OBJECTIVES

After the completion of the topic in intraoperative

nursing, the students will be able to:

▪ Identify the key members during

intraoperative phase and their basic roles and
responsibilities inside the Operating Room
 OBJECTIVES

▪ Explain the basic principles of aseptic

technique and demonstrate proper methods in
ensuring its sterility to provide a safe
environment and a reliable performance of
nursing skills
 OBJECTIVES

▪ Comprehensively discuss and demonstrate the

basic procedures related to surgery and its
underlying principles:
▪ Surgical scrubbing
▪ Gowning and gloving
▪ Identify instruments and practice correct procedure when
passing the instruments to the Surgeon
 Identify instruments and practice correct
procedure when passing the instruments to the
Surgeon

• Maintain sterile technique.

• Pass instruments to the surgeon in the
position of use for surgeons.
• Promote safety when handling and passing
sharps.
• Recognize frequently used hand signals.
• Perform point-of-use instrument care during
the surgical procedure.
INTRAOPERATIVE PHASE
 OR SUITE

• Principles in Design
• Exclusion of contamination from outside
the suite with sensible traffic pattern
within the suite.
• Separation of clean from contaminated
areas within the suite.
 TRANSPORTATION TO
THE OR SUITE
• taken 45 minutes before the scheduled procedure
• via stretcher – side rails raised, restraint straps
applied
• patient should be comfortable, warm, safe – pillow
and blanket
• accompanied by unit nurse until relieved by OR
nurse
PREANESTHESIA/PREMEDICATION

• Time given – at least 45 minutes before induction

• Some drugs require up to 90 minutes to reach peak

effect.

• Choice of anesthesia – made by anesthesiologist in

consultation with the surgeon & the client
 COMMONLY USED DRUGS
▪ Sedatives - Bezodiazepines (Diazepam)

▪ Narcotics – Demerol or Morphine

▪ Antimuscarinic/ Anticholinergic –
Atropine sulfate

▪ Antiemetic/ Antinauseant – Phenergan /

Vistaril
 2 TYPES OF ANESTHETIC AGENTS:

• General anesthetics –narcosis

• stupor or loss of consciousness
& loss of sensation
• Loss of consciousness is
preceded by analgesia and
accompanied by relaxation.
2 TYPES OF ANESTHETIC AGENTS:

• Local anesthetics/Conduction anesthesia

• block conduction when applied locally to any
type of nerve tissue
• abolishing pain sensation to that region
• do not cause loss of consciousness.
 GENERAL ANESTHESIA

• Inhalation or volatile anesthetics

Example: Halothane, Nitrous Oxide, Isoflurane

• Intravenous or non-volatile anesthesia/Basal

anesthesia
• Examples: Thiopental Na, Ketamine HCl
STAGE START-POINT END-POINT PHYSICAL NURSING
REACTIONS INTERVENTIONS

I. Onset Anesthetic Loss of Client may be Close operating

administration consciousness drowsy or room doors; keep
dizzy room quiet; stand by
Possible to assist client.
auditory or
visual
hallucinations

II. Loss of Loss of eyelid Increase in Remain quietly at

Excitement consciousness reflexes autonomic client’s side; assist
activity anesthetist, if
Irregular needed
breathing
Client may
struggle
STAGE START-POINT END-POINT PHYSICAL NURSING
REACTIONS INTERVENTIONS

III. Surgical Loss of eyelid Loss of most Client is Begin preparation (if
anesthesia reflexes reflexes unconscious indicated) only when
Depression of Muscles are anesthetist indicates
vital functions relaxed stage III has been
No blink or reached and client is
gag reflex breathing well, with
stable vital signs

IV: Danger Functions Respiratory Client is not If arrest occurs,

(death) excessively and circulatory breathing respond immediately
depressed failure A heartbeat to assist in
may or may establishing airway;
not be present provide cardiac
arrest tray, drugs,
syringes, long
needles; assist
surgeon with closed
or open cardiac
massage.
 REGIONAL ANESTHESIA

Agent is injected into or around a specific

nerve or group of nerves to depress the entire
sensory nervous system of a limited, localized area
of the body.
• Ex. Procaine
• Tetracaine
• Lidocaine
❑ Nerve Block – interrupts sensory, motor & sympathetic transmission
❑ Spinal (Subarachnoid block)/Corning’s/Spinal/Intraspinal Anesthesia
 NURSING ALERT!!
• Spinal headache is due to the leakage of CSF.
Returning CSF pressure to normal is helpful in
relieving headache:
• Patient is kept flat and quiet to lessen/stop
leakage.
• Apply tight abdominal binders
• Injecting fluid into the subarachnoid space.
 COMPLICATIONS RELATED
TO ANESTHESIA:

• Hypotension –an excess of non-volatile drugs that depress the

vasomotor center.
• Nausea and vomiting – may result from excessive or
cumulative effects of drugs administered during anesthesia,
especially due to anoxia.
• Hypoventilation – may be a lingering effect of neuromuscular
blocks.
• Oliguria – manifested in atony and urinary retention after
perineal-genital operations.
 SURGICAL POSITIONS

• Dorsal / Supine
• Abdominal surgery
except for gall bladder &
pelvis

• Trendelenburg
• Lower abdomen & pelvis
• Head & body are
lowered
• Lithotomy
• Positioned on back with
legs & thighs flexed &
with feet in stirrups
• Ideal for vaginal repairs,
perineal surgery, rectal
surgery

• Sim’s/Lateral
• Renal surgery
• Pt. lies on non-
operative side with a
pillow in bet thighs
• Modified Reverse
Trendelenburg
• Upper abdominal sx.
• Face & neck surgery

• Prone position
• Sx. on posterior
parts of the body
• Modified Fowler’s position
• Used mostly in neurosurgery
• Kocher’s/Subcostal Incision – the incision is started in the
epigastrium and is carried obliquely downward approximately 2
fingerbreadths below and parallel to the costal region.
• Right and Left subcostal incision
• Upper abdominal midline (vertical) – the
incision is started in the epigastrium and the
level of the xiphoid process and is carried
vertically downward to the level of the
umbilicus.
• SYNONYM: Epigastric incision, upper median or
vertical incision.
• USES: Rapid entry to the abdomen to control
bleeding ulcers, gastric surgery, exploratory,
pancreatic surgery, transverse colostomy.
 Lower abdominal midline
incision – incision is started
opposite the umbilicus and is
extended vertically downward
in the midline to the
suprapubic region.
USES: pelvic laparotomy, TAHBSO,
suprapubic prostatectomy, cystectomy,
cystolithotomy, CS, Sigmoid colon
operation.
 McBurney’s incision – the
incision is extended obliquely
from just below the umbilicus
through McBurney’s point
upward
• USE: Appendectomy
• Inguinal incision –
inguinal herniorrhaphy
and excision of
hydrocele of the cord.
• Horizontal flank incision
– nephrectomy
• Thoracotomy incision
– lung operation
 Pfannenstiel incision (Bikini
incision) – transverse incision
across the lower abdomen
within the hairline of the pubis.
• USES: Pelvic laparotomy,
TAHBSO, CS, Prostate
surgery, urinary bladder
surgery
• Collarline incision –
thyroid and parathyroid
surgery
• Coronal, butterfly incision
craniotomy
• Limbas incision – cataract extraction
• Elliptical - radical mastectomy
• Laparoscopic
Incisions
SKILL SEQUENCE AND
INSTRUCTIONS

• Scalpels
and
Handling
There are choices in blade and handle sizes depending on
the requirements of the surgical procedure, surgeon’s
preferences, and OR policy. Preloaded, retractable safety
scalpels are also available.
Blade Handle Number
Blade Handle Number
Blade Handle Number
• Load a #3 handle with any of the
corresponding sized blades: #10, #11,
#12, and #15.
• Load a #4 handle with: #20 or #21
blade.
• Load a #7 handle with: #11 or #15
blade.
• Pass the scalpel using a hands-free
method: emesis basin, no-touch basin,
designated area, or pad.
SKILL SEQUENCE AND
INSTRUCTIONS

• Scissors
and
Handling
• Scissors are available in various sizes and
function to cut tissue, suture, dressing
materials, or wire.
 Metzenbaum “Metz”

• With blunt ends,

will cut and dissect
delicate tissue.
• They are available
in straight or
curved.
 Mayo
• They are thicker
in design, have
blunt ends, and
are commonly
used for cutting
suture and
heavy tissue.
• Pass the scissors by placing the ring handles in
the surgeon’s palm. Pass a curved instrument
with the point facing toward the surgeon’s
midline.
• Recognize hand signals indicating the type
of instrument that you will pass to the
surgeon.
MOST COMMONLY
USED SCISSORS
and its
FUNCTIONS
MOST COMMONLY
USED FORCEPS
and its
FUNCTIONS
MOST COMMONLY
USED
RETRACTORS
and its
FUNCTIONS
MOST COMMONLY
USED OTHER
INSTRUMENTS
and its
FUNCTIONS