OPERATION THEATURE MANAGEMENT

BY DR SHANZA AUROOJ

TABLE OF CONTENTS: Defination of a scrub nurseSpecific role in ORResponsibilities of a scrub nurseVideo on ASEPTIC TECHNIQUESOrientation on SURGICAL NEEDLESOrientation on SURGICAL SUTURESOrientation on SURGICAL INSTRUMENTSVideo on INSTRUMENT HANDLING

WHAT IS A SCRUB NURSE?

A scrub nurse is a medical professional who assists surgeons and other healthcare experts in the operating room.

Specific Role in the Operating Room

To prepare and drape sterile drapes,instruements & supplies

To assist surgeon & assistants throughout operation by providing instruements & supplies

To maintain patient’s safety throughout operation

• Welcoming patient to OR• Preoperative nursing assesment• Checklist before scrubbing• Scrubbing in • Assembling instruements,counting before surgery• Assist surgeon by passing over instruements • Observe patient’s safety• End of procedure

Responsibilities of a scrub nurse

WELCOMING A PATIENT TO OR

• Welcome patient• Introduce yourself• Get personal information

from patient• Ask if he/she needs any

further help• Show her around (where

to sit,bathroom,changing room etc)

• Ask to remove jewelry

Preoperative nursing assessment

• Age• Allergies• Presence of infections (temp ≥38)• Vital signs• Drugs contraindicated (aspirin,heparin,warfarin)• Nutritional status• Physiological state(labs,x-rays)• Psychological state• Tolerance to anesthesia (smoking,alcoholism)

CHECK CONSENTCONFIRM SURGICAL PROCEDURECHECK INSTRUEMENTS CHECK SUPPLIES

Checklist before scrubbing

“SCRUBBING IN” “Scrubbing in”• usually involves thoroughly

washing hands and arms with an antibacterial soap, then putting on a sterile mask, hat, gown and gloves so that patients cannot be contaminated when their bodies are exposed for surgery.

ASSEMBLE INSTRUEMENTS

• Open the inner sterile set & assemble sterile instruments on mayo tray & trolley

• Perform surgical count• Assemble surgical blade• Prepare sutures

Assistance during surgery

• Assist surgeon in cleaning & draping patient• Bring mayo’s tray over the patient

ASSISTANCE DURING SURGERY

• Pass instruments to surgeon in a proper position & safe manner

• Pass & Receive scalpel in kidney dish

• Place the skin knife away from working field

Assistance during surgery

• Retract tissue gently if required

• Remove artery tips as directed by surgeon

• Cut sutures with scissors,help in suturing

• Assist in cautery

Assistance during surgery

• Anticipate surgeon need through out procedure

• keep one step ahead of surgeon in passing instruments,sutures,sponges etc

• Maintain neat & orderly sterile field of operation

Assistance during surgery

• Maintain strict aseptic techniques • Keep talking to minimum,turn away while

sneezing,coughing

Keep your hands at table level while unengaged

End of procedure

• Perform second surgical count of sponges,sharps,instruements as surgeon begins closing

• Apply dressing to the wound by non touch technique & assist in removing the drapes

End of procedure

• Dispose of sharps• Cover the soiled

instruments before sending them for cleaning/autoclave

• Remove gown & glove and check documentation

SURGICAL NEEDLES

• Surgical needles are necessary for the placement of sutures in tissues

• NEEDLE ANATOMY– Swage – Body– Point

NEEDLE SWAGE

Classification by the needle swage:

• 1. Closed Eye• 2. French Eye• 3. Swage

Body of the needle

• classification by the body of the needle:

¼ circle 3/8 circle ½ circle 5/8 circle

Straight Half Curved (Ski) compound Curved

Point of the needle

- Conventional cutting (cutting on the inside)

- Reverse Cutting (cutting on outside)

- Taper point (Pierce and spread tissue without cutting it

- Blunt Pierce and spread tissue without cutting it.

SutureThe word "suture" describes any strand of material used to ligate (tie) blood vessels or approximate (sew) tissues.

CLASSIFICATION OF SUTURESAbsorbable / NonabsorbableNatural / SyntheticBraided / Monofilament

Example Suture Selection

AbsorbableNatural

Synthetic

Non AbsorbableNatural

Synthetic

Fast Absorbing Gut

Chromic gut

Plain Gut

VICRYL*

VICRYLRapide*

PDS II*

MONOCRYL*

(polyglactin 910) suture

( polyglacin 910) suture

(polyglecaprone 25) suture

(polydioxanone) suture

Stainless steel

Silk

PROLENE*

ETHIBOND*

MERSILENE*

NOROLON*

Ethilon*(nylon) suture

(nylon) suture

(polyester) suture

(polyester) suture

(polypropylene) suture

Example Suture SelectionAbsorbable (Natural)

Fast Absorbing Gut Plain Gut Chromic Gut

Tensile strangth 7 daysMass absorption 21- 42 days

Tensile strength 7-10 days Mass absorption 60-90 days

Tensile strength 28 daysMass absorption 90 days

Example suture selectionAbsorbable (Synthetic)

VICRYL Rapide

PDS II

MONOCRYLVICRYL

Mass absorption 42 days

Mass absorption 56-70 days

Mass absorption 6 months

Example suture Selection

NonabsorbableNatural

Stainless steelSilk

Example Suture Selection

NonabsorbableSynthetic

NUROLON ETHIBOND

PROLENEMERSILENEETHILON

GYNECOLOGICAL AND OBSTETRICS INSTRUMENTS

Artery Forceps

used as a hemostat for clamping bleeding vessels. For grasping tissue ( Opening and closing peritoneum) . to hold stay sutures.

Allis' Forceps

for grasping tough structures like Rectus sheath or fascia in LSCS or Hysterectomy

Babcock's Forceps for grasping tubular structures like fallopian tube in tubectomy In Pomeroy's operation , ureter, appendix etc.

Self retaining speculum.Used in OPD for routine examination.procedures like taking of Pap smear , insertion and removal of Copper T can be done

for inspection of vagina and cervix in OPD. It retracts posterior vaginal wall. Taking Pap Smear , Insertion and removal of Copper T, Taking swabs,D&C , Cervix Biopsy , Vaginal Hysterectomy ,

Sims' Speculum

CUSCO’S SPECULUM

Doyen's Retractor

Deaver's Retractor

for retraction of deep structures

Right Angle Retractor

bladder retractor during LSCS/hysterectomy

Mayo scissors

Straight mayo scissorsCurved mayo scissors

Towel clip

PINNARD’S FETOSCOPE

For auscultation of fetal heart sounds

Sims' Anterior Vaginal Wall Retractor

To take biopsy from the cervix

Sponge holding forcepsPunch biopsy forceps

To hold sponges or cervical lips

Episiotomy Scissors

Toothed

To hold tough structures like rectus sheath, vaginal flaps or skin margins during suturing

Non toothed

DISSECTING FORCEPS (TOOTHED AND NON- TOOTHED

LOOP HOOK

To remove IUCD from the uterine cavity when the threads are missing

ELECTRO CAUTERY

Thermal cauterisation of the cervix for cervical ectopy

Foleys Catheter

•self retaining catheter used for drainage of the urinary bladder , It has a bulb below the tip.•This can be inflated by normal saline. It has two channels. One for inflating bulb and the other for drainage of urine to which urobag is attached. No 14 or 16 are used in adult

Female metal catheter

•To empty the bladder prior to major vaginal operations

Hegar's Dilator

It is used for measuring length of the cervix

Uterine sound

For dilatation of cervix

For grasping the cervix in hysterosalpingography or IUCD insertion

TENACULUM

Suction Curette

This instrument is used for first trimester MTP, suction of vesicular mole.

Shirodkars Cerclage Needle

This is specially designed needle for putting stitch around the cervix.

•used in hysterectomy /salpingectomy to clamp fallopian tube•for clamping umbilical cord of new born or for artificial low rupture of membranes ( ARM).

Khocker’s forceps

Surgical Blades/ Scalpel

Green Armytage Forceps Needle holder

used as a hemostat in LSCS

Uterine Curette

Flushing curette

Sharman’s curette

Simple curette

Used for diagnostic D&C

Uterine dressing forceps

•To swab the uterine cavity following D+E operation with a small gauze piece

UTERINE HOLDING FORCEPS

To fix and steady uterus when conservative surgery is done on the adnexae

•To fix the myoma •To give traction in a big uterus requiring hysterectomy

MYOMA SCREW

MULTIPLE TOOTHED VULSELLUM•used for grasping the cervix ( Usually anterior lip of the cervix is grasped)•in procedures like Insertion of IUCD , Cx Biopsy D&C, First trimester MTP with Suction Evacuation. Cx Biopsy•Posterior lip of the cervix is grasped for post. colpotomy

SINGLE TOOTHED VULSELLUM

To hold the cervix after opening the vault of vagina •To hold new cervical stump after amputation of the cervix and fothrergill’s operation after subtotal hysterectomy

WRIGLEY'S FORCEPS

Obstetric forceps for out let forceps delivery. Parts of the forceps are blades ( which has windows or fenestrate for firm grip of the head) ,Shank , Lock( English lock for Wriglys forceps) , Handle.

Alternative to forceps delivery. Causes less trauma to mother and fetus

VACCUM (VENTOUSE)

Silastic cup Metallic cup

Ayre's Spatula

Used for taking PAP smear

RING PESSARY

Used for correction of UV prolapse

UMBILICAL CORD CLAMP

UMBILICAL CORD CUTTING SCISSORS