O&G OT Survival Tips

1. Change to scrub. Bring along pen, staple, carbon paper, stethoscope, chop.
2. Keep an eye on the OT board. / xxx means already called the patient. X xxx means the
patient has arrived. X xxx means operation has done. When the patient arrives, inform you
surgeon.
3. After your patient arrives, go to OT and prepare antibiotics. Take 2 ampules of Ampicillin
500mg from the emergency trolley. Take 10cc syringe, syringe out 10cc water of injection,
and insert into the 2 ampules of Ampicillin, mix well. Then syringe out into the 10cc syringe
again. Label with IV AMPICILLIN 1G, date and time. Keep the 2 ampules just in case the
anaesthetist asks.
4. Right after you prepared the antibiotics, go to get 2 pieces of Neonatal Examination Form
and NNR form, just in case baby need to be admitted. Otherwise one piece of Neonatal
Examination Form is sufficient to discharge baby to mother.
5. Take photos of 1st and 2nd page of pink book, latest review in the BHT. And take note if
there’re any ANC that mandate the baby to be admitted (GDM/PROM>18h/GBS etc)
6. Ready to scrub in! Prepare you and your surgeon for 2 sets of gloves before scrubbing in.
Open the gloves and put them on the scrubs after the scrub nurse open the scrub set
(usually she is the 1st one to scrub in and prepare). Wear an apron before scrub in.
7. Surgeon will clean the patient first before draping. Remember the sequence of draping. 1
down, 1 up, 1 assistant side, 1 surgeon side, 1/3 assistant side, 1/3 surgeon side, ½ down, ½
up, 1 down.
8. Surgeon will then make 3 marks on the patient lower abdomen before cutting. Help to
stretch the lower and upper part of the abdomen for better visualisation.
9. Surgeon will the incise the skin, subcutaneous tissue, rectus sheath and rectus abdominis.
10. Help the surgeon for diathermy if there’s any active bleeding.
11. Help to suction for smoke and blood.
12. Traction the rectus sheath after the surgeon hold it with 2 Allis, tie it and ask the
anaesthetist for traction.
13. After the surgeon split the rectus abdominis, get a Doyen to push down the bladder, hold it
in the middle position.
14. Surgeon will then incise the peritoneum starting from the middle, when hear “SWING”,
swing the Doyen to your side, then swing back to middle, then swing to surgeon side, then
swing back to middle to facilitate the incision of peritoneum.
15. Prepare suction for liquor and blood when surgeon is ready to open up the uterus.
16. Prepare to press on fundal when surgeon is ready to extract the baby, apply constant fundal,
do not do “CPR”.
17. After the surgeon cut the umbilical cord, hold the baby and transfer to the trolley behind
you for the nurse to take care of the baby.
18. Take a kidney dish and support it with you body, free 2 hands either to hold suction or
whatsoever when the placenta is being removed.
19. Surgeon will then clamp the uterus and ready to suture in 2 layers.
20. For the 1st layer, Right hand hold the suture each time surgeon suturing up and swing it to
form a square knot before next suture. Left hand hold a gauze and wipe the suture side after
each suture up.
21. For the 2nd layer, left hand hold a gauze and wipe the suture side after each suture up.
22. Surgeon will the inspect for any active bleeding site.
23. After that help the surgeon to off the traction by cutting the rope.
24. Surgeon will then suture the rectus sheath. Right hand hold the small hook? Left hand hold
the suture each time surgeon suturing up.
25. Allowed to scrub out and start typing. Ask from the surgeon the head of baby, placenta side.
Ask from the anaesthetist EBL and liquor volume. Take a photo from the OT board for
personnel details and operation time.
26. Examine the baby before going out from the theatre.
27. Go to any computer any open Microsoft Word and save it with the patient IC number. Open
Document, search for O&G template and copy to the Word document. Edit the patient and
personnel details. Edit the details from surgeon and anaesthetist. Wait for your surgeon
come out and to edit further detail. Print 3 copies and let the surgeon sign. Put all into the
BHT. Fill the neonatal examination form. Called Paediatrics MO for admission if needed.
Document it in the NNR and Neonatal Examination Form.
28. Ready for your next operation!