Intraoperative Phase: Surgical Team Roles & Procedures PDF

INTRAOPERATIVE PHASE  THE SURGICAL TEAM – personnel performing direct patient care during a surgical procedure in both the sterile and non sterile positions. A. STERILE MEMBERS 1. The Surgeon 2. First Assistant to the Surgeon 3. The Scrub Assistant  THE SURGEON Responsible for deter...

INTRAOPERATIVE PHASE  THE SURGICAL TEAM – personnel performing direct patient care during a surgical procedure in both the sterile and non sterile positions. A. STERILE MEMBERS 1. The Surgeon 2. First Assistant to the Surgeon 3. The Scrub Assistant  THE SURGEON Responsible for determining the pre-operative diagnosis The choice and execution of the surgical procedure Explanation of the risks and benefits Obtaining inform consent and the postoperative management of the patient’s care.  FIRST ASSISTANT OF THE SURGEON may be a resident, intern, physician’s assistant or a perioperative nurse practice under direct supervision of the surgeon Responsible in handling tissue, providing exposure at the operating field, suturing, providing homeostasis & other tasks requested by the surgeon to facilitate speed while maintaining quality during the procedure. needs to be aware of the objectives of the surgery, needs to have the knowledge & ability to anticipate needs & to work as a skilled member of a team, and needs to be able to handle any emergency situation in the OR.  SCRUB NURSE MAY EITHER A NURSE OR A SURGICAL TECHNICIAN ACTIVITIES INCLUDE: – PERFORMING A SURGICAL HAND SCRUB, – SETTING UP THE STERILE TABLES, – PREPARING SUTURES, LIGATURES, SPONGES & SPECIAL EQUIPMENT – MAINTAINING THE STERILITY OF THE SURGICAL FIELD THROUGH ASEPTIC PRACTICES.  SCRUB NURSE – Assist the surgeon & surgical assistants during the procedure by anticipating the instruments that will be required – As the operation is about to close, the scrub person & the circulator counts all needles, sponges, & instruments to be sure all are accounted for & not retained as foreign body in the patient. – Tissue specimen obtained during the surgery must be labeled by the scrub nurse/person & sent to the laboratory by the circulator THE UNSTERILE MEMBERS Anesthesiologist and Anesthetist Circulating Nurse ANESTHESIOLOGIST AND ANESTHETIST anesthetizing the pt. providing appropriate levels of pain relief, monitoring the pt’s physiologic status and providing the best operative conditions for the surgeons. Other personnel - pathologist, radiologist, perfusionist, EVS personnel.  CIRCULATING NURSE responsible for creating a safe environment, managing the activities outside the sterile field, providing nursing care to the patient. Documenting intraoperative nursing care and ensuring surgical specimens are identified and place in the right media. In charge of the instrument and sharps count and communicating relevant information to individual outside of the OR, such as family members. Elements of Aseptic Technique *Sterile gowns and gloves. *Sterile drapes used to create sterile field. *Sterilization of items used in sterile field.  ASEPTIC TECHNIQUE PRACTICE THAT RESTRICTS MICROORGANISM IN THE ENVIRONMENT, EQUIPMENT AND SUPPLIES. CONTROLS THE ENVIRONMENT. – GOALS  EACH ASEPTIC PRACTICE IS TO OPTIMIZE PRIMARY WOUND HEALING  PREVENT SURGICAL INFECTION  MINIMIZE LENGTH OF RECOVERY FROM SURGERY THE PRACTICE OF ASEPTIC TECHNIQUE REQUIRES THE DEVELOPMENT OF STERILE CONSCIENCE, AN INDIVIDUAL’S PERSONAL HONESTY AND INTEGRITY WITH REGARD TO ADHERENCE TO THE PRINCIPLES OF ASEPTIC TECHNIQUE. STERILE TECHNIQUE INFECTION – PREVENTS TRANSFER OF – INVASION AND PROLIFERATION OF MICROORGANISM INTO BODY MICROORGANISM IN THE TISSUE TISSUE INTACT SKIN AND MUCOUS SEPSIS MEMBRANE – PRESENCE OF INFECTION BODY’S FIRST LINE OF DEFENSE  Provide effective barrier that prevent 01 dissemination of microorganism to patient Prohibits contamination of surgical 02 wound & sterile field by direct contact Protects personnel from infected 03 persons HANDWASHING HANDSCRUBBING PREPARATION FOR SURGICAL SCRUB DO: HAVE CLEAN AND TRIMMED NAILS DONT: HAVE LONG NAILS WEAR JEWELRIES 01. scrubbing 02. gowning 03. closed gloving GLOVING  Principles of Aseptic Technique All articles used in an operation have been previously sterilized. Persons who are sterile touch only sterile articles and vice versa. If in doubt of the sterility of anything, considers it not sterile None-sterile persons avoid reaching over a sterile field, sterile person avoid leaning over a non-sterile area (1 foot away) Tables are sterile only at table level (top) Gowns are considered sterile only from waist to shoulder level in front and the sleeves. The edge of anything that enclosed sterile content is not considered sterile. Sterile persons keep well within sterile areas. Non sterile persons keep away from sterile area. Sterile person keeps contact with sterile areas to a minimum. Moisture may cause contamination. When bacteria cannot be eliminated from a field, they must keep to an irreducible minimum.  Skin Preparations Decreases the number of bacteria on the patient’s skin, thus decreasing the chance of the patient acquiring a post operative wound infection. Duration usually is 5 minutes depending on the size of the area to be prepped. Always start the prep at the incision site, working to the outer boundaries. Boundaries are bedside to bedside; nipple line to mid thigh. New sponges should be used when returning to incision site (cleanest to dirtiest) Should be done with firm but not rough movements. Observe for skin reactions. Skin prep is institutional. Latest practice is the 12 balls technique. Nurse must not reach over the prepped area  Draping Draping of the operative area is done immediately after the skin preparation is completed. – Special consideration: If surgery is on an infected area or an area where there are increased number of bacteria (e.g. rectal, perianal, etc.) skin prep must be modified. – Bacteria must not be spread over a cleaner surface from an infected or dirty area even though the incision site is in the unclean area. Therefore, skin preparation starts from the outer boundaries, working towards the incision site. THANK YOU