick-up Forceps w/o teeth • 2 Long Tissue Forceps w/o teeth • 1 Long Blade Holder • 1 Blade No. 3 • 4 Long Round Kelly Curved • 2 Mixter Forceps • 1 Right Angle Scissors • 2 Tissue Forceps w/ teeth (heavy-duty) • 2 Adson Forceps w/ teeth • Stainless Sponge Holder • 2 Big Deaver w/ Wooden Handle • 1 Big Richardson

Biopsy Set III • 4 Towel Clips • 6 Straight Forceps • 13 Curved Forceps • 2 Allis Tissue Forceps • 1 Curette • 1 Metzenbaum Scissors • 1 Mayo Scissors • 2 Blade Holder; (1) No. 3, (2) No. 4

• • • • • •

1 Needle Holder 1 Babcock Tissue Forceps 1 Tissue Forceps w/ teeth 1 Tissue Forceps w/o teeth 2 Eyelid Retractor 1 Probe Director

Biopsy Set IV • 4 Towel Clips • 6 Straight Forceps • 13 Curved Forceps • 2 Allis Tissue Forceps • 1 Bone Curette • 1 Metzenbaum Scissors • 1 Mayo Scissors • 2 Blade Holder; (1) No. 3, (2) No. 4 • 1 Needle Holder • 1 Babcock Tissue Forceps • 1 Adson Forceps w/ teeth • 1 Tissue Forceps w/o teeth • 1 Rake Retractor w/ 3 teeth • 1 Rake Retractor w/ 2 teeth • 1 Probe Director Lap Set I • 16 Kelly Curve • 16 Kelly Straight • 5 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 2 Sponge Holders • 1 Metzenbaum Scissors • 1 Mayo Scissors • 2 Adson Forceps w/ teeth • 2 Tissue Forceps w/o teeth • 2 Blade Holders; (1) No. 3, (1) No. 4 • 2 New Lahey Retractor • 2 Medium Deaver • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Long Tissue Forceps w/ teeth

• • • • •

1 Babcock Tissue Forceps 2 Small Richardson 1 Adson Forceps w/ teeth 1 Tissue Forceps w/o teeth 1 Probe Director

Bronchoscopy Set • Bronchoscope • Light Source • Bronchoscopy Tray w/ the ff: o 1 Medicine Glass o 1 10cc Breakable Syringe o 1 20cc Breakable Syringe o Hypo Needles 21, 22, 23 o 1 Suction Tubing o 1 Suction Catheter o Cotton Applicator o 1 Spinal Needle o 2 Slides o 2 Specimen Bottles o OS Gauze, 4x4 o Mucous Extractor • Anesthesia Tray w/ the ff: o Xylocaine Spray o Xylocaine 2% Oral o 1 Bottle NSS (cooled) o 1 Epinephrine, ampule o KY Jelly Lap Set II • 16 Kelly Curve • 16 Kelly Straight • 5 Allis Tissue Forceps • 6 Towel Clips • 2 Needle Holders • 2 Sponge Holders • 2 Long Metzenbaum Scissors • 1 Mayo Scissors • 2 Tissue Forceps w/ teeth, big and small • 2 Tissue Forceps w/o teeth • 2 Blade Holders; (1) No. 3, (1) No. 4 • 2 Medium Deaver • 1 Stainless Bowl • 1 Stainless Kidney Basin • 1 Long Tissue Forceps w/o teeth • 2 Army Navy Retractors

• • • • • • •

1 Needle Holder 1 Babcock Tissue Forceps 1 Adson Forceps w/ teeth 1 Tissue Forceps w/o teeth 2 Small Deaver 1 Fritz Retractor 1 Probe Director

Hip Prosthesis Set • 1 Rasp • 1 Osteotome • ADSF Set • 1 Impactor • 1 Extractor • 1 Acetabular • 1 Calliper • 1 Bone Skid • 1 Weithlaner Retractor • 1 Mastoid Retractor • 1 Duckbill Rongeur • 1 Dissector • 1 Metal Suction Tip • 1 Plastic Handle Suction Tip

Dr. Siguan’s Instruments • 10 Kelly Curved • 10 Mosquito Curved • 10 Mosquito Straight • 10 Round Nose Forceps • 6 Allis Tissue Forceps • 6 Towel Clips • 2 Babcock Tissue Forceps • 3 Mixter Forceps; (1) long, (2) short • 2 Needle Holders • 2 Sattinsky clamp • 2 Sponge Holders • 1 Long Tissue Forceps w/ teeth • 1 Long Tissue Forceps w/o teeth • 1 Tissue Forceps w/ teeth (heavy duty) • 1 De Bakey Long Tissue Forceps • 1 Adson Forceps w/ teeth • 2 Blade Holders; (1) No. 3, (1) No. 4 • 1 Metal Abdominal Suction Tip • 2 Short Metzenbaum Curved

• • • • • • •

1 Mayo Scissors (heavy duty) 1 Stainless Ruler 1 Lahey Forceps 5 Skin Hooks 2 Army Navy Retractor 1 Stainless Kidney Basin 2 Big Richardson

Classification of Surgical Procedures I.

MAJOR A. GENERAL SURGERY 1. Abdominoperineal Resection 2. Adrenalectomy 3. Appendectomy 4. Biliary Surgery 5. Cholecystectomy 6. Cholecystojejunostomy 7. Colectomy 8. Colon Surgery 9. Creation of Colostomy, Ileostomy, Cecostomy 10. Exploratory Laparotomy 11. Gastrectomy 12. Gestrojejunostomy 13. Gastroduodenostomy 14. Hassab’s Procedure 15. Hemicolectomy 16. Hydrocoelectomy 17. Split Thickness Skin Grafting (Large Areas) 18. Splenectomy 19. Sympathectomy 20. Wound Exploration (Large Areas) 21. Debridement (Large Areas + Depth Affected) B. OB-GYNE 1. Cesarean Section 2. Myomectomy 3. Pelvic Exenteration 4. Pelvic Laparotomy 5. Perineorrhaphy 6. Hysterectomy (TAH & TAHBSO) 7. Mammoplasty and Abdominoplasty (Reconstructive, Reduction, Augmentation) 8. Mastectomy (Simple, Radial) 9. Salpingectomy 10. Salpingo-oophorectomy C. NEURO 1. Craniectomy 2. Burrholing 3. Creation of Ventriculo-Arterial Shunt Ventriculo-Peritoneal 4. Cranioplasty 5. Curettage of Skull 6. Pallidotomy 7. Thaladotomy 8. Ventriculostomy 9. Stereotaxis 10. Spinal Fusion D. URO-GYNE 1. Varicocoelectomy

2. 3. 4. 5. 6. 7. 8. 9. 10.

Cystectomy Nephrectomy (Radical, Partial, Bilateral) Nephrostomy Nephrolithotomy or Pyelithotomy Ureterolithotomy Prostatectomy (Suprapubic, Retropubic) Reconstruction of Epispadias or Hypospadias Renal Exploration Transplantation of Ureters

E. EENT

II.

1. Orbital Bone Reconstruction 2. Squint Surgery 3. Trabeculectomy 4. Lensectomy 5. Cataract Extraction (Intracapsular, Extracapsular) 6. Scleral Buckling 7. Cheiloplasty or Palatoplasty 8. Clef tLip Repair 9. Thyroidectomy (Partial, Total) 10. Thymectomy 11. Lobectomy, Isthmusectomy with Parathyroidectomy F. ORTHO 1. Amputation (Above Knee, Below Knee, Hand) 2. Bone Grafting 3. Hip Prosthesis 4. Intramedullary Nailing 5. Leminectomy 6. Maxillectomy 7. Open Reduction Internal Fixation (ORIF) (Long Bones) 8. Arthroplasty 9. Disarticulation (Hip) MINOR A. GENERAL SURGERY 1. Creation of Arterio-Venous Shunt / Fistula / Graft 2. Circumcision 3. Debridement (Small Areas) 4. Excision of Cyst 5. Electrocautery of Warts and Moles 6. Fistulectomy 7. Fissurectomy 8. Incision and Drainage with or without suturing 9. Release of Contractures (Small Areas) 10. Split Thickness Skin Grafting (Small Areas) 11. Vein Stripping 12. Wound Exploration and Debridement (Small Areas) 13. Resuturing / Closure of Wound Dehiscence 14. Gastrostomy Tube Insertion B. URO-GYNE 1. Rectal Wall Biopsy 2. Kelly’s Procedure 3. Dilation and Curettage 4. Herniorrhaphy 5. Episiorrhaphy 6. Urethroplasty 7. Proctosigmoidoscopy with Fistulectomy 8. Bilateral Orchiectomy 9. Marsupialization of Bartholin’s Glands 10. Hemorrhoidectomy 11. Herniotomy 12. Tracheoplasty 13. Urethral Dilation C. ORTHO

1. 2. 3. 4. 5. 6. 7. 8.

Reduction Internal Fixation (Short Bones) Closed Reduction Insertion of Skeletal Pins or Traction Arthrodesis Removal of Pines, Wires (Short Bones) Escharotomy Disarticulation of Toes Removal or Ingrown Toenail

D. EENT 1. Enucleation 2. Blepharoplasty 3. Evisceration 4. Dacrocystectomy 5. Dental Wiring 6. Rhinoplasty 7. Excision of Pterygium 8. Naso-antrostomy 9. Tracheotomy 10. Tracheostomy 11. Nasal Polypectomy 12. Repair of Corneal Wall 13. Submucous Resection 14. Tonsillectomy 15. Sistrunk Procedure 16. Caldwell-Luc Procedure 17. Removal of Thyroglossal Cyst 18. Removal of Foreign Body E. DIAGNOSTIC PROCEDURE 1. Thoracentesis 2. Incisional Biopsy (Incision Biopsy) 3. Excisional Biopsy (Excision Biopsy) 4. Arthrocentesis 5. Laparoscopic Cholecystectomy 6. Transurethral Prostatectomy 7. Colonoscopy with Polypectomy ROLES AND RESPONSIBILITIES OF THE SCRUB NURSE SCRUB NURSE – works directly with the surgeon within the sterile field passing instruments, sponges, and other items needed during the surgical procedure PRE-OPERATIVE • Do a complete scrub according to accepted practice, gown, and glove • Drape tables as necessary according to standard procedure • Drape the mayo stand • Put blades on knife handles • Prepare sutures in sequence in which surgeon will use them • Arrange instruments on instrument table and count them with the circulating nurse • Fill syringes with the appropriate agents if these are necessary for use • Prepare all the necessary equipment to be ready upon the arrival of surgeons and assistants • Gown and glove the surgeon and assistants right away after they enter the room • Assist in draping the patient • Bring mayo stand into position over patient INTRAOPERATIVE • Hand surgeon and assistants proper instruments needed • Watch field and try to anticipate the surgeon’s needs • Pass instruments in a decisive and positive manner; place a ligature in the surgeon and assistant’s hand • Save all specimens of tissues according to hospital policy • Maintain sterile technique

POST-OPERATIVE • Count sponges, sharps and instruments with circulating nurse when surgeon begins to do closure of the wound • Clear off mayo stand, as time permits • Have a damp sponge ready to wash blood from area surrounding the incision as soon as skin closure is completed • Have dressings ready

ROLES AND RESPONSIBILITIES OF THE CIRCULATING NURSE CIRCULATING NURSE – duties are performed outside the sterile field – responsible for managing the nursing care within the OR – observes the surgical team from broad perspective and assists them to create and maintain a safe, comfortable environment for the surgery – makes sure each member of the surgical team performs in a united effort PRE-OPERATIVE • Fasten back of scrub nurse’s gown • Open packages of sterile such syringes, suction tubing, sutures, sponges, and gloves • Greet and identify patient • Check patient’s nursing care plan, patient’s chart, and consent • Cover patient’s hair with a cap to prevent dissemination of microorganisms, to protect it from being soiled, and to prevent a static spark near the anesthesia machine • Apply restraints comfortably • Help anesthesiologist as needed to apply and connect necessary monitoring devices • Note patient’s position to be certain all measures for his/her safety have been observed • Assist with the gowning • Observe for any breaks in techniques during draping INTRAOPERATIVE • Be alert to anticipate needs of sterile team • Stay in room as much as possible • Keep discarded sponges, instruments and other equipments carefully collected, separated by sizes and counted • Weigh sponges for blood loss as requested • Know condition of patient at all times • Prepare and label specimens for transportation to the laboratory • Complete patient’s chart, permanent OR record, and requisitions for lab tests and chargeable items as required • Be alert to any breaks in sterile technique POST-OPERATIVE • Count sponges, sharps, and instruments with scrub nurse • Prepare for room clean-up so minimal time will be expended between operations, but check with the scrub nurse before leaving the room • Send for a recovery room stretch-error bed with a clean sheet • Open neck and back closures of gowns of sterile team so they can remove them without contaminating themselves • See that the patient is clean • Help move patient to stretcher bed • Be sure to chart proper records including the nursing care plan and accompany the patient

Rules on Surgical Asepsis • Only sterile items are used in the sterile field • Gowns are considered sterile only from the waist to the shoulder level in front and sleeves • Gloved hands must be kept in front and above the waistline • Sterile instruments should be used for only one patient and cannot be used on another patient • A sterile drape is held well above the surface of the operating table and is passed from front to back • Tables are sterile only at table level • Sterile persons touch only sterile items/areas • Sterile articles are to be dropped at a reasonable distance from the edge of a sterile area • Only the top of the patient or table which is draped is considered sterile • Drapes are kept in position by towel clips • Unsterile persons avoid reaching over sterile fields; avoid leaning over unsterile area • Edges of anything that encloses sterile contents are considered unsterile • A tear or puncture of the drape or gloves renders the area unsterile • The lips of the mouth of the solution bottles are considered unsterile • Avoid splashing when pouring sterile fields to sterile bowls • Sterile fields are created as close as possible to the time of use • Sterile areas are continuously kept in view • Sterile persons keep well w/in the sterile area • Sterile persons keep contact w/ sterile area to a minimum • Unsterile persons avoid sterile areas Personal Protective Equipment 1. Head Cover • Various types of lightweight caps, helmets and hoods put on before the scrub suit and fitted well so that confines and prevents any escape of hair 2. Shoe Cover • Knee high impervious styles, plastic or rubber boots to protect from blood or fluid into or onto shoes during procedures 3. Mask • Worn in restricted area to contain and filters droplets containing microorganisms from the mouth and nasopharynx 4. Gown • A sterile gown is worn over the scrub suit to permit the wearer to enter the sterile field. It prevents crosscontamination between the wearer and the field and differentiates sterile (scrubbed) from non-sterile (unscrubbed) team members 5. Gloves • Sterile gloves are worn by sterile team members and for all invasive procedures 6. Aprons • A decontamination apron worn over the scrub suit protects against liquids and cleaning procedures. It should be a full-front barrier • Fluid-proof aprons are worn by sterile team members under permeable reusable sterile gown when extensive blood loss or irrigation is anticipated • Lead aprons worn under sterile gown protect against radiation exposures during procedures performed under fluoroscopy or image intensification or when personnel are exposed to radioactive implants 7. Eyewear • Eyewear or face shield is worn whenever a risk exists of blood or body substances from the patient splashing into the eyes of sterile team members • Laser eyewear is worn for eye protection from laser beams • Protective eyewear, preferably a face shield, should be worn by personnel handling or washing instruments when this activity could result in a splash, spray or splatter to the eyes or face • Eyewear or a face shield that becomes contaminated should be decontaminated or discarded promptly

Criteria for OR Attire • An effective barrier to microorganisms; both reusable woven and disposable non-woven materials are used; The design and composition should minimize microbial shedding • Made of closely woven material void of dangerous electrostatic properties; the garment should meet National Fire Protection Standards (NFPA-56A) including resistance to flame o Undergarments of synthetic materials such as nylon are permissible when in close contact with the skin such as hosiery o Nylon and other static spark-producing materials are forbidden as outer garments • Resistant to blood, aqueous fluid, and abrasion to prevent penetration by microorganisms • Designed for maximal skin coverage • Hypoallergenic, cool, and comfortable • Non-generative of lint • Made of pliable material to permit freedom of movement for the practice of sterile technique • Colored to reduce glare under lights; various types of cloth in colorful prints that fulfill necessary criteria are both attractive and functional • Easy to don and remove Anesthesia 1. General Anesthesia • it acts by blocking awareness centers in the brain causing amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep) and relaxation (rendering a part of the body less tense) 2. Regional Anesthesia • is the temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body; pain is controlled without loss of consciousness Forms of Regional Anesthesia: • Spinal Anesthetic – often used for lower abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic involves injecting a single dose of the anesthetic agent directly into the fluid surrounding the spinal cord in the lower back, causing numbness in the lower body • Epidural Anesthetic – commonly used for surgery of the lower limbs and during labor and childbirth. This type of anesthesia involves continually infusing medication via a thin catheter that has been placed into the epidural space of the spinal column in the lower back, causing numbness in the lower body 3. Local Anesthesia • is injected into a specific area and is used for minor surgical Stages of Anesthesia STAGE ONSET Anesthetic ONSET administration to loss of consciousness Loss of consciousness EXCITEMENT to loss of eyelid reflexes loss of eyelid reflexes SURGICAL to loss of most reflexes ANESTHESIA and depression of vital function

DANGER

Depression of vital function to respiratory and circulatory failure

PHYSICAL REACTIONS Drowsiness/Dizziness Auditory and visual hallucinations Increase in autonomic activity Irregular breathing, client may struggle Unconsciousness Relaxation of muscles Diminished gag and blink reflex Client is not breathing Heartbeat may or may not be present

• • •

NURSING INTERVENTIONS Close OR doors Keep room quiet Standby to assist client

• •

Remain quiet at client’s side Assist anesthesiologist as necessary

•

Begin preparation only when anesthesiologist indicates Stage 3 has been reached and client is breathing well with stable vital signs If arrest occurs, assist immediately in establishing airway, provide cardiac arrest tray, drugs, syringes, long needles, assist surgeon with closed or open cardiac massage

•

Sutures Suture – A suture is a piece of thread-like material used to stitch or approximate tissues, and hold the wound together until healing takes place. 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 11-0 10-0 9-0 8-0 7-0 6-0 5-0 4-0 3-0 2-0 1-0 0 1 2 3 4 5 6 7 Smallest Largest