Atlas scrub nurse

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RESPONSIBILITIES OF A SCRUB NURSE ATLAS HOSPITAL, RUWI

Transcript of Atlas scrub nurse

RESPONSIBILITIES OF A SCRUB NURSE

ATLAS HOSPITAL, RUWI

MODERN OPERATION THEATRE

Introduction to Perioperative Nursing

**** All patients consider their surgery a major thing ****

Phases of Perioperative Care

Pre Operative - begins with the patient’s decision to have

surgery, ends with entry into the operating room

Intra Operative - begins with entry into the operating room and

ends with admission to the recovery room

Post Operative - begins with admission to recovery room, and

ends with discharge from care

Pre-Operative

Responsibilities of Operating Room

Nurse:

Patient Assessment

Physical Problems

Emotional Aspects

Understanding of surgery/consent

Legal requirements for chart

completion

Read and interpret lab results

Peri-Operative Teaching

Intra-Operative

Provide for quiet environment during induction

Assist during intubation

Observe aseptic technique

Safe operation of equipment (lasers, electrosurgery unit)

Position patient safely - CV, nervous, respiratory system

Document events, patient care given,

Provide all supplies, equipment, to team during surgery

Provide for a safe transfer to recovery room

Peri-Operative Standards of Care …

Pre-operative skin prep shall be done without abrading, cutting or

irritating the patient’s skin

Patient privacy shall be provided at all times

Any pre-operative drainage tubes shall be placed without tissue trauma

and be completed utilizing sterile techniques when indicated

All IV infusions shall be monitored to maintain the appropriate flow rate

and type of solution and remain patent without signs of inflammation or

swelling

The patient shall be provided emotional and educational support to

reduce pre-operative anxiety

The patients shall be provided a safe and normothermic environment in

the pre-op waiting area

The patient shall be transferred safely to the OR table and safety straps

appropriately applied

Circulating Nurse

Unsterile Team Member - Circulating Nurse

Responsible for nursing care in the operating room

Responsible for the organization of the workload

Responsible for the maintenance of policy and

procedures

Responsible for signing and documentation

The Circulating Nurse is the professional staff

member in the operating room, representing the

patient (Patient Advocate) and the hospital

administration

SURGICAL POSITIONING

Facilitated through the nursing process

Patient’s body must remain in physiologic alignment

Dependent Upon: The surgical procedure

Exposure at the surgical field

Surgeon’s preference and idiosyncrasies

Patient’s condition

Special Considerations:

Geriatric patients

Obese patients

Malnourished patients

TYPES OF SURGERY

MAJOR -- Present a real threat to life

MINOR -- Present little threat to life

Surgical Nurse 1889

A level head & keen eyes, ever watchful for

all that may be required, a mind not easily

irritated or confused, combined with the

facility of keeping out of the way & still being

of the greatest help……..Thoroughness,

speed, gentleness especially fit the surgical

nurse.

(Asepsis for the Nurse, Clemons, 1889)

SCRUB NURSE

“ The nurse who is the immediate assistant to the surgeon is often called the “scrub” or “sterile” nurse. She first scrubs her hands and arms the required length of time, puts on sterile gown & gloves, and handles only sterile material.”

Crawford 1945

• PLACE THE BLADE TO THE KNIFE HANDLE USING NEEDLE HOLDER, ASSEMBLE SUCTION TIP & SUCTION TUBE

• BRING MAYO STAND & INSTRUMENT TABLE NEAR THE DRAPED PATIENT AFTER DRAPING IS COMPLETE

• SECURE SUCTION TUBE & CAUTERY CORD WITH TOWEL CLIPS OR ALLIS

• PREPARE SUTURE & NEEDLE ACCORDING TO NEED

DURING AN OPERATION

• MAINTAIN THE STERILITY THROUGHOUT THE PROCEDURE

• AWARENESS OF THE PATIENT’S SAFETY

• ADHERES TO THE POLICY REGARDING SPONGE/INSTRUMENTS/NEEDLE COUNT

• ARRANGE THE INSTRUMENTS ON THE MAYO & INSTRUMENTS TABLE

BEFORE THE INCISION• PROVIDE SPONGES/MOPS NEAR

OPERATIVE SITE PRIOR TO INCISION• PASS THE FIRST KNIFE FOR THE SKIN

TO THE SURGEON WITH THE BLADE FACING DOWNWARD & HEMOSTATS TO THE ASSISTANT SURGEON

• HAND THE RETRACTOR TO THE ASSISTANT SURGEON

• WATCH THE FIELD/PROCEDURE & ANTICIPATE THE SURGEON’S NEEDS

• PASS THE INSTRUMENTS IN A DECISIVE & POSITIVE MANNER

• WATCH OUT FOR HAND SIGNALS - FOR INSTRUMENTS

• KEEP USED INSTRUMENTS CLEAN BY WIPING INSTRUMENTS WITH A MOIST SPONGE

• ALWAYS REMOVE THE CHARRED TISSUE FROM THE CAUTERY TIP

• NOTIFY CIRCULATING NURSE IN A CLEAR MANNER IF ADDITIONAL INSTRUMENTS ARE NEEDED

• KEEP SPONGES ON THE FIELD FOR USE• SAVE & CARE FOR TISSUE/SPECIMEN

ACCORDING TO HOSPITAL POLICY

• REMOVE EXCESS INSTRUMENTS FROM STERILE FIELD

• ADHERE & MAINTAIN STERILE TECHNIQUES & WATCH FOR ANY BREAKS

END OF OPERATION• UNDERTAKE COUNT OF SPONGES &

INSTRUMENTS ALONG WITH CIRCULATING NURSE

• INFORM THE SURGEON THE COUNT RESULT

• REMOVE INSTRUMENTS & EQUIPMENTS• AFTER OPERATION HELP TO APPLY

DRESSING• REMOVE & DISPOSE THE DRAPES (if

disposable)• COVERS PATIENT BEFORE SHIFTING TO

HDU

SCRUB NURSES IN ACTION

Dressing for ACTION!

Appropriate attire for restricted area in preparation for scrubbing

About sterility…….

• Unless you are scrubbed, gowned and gloved, do not enter the ‘sterile zone’.

• For example, do not walk between two sterile areas (such as between the scrub nurse’s trolley and the draped patient), and do not touch the drapes. If you accidentally breach the sterile field, it is essential that you admit your mistake.

• If your gloved finger accidentally touches something unsterile when you are scrubbed, you must immediately stop using that hand in the sterile field (unless removing the hand will cause a problem), and request a new glove from the scrub nurse, as soon as the opportunity arises. No-one should think badly of you for doing this; on the contrary, they will probably be pleased with your honesty and respect for the sterile field.

About sterility…….contd.

• The degree to which a surgeon will adhere meticulously to sterility will vary according to the operation.

• Clearly, meticulous asepsis is much more important when implanting a new cardiac valve, than when draining a perianal abscess

When to scrub

• The scrub nurse normally scrubs well before the surgeon, to allow time to set up the sterile instruments.

Gowning….

Method for Open Gloving ……..

Where to put your hands

Any area lower than the level of the operating

table is usually considered suspect, even if it

is covered by sterile drapes.

Firstly, you should keep your hands above

this area

Rest the hands together against the chest, as

though praying but with fingers interlaced

How to keep sterile?

Where to rest your hands once scrubbed. A rectangle

Bounded by the mid-sternum, umbilicus and anterior

axillary line

Note these…….

How the scrub nurse should move!

Assisting properly..

SCRUB TEAM @ WORK

Contd…

Contd…

OT LayoutOT LAYOUT

PRESENT DAY OPERATION

THEATRE – MAJOR SURGERY

Fundamentals of Nursing Care: Concepts, Connections, & Skills

Copyright © 2011 F.A. Davis

Company

ROBOTIC SURGERY

Fundamentals of Nursing Care: Concepts, Connections, & Skills

Copyright © 2011 F.A. Davis

Company

ROBOTIC SURGERY

The Operating Room of the Future

The Operating Room of the Future

The Operating Room Personnel of the Future

Satava March, 2000

Surgeon Assistant Scrub Nurse Circulating Nurse