SURGERY ROTATION

ATTIRE IN THE OPERATING ROOM

1. Surgical Cap
2. Surgical Mask
3. Scrub Suit
4. Close White Shoes

BASIC SURGICAL PROCEDURES:

(SEQUENCE)
1. Gather the packs and
instruments. (wait for the go
signal of the CI)
Major Case – Abdominal Set
Minor Case – Incision Set

*If first case, the night shift will place the

packs and instruments in the OR. If the
NS did not put it, go to the stock room.
*In getting the pack in the stock room,
check for the details attach to the pack.
*Big Packs – Back table
Other packs and ins – Mayo Table

2. Medical Handwashing
*if lack of time, use alcohol.
After doing medical handwashing,
prepare for opening the pack.

OR SET-UP 3. Opening the pack (opens

30min-1hr before the cutting time
provided with the signal of the
staff)
*Make sure that the pack that you
are opening is the right pack.
*Read the label and make sure that
the pack undergone sterilization
process.
 *Check also the expiry date. (check integrity and expiry and if pack
underwent sterilization).
*Check the integrity of the pack,
check for holes and tears and make *Open all the instruments then just drop
sure that the pack is not moist. it to the back table to prevent
contaminating it since you are still
- In opening the pack, the first flop
unsterile.
or the opening of the pack must
be facing towards the scrubbing *Then get pick up forceps to separate
area/right. It is important that the the 2-suture basin (the small and big)
1st flop is always facing the
scrubbing area because the gown * Then next is suture basin “BIG” here
must be facing where the surgical we will place the sponges and sutures
team is entering. Untangle then
*Suture basin should be placed in line
remove the tie. Hold the top,
with drapes
open slowly then open all the
flops by holding the tip one by
one. For the last flop, use both *Open MS and put it in the big basin
hands facing your palm upward.
Make sure to not touch the inside
*In small basin we put the atraumatic or
part. sutures, blades.
Contents of Big Pack
* The last one that we will be opening is
• OR Gowns (5) the Gloves. It should be place in line
• Mayo Cover (1) with the Gowns with the use of forceps.
• OR Towels (5) Left glove first (right over left always).
• Foot Drape (1) The thumb should be placing up.
• Head Drape (1) Sequence of the Gloves:
• Lap Sheet (1)
*Separate the Gowns and Drapes by
using the forceps. Grasp the bottom part
of the OR gown and bring to the right
side. (Pag hold ng forceps use thumb
ang middle finger while ang pointing
finger sa box lock)

*Then grasp the lap sheet and bring to - Surgeon

the other side. It is to have some space - Residence
for the instruments. - Staff
*Always remember to maintain 1foot - Student Nurse
distance against the table. Suture Book:
* Open instruments start from big and Major – 12
heavy instruments.
Minor – 10 Balfour Retractor

Type of Sponges:
AP – Abdominal Pack
MS – Medium Sponge
OS – Operating Sponge
CB - Cherry Balls
PB – Peanut Ball
Cottonoids

*CB, PB, and Cottonoids must be placed

only the back table and never in the kick
bucket. Fine Curve Scissors
*When counting, lift the sponges.

Straight Clamp
INSTRUMENTS
Retractor
Big Curve Kelly Needle Holder

Allis Forceps

Army Navy

Babcock Towel Clip

Ovum Forceps Tissue Forceps w/o teeth

Tissue Forceps with Teeth

Blade Handle

Adson w/ Teeth

Long Thumb
Adson w/o Teeth 4. Surgical Handwashing
(indication of the anes/wait for the
signal of the CI)

- Surgical handwashing is the

lengthy and vigorous cleaning of
the hands and arms with the use
of water, brush and antiseptic
solution. Its purpose is to
decrease the number of
microorganisms into zero as
possible.
1. Before wetting the hands, make
sure to wear your mask and cap.
2. Make sure to keep distance from
the sink.
Suction Tubing
3. Turn on the faucet. Wet Hands
from the fingertips down to 2 inches
above the elbow.
4. Get the brush, wet it first then
dispense it with soap. Make a lather
then start brushing the non-dominant
hand.
5. Start brushing the fingertips in 20
circular strokes. Use the bristles all
throughout the procedure.

Cautery Pen 6. After brushing the fingertips,

proceed with brushing the fingers
with 10 circular strokes each and do
not forget to include the webspace.
7. Proceed to the palm with 10
circular strokes and also the back of
the palm with also 10 strokes.
8. In the forearm, we are going to
divide it into 2. From your wrist, up to
the mid forearm then the 2nd section
is from the mid forearm up to 2
inches above the elbow
9. Then subdivide it into 4. Brush waist level manner. It is to
each section with 10 circular strokes. observe the principle that
anything below waist is
10. The last part is the elbow since it
considered unsterile.
is the most contaminated part with
also 10 strokes.
2. Position where the gowns are
11. Always maintain a 90degree located. Grab the gown on the
angle when doing surgical top with your non-dominant hand.
handwashing. Move backwards then face
sideways. Dangle half of the
12. Before going to brush the other gown and grab the foot part to dry
hand, you need to rinse the brush the hands. Mae sure that the
first. bottom part will not come in
13. After rinsing the brush, dispense contact with the floor. If there is
it again with soap then make a lather no available OR towels, it is the
and start scrubbing the dominant alternative in drying the hands.
hand.
14. After scrubbing both hands, drop 3. Bend a little, maintaining the
the scrub into the lavatory. distance of the gown from my
15. Proceed with rinsing the hands scrub suits at least an arms-
with starting at the fingertips to the length away to prevent
forearm up to 2 inches above the contamination of the OR gown
elbow. Make sure to rinse it well. from any portion or area of my
scrub suits.
16. After hand scrubbing, maintain
the level of the hands. It should be 4. Start drying from the finger. Each
above waist level. finger then the palm and towards
17. Then proceed to the operating the elbow. Making sure that the
theatre to done the gowning and gown is not swinging towards me.
gloving. When entering, make sure Continue drying the other hand
to use your back to avoid with the same manner.
contamination.
5. Gowning and Closed Gloving 5. Locate the armhole in positioning
- Donning of the sterile gown and the hands with palms up. 1 thumb
gloves is for us to manipulate will locate the armhole then 4
what’s in the sterile field and get fingers will locate the other one.
hold of any sterile items. Then release the lower portion of
GOWNING the gown.

1. From the scrubbing area, the 6. Start inserting your arms to the
hands must maintain in a above armholes. After which, spread the
 arms sideways. Then the sleeves of the gown into the wrist
circulating nurse will go at your of the glove.
back and will secure the ties.
7. Then proceed with the non-
dominant hand with the same
7. After that, proceed at the back sequence.
table to done the close gloving.

8. Fix the gloves properly.

CLOSED GLOVING
1. Hands must be kept inside the
gown to avoid contaminating the 6. Setting up the Mayo table and
sterile field. back-up table.
- Initial counting (wait for the
2. Grab the Right glove with the surgeon to arrive)
non-dominant hand and place it
*Unfold the mayo cover. Open in top of
in the palm.
the OR towels and place the opening
portion of the cover away from u while
you are holding the close end of the
3. Flip the glove with the direction of
mayo cover.
the opening of the glove is facing
away from me. Observe with the *Then the close end will be inserted in
principle of palm to palm, thumb the cuff of the mayo cover so that it can’t
to thumb, and edge to edge. The prevent dangling while you are covering
glove must be in parallel with our the mayo table.
palm, thumb, and edge of the
*Then go near to the mayo table. Step
fingers.
your foot in the base of the mayo table
so that while u insert the mayo cover the
table is not moving.
4. Lift the upper opening of the
glove with the non-dominant hand *Then insert slowly while unfolding the
and the lower opening with the cuff then move the mayo cover a little
dominant hand. forward until the end portion of the mayo
cover is parallel to end portion of the
5. Make a close fist sot that the mayo table.
glove will be inserted in my hand.
*To make the table neater u can pull the
one side of the mayo cover and then
6. Unfold the cuff of the glove and insert the excess portion into the lower
expose the fingers by pulling the portion of the mayo tray (pwede pa
sleeves of the gown. Make sure triangle and tuck it in under the tray)
to not expose the fingers of the
non-dominant hand. Position the
*Get towel first spread it in Mayo table *Then remove all the instruments and
(make sure that the end portion of your set it aside then remove slowly the towel
towel is parallel to the mayo tray) or wrapper (One hand will support
instrument and other hand pull the
*Then get the abdominal set (contains
wrapper)
all the basic instruments that is needed
in the procedure). *Then make a roll towel. It is where we
are going to put the grasping
CONTENTS OF THE ADOMINAL SET
instruments. After rolling the towel, use
Fine Curve (12) the indicator tape to secure the end
Straight Clamp (6) portion of the towel. (dili pa tangalon ang
Big Curve/Kelly (6) towel clip and ovum forceps nan aga
Allis (3) hold sa grasping isntruments)
*Place the grasping instruments on top
of the towel and move it a little up (kay e
use ang area near u sa pag arrange sa
cutting instruments.) then pwede na
tangalon ang ovum and towel clip (ang
overm forceps e butang sa back up
table ang clip kay e sabay sa ubang
towel clips).
*Start arranging the instruments starting
with the big. First are the retractors.
(Army Navy) Then continue with all the
Babcock (3) grasping instruments.
Needle Holder (2)
Army Navy (2)
Towel Clip (7) Lower portion of mayo tray is Cutting
Ovum Forceps (1) instruments (get it from the back up
Blade Handle (2) table and arrange according to use).
Long Tissue Forceps w/o Teeth (2)
2 blades
Tissue Forceps w/ Teeth (2)
2 blade handles
Adson w/ teeth (1)
Mets and bomb
Adson w/o teeth (1)
Mayo scissors
Suture scissors
*Place it in the top of the mayo tray
(then ang indicator strips kay pwede
ilagay sa anterior part of the gown) * Proceed with mounting of the blade
*Remove slowly the wrapper of the - Get the needle holder in a small basin
abdominal set by rolling the cover. u have 2 blades, so u will be mounting 2
blades get 1 blade first and make sure
check the size of blade if size 20 fits
blade number 4.
- With the use of needle holder, grasp
the non-sharp side of the blade and
make sure to lock the needle holder and
match the needle and your blade holder
(click sound means inserted na ang
needle sa blade handle) then arrange it
first 2 scalpel, metz, mayo scissors and
suture scissors. - Then prepare the 4 towels. Unfold the
towel and fold 1/3 of the towel. In
- Then initial counting na with circulating
placing it, the folded part is facing
nurse u can use ovum forceps to towards you. Place it in cascading
separate each instrument while counting manner and place it on the top of
in INS manner (instruments, needles drapes.
then sponges) In initial counting first
mention name instrument count then
total.
- Then remove 4 towel clips and place it
lower right side of the mayo tray then
place the other 3 towel clips to the back
up table.
- Get the Ancillary instruments such as
suction tubing and attach the tip of it
place it in the top of mayo table with
- Then continue the initial counting of
cautery pen and make sure to include
needles and sponges in the back up
the tip in counting then get one towel
table.
clip and place it on top.
BACK UP TABLE

- This time we will place all of the drapes

on the mayo table directly place it in the
top because it arranges accordingly.
 WHITE BOARD gown.

o Once the circulating nurse

is tying I’m going to start
preparing the gloves of the
surgeon (SERVE THE
RIGHT GLOVE RIGHT
OVER LEFT MANNER NA
GLOVE)

➢ Grasps the glove and unfold it

and check for any holes by
7. Serving of the gown and inflating the gloves.
gloves to the surgeon.
➢ After that I’m going to make a
➢ Once the surgeon is inside the small cuff with my four fingers
operating room, offer either OR and thumbs abducted and make
towel so that he/she will be able sure that the thumb and palm
to dry his hands if there is no portion of the glove is facing
available towel, we can use the towards the surgeon.
OR gown.
- Stretching the gloves will allow
➢ Grab the gown with the both the surgeon to insert his/her hand
hands because we are now without touching the scrub
considered sterile and offer the nurse’s gloves.
foot part of the gown to the
surgeon by unfolding the gown - The scrub person protects own
and make sure that the hands are gloved fingers by holding them
at the middle part of the gown so beneath the cuff of the glove, and
that the surgeon will not able to their thumbs by holding them
come in contact with my sterile away from the partly-gloved hand
gloved hand.
➢ Once I am ready I’m going to
➢ Once the surgeon is drying face the surgeon with keeping my
his/her hand I’m going to locate feet apart (or placing one foot
the anterior part of the gown forward) this will serve as a
(labas ng jacket) place my hands support once a surgeon will glove
inside the shoulder portion her/his hand.
exposing the open armholes
towards the surgeon. ➢ Once I am ready I’m going to say
“right glove doc”
o Once you are half way you
can now release and ask ➢ Then I am going to pull up the
the circulating nurse to tie cuff over the wristlet of the gown
the back portion of the while the surgeon slips his/her
 hand well into. Excuse me doctor magno, doctor
llorente and the rest of the surgical
➢ After that same manner with the team. The 3rd and final counting of
other glove. Unfold the cuff, sponges, instruments and needles is
check if there are any holes by complete.
inflating the gloves and make a
small cuff with both four fingers *Wait to be acknowledge by the
and thumb abducted. surgeon. If not, say again that the
counting is done.
➢ And then face the surgeon then
place one foot forward and offer
the gloves then pull up and then 10. After care.
release the gloves slowly.
*Remove gown and gloves (yellow bin
itapon)
8. Serving of Instruments.
-------------------------------------------
*Transfer the Mayo near the foot part
of the patient including the back table *Document the accounting clearance.
Copy it to the jot down note book.
*Cautery pen is the first instrument
that we will going to offer to the *Write it in the booklet.
surgeon.
*Sign it to the scrub or circulating staff
and also the supervisor.
9. Counting during closure of the
surgical site.
1st counting closure of peritoneum
2nd count closure of fascia
3rd count closure of skin
*It must be counted in an INS
manner (Instruments, Needles,
Sponges)
*Use the ovum forceps in counting
the used sponges.
In counting, say:
Excuse me doctor magno, doctor
Llorente and the rest of the surgical
team, the 1st counting of sponges,
instruments and needles is complete.