Perioperative Skills

Perioperative skills By: Liezel A. Castillo

Pre-operative preparation 

Principles of sterile technique: – –

Only sterile item are use in sterile field Gown are considered sterile only from the waist to shoulder level in front and the sleeves

*sterile person keep hands in sight and at or above waist Level *hands are kept away from face ,elbow are kept close to sides , hands are never folded under arms *changing table level is avoided *items dropped below waist level are considered unsterile

and must be discarded

-tables are sterile only at the table level *only the top of the table with sterile drape is considered sterile , edges and drapes extending below the table are considered unsterile *anything falling or extending over table edge is unsterile *in unfolding sterile drape, the part that drops below table surface is not brought back to table level

- person who are sterile touch only sterile items or areas * sterile team members maintain contact with means of gown and gloves *nonsterile circulating nurse does not directly with the sterile field

sterile fields by come into contact

-unsterile person avoids reaching over sterile

field ; persons avoid leaning over an unsterile area * unsterile circulating nurse never reach over a sterile field to transfer sterile items *in pouring solution into sterile basin , circulating nurse holds only lip of bottle over basin to avoid reaching over sterile field *scrub nurse drapes a nonsterile table toward self first to protect gown

- edges of anything that encloses sterile contents are considered unsterile *sterile persons lift content from packages by reaching down and lifting them straight up, holding elbow high *after sterile bottle is opened ,content must be used or discarded

-sterile field is created as close as possible to time of use

*degree of contamination is proportionate to length of time sterile items are uncovered and exposed to the environment ,precaution should be followed :

*sterile table are set up just prior to the operation *covering sterile tables for later use is not recommended

- sterile areas are continuously kept in view *sterile persons face sterile areas

-sterile persons keep well within the sterile area * sterile person stand back at a safe distance from the operating table when draping the patient * sterile persons pass each other back to back *sterile person turn back to nonsterile person or area when passing *sterile person faces sterile area to pass it

- sterile person keep contact with sterile area to a minimum *sterile persons do not lean on sterile tables and on the draped patient

-unsterile persons avoid sterile areas * unsterile person maintain atleast 1 foot distance from area of the sterile field *unsterile persons face and observe a sterile area when passing it to be sure they do not touch it

- destruction of integrity of microbial barriers results in contamination

Operating room attire 



Consist of the scrub dress, head cover mask and shoes or shoe cover , sterile gown and gloves are added for scrubbed team Purpose: to provide effective barriers that prevents the dissemination of microorganism to the patient and to protect personnel from infected patient scrub dress- worn only in the operating room head cover- used to cover hair completely shoes- shld be clean and conductive ,washable and soft soled mask- is put on by all personnel before coming into operating room sterile gown – are worn over scrub attire sterile gloves- are worn to complete the attire for scrubbed team members

Position for surgery 











Supine position- usual position for induction of general anesthesia Modified trendelenburg position- used for lower abdominal surgery, pt is positioned as in the supine position , the entire operating table is slightly tilted so that the patient head is lower than his feet by 1-5 degrees Lithotomy position- used in operation requiring a perineal approach Prone position- having surgery on the posterior part of the body Lateral position- used for operation on the kidneys , lungs, or hips Modified fowlers or sitting position- mostly in neurosurgery

Skin preparation 







Lateral thoracoabdominal preparation- includes axilla, chest, abdomen from neck to crest of the ilium Chest and breast preparation- includes shoulder upper arm, down to the elbow axilla and chest wall to the table line beyond sternum to opposite shoulder, place on lateral position Abdominal preparation- includes breastline to upper third of thigh from table line to table line in patient in supine position Knee and lower leg preparation- includes the entire circumference of affected leg and extends from foot to upper part of thigh





Rectoperineal and vaginal preparation-includes pubis, vulva, labia, perineum anus and adjacents areas including inner aspect of upper 3rd thigh Hip preparation- includes abdomen to the affected side , thigh to the knees, buttocks to table line , groin and pubis

 Skin

preparation on operating table:

- done after patient has been anesthesized on the operating table , surrounding is mechanically cleansed again with an antiseptic agents immediately prior to draping - the first assistant is the person who scrubs the patient after he has scrubbed his own hands and arms Procedure: 1. wear sterile gloves 2.wscrub skin , starting at site of incision with circular motion or over widening circles to the periphery, use enough pressure and friction to remove dirt and microorganism from skin and pores

3. discard sponge after reaching periphery, never bring a soiled sponge back toward the center 4. repeat scrub with a separate sponge for each rounds and apply antiseptic 5. paint area with solution from incision site to periphery with circular motion

Surgical scrub 





Removal of as many bacteria as possible from hands and arms by mechanical washing and chemical disinfection before participating in an operation Purpose: - to help prevent the possibility of contamination of the operative wound by bacteria on the hands and arms Preparation prior to surgical scrub: 1. skin and nails shld. Be kept clean and in good condition and cuticles uncut 2. fingersnails shld not reach beyond the fingertip to avoid glove puncture 3. fingernails polish shld not be worn 4. remove all finger jewelry





5. be sure all hair is covered by headgear 6. adjust disposable mask snugly and comfortably over nose and mouth 7. adjust eyeglasses comfortably in relation to mask Length of scrubbing: - varies from one institution to another Surgical scrub procedure: 1. time-method 2. counted brush –stroke method

Time method 

Complete scrub takes 5-7 min. done : 1. in the morning before the 1st gowning and gloving 2. following a clean case if gloves have been removed inadvertently before the gown 3. following a clean case,if gloves have had a hole between them 4. before an emergency case at anytime



Short scrub takes 3 min. this is done ff a clean case, if the hands and arms have not been contaminated. Done to remove bacteria that have emerged from the pores and multiplied while the glove were on.

Brush-stroke method 



A prescribed number of strokes ,applied lengthwise of the brush or sponge ,use for each surface of the fingers ,hands, and arms. Scrub nails of one hand 30 strokes ,all sides of each finger 20 strokes , the back of hand 20 strokes, the palm of hand 20 strokes,the arm 20 strokes for each third of the arm, to 3 inches above the elbow

Drying hands after surgical scrub 

Procedure: 1. when picking up the towel ,do it with a swift , efficient motion 2. take the towel in 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 hands to mid-lower arm, then transfer dry end of towel to other hand 5. do not dry hand then arm and return to same hand 6. after the second hand and mid-lower have been dried , fold towel in 3rd and dry elbow 7. be sure hand is well covered 8. discard towel in linen

Gowning  Purposes

of gowning: 1. to exclude skin as a possible contaminant and to create a barrier betweens 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

 Gowning

1. 2. 3. 4. 5.

technique: gowning for open glove technique gowning for closed glove technique gowning another person changing gown during operation removing gown



Gowning for open glove technique 1. reach down to the sterile package and lift the folded gown directly upward or scrub nurse receives sterile gown from the circulating nurse 2. step back away from the table , into clear area ,to provide wide margin of safety while gowning 3. holding the folded gown ,carefully locate the neckband 4. while holding the neckband carefully shake the fold from the gown 5. slip both hands into the sleeves 6.circulating nurse reaches inside the gown and pull over the hands 7. circulating nurse fasten the back part ,ties waist band

Gloving 

Purposes: 1. to exclude skin as a possible contaminant 2. to create a barriers between sterile and unsterile areas 3. to permit the wearer to handles sterile supplies or tissues of the operative wound 2 way of gloving 1. close glove technique 2. open glove technique



Closed glove technique