surg tech 1505 t2
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| Patient Checkin | Admitted ID Wristband Person issuing the ID band will verify Name Birth date Spelling Place of admittance Same-day surgery check-in Various depts. (ER, specialty floor)In-patients Out-patients May come in ahead of time for lab work
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| Circulator Interview (pre-operative interview) | Checks patient ID wristband Asks patient’s name Compares name (Including spelling) ID band All documentationDO NOT USE DIRECTIONAL QUESTIONS. USE OPEN ENDED QUESTIONS.
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| Required Questions (pre-operative interview) | Patient Name Patient Allergies Name of surgeon Any jewelry, contact lenses, prosthesis, also check for piercings Procedure and side Bilateral ? NPO status
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| Recommended Questions (pre-operative interview) | Were pre op orders followed? Did the patient recently void? Is family here and where?
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| Documentation (pre-operative interview) | Documentation History and Physical Informed Consent and blood permit Doctor Orders Lab Values
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| Anesthesia Interview | Anesthesia provider conducts their own interview
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| Surgeon Visit | Surgeon sees the patient in the preoperative area before the patient is sedated. The surgeon will verify with the patient the procedure, answer any questions, and check the H & P.
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| All documents used are stamped... | with the patient’s information and all stamps are verified for accuracy.
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| Transporter checks what? | Correct Patient Correct Chart Patient Safety How patient arrives to holding area: Walking Wheelchair Stretcher Patient Room Bed
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| Patient transported to or by circulator and anesthesia provider | On a Gurney (stretcher) On a Hospital Bed Infants Transported in Isolette Toddlers may arrive in a “crib”, wagon, walking, carried by staff, anything that makes it fun
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| Safety | Patient always travels FEET FIRST Ensure patient’s dignity and comfort by providing sheets or blankets. Unless otherwise directed, patient’s head may be raised for comfort. Be aware of catheters, drains, Siderails up Never leave unattended
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| Transferring a Patient - Awake and alert may move themselves. | Patient may need assistance. Use a draw sheet Most patients require a roller or transfer board Minimum of 4 people required: 1 on each side 1 at foot 1 at head ANESTHESIA PROVIDER CONTROLS THE HEAD/NECK AND DIRECTS THE TIMING.
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| Body Mechanics | Use proper body mechanics Bend knees Legs shoulder width apart Keep back straight Lift with legs and arms, NOT BACK!!! Use assistive devices when available and necessary.
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| Circulator | The circulator is the unsterile team member. Registered Nurse or a Surgical Technologist supervised by a Registered Nurse. Helps create and maintain the sterile field and provide a safe environment for the surgical patient
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| Circulating Guides and Duties 1 | Know the preference card. Assemble necessary supplies / equipment for procedure. –Suction? –Electrocautery? –Positioning Aids? Make sure circulator and scrub are ready with set-up.
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| Circulating Guides and Duties 2 | Assist anesthesia. Maintain quiet atmosphere during induction and emergence. Maintain patient safety, privacy and dignity. Know supplies, instruments and equipment. Watch for breaks in technique. ANTICIPATE needs of the team.
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| Circulating Guides and Duties 3 | Be organized. Be ready to count and receive surgical specimens. Keep room stocked. Position, ground, shave, and prep patient. Catheterize if necessary. Highest Priority: hook sterile team up. Documentation Charges
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| Time Out | A “time out” should occur prior to the incision being made on every case. Circulator verifies information with: surgeon, anesthesiologist and scrub Verify: identity of patient, procedure, and site. Position and implants should be verified also.
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| Correct Site Surgery | Help improve the accuracy of patient identification, and eliminate wrong site, wrong procedure and wrong person surgery.
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| Correct Site Process | Pre-op verification occurs Marking the operative site –Mark at or near the incision site only. Do not mark any non-operative sites. –The mark must be“yes” or initials. Use perm, non-toxic marker. •Must be visible after prep and draping. Marked by Dr.
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| Correct Site Process (con’t) | Time Out –Verbal verification with team. Exception: Teeth, single organ cases and premature infants because the mark may cause a permanent tattoo.
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| Documentation 1 | Legal account of what occurs in the OR. O.R. records should include: –Patient interview verification –Date –O.R. number –Names of all personnel in room •Surgeon •Assistant •Scrub(s) •Circulator(s) •Anesthesia •Others
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| Documentation 2 | Diagnosis –pre and post-op Surgical Procedure Times Anesthesia information and ASA class Wound Class Position and aids Prep Shave
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| Documentation 3 | Documentation Catheterization Electrosurgery Tournequit Blood, Medications, Irrigations Specimens, Cultures Dressings, Drains, Packing Counts Implants
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| Documentation 4 | Transferred to… Nursing care plan Additional equipment Possibly a diagram to draw on. Additional forms may include –Charge sheet –Q.A. sheet
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| If it’s not documented, | it was never done!
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| Purpose of Counts | To protect the patient serious post-operative complications caused by sponges, sharps, or instruments inadvertently left in the patient during a procedure. Protect yourself and your employer from legal liability To keep instrument sets complete
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| Sharp and Sponge Count: | Scalpel blades, suture needles, hypodermic needles, needle bovie tips, raytec sponges, lap sponges, peanuts, etc.
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| Full count: | Sharp and sponge count, plus instruments.
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| Type of Counts | Sharps and sponge counts are done for every procedure Full counts are done whenever a cavity is opened.
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| When to do Counts | Initial count –prior to the patient arriving in the OR. (Full count if cavity is entered) Closing counts –Cavity closure –full count –Skin closure –sharps and sponges
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| Number of Counts if cavity is not entered | Two
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| Number of counts if cavity is entered | Three
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| Number of counts for Cesarean Section | Four
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| Who Counts? | Circulator andScrub personnel. Counts must be done by two people. Many institutions require that one of the people be a registered nurse. Counts are done audibly and visibly. Both people should hear and see each item.
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| Who Initiates the Count | Both the circulator and scrub are responsible for insuring the counts are done. – However, the scrub person has the advantage of knowing when the peritoneum is being closed and should inform the circulator.
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| Sequence of Counts | Start at operative site -> mayo -> backtable -> kickbucket. Start with sponges -> sharps -> instruments
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| Counts are done by two people... | each responsible for the accuracy of the count.
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| If any member of the team is concerned about the accuracy of the count... | COUNT AGAIN –no questions asked, until the team is satisfied with the accuracy of the count
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| Omission of Counts | The occurrence and reason for the occurrence is documented. An x-ray is taken at the end of the procedure. A count should always be performed, if at all possible, when the opportunity presents itself during the case.
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| Incorrect Count | Count again. Notify surgeon. Scrub checks field, Circulator checks off the field, Surgeon checks wound. If item is not found, X-ray is taken and an incident report is filed.
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| Thermoregulatory Devices | Maintain patient’s temperature Monitor temperature with: –Esophageal –Bladder –Rectal –Tympanic –Axillary –Forehead
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| Heat Loss Depends on: | –Patient’s age –Patient’s physical status –Type of anesthesia planned –Ambient room temperature –Length and type of surgical procedure
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| Heat Loss occurs through: | – Evaporation – Radiation – Convection – Conduction
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| What can we do to minimize heat loss? | Cover patient with warm blankets Expose the smallest area feasible Decrease air movement Warm solutions Keep linens dry Warming / Cooling Blankets Warm Air Blowers (Bair Hugger) Heat Lamps Thermal Blankets, hats, leggings
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| Pediatrics and heat loss | Infant lose heat quicker due to a larger surface area. Warm the room temperature ~ 70’s. Use K-thermia pad and possibly heat lamps or Ohio bed with built in lamps.
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| Sequential Compression Devices | Used to prevent venous pooling in the legs. “massage” the legs sequentially
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| Role of the Scrub | Know the preference card Check the case cart and pull any needed supplies or equipment Open case Scrub, gown and glove Set up the backtable and mayo Count Be aware of what is going on in the room
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| Role of the Scrub 2 | Gown and glove other sterile team members Drape the patient Pass off suction, bovie, light handle cover, etc. Pass instruments correctly and efficiently as needed Retract, suction, sponge, etc. to assist in the progression of surgery
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| Role of the Scrub 3 | Anticipate the needs of the surgical team and troubleshoot as necessary Assure correct specimen handling and specimen identification Count with circulator
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| Role of the Scrub 4 | Apply dressings using sterile technique Keep table sterile until patient is out of room Assist with room turnover Knowing the anatomy and procedural steps will facilitate the surgery and decrease the anesthesia / surgical time.
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| cassettes for xray | 4 platforms under the pads on OR bed
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| Kidney elevation bar | to lift mid section while patient in lateral position
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| Perineal cutout | Butt goes right up to cutout
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| HOB / FOB | Head of Bed / Foot of Bed
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| breaks | OR section separators
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| OR attachments | Saftey Belts, armboards, metal footboard, stirrups, stirrup holders (clark socket), shoulder brace
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| Postioning aids | sandbag, beanbag, lift sheet, foam pads, pillows, wedges, IV bags
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| Postioning considerations | surgical procedure to be performed (approach and anteseptic technique), Age, Height and Weight, Physiologic Consideration (respiratory, circulatory, peripheral nerves, musculoskeletal, soft tissue)
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| Responsibility for Postioning - Position Selection | Surgeon/consults with anesthesia,
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| Responsibility for Positioning - Positioning Patient | Surgeon, Anesthesia, Circulator, First Assistant, Surg Tech (if unsterile) Anesthesia has the final word.
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| When is Patient Positioned? | After administration of anesthesia
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| How do we know positioning required? | review surgeons preference card, if unsure, ask surgeon.
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| Prep for positioning | assemble all attachments and pads, check working parts and devices, check for cleanliness.
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| Goals of proper position | Optimize surgical site exposure, Minimize risk of adverse physiologic effects, Facilitate physiologic monitoring by anesthesia, Promote safety and security for the patient.
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| Safety measures | no body part should extend beyond edges of table, minimize body exposure, Do not obstruct or dislodge IV or monitors, Arms protected from hyperextension, legs uncrossed, protect from crush injury moving bed parts, protect from compression injury.
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| Equipment for positioning | Safety belt or thigh strap, anesthesia screen/IV poles, armboard, stirrups, pads and pillows
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| Supine Pressure Points Nerves: | Nerves: Radial, Medial, Ulnar, Common Peroneal, Tibial, Brachial Plexus
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| Supine Pressure Points Bony Prominences: | Occiput, Spinous process, Scapula, Epicondyles of the humerous, Olecranon process, Sacral promontory, Calcaneus.
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| Occiput | anatomical term for the posterior (back) portion of the head
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| Supine Positioning Materials | Pillow/Headrest, Padding for bony prominence, Armboards, Safety Belts
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| Supine Common Procedures | Appendectomy, Thyroid/Neck Surgery, Arm/Hand surgery, Total Knee Athroplasty, Abdominal Aortic Aneurism
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| Supine pressure points | occiput, vertebrae, humerous, elbow, sacrum, thighs, heel, toes
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| Supine variations | Trendelenburg -> total abdominal hysterectomy; Reverse Trendelenburg -> cholesystectomy
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| Modified Recumbant | Coronary Artery Bypass with graft, bladder surgery (this is frog-like leg arrangement)
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| Prone Position Pressure Points Nerves: | Radial, Medial, Ulner, Brachial Plexus
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| Prone Position Pressure Points Bony Prominences: | Zygomatic Arch, Temporal Area, Acromion Process, Clavicle, lateral chest wall, Olecranon process, anterior superior iliac spine, patella, tibial tuberosity, dorsum of feet
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| Prone Positioning Materials | Pillow/headrest, padding for bony prominences, Armboards, safety belt, wide adhesive tape
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| Prone Common Procedures | Craniotomy, Spine surgery (modified prone)
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| Prone Pressure Points | ear, rib cage, thigh, patella, toes
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| Kraske of Jackknife | Rectal Procedures
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| Lithotomy Pressure Points Nerves: | Radial medial, ulnar, common peroneal, tibial, sciatic, femoral, obturator, brachial plexus
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| Lithotomy Pressure Points Bony Prominences: | Occiput, spinous process, scapula, olecranon process, lateral malleolus, femoral and tibial epicondyles, sacral promontary
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| Lithotomy Positioning Materials | Pillow/headrest, padding for bony prominence, armboards, safety belt, protective coverings for leg stirrups, table attachments
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| High Lithotomy Common Procedures | Most vaginal procedures, perineal prostatectomy, hemorrhoidectomy
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| Low Lithotomy Common Procedures | Laparoscopic GYN Procedures
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| Lateral Positioning Pressure Points Nerves: | Radial, Medial, Ulnar, Common Peroneal, Brachial Plexus
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| Lateral Positioning Pressure Points Bony Prominences: | Zygomatic Arch, Temporal Area, Acromiun process, greater tubercle and lateral and medial epicondyles of humerous, olecranon process, lilac crest, greater trochanter of femur, medial and lateral malleolus
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| Lateral Positioning Materials: | Pillow/headrest, padding for bony prominence, armboards, safety belt, kidney rest (optional), suction bean bag (optional), adhesive tape, axillary roll
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| Lateral Positioning Common Procedures | Thoracotomy, Hip Arthroplasty
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| Lateral Positioning Pressure Points | Ear, Humerous, greater trochanter, knees, lower leg, heel
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| Kedney Lateral Common Procedures | Kidney Procedures
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| Sitting / Semi-Fowlers Pressure Points Nerves: | Radial, Medial, Ulnar, Sciatic
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| Sitting / Semi-Fowlers Pressure Points Bony Prominences: | Occiput, Spinous process of thoracic vertabra, scapula, olecranon process, sacral promontory, calcaneus
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| Sitting / Semi-Fowlers Positioning Materials | Head Holder (mayfield, horseshoe, etc), Padding for bony prominence, Armboards (possibly), safety belt, padded foot board, Captain's chair (shoulder surgery)
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| Sitting / Semi-Fowlers Positioning Common Procedures | Craniotomy, shoulder surgery, nasopharyngeal surgery, facial surgery
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