OPERATION THEATRE TECHNIQUE

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 OPERATION THEATRE

• The design of OT should provide with optimum facilities and minimum

inconvenience in the management of different areas . The prime requirements
in the design to theatre are the control of infections and safe environment for
the pt.

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 The structure of operation theatre

• The wall should be hard and easily washable material e.g

marble.

• Pipes and central oxygen , nitrous oxide ,suction should be

fitted to the walls.

• Adequate air conditioning should be provided.

• In the absence of window adequate light should provided.

• Fire extinguisher should be adequate

 1. ANAESTHESIA ROOM-

• Preparation of an anaesthetic room-

• Attach an anaesthetic breathing system with a proper size face

mask.

• Con rm proper functioning of mechanical ventilators .

• Con rm availability and proper functioning of wall suction.

• Intravenous solution and connecting tubes.

• Suction catheter

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 Preparing drug for induction and those
to use in case of emergency-

• Local anaesthesia ( lidocaine )

• Benzodiazeoine ( diazepam )

• Catecholamine to treat allergic reaction

• opiod( fentanyl , sufentanol )

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 • 2. Sterilisation room: a steriliser room should be built adjacent to the OT
with a window .The equipment can be passed between the rooms without
repeated opening doors.

• 3. Recovery room- the main purpose of recovery room is to given nursing

care to the post operative pt.

• The resuscitation equipments must be available and facilities for O2 and

suction should also be there.

• Essential articles such as IV infusion , fluids ,IV stand, stethoscope ,bp

apparatus etc.should be there

 • Store room : cylinder of O2 and nitrous oxide ,additional equipment ,

infusion fluid bag , syringes, needles, drugs , and operation instrument are
kept in the room.

• Changing room: a room is provided for theatre personnel to change into

OT clothes from their sweat clothes ,foot wear, sterile caps and mask also
kept in this room.

• Scrub room: the surgeon and the nurses scrub in this room and this room
open into the OT.

 • OPERATION TABLE - a modern operation table has adjustments to

enable the surgeon to give proper and safe position to the pt.

• Some tables are designed for specific type of operation but most are made
as an all purpose.

• Theatre technique -

• Surgical scrub technique

• Gowning and gloving

 • Positions used for surgery -

• Supine, dorsal ,recumbent position used for operation of

eye, ear , face, chest, abdomen , breast ,legs, feet and hands.

• Lateral position- used for operation on kidney ,liver, hip.

• Lithotomy position - used for operation on external

genetelia , vagina , and anal infection

• Prone position position - used for cellae

• Breast and axilla position.

 • Preparation of theatre equipment and supplies:

• Theatre cleaning -

• Cleaning is a process which physically removes organic matter but does not necessarily
destroy micro-organism.

• Daily routine cleaning - the operation theatre is cleaned at least 1hr before operations are
started. The floor is cleaned at the end of the days work . Ideally the floor is cleaned with
machine with scrub and suction dries.

• Cleaning between cases: which is contaminated or dirty have to clean between cases, if blood
spills on the floor it is covered by 1% hydrochloride solution for 10 Mts.

• Daily cleaning at the end of the day : cleaning routine is as the same, but attention should be
paid to the wall.

• Weekly cleaning.

• Cleaning after an infected cases: fumigation must be done,1% hydrochloride, formalin vapour

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 • Preparation of equipments for sterilisation -

• Instrument are prepared on a metal tray which is covered by a large

drape which is secured to the rim of the tray .

• Cleaning and care of instrument:

• Instrument must be thoroughly washed either by hand or by using a

sonic washer. Paid to joint and grooves.

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 • Instrument and different type of disinfection -

• The precise type of disinfection depends on the type of instruments.

Medical devices , equipment and surgical materials are divided into
three general categories depending on the potential risk of infection.

• Critical item : these are instrument or objects that are introduced

directly into the bloodstream or into other normally sterile areas of the
body. E.g cardiac catheter

• Semi critical items : the instruments are induced into body cavities and
therefore come into contact with intact mucous membranes, but do not
ordinarily penetrate body surface. E.g: endotracheal tube.

• Non critical items - these are items that do not ordinarily penetrate ,
but touch only intact skin, such items include crutches ,bed board,
blood pressure cuff.

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 • Instrument preparation :

• Clean all the instrument and material prior to sterilisation.

• Dirt ,blood and all contamination are should be completely removed as

they compromise sterilisation.

• Always soak instrument in water and detergent immediately after

surgery to remove blood.

• Rinse instrument throughly after washing to remove any residue from

the cleaning agents.

• Dry instrument should be pack loosely.

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 METHODS OF STERILISATION

• HEAT STERILIZATION :

• Moist heat method -

• An autoclave provides moist heat under pressure which achieves temperature

higher than that of boiling point of H2O.

• Autoclave is used to sterilise most of the equipment in common use like dressing ,
metal wire and instrument.

• Dressing should be wrapped in paper or cloth.

• Glassware should be packed individually ,rubber gloves wrapped in glove cover or

paper.

• Rubber catheter ,suture and treatment trays should be wrapped in paper or muslin
cloth.

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 • DRY HEAT - here the sterilisation is done in hot air oven at 1600c
for 1hr. It is usually fitted with internal fan to provide an even
distribution of heat.

• Item time and min:

• Glassware : 60 min

• Instrument : 60 min

• Wooden articles : 60 min

• Suture needles : 60 min

• Syringes : 75 min

• Needles : 120 min

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 • Steam and formaldehyde -

• Low temperature steam with formaldehyde autoclave can be used to steralize heat
lablin materials such as plastic and anaesthetic.

• Saturated steam under pressure -

• The flash sterilizer is frequently used in the operation theatre for urgently needed
unwrapped instrument. The temperature used is 270 degrees for a period of 3-10 mi
cycle.

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 COLD STERILISATION

• Gama - radiation : gamma rays ionizing radiation can be used

commercially for sterilisation of a wide range of articles such as
suture , syringes needles , catheters , dressing materials.

• Ethylene oxide : this is colourless liquid with boiling point with a

10.70c and it is highly inflammable and explosive . It is especially
used for sterilising anaesthetic machine , sutures , dental
equipment etc.

• Pasteurisation : is a method of low temperature disinfection

particularly used for endoscopic instrument is totally immersed in
an electrically heated water tank at 75 degrees for at least 10 mts.

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 • Boiling -

• Each instrument should be totally immersed in

a container of distilled water and boil for 5
min. At a temp of 90-100 degree celsius.

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 SUTURE

• A stich or row of stitches holding together the edges of a wound or

surgical wound.

• Purposes of suture:

• To hold wound together in good apposition until such time as the

natural healing process is sufficiently well established to make the
support from the suture.

• Choice of suture material:

• Properties of suture material

• Absorption rate size of suture

• Size suture

• Type of needle handling characteristics of knotting properties

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 • Natural suture material -

• Non absorbable -

• Silk

• Linen

• Stainless steel wire

• Synthetic suture material

• Absorbable -

• Polyglycolic acid

• Polyglactin

• Polydiosone

• Non - absorbable-

• Polyamide (nylon)

• Polyester (dacron)

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 NEEDLE POINT

• Five point of needle points are in common use-

• Convention cutting needle

• Reverse cutting needling blunt point needle

• There are several shapes of surgical needles, these include -

• Straight

• 1/4 circle

• 3/8 circle

• 1/2 circle

• 5/8 circle

• Half curve

• Half curve at both end

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