Colegio de Sta. Lourdes of Leyte Foundation, Inc.

COLLEGE OF NURSING
Tabontabon, Leyte

NCM 112 – Related Learning Experience

PERFORMANCE RATING SCALE – PERIOPERATIVE NURSING COMPETENCIES

Name: BSN III Date:

PROCEDURE FOR PACKAGING OF MATERIALS Remarks
1. Gather the materials/instruments that must be packaged.
2. Consult institutional policy for the type of materials to be used for packaging.
3. Determine the type of sterilization method to be used.
4. Wash hands thoroughly.
5. Pat hands to dry using a clean towel.
(SQUARE FOLD PACKAGING)

1. Place two sheets of wrapper on top of a surface with its

2. Place item(s) to be wrapped in center of two sheets of material. Distribute the

weight of the items evenly at the center.

3. Holding the far-end corners of the first sheet of wrapping material, fan-fold over
the items towards the center. Cuff top layer of the sheet with end away from you.

4. Fan-fold the other half of the sheet towards the center. The end of the top layer
should face toward you.

5. Miter left end and fold neatly up and over the top of pack.

6. Miter right end and fold up neatly over the top of pack. Cover the items completely

7. Repeat the procedure using the second sheet of wrapping material.

8. Securely affix the end of the fold with pressure sensitive indicator tape.

9. Label the identification of the contents and record the date of packaging.

ENVELOPE/DIAGONAL FOLD PACKAGING)

1. Place two wrappers on flat surface with one point toward you.

2. Place item(s) to be wrapped in center of wrapper with its length parallel to you.

3. Fold corner nearest you over the item(s) until it is completely covered. Fold corner
back towards you 2 to 3 inches.

4. Fold left side of wrapper over and parallel to item(s). Fold the end of corner back 2
to 3 inches.

5. Fold the right side of the wrapper over and parallel to the item(s). Fold the end of
the corner back at least 1/2 inch.

6. Tuck in side edges of remaining corner to eliminate any direct opening to the
item(s). Bring top corner down to bottom edges and tuck in, leaving point for
opening.

7. Repeat the procedure for the second sheet of wrapper.

8. Bring the end corner of the wrapper completely around package and seal with
pressure-sensitive indicator tape.

9. Label the identification of the contents and record the date of packaging.

PROCEDURE FOR SURGICAL HAND WASHING

AND SCRUBBING

1. Consult institutional policy for length of time for hand washing.

2. Prepare yourself.

a. Put on surgical attire (scrub garments).

b. Put on cap or hood, shoe covers, and mask.

c. Examine hands and forearms for cut and blemishes.

d. Remove watches, rings, and bracelets.

e. Remove nail polish or artificial nails if worn, and cut nails so they are no
longer in length than the fingertips.

3. Perform the pre-scrub.

a. Turn on water and adjust temperature.

b. Moisten hands and arms.

c. Lather hands and arms for 1 minute.

d. Rinse hands and arms, keeping hands higher than elbows.

 4. Scrub. (Counted brush-stroke method )

a. Select sterile brush or sponge, rinse and apply liquid antimicrobial

cleanser/soap.

b. Scrub for 20 strokes each of the following:

• Fingers and interphalanges

• The palmar surface

• Over dorsal surface of the hands

• Over the wrist

• Over each region of the arm ending 2-3 inches above the elbow.
5. Repeat step 4 for the right hand and arm.

6. Rinse hands and arms, keeping hands above elbows, in front and away from the
body. Continue to scrub for at least 5 - 10 minutes by repeating 3 to 5 cycles.

7. Discard brush while keeping hands above elbows. Turn off water with foot or knee
control.

8. With hands above elbows, proceed to room entrance with the back of the body
facing the door.

 9. Dry hands and arms.

a. Pick up sterile towel. Allow towel to unfold.

b. Pat dry one hand thoroughly from fingers to elbow in a rotating motion using
only one side of the sterile towel.

c. Repeat drying method for other hand, using a different side of the towel or a
new sterile towel.

d. Push cuticles back as you dry. Inspect hands again for dermatitis or cracked
skin.

PROCEDURE FOR GOWNING

1. Select an unobstructed area of the room with enough space for gowning.

2. Have circulating nurse open packs containing sterile gown and sterile surgical
gloves.

3. Bend slightly forward and pick up gown at neckline without touching outside of the
gown.

4. Facing the sterile field hold gown at arm's length and allow it to unfold by itself.

5. Locate armholes and hold the inside top neckline. Position gown with the back
opening facing the body.

6. Insert each hand through armholes simultaneously.

7. Turn your back to circulating nurse or assistant for securing gown at neck and
back.

8. Have circulating nurse bring gown over shoulders and

back, leaving sleeves covering the hands.

9. For sterile gowns with front tie, hand tie to circulating

nurse by bending slightly forward and turning 180 degrees to left and right; letting it
sway at the back for the assistant to catch and secure tie to gown.

PROCEDURE FOR CLOSED GLOVING

1. With hands covered by sleeves, open sterile glove package. Identify left and right
gloves.

2. Pick up glove for dominant hand by holding the edge of the folded cuff.

3. Place glove palm-side down on palm of sleeve-covered dominant hand, with glove
fingers pointing towards elbow.

4. Use sleeve-covered nondominant hand to grasp bottom fold of glove and pull glove
cuff over the sleeve covered dominant hand.

5. Grasping top of glove with nondominant hand, extend fingers of the dominant
hand. Pull the sleeves until cuff of gown positioned at the wrist fully covered by the
gloves.

6. Repeat steps 2 to 5 to glove the nondominant hand.

7. Adjust fingers until fully extended into both gloves.

PROCEDURE FOR OPEN GLOVING

1. With gowns on, grasp inner package of sterile glove and lay it on a sterile draped
surface at waist level. Never lean on the table. Maintain a distance of one foot apart
from the table.

2. Open package by holding the flap of the wrapper. Keep gloves on wrappers inside
surface.

3. Identify right and left glove.

4. Pick up the gloves for dominant hand using the thumb and first two fingers of the
nondominant hand.

5. Glove the dominant hand.

6. Carefully pull glove over dominant hand, leaving a cuff | and being sure that cuff
does not roll up to wrist.

7. With gloved dominant hand slip fingers underneath second glove's cuff with thumb
abducted.

8. Glove nondominant hand.

9. Carefully pull glove over nondominant hand, leaving a folded cuff.

10. Extend the glove fully covering the hand and gown's cuff.

11. Using the gloved nondominant hand, slip fingers underneath the gloves cuff
touching only the outside of the gloves, pull gloves toward the arm covering the
gown's cuff.

12. Fixed gloves. Inspect for tear of gloves and gown's sleeves. The gown's cuff
should be covered entirely.

13. Interlock hands together above waist level to ensure smooth fit over fingers.

PREPARING A STERILE FIELD (DRAPING A MAYO TABLE)

1. Prior to gowning and gloving, consult institution policy in preparing a sterile field.

2. Gather the sterile packages for draping and position tables to be draped.

3. Wear sterile gowns and gloves.

4. Ask the circulator to open the sterile packages.

5. Pick up the Mayo table drape; unfold it toward yourself with the opening of the
drape facing the front edge of the table. Insert the gloved hands over a folded cuff.

6. Standing at the front of the Mayo table, insert the table and tray through the
opening of the sterile drape. Support the folds of drape on arms while bending the
elbows.

7. Completely drape the Mayo table while gloved hands are inserted in cuff.

8. Unfold the remainder of the table drape over the surface of the table and away from
yourself. Allow the edges to fall over the ends of the table.

9. Cover with another sterile linen.

SETTING UP THE INSTRUMENT TABLE

1. With gowns and gloves on, approach the draped Mayo table. The height of the
Mayo table should be at the level of the elbows.

2. Count the number of the instruments, sponges and sharps.

3. Handle loose instruments separately to prevent interlocking or crushing.

4. Inspect the instruments for alignment, imperfections, cleanliness, and working

condition. Check the expiration date of suture packs and other sterile packages.
Remove any malfunctioning instrument and expired packages from the set.

5. Sort instruments neatly by classification.

6. Using the needle holder, set blades properly on appropriate blade holders. Protect
sharp blades, edges and tips. They should not touch anything.

7. Keep ring-handled instruments together with the curvatures and angles pointed in
the same direction.

8. Close box locks on the first rachet.

9. Hang ring-handles over a rolled towel or over the edge of the instrument tray or
container.

10. Leave retractors and other heavy instruments in a tray or separate sterile working
table.

11. Open suture packs. Remove the needle from the pack using the needle holder.
Avoid unnecessary knots along thread line.
12. Clamp the body of the needle in an area 14 to 72 of the distance from the
eye/swaged. Place the needle securely in the tip of the needle holder jaws, and close
the needle holder in the first rachet.

13. For needles with an eye, insert strand across needles and draw out 1/3 of the
length of the thread.

14. Make a suture book by fan-folding a towel and place it at a corner of the Mayo
table. Ligating strands are placed at the bottom layer of the suture book. Anchor
needles at the second layer of the book and arranged according to size, shape and
characteristics. Place needle holders at the top of the suture book.

15. Pile sponges of separate kind. Inspect each for cleanliness, and excess strands.

HANDLING AND PASSING OF INSTRUMENTS

1. Know the name and appropriate use of each instrument.

2. Handle instruments individually.

a. Hemostatic forceps are held near the box locks.

b. Curve-tipped instruments are held near the box locks with the curve tip faces
away from you.

c. Sharp and delicate instruments may be placed on a flat surface or container

for the surgeon to pick up.

d. Grasping forceps (eg. Tissue forcep) are held near the tip and are passed by
the handle. e. Needle holder with suture is held near the box lock, and sharp
point faces away from you.

f. Other instruments are held near the tip while providing allowance for the
surgeon to hold the handle. Tips should be visible.

3. Hand the surgeon or assistant the correct instrument for each particular task by
rotating the risk clockwise.

a. If the surgeon is on the opposite side of the operating bed, pass across right
hand to right hand (or with the left hand to a left-handed surgeon)

b. If the surgeon is on the same side of the operating bed and to the right, pass
with your left hand; if the surgeon or assistant is to your left, pass with your
right hand.

4. With a moist sponge, wipe blood and organic debris from instruments promptly
after each use.

5. Place back used instruments from the same location where you picked them.

6. Flush the suction tip and tubing with sterile distilled water periodically.

7. Remove debris from electrosurgical tip.

DISMANTLING THE INSTRUMENT TABLE

1. Check drapes, towels and table covers for loose instruments, sponges and needles.

2. Collect instruments from the Mayo stand and other tables.

3. Separate delicate, small instruments and those with sharp or semi-sharp edges for
special handling. Discard disposable sharp instruments to the sharp containers.

4. Disassemble all instruments with removable parts to expose all surfaces for
cleaning.

5. Open all hinged instruments to expose box locks and serrations.

6. Flush cold, distilled water through hollow instruments (suction tips, endoscopes,
etc.).

7. Discard used sponges and packs into trash bins for infectious materials.

8. Rinse off blood and debris with demineralized distilled water.

REMOVAL OF GOWN AND GLOVES

1. Have circulating nurse untie the back strings of gown.

2. Go near to the linen hamper.

3. Using the dominant hand, grasp the gown of the nondominant arm/shoulder,
touching only the outside of the gown.

4. Roll the gown inside out from the shoulder down the wrist with hand below waist
level.

5. Using the non-dominant hand, pull the gown by rolling it inside out from the
dominant arm/shoulder down the wrist. Touch only the outside of the gown, with
hands positioned away and below waist level.

6. Carefully pull the cuff of the gown from the gloves away from the hands.

7. With the gloves on, discard the gown directly into the linen hamper holding it
away and below the waist level.

8. Grasp outside of one cuff with other gloved hand; avoid touching wrist.

9. Pull glove off, turning it inside out.

10. Hold the removed gloves using the other gloved hand.

11. Take fingers of bare hand and tuck inside remaining glove cuff. Peel glove off
inside out.

12. Discard in receptacle.

13. Wash hands thoroughly.

Signature of Student Signature of CI