1.

14 Principles of Sterile Technique

 Only sterile items are used within the sterile field.
 Gowns are considered sterile only from the waist to shoulder level in front and the
sleeves.
 Tables are sterile only at table level.
 Persons who are sterile touches only sterile items or areas.
 Unsterile person avoid reaching over a sterile field; persons avoid leaning over an
unsterile area.
 Edges at anything that encloses sterile contents are considered unsterile.
 Sterile field created close a possible at time at use.
 Sterile areas are continuously kept in view.
 Sterile persons keep well within the sterile area.
 Sterile persons keep contact with sterile area to minimum.
 Unsterile persons avoid sterile areas.
 Destruction at integrity at microbial barrier result in contamination.
 Microorganism must be kept to an irreducible minimum.
 There should be no compromises with sterility.
Reference: http://pinoynursesgalore.blogspot.com/2010/05/14-principle-of-sterility.html

2 Appropriate OR Attire & Policies

 In restricted or semi-restricted procedural areas, wear clean scrub attire that fits well.
 When choosing scrub material, consider both containment of shed skin particles and
comfort.
 Establish and implement a process for laundering scrubs regularly and whenever they
become visibly soiled. Change out of visibly soiled scrub attire as soon as possible
without delaying exigent patient care.
 When in a restricted or semi-restricted procedural area, cover the hair and scalp with head
gear made of a disposable or launderable re-useable material.
 When choosing head gear material, consider containment of shed particles, comfort and
fit.
 Establish and implement a process for laundering reusable head coverings regularly and
whenever they become visibly soiled.
 During a procedure in which normally sterile surfaces or mucous membranes are exposed
or entered through a needle or cannula, wear a surgical mask that fully covers the mouth
and nose. Wear the mask when sterile instruments intended for the procedure are
exposed.
o This does not apply to the insertion of cannulas into superficial peripheral veins
for shortterm (less than 3 days) intravenous access.
  When in a restricted or semi-restricted procedural area, cover facial hair not contained
within a mask, especially when working over or near the surgical field.
 When choosing a facial hair covering material, consider containment of shed particles,
comfort and fit.

3. Different Anesthetics Agents used in OR (General, Reginal-Spinal, Caudal)

General anesthetics are medications that induce and maintain a state of
unconsciousness. They cause anterograde amnesia, meaning that a patient does not
remember the events that follow their administration. This class of medications create
amnesia for surgery These can be given either by IV injection or inhaled as a gas. There
are 5 main classes of anesthetic agents: intravenous (IV) anesthetics, inhalational
anesthetics, IV sedatives, synthetic opioids, and neuromuscular blocking drugs. Every
class has its own set of strengths and limitations, and being familiar with these qualities,
as well as major side effects, can help the surgical team.
Reference: American Society of Anesthesiologists.
On the other hand, For regional anesthesia, an anesthetic is injected close to a
nerve, a bundle of nerves, or the spinal cord. In rare cases, nerve damage can cause
persistent numbness, weakness, or pain. Regional anesthesia also carries the risk of
systemic toxicity if the anesthetic is absorbed through the bloodstream into the body.
Lidocaine, tetracaine, and bupivacaine are the local anesthetic agents most commonly
employed for spinal anesthesia in the U.S. Lidocaine provides a short duration of
anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than
one hour. Tetracaine and bupivacaine are used for procedures lasting 2 to 5 hours.
Tetracaine appears to provide a somewhat longer duration of anesthesia and a more
profound degree of motor block than does bupivacaine. 

https://pubmed.ncbi.nlm.nih.gov/2646230/#:~:text=Lidocaine%2C%20tetracaine%2C%20and
%20bupivacaine%20are,lasting%20less%20than%20one%20hour.

Lastly, Caudal anaesthesia has been used for many years and is the easiest and
safest approach to the epidural space. When correctly performed there is little danger of
either the spinal cord or dura being damaged. It is used to provide peri and post operative
analgesia in adults and children. It may be the sole anaesthetic for some procedures, or it
may be combined with general anaesthesia.
Reference: American Society of Anesthesiologists.

4. Different Sutures used in OR (Absorbable and None Absorbable).

Absorbable Sutures
  Gut. This natural monofilament suture is used for repairing internal soft tissue wounds or
lacerations. Gut shouldn’t be used for cardiovascular or neurological procedures. The
body has the strongest reaction to this suture and will often scar over. It’s not commonly
used outside of gynecological surgery.
 Polydioxanone (PDS). This synthetic monofilament suture can be used for many types of
soft tissue wound repair (such as abdominal closures) as well as for pediatric cardiac
procedures.
 Poliglecaprone (MONOCRYL). This synthetic monofilament suture is used for general
use in soft tissue repair. This material shouldn’t be used for cardiovascular or
neurological procedures. This suture is most commonly used to close skin in an invisible
manner.
 Polyglactin (Vicryl). This synthetic braided suture is good for repairing hand or facial
lacerations. It shouldn’t be used for cardiovascular or neurological procedures.
Nonabsorbable Sutures

types of sutures can all be used generally for soft tissue repair, including for both cardiovascular
and neurological procedures.
 Nylon. A natural monofilament suture.
 Polypropylene (Prolene). A synthetic monofilament suture.
 Silk. A braided natural suture.
 Polyester (Ethibond). A braided synthetic suture.
REFERENCE: https://www.healthline.com/health/sutures

5. Abdominal Incisional Site with indications.

 Midline incision: incision that follows the linea alba (a relatively avascular structure) to
access most of the abdominal viscera; performed on a wide variety of abdominal
surgeries, including emergency procedures, as this incision causes minimal blood
loss; the downside is the susceptibility of significant scars.
 Paramedian incision: incision 2-5cm lateral to the midline; used to access mostly
the lateral viscera (such as kidneys, spleen, and adrenal glands); the anterior rectus sheath
is separated and moved laterally, preventing any division of the rectus muscle; however
this approach takes a long time and is often technically difficult; it also can damage blood
and nerve supply of the muscles, which may result in the atrophy of the muscle; this
technique is rarely perform in the UK.
 Kocher incision: subcostal incision made parallel to the costal margin, starting below the
xiphoid and extending laterally; used to access the gall bladder; these subcoastal incisions
provide good abdominal viscera exposure and good healing. Other variations of Kocher
incision are:
o Chevron / rooftop incision: the extension of the incision to the other side of the
abdomen; used to access the oesophagus, the stomach, and the liver.
 o Mercedes Benz incision: Chevron incision with a vertical incision and break
through the xiphisternum; same indication as Chevron incision, but mostly
performed in liver transplantation.
 Transverse Incision: they vary in size and location; when a full-length
transverse incision is made some muscles (the oblique, the transverse and the rectus
abdominis) and linea alba are cut in a horizontal plane, causing more blood loss than the
midline incision and being more time-consuming; surgeons may also perform smaller
transverse incisions and remain unilateral.
o Supraumbilical transverse incision: offers excellent exposure of the upper
abdomen;
o Pfannenstiel incision: infraumbilical transverse incision in the lower abdomen;
mostly used for gynaecological and obstetric procedures. The skin is incised
transversely, often with a convexity downward to avoid dissection of blood
vessels and nerves.
 Lanz incision and Gridiron incisions: used to access the appendix, mostly to perform
appendicetomy; both are made at McBurney’s point. In comparison to Gridiron
incision, Lanz incision produces better aesthetics results with reduced scarring as it
follows the Langer’s lines.
 Rutherford-Morison incision: similar with the Gridiron incision but the surgeon
extends the incision into an oblique and curvilinear orientation, facilitating access to
the ascending colon and sigmoid; also used for kidney transplantation.
References:
Geeky Medics – Abdominal Surgical Incisions
TeachMeSurgery – Abdominal Incisions in General Surgery
Scandinavian Journal of Surgery – Abdominal Incisions: Techniques and Postoperative
Complications
Surgery (Oxford) – Abdominal access techniques (including laparoscopic access)

6. Different Classification of O.R. instruments.

The different types of operating room instruments include forceps, retractors, scalpels,
clamps, suctions, and punches. The instruments are often used more than once and are
kept sterile with a chemical solution designed to kill germs.
Forceps are like tweezers and are used to grasp. Retractors are scissor style operating
room instruments and are used to retract bone or tissue. Retraction is necessary for the
surgeon to more easily move around in the body cavity and see what area needs repair.
Clamps are also operating room instruments used for grasping. Unlike forceps, which
closely resemble tweezers, clamps have scissor-like handles that allow the surgeon to
have a firmer grasp on the tissue. Suctions are operating room instruments used for
removing fluid from the area of the body cavity where the surgeon is performing the
medical procedure. Scalpel is an essential dermatological tool used “for making skin
incisions, tissue dissections, and a variety of surgical approaches since the onset of
'modern' surgery.” Punch instrument is a circular blade that can be used for many
diagnostic and therapeutic purposes in different medical and surgical specialties.
Reference: https://www.wise-geek.com/