Bethlehem University

Faculty Of Nursing and Health Science

NURS 337

Operation Room Report

St. Salsabil Najdi

Instructor : Mr. Zaher Hudrob

Fall2017
Introduction:
Because I am fourth year advance student, Operation Room Report is one of
assignments in this semester. So, I will start with a simple introduction about
OR department which is one of most important departments that must found in
each hospital.

Operation Rooms is also called Surgical Rooms which are performed a unit
of the hospital where surgical procedures are done. And these rooms are
designed to provide a care for patients in their conditions, it also supplied by all
medical and non-medical equipment that needed in operations.

This department has Doctors (specialist and residents), Nurses and others.
Nurses provide care and support to patients Pre, Intra and Post-Operation. these
nurses are responsible for maintaining a sterile environment in the operating
room, and must avoid any source of infection through wearing special clothes
for OR by all members of the Team such as (Uniform specialized for OR which
wear it only in the department, head cover, shoes cover, gloves, masks and
others) and keep rooms cold.

Other nursing responsibilities include providing for the safety and well-being
of the patient, coordinating with the OR team, performing scrub and circulating
activities, monitor patient until full recovery post operation.
Structure of OR in Al-Makassed Hospital:
This department is in 1st floor by elevator, near surgical ward above GF. It
also has a special elevator to received and transport pts from and to wards, but
this elevator also used by other people in hospital because it is located out of the
ward. And there is another elevator only between OR and CSS which used for
equipment and it is in the ward.

Operation ward is divided into:

1st one: Unrestricted area which is has Reception area, sitting room,
changing groom (one room for men and one for women inside it has bathroom
for team), the area that received pts in it before operations from hospital wards
and transfer pts from it to their wards, waiting area for companions and team
before wearing special clothes for OR.

2nd one: Semi-Restricted Area which is has sitting rooms specialist for team
such as sitting room for nurses, for perfusionist, for Dr. anesthesia, for Doctors,
for head nurse and one for all that mainly used for smoking.
 This area also includes corridors between rooms, stores that contain all
equipment that needed in OR such as (medications, surgical sets, sterile
equipment and others), recovery room that has(monitors, suctions, O2 resources
and cylinder, refrigerator used for medications, medical instrument, medication
and narcotic drugs, emergency trolley and defibrillator, 2 RN nursing most of
time that have ICU experience, computer and telephone, it doesn’t has
permanent beds which pts received and transferred at the same bed).

Also has utility room and room that has elevator with CSS where medical
equipment is cleaned and sent to CSS. Mainly cleaned by Aid-Nurse in utility
room through washing it in water then soak it in water with chlorhexidine then
wash it again to send it for CSS by elevator that used for dirty equipment but
received equipment after sterilization in other one.

3rd one: restricted area which has operation rooms, inductions room and
scrubbing room.
 Operation Rooms are:
Room one for neurosurgery such as craniotomy, dichotomy. This room
contain portable X-Ray, its bed differs than other beds which we can’t put
pt. on prone position on others but we can do it in this bed and also has
other medical equipment and machine like any other room such as (ER
trolley, sutures, defibrillator, coterie machine, anesthesia equipment and
drugs, extra lights, portable suction, store for gloves, gauze, pads,
disinfectants solutions {savior and Iodine and others}, ventilator… etc).
This Room used for ENT at Saturday.

Room two for adult open heart which has perfusion machine (BYPASS),
cardiac medications specially that used in cardioplegia, head light for
cardiologist and his assistance, ABG’s machine, ACT machine and also
has the same other medical equipment in each room, and this room should
be very cold during operation. This room used for orthopedic surgery at
Saturday.

Room three for surgical operations such as Lab. Coli which has color full
TV and camera, Portable X-Ray, heater for gowns that used after surgery
and fluids that used during surgery for camera, all types of sutures,
portable suction. Also has other medical equipment that used in each
operation room.
Room four for urology which has special cystoscopy and another
endoscopy that used by urologist. Also has other medical equipment as
other rooms.

Room five for infected cases specially at Saturday, but may be used for
simple pediatric cases in other days. There’s so special equipment in this
room but it has color full TV ad camera that used in simple endoscopy for
pediatric.

Room six for pediatric open-heart surgeries this room has the same
equipment in Adult open-heart room but for pediatric not for adult.

Room seven for maternity cases such as hysterectomy or CS, it contain

color full TV and camera, 3-4 open-portable-incubators, nursing station
that used for receiving newborns during CS and maternity drugs such as
Methergine and Syntocinon that used in emergency for Gyna. And other
medical equipment as other rooms.

Room eight the last operation room it is for emergency cases, this room
should be prepared all the time specially when the 7th rooms were busy, to
receive emergency cases immediately and it should have all equipment, if
not available the team brining it form room that related to emergency case,
but in these days, is closed because they will open another one in future.

Note: all sterile medical equipment that needed in each operation are
prepared from stores before each surgery by circulatory nurse, which
there’s no special stores that contain sterile equipment for each room.

Each operation room has a positive pressure, temperature is 17oC to

25oC, humidify is 50%-60% but sometimes reached to 64%, hasn’t
windows, entrance and exit door is the same one and good lights.

 Induction rooms:
This room has anesthesia drugs and equipment which pt. should inducted
in this room, and it mainly be conjoint between two rooms such as
between 1and 2, 3and 4.

 Scrubbing rooms:
These rooms are conjoint between 2 rooms or separated for each room,
conjoint scrubbing room such as between 2and3, 6and7, and other each
 room has separated scrubbing room such as 1,4, 5. These rooms have
source of water which work by sensations and scrub soap.

Team of OR:
Medical team is:
Nurses 38 (PN5, RN31, RN have ICU experience 2), A and B shift are fixed
together which mainly the same Team because A shift start at 7:00am and B
shift start at 8:00am. Doctors of anesthesia are 13 and anesthesia technicians are
2. Perfusionists 4. This team is distributed as A and B shift which each room
has 2-3 nurses, 2-3 surgeon included residents. Also, these shifts have 10-11
Anesthesia Dr, 1 anesthesia technician. Perfusionists at Sunday and Monday 3
but in other days 2. In the Other Hand they distributed in on call shift as 4-6
nurses, 3-4 Anesthesia Dr, 1 anesthesia technician, 1-2 perfusionist, and surgeon
is related to case that comes.

Non-medical Team is:

Aid nurse 2 for OR and sometimes came others from other departments.
Correspondent 6, secretary isn’t stable in OR which is conjoint with other
departments. This team is distributed On A and B shift, Secretary 1, Aid-nurse
2, correspondent 3-4, no security. But in On call shift there were only 2
correspondent.

Ideal Structure of OR and compare it with Al-Makassed

OR structure:
:The characteristics of the ideal O.R

- Closed building (room) without any windows. applicable

- It has special ventilation. Applicable all rooms have effective AC except
room1 it doesn’t work.
- It has an easy access. Applicable.
- There is a special entrance for the patients pre-operatively and post-
operatively. Not applicable because all pts and their companion and team
members are entering and exiting from the same door.
- There is a special room for the infectious cases. Applicable it’s room 5 but
sometimes it used for simple pediatric surgery.
 - It includes a room for the sterilization. Not Applicable because
sterilization are done in CSS not in OR, but there are utility room where
disinfected instruments and medical equipment before sending it to CSS.
- It has rooms specialized for orthopedic surgeries, gynecology surgeries,
and neurology surgeries and open-heart surgeries. Applicable and each room
is supplied by all machines that needed in each one.
- It has a clean corridor for the clean equipment, and a dirty corridor for the
dirty equipment. Not applicable because it has a one corridor for all
equipment (dirty and sterile) and also it the same one for people.
- It has an elevator for the clean equipment separated of the elevator for the
dirty equipment. Applicable, in the past each room had elevator with CSS for
dirty equipment.
- Good lights, humidity, temperature and ventilation of the O.R, supplies,
equipment and other machines for the surgeries should be available in the
operative room. Applicable, but sometimes Temp are can’t controlled at room
1 related to impairment in AC, and humidity should be between 50-60% but I
see it 64% which is not applicable.
.It should also include the availability of qualified team. Applicable -

:The operation room parts

The numbers of operation rooms in the hospitals vary from one to another
according to the requirement of the hospital itself. The recommended size is
:6.5m x 6.5m x 3.5m. The O.R includes different parts such as

:The doors -1
The doors of each O.R should be spring loaded flap type. The sliding doors are -
preferred more because no air currents are generated from them. All fittings in
O.R should be flush type and made of steel Applicable but there are 2 doors are
.impaired which are for room 1 and 5

:The surface and the flooring -2

It must be slip resistant, strong and impervious with minimum joints. It -

.applicable just in room 6 and 7

:The walls -3

The walls of the operation room should be covered by either laminated -

polyester or smooth paint that provides seamless wall, because the tiles can
break and epoxy paint can chip out. The collusion corners of the walls must be
covered with steel or aluminum plates, and the color of paint should allow
reflection of light and yet soothing to eyes. The light color can include either
light blue or green, a washable paint will be ideal. A semi-matt wall surface
reflects less light than a highly gloss finish and is less tiring to the eyes. Not
applicable but the wall hasn’t effect on the light or vison which good for vison
.and can be clean and disinfected it easily and in a better way

:The operation table -4

There should be one operation table for each operation room. Applicable and -
each room as a specific table to fit with the operations that done in it such as
.table in room 1

:The electric point -5

There should be adequate electric points on the walls of a height of 1.5m of -
.the floors. Applicable

:The x-ray illuminators -6

There should be x-ray film illuminators preferably recessed into the wall. -
.Applicable there are 3 portable X-Ray in the Department

:The scrub area -7

It should be planned to fit at least 2-3 persons in each operation room. Not
Applicable for all rooms because room 2 and 3 have conjoint scrubbing area
and room 6and7 also the same.

8- The ventilation of O.R:

The ventilation of O.R should be on the principle that the direction of air
flow is from the operation theatre (room) to the main entrance .There should
be no interchange air movement between one O.R and another. Efficient
ventilation will control temperature and humidity in O.R it will lead to the
dilution of contamination caused by micro-organisms and anesthetic agents.
The recommendations for the ventilation include:

- The positive air pressure system in operation room, it should ensure a

positive pressure of 5cm H 2O from ceiling of O.R downwards and outwards to
push out air from operation room. Applicable but I can’t read a true pressure
through the system in the wall because it doesn’t work.

- The temperature should be between 20ºC-24ºC. The temperature should

not be adjusted for the comfort of O.R personnel but for the requirement of the
patient, especially in pediatric, geriatric, burns, and neonatal cases. Applicable
but sometimes they need to decrease Temp for 17oC as Operation needs such
as in open-heart surgeries. And it also doesn’t work in room 1 which is has a
high temp more than 24 oC.

:The lightening -9
The general lighting: Color corrected fluorescent lamps it should be either
recessed or surface ceiling mounted; to produce even illumination of at least
500 Lox at working height and with minimal glare are preferred. The means of
dimming may be needed during endoscopies, to minimize eyes fatigue and
weakness. Applicable.

10- Other parts:

- There should be other separated corridors for the staff to use other than
going into an operation room. Not applicable because there is only one
corridor for all.

- There should be a preparation room in clean zone. Not applicable because

the pts came from their departments, so they prepared in it.

- The corridors of the operation room should have an adequate width for
movement. Applicable but not applicable in the corridor that arrived to room
6and 7 which is narrow.

- The oxygen, gas and the suction should be connected with central facility.
Applicable and also has a cylinder of O2.

- It should include a proper drainage system. Applicable.

- It should include safety while working in O.R. Applicable.

Operation Room Case:
Name: H.A Age: 24yrs Wt.: 74 Kg Sex: female.
Medical DX: Bilateral Lung Mass. Type of surgery: elective.
Name of surgery: Bilateral uniporter VATs for Mass excision.
Surgery duration: 1hr and 40 mins, (10:30am – 12:10md), Induction Time at
10:30am, time of incision at 10:49am, Closure Time at 12 md, recovery Time at
12:10 md .
Type of anesthesia: GA
Position: 1st on was Lt lateral position then Rt lateral position.
Date: 29th of Oct.2017 Room Number: #7
 Pre-op
Patient instructed to fast at the midnight before Operation to avoid risk of
aspiration, pre-0p check list and all forms are documented, and all history are
taken specially NO ALLERGY.

V/S Pre-Operation: BP 103/53mmHg, Sat 100%, Temp 37 oC, Hr 74bpm.

Drugs for Induction:

Dormicom 1.5 mg anxiolytic agent
Propofol 200 mg Hypnotic
Fentanyl 300mg Analgesia
Esmeron 50mg Muscle relaxant
Pramine 10mg Ratadine 50mg.
Antibiotics: Cefazoline 1g IV pre-op and 1 g IV Intra-op.

Pt put during induction on 4L of O2 , took 1000ml of N/S 0.9% and 500ml

R/L during Op, connected with ventilator by DLT (double lumen endotracheal
tube) size 35 on CMV mode, Has Arterial line on Lt radial artery, has cannula at
the Rt arm For Medications and once in the Lt foot for IVF.

Disinfect Pt. By Scrub soap at the site of incision (Chest and Abdomen) as
Dr. recommended because as his knowledge Bouldin can’t kill fungus and scrub
soap can do it.

 V/S Intra-Operation: BP(AL) 92/51mmHg, Sat 100%, HR 74 bpm,

RR15b/min, Temp Didn’t measure.
 Post Op:
BP 104/53mmHg, Sat 99%, HR 88 bpm, Temp 36.8oC.
Urine Out Put 140ml , Pt transferred to Adult Open Heart By bilateral water
chest tube.

The role of circulate& scrub nurse

o Scrub nurse

1- Scrub hands and arms then put on sterile gown and gloves.
2- Check all the instruments to be used in the surgery, such as: suture,
instrument, & bowels set.
3- Draped the instrument table.
4- Collected the instrument trays, suture, needle, blades & other necessary
sterile equipment from the circulator nurse.
5- Observe the septic technique for possible break from team member.
6- Maintain sterility of the environment.
7- Have knowledge of anatomy and physiology.
8- Give equipment to the surgeon.
9- Observed the surgical field, tried to keep it from unnecessary instrument.
10- Prepared the suture and left unopened until they are required.
11- Assist in focusing of light.
12- Disposed all knife blades and needles in puncture resistant container.
13- Removed the instrument from the stand table.
14- Ensured that the area around the dressing, the sheet, and the pts gown are
dry and clean.
15- Assist Covered the pt with clean sheet.
16- Count with the circulating nurse all equipment, pads and gauze.
17- Helped to transfer the pt from the operating table to the Bed.
18- Took off the gown & then the gloves (helps in cleaning room after op).
 o Circulating Nurse

1- Receives and identifies pt. from receiving area.

2- Introduces her/his self to the pt.
3- Checks for available X-Ray, Blood, consent form and other important thing
in check list.
4- Helps in transferring patient to O.R. table and safety of him.
5- Prepare surgery room and check the equipment and lights.
6- Ensure temp and humidity control correctly set.
7- Assisting and preparing the procedure.
9- Help on positioning the pt for surgery
10- Assist the scrub nurse during surgery if need any equipment.
11- Maintaining accurate documentation of nursing activities during the
procedure.
12- Dispensing supplies and medication to the surgical field.
13- Maintaining an aseptic and safe environment.
14- Estimating fluid and blood lose.
15- Safety of pt when using electrical equipment like; drill and proper way of
using electrical surgical unit & take special care of power cables.
17- Take care of drains.
18- Receives and labels all specimens.
19- Assist with count & record before the end of the operation.
20- To be available for the request of scrub team.
21- Helps in transferring pt to recover.

Safety precaution that we carried out when the patient admitted

to surgery
- Safety precaution for staff: All team in operating room wear gloves, gown,
head cover, mask, and all protective devices to prevent infection to pt and
themselves.
1- Consent form and anaesthesia form were signed by pt as protection to team.
2- Check list to make sure that all the necessary pre-operative routine was done.
3- Check pt name to confirm that correct pt admitted to correct surgery.
4- Explain the surgery to the patient.
5- Surgical team should be free of any infection (upper respiratory infections,
dermatitis, any unhealed wound, infection of the mouth or eyes).
6- Temperature should be within human body temp. to prevent
hypo/hyperthermia but in open heart surgeries we need to decrease room temp.
Humidity should also be appropriate 50%-60%.
7- Operation room should be close ventilator system, no window to control
infections.
8- Side rails of the trolley and the breaks should be closed when transferring the
pt to OR table.
9- During the surgery, the team reduces their talking and movement to help the
surgeon to keep concentrate.
10- Place the electrical safety.
11- Check all equipment that surgeon may use in the surgery such as suction
and coterie to prevent any potential hazards.

Potential Hazard:
1. Risk for Infection because any opening in the body has a high risk to
infected and this risk increased by continuous opening of room’s door by
other staff team.
2. Risk for Aspiration related to Anesthesia and Intubation.
3. Risk for Pneumothorax or Hemothorax related to surgery site.
4. Risk for Bleeding.
5. Risk for burning from cautery if pt. was wear clothes.
6. Risk for Hypoxia if occurred sudden decreasing in saturation and may
related to closed in airway or obstruction in DLT related to Lateral
position.
7. Risk for puncture wounds and needle sticks, cuts.
8. Risk for forget instrument inside pt such as gauze or forget sharp
instruments behind pt.
9. Risk for falling.
10.Risk for respiratory alkalosis or acidosis related to mechanical ventilator.
11.Risk for uncontrolled lung injury.
Nursing Aim to preventing these potential hazards:
1. Scrubbing operational site well, applicate all infection controlled process
and the last one prevents any other team members from opening the
room’s door during surgery.
2. Ensure that patient is NPO from last 12md, do intubation perfectly but
this is a Dr. responsibility not for nurses.
3. Ensure with dr. that there’s no any sign of bleeding intra-chest before
closing operation site which is to avoid Hemothorax but for
Pneumothorax they should ensure that both lungs are closed well after
lobectomy by tell Anesthesia Dr to fill the lung for 30% of pressure to see
if there’s any leakage then ensure that Chest tube are patent correctly and
operation sites are closed well.
4. The nurse should check the cross match and blood bank before entering
pt to operation, which this is helps in control bleeding of occurs.
5. Ensure that pt doesn’t wear anything and we put the pad that used on
cautery machine on pt’s leg.
6. Continuous monitoring for Ventilator and ensure that there is no
obstruction in DLT or in airway in general.
7. The nurse should remove all sharp instruments that didn’t need from
working site.
8. They should calculate all instruments specially goes before and after
surgery to ensure that no one is missed in pt.
9. Support pt’s position well to avoid risk of falling.
10.Check ABG’s continuously as recommended.
11.Uncontrolled lungs injury this a dr. responsibility which should avoid
using of sharp instruments near the lung and he can altered it by cautery.

My reflections and Summery

At the first, this is a new trial for me! Especially when I see CABG and the
case that mentioned above. This was a very interesting. OR training give me a
chance to see body organs such as Heart, lungs, diaphragm and liver. For future
care, I don’t think so that I can’t work well in this department because there are
many type on instruments and equipment and each one has a name! and I
trained in this department only for 4 days and this is not enough to save these
names, nursing roles for each one circulates, scrub, recovery supervisor and
female and male duties which is differ than each other.
At the end, this as good and different experience. Team was very helpful,
and they explained everything for us. In this ward you can learn physical
anatomy very well, but your duties are completely different than other nurse
duties that worked in other departments and this may lead to forget your critical
knowledge if you worked in this department for a long period.