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Major Procedures Tray Neurologic Procedures Tray Minor/Basic Procedures Tray

Retractors Retractors Retractors


• 2 Ribbon/Malleable; (1) 1 • 1 Mastoid • 1 Ribbon/Malleable
1/2", (1) 2 1/2" • 2 Weitlaner • 1 Richardson, small
• 3 Richardson; (1) small, • 1 Curved Weitlaner • 1 Weitlaner, sharp
(1) medium, (1) large • 1 Adson Cerebellar • 2 Goulet
• 2 Goulet • 2 Brain Spoons • 2 Army Navy
• 2 Army Navy • 8 Malleable Brain Spatulas, • 1 Deaver, narrow
• 3 Deaver; (1) narrow, (1) double-ended • 2 Senn, sharp
medium, (1) wide • 2 Nerve Hooks; (1) sharp, (1) blunt
• 2 Nerve Root Forceps
Forceps • 2 Tissue w/o teeth
• 2 Hoen Dura Separators
• 2 Tissue w/o teeth; (1) 5 • 2 Tissue w/ teeth
• 2 Dura Hooks
1/2", (1) 10"
• 1 Russian
• 3 Tissue w/ teeth; (1) 5
Forceps • 4 De Bakey
1/2", (1) 8", (1) 10"
• 2 Adson w/ teeth • 1 Adson w/o teeth
• 2 Russian; (1) 7", (1) 10"
• 2 Adson cup • 2 Adson w/ teeth
• 6 De Bakey; (2) 6", (2) 7
• 4 Cushing w/ teeth
3/4", (2) 9"
• 2 Cushing w/o Teeth Scissors
• 2 Adson w/ teeth
• 2 Bayonet • 2 Straight Mayo
Scissors • 1 Curved Mayo
• 2 Straight Mayo 6 1/4" Scissors • 3 Metzenbaum
• 2 Straight Mayo • 1 Stevens Tenotomy
• 1 Curved Mayo 6 1/4"
• 1 Curved Mayo • 1 Straight Iris
• 1 Metzenbaum 7"
• 2 Metzenbaum • 1 Curved Iris
• 1 Wire Cutter
• 1 Wire Cutter
Clamps Clamps
• 10 Towel Clips 5 1/2" Clamps • 10 Towel Clips
• 2 Curved Pean • 12 Curved Mosquito
• 18 Curved Crile 5 1/2"
• 10 Curved Crile • 2 Straight Mosquito
• 6 Straight Crile 5 1/2"
• 6 Curved Mosquito • 12 Curved Crile
• 6 Straight Kocher 6 1/4"
• 36 Hemostatic Scalp • 4 Straight Kocher
• 6 Allis 6"
• 2 Allis • 4 Allis
• 4 Babcock 6"
• 2 Tonsil • 2 Babcock
• 4 Tonsil 7 1/2"
• 4 Needle Holder; (2) fine, (2) heavy • 2 Webster Needle Holder
• 2 Right Angle 8"
• 12 Towel Clips • 4 Needle Holder
• 6 Needle Holder; (2) 6",
(2) 7", (2) 8" • 2 Sponge Forceps
Suction Tubes/Tips
• 4 Sponge Forceps 10"
• 4 Frazier Suction Tubes/Tips
• 2 Carmalt 8"
• 1 Poole
Miscellaneous • 1 Yankauer
Suction Tubes/Tips
• 3 Knife Handles • 1 Frazier, No. 10
• 1 Poole
• 1 Langenback Periosteal Elevator
• 1 Yankauer 10 3/8"
• 1 Freer Miscellaneous
Miscellaneous • 2 Panfield Disectors, No. 1-5 • 3 Knife Handles
• 3 Knife Handles; (2) No. • 2 Short Kerrison Rongeur, up • 1 Probe, Malleable
3, (1) No. 7 • 1 Flat Kerrison Rongeur • 1 Grooved Director
• 1 Probe, Malleable • 1 Kerrison Rongeur 30º, up • 1 Medicine Cup
• 1 Grooved Director • 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
• 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 I AP Set III (with Stainless Mayo Tray) AP Set V


• 16 Kelly Curve Forceps • 16 Kelly Curve Forceps • 10 Mosquito Straight
• 16 Kelly Straight Forceps • 16 Kelly Straight Forceps • 10 Kelly Curve Forceps
• 4 Allis Tissue Forceps • 4 Allis Tissue Forceps • 10 Kelly Straight Forceps
• 6 Towel Clips • 6 Towel Clips • 4 Allis Tissue Forceps
• 2 Needle Holders • 2 Needle Holders • 6 Towel Clips
• 1 Sponge Holder • 1 Sponge Holder • 2 Needle Holders, long and
• 1 Bobcock Tissue • 1 Bobcock Tissue Forceps short
Forceps • 1 Metzenbaum • 2 Sponge Holder
• 1 Metzenbaum • 2 Big Richardson • 3 Bobcock Tissue Forceps
• 2 Big Richardson • 1 Long Tissue Forceps w/o teeth • 1 Metzenbaum
• 1 Long Tissue Forceps • 2 Blade Holder; (1) No. 3, (1) No. 4 • 2 Richardson
w/o teeth • 1 Stainless Bowl • 3 Long Tissue Forceps; (1) w/
• 2 Blade Holder; (1) No. 3, • 1 Stainless Kidney Basin teeth, (2) w/o teeth
(1) No. 4 • 1 Mayo Scissors • 3 Blade Holder; (1) No. 3, (2)
• 1 Stainless Bowl • 2 Army Navy Retractors No. 4
• 1 Stainless Kidney Basin • 1 Adson Forceps w/ teeth • 1 Stainless Bowl
• 1 Mayo Scissors • 1 Tissue Forceps w/ teeth • 1 Stainless Kidney Basin
• 2 Small Ribbon Retractors • 2 Tissue Forceps w/o teeth • 1 Mayo Scissors
• 2 Fritz/AP Retractors • 2 Army Navy Retractors
• 1 Adson Forceps w/ teeth AP Set IV (with Stainless Mayo Tray) • 2 Medium Deaver
• 1 Tissue Forceps w/ teeth • 16 Kelly Curve Forceps • 1 Abdominal Suction Tip
• 2 Tissue Forceps w/o • 16 Kelly Straight Forceps • 2 Adson Forceps w/ teeth
teeth • 4 Allis Tissue Forceps • 2 Tissue Forceps w/o teeth
• 6 Towel Clips • 4 Mixter Forceps
AP Set II
• 2 Needle Holders
• 16 Kelly Curve Forceps APR Set (Abdominal-Perineal
• 1 Sponge Holder
• 16 Kelly Straight Forceps Resection) w/ Stainless Tray
• 1 Bobcock Tissue Forceps
• 4 Allis Tissue Forceps • 10 Mosquito Straight
• 1 Metzenbaum
• 6 Towel Clips • 10 Kelly Curve Forceps
• 2 Medium Richardson
• 2 Needle Holders • 10 Kelly Straight Forceps
• 1 Long Tissue Forceps w/o teeth
• 1 Sponge Holder • 10 Pean Forceps Curved
• 2 Blade Holder; (1) No. 3, (1) No. 4
• 1 Bobcock Tissue • 7 Adson's Tip Forceps Curved
• 1 Stainless Bowl
Forceps • 3 Mixter's, long
• 1 Stainless Kidney Basin
• 1 Metzenbaum • 2 Allis Tissue Forceps
• 1 Mayo Scissors
• 2 Small Richardson • 6 Towel Clips
• 2 Army Navy Retractors
• 1 Long Tissue Forceps • 2 Needle Holders; (1) short,
w/o teeth • 1 Adson Forceps w/ teeth
(1) long (gold-plated)
• 2 Blade Holder; (1) No. 3, • 1 Tissue Forceps w/ teeth • 2 Sponge Holder
(1) No. 4 • 2 Tissue Forceps w/o teeth • 1 Metzenbaum
• 1 Stainless Bowl • 2 Long Tissue Forceps; (1) w/
• 1 Stainless Kidney Basin teeth, (1) w/o teeth
• 1 Mayo Scissors • 3 Blade Holder; (1) No. 3, (1)
• 2 Army Navy Retractors No. 4, (1) No. 7
• 1 Adson Forceps w/ teeth • 1 Stainless Bowl
• 1 Tissue Forceps w/ teeth • 1 Mayo Scissors
• 2 Tissue Forceps w/o • 2 Big Deaver
teeth • 1 Tissue Forceps w/ teeth
• 1 Tissue Forceps w/ teeth
(heavy duty)
• 1 Tissue Forceps w/o teeth

Ophthalmic Tray (Basic Eye Vascular Procedures Tray Cholecystectomy Set


Procedures) Forceps • 2 Babcock Tissue Forceps
Scissors • 6 De Bakey • 1 Ovum Forceps
• 1 Blunt • 2 Allis Tissue Forceps
• 1 Curved Iris Scissors • 6 Kelly Curved
• 1 Stevens Tenotomy • 1 Potts • 6 Kelly Straight
• 1 Suture • 6 Towel Clips
Clamps
• 6 Mosquito Straight
Clamps • 2 De Bakey Multipurpose
• 1 Mayo Scissors, long
• 2 Halsted Straight • 1 De Bakey Curved Aorta
Aneurysm • 1 Metzenbaum Scissors, short
Mosquito
• 5 De Bakey Tangential Occlusion • 3 Needle Holder; (1) long, (2)
• 1 Halsted Curved
• 1 Hufnagel Ascending Aorta short
Mosquito
• 4 Randall forceps
• 4 Towel Clip • 2 Angled De Bakey 90º
• 2 Pick-up Forceps w/o teeth
• 1 Medium Curved Crawford Auricle
Miscellaneous • 2 Long Tissue Forceps w/o
• 1 Glover Coarctation, straight
• 1 Irrigating Tip, No. 21 teeth
• 1 Glover Coarctation, angled
• 1 Knife Handle, No. 9 • 1 Long Blade Holder
• 1 Glover Patent Ductus, straight
• 6 Medicine Cups • 1 Blade No. 3
• 1 Glover Patent Ductus, angled
• 4 Long Round Kelly Curved
• 1 Straight Glover
Needles • 2 Mixter Forceps
• 2 Curved Glover
• (1) 23 Gauge • 1 Right Angle Scissors
• 2 Cooley Multipurpose, straight
• (2) 23 Gauge Retrobulbar • 2 Tissue Forceps w/ teeth
• 1 Cooley Multipurpose, curved
• (2) 25 Gauge Retrobulbar (heavy-duty)
• 1 Curved Cooley • 2 Adson Forceps w/ teeth
Syringes • 6 Cardiovascular Needle Holder • Stainless Sponge Holder
• 2 5mL Luer-Lok • 2 Big Deaver w/ Wooden
• 5 2mL Luer-Lok Handle
• 1 Big Richardson
• 1 Eyepad
• 2 Eyeshield; (1) metal, (1)
plastic
• 2 Serrefine Clamps
Biopsy Set I Biopsy Set II Biopsy Set III
• 4 Towel Clips • 4 Towel Clips • 4 Towel Clips
• 6 Straight Forceps • 6 Straight Forceps • 6 Straight Forceps
• 13 Curved Forceps • 13 Curved Forceps • 13 Curved Forceps
• 2 Allis Tissue Forceps • 2 Allis Tissue Forceps • 2 Allis Tissue Forceps
• 1 Curette • 1 Curette • 1 Curette
• 1 Metzenbaum Scissors • 1 Metzenbaum Scissors • 1 Metzenbaum Scissors
• 1 Mayo Scissors • 1 Mayo Scissors • 1 Mayo Scissors
• 2 Blade Holder; (1) No. 3, • 2 Blade Holder; (1) No. 3, (2) No. 4 • 2 Blade Holder; (1) No. 3, (2)
(2) No. 4 • 1 Needle Holder No. 4
• 1 Needle Holder • 1 Babcock Tissue Forceps • 1 Needle Holder
• 1 Babcock Tissue • 2 Small Richardson • 1 Babcock Tissue Forceps
Forceps • 1 Adson Forceps w/ teeth • 1 Adson Forceps w/ teeth
• 1 Tissue Forceps w/ teeth • 1 Tissue Forceps w/o teeth • 1 Tissue Forceps w/o teeth
• 1 Tissue Forceps w/o • 1 Probe Director • 2 Small Deaver
teeth • 1 Fritz Retractor
• 2 Eyelid Retractor • 1 Probe Director
• 1 Probe Director

Biopsy Set IV Bronchoscopy Set Hip Prosthesis Set


• 4 Towel Clips • Bronchoscope • 1 Rasp
• 6 Straight Forceps • Light Source • 1 Osteotome
• 13 Curved Forceps • Bronchoscopy Tray w/ the ff: • ADSF Set
• 2 Allis Tissue Forceps o 1 Medicine Glass • 1 Impactor
• 1 Bone Curette o 1 10cc Breakable Syringe • 1 Extractor
• 1 Metzenbaum Scissors o 1 20cc Breakable Syringe • 1 Acetabular
• 1 Mayo Scissors o Hypo Needles 21, 22, 23 • 1 Calliper
• 2 Blade Holder; (1) No. 3, o 1 Suction Tubing • 1 Bone Skid
(2) No. 4 o 1 Suction Catheter • 1 Weithlaner Retractor
• 1 Needle Holder o Cotton Applicator • 1 Mastoid Retractor
• 1 Babcock Tissue o 1 Spinal Needle
• 1 Duckbill Rongeur
Forceps o 2 Slides
• 1 Dissector
• 1 Adson Forceps w/ teeth o 2 Specimen Bottles
• 1 Metal Suction Tip
• 1 Tissue Forceps w/o o OS Gauze, 4x4
• 1 Plastic Handle Suction Tip
teeth o Mucous Extractor
• 1 Rake Retractor w/ 3 • Anesthesia Tray w/ the ff:
teeth o Xylocaine Spray
• 1 Rake Retractor w/ 2 o Xylocaine 2% Oral
teeth o 1 Bottle NSS (cooled)
• 1 Probe Director o 1 Epinephrine, ampule
o KY Jelly
Lap Set I Lap Set II Dr. Siguan’s Instruments
• 16 Kelly Curve • 16 Kelly Curve • 10 Kelly Curved
• 16 Kelly Straight • 16 Kelly Straight • 10 Mosquito Curved
• 5 Allis Tissue Forceps • 5 Allis Tissue Forceps • 10 Mosquito Straight
• 6 Towel Clips • 6 Towel Clips • 10 Round Nose Forceps
• 2 Needle Holders • 2 Needle Holders • 6 Allis Tissue Forceps
• 2 Sponge Holders • 2 Sponge Holders • 6 Towel Clips
• 1 Metzenbaum Scissors • 2 Long Metzenbaum Scissors • 2 Babcock Tissue Forceps
• 1 Mayo Scissors • 1 Mayo Scissors • 3 Mixter Forceps; (1) long, (2)
• 2 Adson Forceps w/ teeth • 2 Tissue Forceps w/ teeth, big and short
• 2 Tissue Forceps w/o small • 2 Needle Holders
teeth • 2 Tissue Forceps w/o teeth • 2 Sattinsky clamp
• 2 Blade Holders; (1) No. • 2 Blade Holders; (1) No. 3, (1) No. • 2 Sponge Holders
3, (1) No. 4 4 • 1 Long Tissue Forceps w/
• 2 New Lahey Retractor • 2 Medium Deaver teeth
• 2 Medium Deaver • 1 Stainless Bowl • 1 Long Tissue Forceps w/o
• 1 Stainless Bowl • 1 Stainless Kidney Basin teeth
• 1 Stainless Kidney Basin • 1 Long Tissue Forceps w/o teeth • 1 Tissue Forceps w/ teeth
• 1 Long Tissue Forceps w/ • 2 Army Navy Retractors (heavy duty)
teeth • 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. Cystectomy
3. Nephrectomy (Radical, Partial, Bilateral)
4. Nephrostomy
5. Nephrolithotomy or Pyelithotomy
6. Ureterolithotomy
7. Prostatectomy (Suprapubic, Retropubic)
8. Reconstruction of Epispadias or Hypospadias
9. Renal Exploration
10. Transplantation of Ureters
E. EENT
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)
II. 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. Reduction Internal Fixation (Short Bones)
2. Closed Reduction
3. Insertion of Skeletal Pins or Traction
4. Arthrodesis
5. Removal of Pines, Wires (Short Bones)
6. Escharotomy
7. Disarticulation of Toes
8. 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 com-
pleted
• 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 them-
selves
• 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 cross-
contamination 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 PHYSICAL REACTIONS NURSING INTERVENTIONS
Anesthetic Drowsiness/Dizziness • Close OR doors
ONSET administration to loss Auditory and visual • Keep room quiet
of consciousness hallucinations • Standby to assist client
Loss of consciousness Increase in autonomic activity • Remain quiet at client’s side
EXCITEMENT to loss of eyelid Irregular breathing, client may
• Assist anesthesiologist as necessary
reflexes struggle
loss of eyelid reflexes Unconsciousness • Begin preparation only when
SURGICAL to loss of most reflexes Relaxation of muscles anesthesiologist indicates Stage 3 has been
ANESTHESIA and depression of vital Diminished gag and blink reached and client is breathing well with
function reflex stable vital signs
• If arrest occurs, assist immediately in
Depression of vital Client is not breathing establishing airway, provide cardiac arrest
DANGER function to respiratory Heartbeat may or may not be tray, drugs, syringes, long needles, assist
and circulatory failure present 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 di-
gestion 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 su-
tures. 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