Ot notes for nurse

The design of OT should provide with optimum
facilities and minimum inconvenience in the
management of different areas. The prime
requirements in the design to theatre are the
control of infections and safe environment for the
pt .
Operation theater
Made By- Shivang patel

Ideallocation
OT Locationnearto-
• All OTsin anOTcomplex
• Emergency
• Bloodbank
• Radiology
• Intensivecareunit
• Centralsterile supplydepartment
• Laboratory

Types of OT
• Basedon Sterility
– Ultra sterile (CTVS,TransplantOT)
– Sterile
– Septic
• Basedon construction
– Modular
– Nonmodular
• Basedon timing ofsurgery:
– Routine
– Emergency

Requirement for OT
• CentralAC:20-22 degcentigrade
• Humidity:50-60%
• Positivepressure ventilation
• Airchange:20 times/hr with recycled air; of which 5 times with fresh
air
• HEPAfilter of “S” class
• Laminarair flow through diffuser
• GeneralLighting:Cold light, even distribution, varyingintensity
• Operating light: Ceiling mounted, cold light, shadow lessfocusablebeam
• Medical gas pipeline: Anesthesia gas,Air, Oxygen & Suction
• Powersupply:Uninterrupted (UPS)and generator back up (safety)
• Earthing:All electrical equipment (safety)
• Firesafety: Fire/smoke detectors. Fire hydrants & extinguishers
(Safety)
Powerswitches:Away from Operating area (Safety)

 Sterilezone(OT attire mandatory in this area)
• Operatingsuite
• Sterilepreparationarea
• Scrubstation
• Gowningarea
• Anesthesiainductionarea
• Cleanzone(OT attire mandatory in this area)
• Sterilizationarea
• Storearea
• Preoperativearea/room
ZONE of OT

• Postoperative recoveryarea/room
• OTStaff& Doctor’srooms
 Protectivezone (OT attire not mandatory in this area)
• Changingrooms
• Receptionarea
• Waitingarea
• Trolleybay
 Disposal zone (OT attire mandatory in this area)
• Dirty utilityarea
• Disposalcorridor

 The structure of operation theatre-
 The wall should be hard and easily washable
material e.gmarble
 Pipes and central oxygen , nitrous oxide, suction should
be fitted to the walls.
 Adequate air conditioning should be provided
 In the absence of window adequte light should
provided.
 Fire extinguisher should be adequate
Floor:
– Non slippery, antistatic, non reflective, non porous, water, stain
and fire resistant.
– Seamless

Walls:
– Samequality asthe floor
– Seamless
– Usuallystainlesssteel
Ceiling
– Samequality asfloor
– Usuallystainless steel
– Diffuser for laminar airflow
– Mounting for lights
Widedoors:
– soundproof,
– non reflectivesurface,
– radiation resistant
– fire resistant.
Slidingtype ofdoor
Glasscut out forvisibility

Preparing drug for induction and
those to use in case of emergency-
 Local anaesthesia(lidnocaine)
 Benzodiazepine(diazepam)
 Catecholamine to treat allergic reaction
 Opiod(fentanyl,sufentanol)

Anaesthesia room-
Preparation of an anesthetic room-
 attach an anaesthetic breathing system with a
proper size face mask.
 Confirm proper functioningof mechanical ventilators
 Confirm availability andproper
functioning of wallsuction.
 Intravenous solution and connecting tubes
 Suction catheter

Sterilzer room-a sterilizer room should be built
adajecent to the OT with a window.the equipment can
be passed between the rooms without repeatedly
opening doors
Recovery room-the main purpose of recovery
room is to given nursing care to the post operative
pt.
 The resuscitation equipment must be available and
facilities for O2 and suction should also be there.
 Essential articles suchas IV infusion, fluids, IV stand,
stethoscope, BP apparatus etc. should be there.Made By- Shivang patel

Store room- Cylinder of O2 and nitrous oxide,
additional equipment, infusion fluid bag , syringes,
needles, drugs, and operation instrument are kept in
thisroom.
Changing room- a room is provided for theatre
personnel to change into OT clothes from their sweat
clothes, foot wear, sterile caps and mask also kept in
this room.
Scrub room-the surgeon and the nurses scrub
in this room and this room open into the OT.

Operation table-a modern operation table has
adujustments to enable the surgeon to give proper
and safe position to thept.
 some tables are designed for specific type of
operation but most are made as anall purpose.

Theatre technique-
 Surgical scrub technique
 Gowning and gloving
 Position used for surgery
Position used for surgery-
 Supine, dorsal, recumbent position- used for
operation of eye, ear, face,chest,abdomen,breast,legs,
feet and hands.
 Lateral position-used foroperation on kidney,liver,hip.
 Lithotomy position-used for operation on external
genetelia, vagina, and anl infection

Preparation of theatre Theatere cleaning-
Cleaning is a process which physically removes
organic matter but does not necessarily
destroy microorganism.
Daily routine cleaning-the operation
theatre is cleaned at least 1 hr before
operation are started. the floor is cleaned
whenever it gets dirty. it also cleaned at the
end of the days work. ideally the floor is
cleaned with machine with scrub and
suctiondries.

2.Cleaning between cases-Area which is contaminated
or dirty have to clean between cases.if blood spills on the
floor it is covered by 1%hypochloride solution for 10min
then it is mopped away.
3.Daily cleaning at the end of the day-cleaning
routine is as the same, but attention should be paid to
the wall.
4.Weekly cleaning- the floor is wshed after removing
all equipment and furniture from thetheatre.
5. Cleaning after an infected cases-
Routine cleaning is carried out. Fumigation should be
done either with the formalin vapor or hypochloride
spray.in case the pt have an infection that can be
transimitted through blood, all linen and instrument are
soaked in 1%hypochloride solution beforewashing.

Deep clean- this is a 6 monthly programmed clean of the
clinical area of the theatre departments which will be
undertaken by a dedicate deep clean team.
 the clean includes all the pt areas
,preparation room, ceilings, walls etc.
 Non clinical area such as store rooms and offices will
receive a yearly clean
 The deep clean programme will be drawn up in the
consultation with cleaning managers, facilities
staff,infectioncontrol team and thetre manger

Preparation of equipments for sterilization-
instrument are prepared on a metal tray which is
covered by a large drape which is secured to the rim
of the tray.
Cleaning and care of instrument- instrument must
be thoroughly washed either by hand or by using a
sonic washer. Paid to joint and grooves.

Instument and different type of disinfection- the
precise type of disinfection depends on the type of
instruments. medical devices, equipment and surgical
materials are divided into three general categories
depending on the potential risk of infectio-
a. Critical item- these are instrument or objects that are
introduced directly into the bloodstream or into other
normally sterile areas of the body.
b.Non critical items- these are items that do not ordinarily
penetrate, but touch only intact skin. such items
include crutches ,bed board, blood pressure cuff.
Instrument preparation-
 Clean all the instrument and material prior tosterilization.
 Dirt,blood and all contamination are should be completely
removed as they Made By- Shivang patel

e.g; cardiac catheter
b. Semicritical items- these instrument are induced
into body cavities and therefore come into contact
with intact mucous membranes, but do not
ordinarily penetrate body surfaces.E.g;
endotracheal tube
Compromise sterilization
• Always soak instrument in water and detergent
immediately after surgery to removeblood.
• Rinse instrumentthroughly after washing to remove
any residue from thecleaning agents
• Dry instrument should be pack loosely

Method of sterelization-
HEATSTERALIZATION-
 Moist heatmethod-
 an autoclave provides moist heat under pressure which
achieves temperature higher than that of boiling point of
H2O.
 autoclave is used to sterilize most of the equipment in
common use like dressing,metal wire andinstrument.
 Dressing should be wrapped in paper or cloth.
• Glassware should be packedindividually
• Rubber gloves wrapped in glove cover or paper
• Rubber catheter,suture,and treatment trays should
be wrapped in paper or muslin cloth.

Dry heat- here the sterelization is done in hot air oven at
1600c for 1hr.it is usually fitted with internal fan to provide an
even distribution of heat.
Steam and formeldeyde- low temperature steam with
formaldehyde autoclave can be used to steralize heat
labile material such as plastic and anesthetic.
Saturated steam under pressure- the flash stralizer is
frequently used in the operation theatre for urgently
needed
unwrapped instrument.the temp used is 270 degree for a
period of 3-10 mi cycle.

COLD STERILIZATION-
 Gama-irradiatin-gamma rays ionizing radiation can be
used commercially for steralization of a wide range of
articles such as suture ,syringes needles,catheters
, dressing materials.
 Ethylene oxide- this is colorless liquid with boiling
point with a 10.70cand it is highly inflammable and
explosive. it is especially used for sterilizing anesthetic
machine,sutures,dental equipmentetc.
• Pasteurization- I is a method of low temperature
disinfection particularly used for endoscopic instrument.
the cleaned instrument is totally immersed in an
electrically heated water tank at 75 degree foe at least 10
min.

• Boiling- each instrument should be totally
immersed in a container of distilled water and
boil for 5 min. at a temp. of 90-100 degreeCelsius.

Suture-
a stitch or row of stitches holding together the edges of a
wound or surgical wound.
Purpose of suture-to hold a wound together in good
apposition until such time as the natural healing
process is sufficiently well established to make the
support from the suture.
Choice of suture material-
Choice is depend on-
 Properties of suture material.
 Absorption rate
 Size of suture
 Type of needle
 Handling characteristics ofknotting properties.

Natural suture material-
Non-absorbable-
 Silk
 Linen
 Stainless steel wire
Synthetic suturematerial-
 Absorbable-
 Polyglycolic acid
 Polyglactin
 Polydiosone
Non-absorbable-
 Polyamide(nylon)
 Polyester(dacron)
Type of suture

Needle point-
Five points of needle points are in common
use-
 Conventional cutting needle
 Reverse cutting needle
 Blunt point needle
There are several shapes of surgical needles.these
include-
 Straight
 ¼ circle
 3/8 circle
 ½ circle
 5/8 circle
 Half curve Made By- Shivang patel

Ot notes for nurse

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