Operating Room Techniques

PERIOPERATIVENURSING

Venus Sofia J. Balatero, RN, USRN

Perioperative Nursing

• Perioperative nursing is not just "technical work anyone can do". Perioperative nurses are skilled, knowledgeable RNs that care for patients before, during, and after surgery.

• The fundamental nursing values (knowledge, skills, and judgment) are ever present and are the basis of the quality of care that surgical patients have relied on

and can expect.


•The patient is the center of the sterile

field


The OR team usually consists of:• Surgeon: Scrubbed and in surgical attire to perform

the surgery• Anesthesia provider: Masked and in clean scrub

attire to administer the anesthesia- During the procedure the anesthesiologist monitors the patient’s vital signs and is responsible for keeping the surgeon aware of

the patient’s condition. The anesthesiologist determines when the patient may be moved to the post anesthesia recovery stretcher after the surgical procedure has been completed. This person usually checks the patient’s airway and vital signs before taking the patient to the post anesthesia recovery room.


The OR team usually consists of:

• Surgical assistant (first assistant): Can be another physician, a nurse, or physician’s

assistant (PA) who is scrubbed, in sterile attire, and assists the surgeon to ligate, suction, and suture

• Scrub nurse: Scrubbed and in sterile attire; prepares the instrument tray and passes the instruments,

sponges, needles, and sutures to the surgeon• Circulating nurse: In clean scrub attire and mask; assure that sterility is maintained at all times; obtains supplies, delivers materials, pours solutions, handles specimens, positions the client and surgical drapes, and disposes of soiled items


•PHASES–Perioperative

–Intraoperative

–Postoperative


• PREOPERATIVE PHASE– Begins when the decision is made to undergo

surgical intervention and it ends when the patient is transferred to the OR bed

– During this phase, the perioperative nurse performs the assessment, determines the nursing diagnoses, identifies potential outcomes and develops a plan of care

– The perioperative nurse plans, prioritizes, and initiates the patient care necessary for the attainment of the desired outcomes


• INTRAOPERATIVE PHASE -Begins with the placement of the patient on

the OR bed and continues until the patient is

admitted to a postprocedure or

postoperative area

-Implementation of the plan and evaluation of care continues during this phase.


• POSTOPERATIVE PHASE-Begins with admission of the patient to a postprocedure or

postanethesia area, which may be a postanesthesia care unit

(PACU) or an intensive care unit (ICU). -Patients admitted to the facility on an ambulatory 1-day-stay

basis may return to the ambulatory unit. As indicated by his condition, the patient will transfer from the immediate

postoperative patient care division for progressive stages of self-care on a surgical unit before being discharged from the hospital. -The postoperative phase ends when the surgeon discontinues follow-up care-Evaluation, the sixth component of the nursing process, is

completed during this phase


Phase From To

Preoperative Decision for surgical intervention

Transfer to Operating Room

Intraoperative Received in Operating Room

Admission to Recovery Room

Postoperative Admission to recovery Room

Follow-up Evaluation

Type of Surgery acc. to URGENCY

Type of Surgery

Time requirement for surgery

Example

Optional At the preference of patient; surgery not needed

Cosmetic surgeryLiposuction

Elective At the convenience of patient as failure to have surgery is not catastrophic

Excision of superficial cyst

Planned/ Required

Within a few weeks as surgery is important

Cataract extraction

Urgent/ Imperative

Within 24-48 hours Cancer surgery

Emergency Immediately without delay to maintain life or organ, remove damage, stop bleeding

Intestinal Obstruction

Type of Surgery acc. to PURPOSE

Type of Surgery Purpose Example Diagnostic To confirm diagnosis Excision and

biopsy Exploratory To estimate the extent of the

disease and confirm diagnosis as well

Exploratory Laparotomy

Curative-Ablative-Constructive-Reconstructive

Removal of diseased organRepair of congenital defectsRestoration of damaged

organ

HysterectomyRepair of cleft lip

or palateEpisiorrhapy

Palliative Relieves symptom but does not cure the disease

Rhizotomy and chordotomy (for pain relief)

Type of Surgery acc. to SERIOUSNESS

Type of Surgery

Extent of Surgery

Minor Surgery that involves minimal (few) complications and minimal blood loss

Major Extensive surgery that involves serious risk and complications (and loss of blood) as it involves major organs

Sterile Technique

Sterile Technique

• Strict adherence to sound principles of sterile technique and recommended practices is mandatory for the safety of the patient.

• This adherence reflects one’s surgical conscience.

• Principles remain the same; it is the degree of adherence to them that varies.

Principles of Sterile Technique

• Sterile persons have scrubbed and are gowned and gloved; unsterile person have not.

• Only Sterile Items Are Used Within the Sterile Field.

• If you are in doubt about the sterility of anything, consider it not sterile.

• Gowns Are Considered Sterile Only from the Waist to Shoulder Level Front and the Sleeves

• Tables Are Sterile Only at Table Level


• Persons Who Are Sterile Touch Only Sterile Items of Areas; Persons Who Are Not Sterile Touch Only Unsterile Items or Areas

• Unsterile Persons Avoid Reaching over a Sterile Field; Person Avoid Leaning over an Unsterile Area

• Edges of anything that encloses Sterile Contents are Considered Unsterile

• Sterile Field is Created as close as Possible to time of Use


• Sterile Areas are Continuously Kept in View• Sterile Persons Keep well within the Sterile Area

- They do not walk around or go outside room- Sterile Persons keep Contact wit Sterile Areas to a

Minimum• Unsterile Persons Avoid Sterile Areas• Destruction of Integrity of Microbial Barriers Results

in Contamination- Strike-through is soaking of moisture through unsterile layers to sterile layers or vice-versa.

• Microorganism Must be kept to an Inducible Minimum


• PATIENTS SKIN PREP

- done after patient has been anesthetized and positioned on the operating table, skin of the operative site and extensive

area surrounding it is mechanically cleansed again with an antiseptic agent immediately prior to draping



- Responsibility:

The first assistant is the person who scrubs the patient after he has scrubbed his own hands

and arms



- Scrub skin, starting at site if incision, with a circular motion or over

widening circles to the periphery. Use enough pressure and friction to remove dirt and microorganisms from skin and pores.

- Discard sponge after reaching periphery. Never bring a soiled

sponge back toward center of area


• Contaminated Areas within the Operative Field:

- Umbilicus, stoma, draining sinuses, skin ulcer, vagina, anus, colostomy,

(In all contaminated areas, follow general rule of scrubbing the most contaminated area last of with a separated sponge

Layers of Tissue

The five main layers of abdominal tissue from the outer most are:

• Skin

• Subcutaneous

• Fascia

• Muscle

• Peritoneum

PACU• The post anesthesia recovery room is rarely called an intensive

care unite, but it is.• Everyday is a real challenge to PACU nurses because many kinds

of situations occur. They are expected to have good knowledge of both medical and surgical procedures because they care for patients with all types of medical and surgical problems. The nurses must be calm and in full command of the situation but know their limitations

• The PACU nurse works under the direction of the anesthesiologist or surgeon. The nurse must carry out simultaneously four assignments:

- Observation of the patient- Evaluation of those observations- Performance of the necessary treatment- Reporting and recording observations and treatment

• Total care of the patient requires both-in-depth study and experience in post anesthesia recovery nursing.

PACU• The PACU nurse must totally evaluate the patient and record

the finding. This evaluation is done every 15 minutes or more often, depending on the patient’s conditions.

• Airway• Vital signs• Color• Skin• Level of consciousness• Fluid and electrolyte balance• Dressings, tubes, drains, or casts• Position• Safety measure• Physician’s orders• Comfort of the patient• Reporting and Recording

PACU

POSTOPERATIVE COMPLICATION• Circulatory problems

- Shock

- Hemorrhage

- Femoral phlebitis or thrombosis• Pulmonary complications

- Atelectasis• Urinary complications

- Urinary retention

- Urinary incontinence


• How to describe an operation- the terminology used to describe all operations is a composite of basic Latin or Greek terms.- describe the organ to be operated on

lapar-, abdomen (laparus = flank); nephro-, kidney pyelo-, renal pelvis cysto-, bladder chole-, bile/the biliary system col(on)-, large bowel hystero-, uterus thoraco-, chest rhino-, nose masto/mammo-, breast


• describe any other organs or things involved in the procedure docho-, duct

angio-, vessel (blood- or bile-carrying)

litho-, stone• describe what is to be done

-otomy, to cut (open)

-ectomy, to remove

-plasty, to change shape or size

-pexy, to change position

-raphy, to sew together

-oscopy, to look into

-ostomy, to create an opening in (stoma = mouth)

-paxy, to crush

-graphy/gram, image (of)


• Add any terms to qualify how or where the procedure is done percutaneous, via the skin;

trans-, across;

antegrade, forward;

retrograde, backwards.

• Choledochoduodenostomy: an opening between the bile duct and the duodenum

• Rhinoplasty: nose reshaping• Bilateral mastopexy: breast lifts• Percutaneous arteriogram: arterial tree imaging by direct puncture injection• Loop ileostomy: external opening in the small bowel with two sides• Flexible cystourethroscopy: internal bladder and urethral inspection

Operating Room Techniques

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