Angelica R.
Bapial BSN 3G Group 1
DUTIES AND RESPONSIBILITIES 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
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 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
After an Operation
Basic Instruments in the Operating Room
A. Cutting or Dissecting Instruments 1. Scalpel - A small straight knife with a thin sharp blade used in surgery and dissection.
2. Mayo Scissors a. Straight Mayo - Used to cut suture and supplies. Also known as: Suture scissors. b. Curved Mayo - Used to cut heavy tissue (fascia, muscle, uterus, breast).
3. Metzenbaum Scissors - Used to cut delicate tissue.
B. Clamping Instruments 4. Kelly Forceps a. Curved Kelly - used to clamp off vessels or tissues such as aorta or uterus. b. Straight Kelly - used to clamp off superficial arteries and vessels on the muscle layers. It is also used in clamping umbilical cord during baby deliveries.
5. Mosquito Forceps - Mosquito forceps are used for more delicate tissues. They are very fine and straight or curved hemostatic forceps used during the surgery to control the bleeding of finer vessels or compressing a bleeding vessel.
6. Babcock - These forceps are more delicate than Allis but less directly traumatic. They have broad, flared ends with smooth tips. These forceps are used to atraumatically hold viscera (bladder and bowel).
7. Allis - These forceps have interdigitating short teeth to grasp and hold tissue or bowel. These forceps are slightly traumatic and hold intestine, fascia and skin.
8. Towel Clamps - Towel-clamp forceps or simply towel clamps are used to maintain surgical towels and drapes in the correct position during an operation.
9. Foerster Clamp - A foerster clamp is a surgical clamp with a round eyelet. It is commonly used in body piercing, particularly for tongue piercing.
10. Thumb Forceps - A forcep operated by compression with thumb and forefinger used to hold skin/tissues.
11. Tissue Forceps a. Tissue Forceps with Teeth - They are used to hold skin/dense tissue. They have interdigitating teeth to hold tissue without slipping. b. Tissue Forceps without Teeth - They are hinged forceps or locking forceps used for grasping and holding tissue. 12. Russian Forceps - Tissue handling forceps with broad, spoonshaped tips, serrated around the edge. 13. Adson Forceps a. Adson with Teeth - Standard tissue forceps with the opposing blade surfaces covered with long, needle-like teeth used to grasp delicate tissues without slipping.
b. Adson without Teeth - These forceps are meant for light, careful handling of tissue.
14. Debakey - Delicate surgical thumb forceps with longitudinal ribs, designed for delicate, nontraumatic vascular surgery.
15. Mixter Forceps - Mixter forceps are useful for dissecting around venous structures. They are the threading forceps used for hemostatic purposes.
16. Crile-wood Needle Holder - They lock to hold the needle in a manner which allows the operator to maneuver the needle through the various tissues.
C. Retractors 17. Malleable Retractor - A type of retractor that can be shaped or formed to adjust on changing circumstances.
18. Weitlaner Retractor - A self-retaining instrument, shaped like a scissors but the blades open when the ratcheted handles are closed. The blades each have four downward-pointing, curved prongs which retain their position in a spread wound.
19. Balfour Retractor - Three individually operable, outwardlooking curved loops mounted on a bar. By inserting the blades into an incision and spreading them all the incision is opened to give maximum access to tissues below.
20. Deaver Retractors - A Deaver Retractor is used to retract deep abdominal or chest incisions.
21. Richardson Retractors - A handheld retractor used to retract deep abdominal incisions.
22. Army Navy Retractor - A handheld retractor used to retract shallow or superficial incisions.
23. Senn Retractor - A handheld instrument with a curled, threepronged claw at one end and a right-angled, single blade at the other. Suitable for short-term displacement of soft tissue.
24. Gelpi Retractor - A self-retaining with two blades, hinged in the middle, separate as the handles are closed and are held open by a rachet. The blades turn down at right angles at their tips, and are bowed towards each other so that they push the edges of the incision apart and retain themselves in it.
25. Rake Retractor - A metallic instrument with prongs set transversely for engaging and retracting soft tissues.
E. Miscellaneous Instruments 26. Rib Spreader - Two broad, curved-outward blades which are mounted on a ratcheted bar. Spreading of the ribs can be achieved by inserting the blades through the thoracotomy incision and spreading them manually.
27. Curette - A spoon-shaped surgical instrument used for cleaning a diseased surface. (e.g. To biopsy a mass in the nose.)
28. Bone Rongeur - a multijointed, springloaded, plier-like instrument used to break off pieces of bone.