Scissors <ul><li>The blades of scissors may be straight, angled or curved, as well as either pointed or blunt at the tips. The handles may be long or short. Some scissors are used only to cut or dissect tissues; others are used to cut other materials. To maintain sharpness of the cutting edges and proper alignment of the blades, scissors should be used only for their intended purpose. </li></ul>
<ul><li>Tissue/ dissecting scissors must have sharp blades. The type and location of tissue to be cut determines which scissors the surgeon will use. Blades needed to cut tough tissues are heavier than those needed to cut fine, delicate structures. Curved or angled blades are needed to reach under or around structures. Handles to reach deep into body cavities are longer than those needed for superficial tissues. </li></ul>
Tissue Forceps <ul><li>Tissue Forceps are used to pick up or hold soft tissues and vessels. Forceps used to grasp and hold soft tissues and organs are too numerous to allow further elaboration. The collaboration of each is designed to securely grasp but prevent injury to tissues. </li></ul>
<ul><li>Smooth Forceps- Also referred to as thumb forceps or pick-ups, smooth forceps resemble tweezers. They are tapered and have serrations (grooves) at the tip. They may be straight or bayonet (angled), short or long, and delicate or heavy. </li></ul>
<ul><li>Toothed Forceps differ from smooth forceps at the tip. Rather than being serrated, they have a single tooth on one side that fits between two teeth on the opposing side or they have a row of multiple teeth at the tip. Toothed forceps provide a firm hold on tough tissues, including skin. </li></ul>
Grasping and Holding Instruments <ul><li>Tissues should be grasped and held in position so the surgeon can perform the desired maneuver, such as dissecting or suturing without injuring the surrounding tissues or organs. </li></ul>
<ul><li>Allis Forceps has a scissor action. Each jaw curves slightly inward, and there is a row of teeth at the end. </li></ul>
<ul><li>Babcock Forceps </li></ul><ul><li>The end of each jaw of a Babcock forceps is round to fit around a structure or to grasp tissue without injury. This rounded section is circumferentially fenestrated. </li></ul>
<ul><li>Stone Forceps </li></ul><ul><li>Either curved or straight forceps are used to grasp calculi such as kidney stones or gallstones. These forceps have blunt loops or cups at the end of the jaws. </li></ul>
<ul><li>Tenaculums </li></ul><ul><li>The curved or angled points on the ends of the jaws of tenaculums penetrate tissue to grasp firmly, such as when a uterine tenaculum is used to manipulate. </li></ul>
Clamping Instruments Clamping and Occluding – instruments that clamp and occlude are used to apply pressure
<ul><li>Hemostatic forceps </li></ul><ul><li>Most clamps used for occluding blood vessels have two opposing serrated jaws that are stabilized by a box lock and controlled by hinged handles </li></ul>
<ul><li>Hemostats – </li></ul><ul><li>Hemostats are the most commonly used surgical instruments and are used primarily to clamp blood vessels. Hemostats have either straight or curved slender jaws that taper to a fine point. The serrations go across the jaw </li></ul>
<ul><li>Crushing Clamps </li></ul><ul><li>Many variations of hemostatic forceps are used to crush tissues or clamp blood vessels. The jaws may be straight, curved or angled and the serrations may go across or along the jaws. </li></ul>
Retracting Instruments <ul><li>Exposing and Retracting – </li></ul><ul><li>Soft tissues, muscles and other structures should be pulled aside for exposure of the surgical site </li></ul>
<ul><li>Handheld retractors </li></ul><ul><li>Most retractors have a blade on a handle. The blades vary in width and length to correspond to the size and depth of the incision. The curved or angled blade may be solid or pronged like a rake. These blades are usually dull, but some are sharp. Some retractors have blades at both ends rather than a handle on one end. Other retractors have traction grooves for slippery surfaces such as the tongue. Handheld tractors are usually used in pairs and they are held by the first or second assistant. </li></ul>
<ul><li>Malleable retractors </li></ul><ul><li>A malleable retractor is a flat length of low carbon stainless steel, silver or silver plated copper that may be bent to the desired angle and depth for retraction. </li></ul>
<ul><li>Self Retaining Retractors </li></ul><ul><li>Holding devices with two or more blades can be inserted to spread the edges if an incision and hold them apart. For example, a rib spreader holds the chest open during a thoracic or cardiac procedure. A self retaining retractor may have shallow or deep blades. Some retractors have spring locks to keep the device open; others have wing nuts to secure the blades. Some retractors have interchangeable blades of different sizes. </li></ul>
As a Scrub Nurse Performs surgical scrub using the accepted technique. Gowns and gloves himself using the proper technique. Opens sterile packs and set correctly Counts instruments and sponges correctly. Assist in draping the patient. Anticipates the need of the surgeon.
Keep sterile field neat, clean and dry. Counts instruments and sponges before the end of operation
Hands and serves instruments and sterile supplies adeptly
Prepares the dressing properly. Washes and keeps the instruments used.
Properly label specimen. Disposes waste material properly
Assist in cleaning, re-arranging and preparing the room for the next case. Assist with drying and packing of instruments.
<ul><li>AS A CIRCULATING NURSE </li></ul><ul><li>Wear the required and accepted attire. </li></ul><ul><li>Prepare and readies the OR table. </li></ul><ul><li>Position patient properly on the OR table. </li></ul><ul><li>Performs the skin prep of the patient correctly. </li></ul><ul><li>Assist the anesthesiologist and the scrub nurse. </li></ul><ul><li>Counter checks with the counting of the instruments and sponges. </li></ul>
The circulating nurse is also responsible for correctly labeling and caring for the surgical specimen. If a frozen section is to be performed, he/she would be responsible for contacting pathology.
If a sponge drops on the floor, the circulating nurse removes the sponge using an instrument or gloved hand and wipes the area immediately with a hospital grade disinfectant.
<ul><li>Anticipates the needs of the SURGICAL TEAM. </li></ul><ul><li>Accomplishes forms and records correctly. </li></ul><ul><li>Keeps the room clean and tidy. </li></ul><ul><li>Sees to it that all equipment are in good working condition. </li></ul><ul><li>Provides immediate post-op care. </li></ul><ul><li>Assist in cleaning, re-arranging and preparing the room for the next case. </li></ul><ul><li>Assist in transporting the patient to room or to the recovery room. </li></ul>
Once the desired surgery is accomplished, the surgeon is ready to close the incision. All instruments and sponges are removed from the wound. The surgeon may wish to irrigate with warm saline at this time. The circulating nurse will need to pour additional saline from the warmer. The scrub nurse must test the temperature of the saline to make sure it is not too hot.
Prior to suctioning the saline from the wound, the scrub nurse should note the amount of blood in the suction canister and anesthesia personnel should record this blood loss.
A sponge, needle, and instrument count is performed at the beginning of closure. The first layer of closure is the peritoneum. If the surgeon chooses to close this layer, he/she may grasp the peritoneum with three to four kelly or pean clamps to lift it and avoid injury to the underlying organs while suturing. Suture for this layer may be 0 or 2-0 absorbable on a tapered needle using a long needle holder. A continuous stitch would be used. Pick up forceps would be long and smooth.
Personal Attributes <ul><li>Observe punctuality in all activities. </li></ul><ul><li>Observe silence, speak softly in the area. </li></ul><ul><li>Observe cleanliness. </li></ul><ul><li>Displays emotional stability in various situations. </li></ul><ul><li>Maintains proper grooming. </li></ul><ul><li>Respects other members, acknowledges and accepts. </li></ul>
<ul><li>Applies ethico-moral-spiritual-legal principles in nursing practice. </li></ul><ul><li>Recognizes leadership/managerial roles in her performance of duties as a circulating and scrub nurse, before, during and after the operation. </li></ul><ul><li>Always remember your SURGICAL CONSCIENCE. </li></ul>
Manner of reporting (CEH) <ul><li>“ EXCUSE ME DOCTOR (SURGEON), (ANESTHESIOLOGIST), (FIRST ASSISTANT), (SECOND ASSISTANT), ALL INSTRUMENTS, NEEDLES AND SPONGES ARE ALL COUNTED CORRECT AND COMPLETE. REPORTED BY ( STUDENT SCRUB NURSE) SUPERVISED BY (CLINICAL INSTRUCTOR) CONFORMED BY (OR NURSE)” </li></ul>
Counting Procedures in OR <ul><li>All items are counted initially by the circulator and the scrub nurse together aloud as the scrub nurse touches each item. </li></ul><ul><li>The number (count) of each type of item is immediately recorded by the circulator. </li></ul><ul><li>If there is any uncertainty regarding the initial counting, it is repeated. </li></ul>
<ul><li>As additional items (e.g. Sponges or needles) are added to the sterile field during the procedure, the scrub nurse counts the item(s) with the circulator, who adds the count to the record and initials it. </li></ul><ul><li>Nothing (including laundry, trash, instruments, and sponges) may be removed from an operating room while the procedure is in progress until the final count is acknowledge to be correct. </li></ul><ul><li>Whenever there is a change of team members, a count is taken. </li></ul>
<ul><li>When an incorrectly numbered package of items is dispensed, the items should be nagged, labeled accordingly, set aside, and not recorded in the count. </li></ul><ul><li>Counts are taken before beginning the procedure, before wound closure begins, and when skin closure is initiated. </li></ul><ul><li>Incorrect closure counts must be repeated immediately, and alert the surgeon who will inspect the patient’s wound for the missing item. </li></ul>