UNIVERSITY OF BOHOL

0186 Dr. Cecilio Putong Street

Tagbilaran City,Bohol,Philippines
Tel. Nos.(038)411-3484,Fax no.(038)411-3110
www.universityofbohol.com

COLLEGE OF NURSING
EVALUATION TOOL FOR RETURN DEMONSTRATION
IN THE OPERATING ROOM
(v.2020)

Name: _________________________________________Year/Section: ________ Gen Ave.: _________

Date of Return Demonstration: ___________________________________

0 1 2
I. PREPARATION PHASE OF THE OPERATION
1. Wearing the complete OR attire and with clean hands, the nurse then opens the outer
wrapper of both lap pack and instrument pack using bare hands, making sure not to cross
over the sterile packs

The second wrapper of both packs are then opened using sterile picking forceps making
2. sure that the wrappers completely cover the area of the table in between both packs.

All other necessary accessories are added to the preparation table with the use of sterile
3. picking forceps. These are gloves, scalpel, blades, sutures, needles, suction tubing.

The scissors, mayo straight, mayo curve and metzenbaum are also prepared. They are
4. soaked in cidex solution before the operation. The bandage scissors is added for
caesarean section operation. They are rinsed with NSS before they are added to the
preparation table.

II. PROCEDURE FOR COMPLETE SCRUB

Start with initial hand washing, rinse hands and arms.
1.
Using a a few drops of betadine on hand, start alternate scrubbing fingertips of each hand
2. in circular motion using the small bristle of the brush.

Proceed to alternate scrubbing of fingers and in between fingers of each hand.

3.
4. Proceed to alternate scrubbing of the palm of each hand, knuckles, then back of the palm.

Proceed to alternate scrubbing of arms and forearms using circular strokes.

5.
Rinse hands and arms. Start from fingertips going to arms then to forearms. If another
6. rinsing is necessary always start with fingertips going upward.

During the entire scrubbing of arms and forearms using circular strokes.
7.

III. DRYING THE HANDS

1. Reach down onto the sterile pack and pick up the towel. Take care that water does not drip
onto the contents of the pack.

Open the towel out full length. Be careful not to touch the towel to the non-sterile scrub
2. dress.

Dry both hands and arms alternately with one hand and arm using one end of the towel;
3. use the opposite end of the towel for the other hand and arm.
Note: If no available sterile towels use the sterile gown in drying. Appropriate handling of
gown is necessary.

Start drying hand going up towards the arm. Use oscillating motion in drying arms. Once
4. one end of the towel has been used in drying the arms it should not be used to dry hands
again.

After both hands and arms are dried, discard towel by dropping it into the plastic pail
5. keeping hands higher than the elbow.
IV. GOWNING

1. Reach down onto the sterile pack and lift the gown directly upward, avoiding the edge of
the wrapper.

Step far enough away from the non-sterile objects while dressing to give a wide margin of
safety.
2.
Holding the neckband with both hands, gently shake the folds from the gown.
3.
Slip the hands into the armholes, holding on a level with the shoulders.
4.

V. GLOVING
With the left hand grasp the cuff on the right glove on the fold. Pick up the glove and step
1. back from table.

Insert the right hand into the glove and draw it on, leaving the cuff turned well down over
2. the hand.

Slip the fingers of the right hand under the turned back cuffed off the left glove, pick it up
3. and step back.

Insert the left hand into the left glove and pull it on, leaving the cuff turned well down over
4. the hand.

5. With the fingers of the right hand pull the cuff of the left glove over the cuff of the left sleeve.
Avoid touching the gloved fingers to the bare wrist.

6. Repeat for the right cuff.

Note: Left glove may be put on first. The point is to make it

consistent.
Right use of Closed Gloving Technique.

VI. PREPARATION FOR THE MAYO TABLE

The closed end of the mayo cover is folded towards the flap of the open end of the mayo
1. cover. Using the Thumbs and index fingers, insert the remaining 6 fingers under the folded
flap.

With the hands protected under the flap, the mayo cover is inserted into the mayo table,
2. while one foot of the nurse is placed on the base of the mayo stand to stabilize it. Insert the
mayo cover slowly, one side at a time to avoid becoming unsterile.

A sterile green towel is lined on the mayo cover to complete the sterility of the table.
3.
Carry as many instruments as possible from the preparation to the mayo table making sure
4. that the ovum forceps used to gather the instruments is locked. In placing the instruments
on the table, handles are directed toward the head of the patient as point of reference.

VII. ARRANGEMENT OF THE INSTRUMENTS IN MAYO TABLE I

1. From the preparation table, the instrument nurse lifts the instruments to the mayo table.
Place the handles of the forceps at the edge of the table with the Kelly straight forceps
toward the scrub nurse and the towel clamps away from her.

2. The head of the ovum/allis forceps are exposed and the towel clamp is released from the
head of the ovum/allis forceps. The towel clamp is piled with the rest of the towel clamps
and the ovum/allis forceps is returned to the preparation table.

3. The scissors are arranged in this order: from left to right of the scrub nurse: straight, curve,
Metzenbaum, bandage scissors (c/s). The handles are away from the scrub nurse and are
placed near the end tip of the Kelly forceps.

4. The tissue forceps are arranged in the same manner as the scissors and are placed near
the end tip of the allis forceps and towel clamps.
 5. The skin retractor is placed beside the tissue forceps. The UPs are placed next to the towel
clamps. Divide the total number of UPs into 2 to avoid dropping and position the UPs next
to the towel clamps and tissue forceps.

6. Attach the scalpel blade to the scalpel holder. Position the scalpel blade and holder in such
a way that the number of the blade and the scalpel holder are visible to the scrub nurse.
The needle holder is used to attach blade to holder. Grasp the blade with the needle holder
at its widest, strongest part with the sharp edge away from the nurse and slip the blade into
the groove on the scalpel holder. For scalpel holder #3, use blade # 19 and below. For
scalpel holder #4, use blade #20 and above.

7. To remove the scalpel blade from holder: hold it down and away from eyes of the scrub
nurse, grasp the blade at its base with a needle holder and slip the blade from its holder.
8. Open the wrapper of the ties and place it under the suture towel, exposing one end. The
other end is then tucked in under the suture towel.

VIII. ARRANGEMENT OF MAYO TABLE II

1. Sutures are prepared and then arranged by layers in the towel. The suture for the
innermost layer is placed on the topmost fold. Always start with suture that will be used first.

2. Open the wrapper of the ties and place it under the suture towel, exposing one end. The
other end is then tucked in under the suture towel.

3. Place the big retractors (Deaver, army-navy, mayo Collins, Richardson and ribbon)
horizontally with its handles directed toward the head of the patient. These are placed on
the middle of the table.

4. Place the suture towel with its prepared sutures and needles on the outer corner of the
table, on the side where the suture nurse stands.
5. The needle holders are placed on top of the suture towel, its handle directed towards the
head of patient.
6. Right across the suture towel are the kidney basins. Place it in such a way that it utilizes a
minimum space as possible to give space to additional instruments and supplies needed
intraoperatively.
7. The AP is placed on the kidney basin.

IX. DRAPING
1. From the longitudinal length of the sterile green towel, it is folded one-third away from the
sterile nurse.
2. The sterile green towels are alternately placed to line the operative site starting from the
lower part, followed by the upper part and then to each of the sides.

3. Four towel clamps are used to anchor the initial drapes and are placed properly. Lift the
clamps before locking to avoid injury to the patient’s skin.
4. Place the laparotomy sheet on the operative site with the opening directly over the skin.
The thick fold is towards the foot, while the thin fold is directed towards the head part.
5. Drop the folds over the sides of the table.

6. While the thick fold is supported by one hand, the thin fold is opened, draping the head part
of the patient over the anesthetic screen.

7. The same is done when draping the foot part of the patient.

8. From the longitudinal length of two sterile green towels, which are folded once, place
directly on top of the opening of the lap sheet one towel on top of the other.
9. After draping, the suction tubing and cautery cord are anchored onto the grapes using a
towel clamp. The end part of the tubing and cautery cord are dropped for the Circulating
nurse to facilitate attachment to equipment.

X. GOWNING AND GLOVING OF SURGEON BY THE SCRUB NURSE

1. Open the hand towel and lay it on the surgeon’s hand.

2. Shake out the folds of the gown, holding it on the neck area.

3. Keep the hands on the outside of the gown, under a protective cuff made by the neck area.
Offer the inside of the gown to the surgeon.
 4. Grasp the right glove firmly with the fingers under the turned back cuff. Hold the palm of the
glove toward the surgeon. Stretch the cuff sufficiently and avoid touching surgeon’s hand
by holding thumbs out.

5. Repeat procedure for the left hand.

XI ASSISTING DURING AN OPERATIVE CASE

INSTRUMENT NURSE

1. Once the tables are set, drag the Mayo tables towards the OR table. Take note that the
instrument nurse stays at the right side of the surgeon, while the Scrub nurse stands at the
left side of the Assisting surgeon.

2. Place the cautery tip onto the cautery pen.

3. Before the start of the operation, check the Surgical Safety Checklist of the WHO.

4. When serving the knife, the instrument nurse sees to it that the sharp edge is away from
her gloved hands. An unclamped UP is served together with the knife. Return knife to the
Mayo Table to avoid injuries.

5. In serving the skin retractor, hold one end and serve the other end to the surgeon.

6. In serving an instrument, hold on to the tip of the instrument with the handle directed
towards the palm of the surgeon’s awaiting hand.

7. Always serve instruments in a manner that the surgeon can immediately use the instrument
with ease.

8. Once the peritoneum is about to be cut open, clamp the free end of the UP with a Kelly
straight forceps.

9. In making a sponge stick, roll the folded UP and clamp using an Allis forceps. Serve the
handle.

10. Another technique is to roll the folded UP and fold crosswise. Clap with an Allis forceps.

11. Soiled sponges are taken from the field and discarded into the pail, keeping the hands at
table level.

12. For Ups on site, transfer the Kelly straight to the soiled end part of the UP and offer the
clean end.

13. Once the peritoneum is open, always serve clamped sponges.

14. Forceps and other instruments not being used at the moment in the operative field should
be returned to its place. Always lock forceps before returning them to the pile. Return them
the same ways it was arranged. Keep the mayo table neat.

15. In serving the Tissue forceps, hold by pressing the tip portion and serve the handle pointing
upward.

16. Before closing the peritoneum, initial counting of instruments, needles/ and sponges are
done. In counting name, the instruments first then count twice and total the instruments.

17. Dropped UPs are counted one by one and are added to the total no. of Ups on the table.

18. Final counting of instruments sponges and needs/ATRs is done by naming the instruments
only once using the same method above.

19. The scrub nurse prepares the top dressing.

20, After care is done when operation procedure has ended.

SUTURE NURSE
1. The suture nurse prepares sponges for the peritoneum. The whole length of the UP is
unfolded. One end is folded once crosswise and once lengthwise, then clamped
 longitudinally with Kelly straight forceps. Make two of this and place them on the first table
near the handles of tissue forceps.

2. Prepare the AP. Its end has a tie which is made into a loop. An allis forceps is inserted and
wound into this loop, and then its tip is clamped to the corner of the AP. The clamped AP is
then placed on top of the big retractors.

3.. Serve retractors offering the handle or one end to the surgeon.

4. In handling ties, pull one strand. Hold both ends outstretched and offer to the surgeon. For
double tie, pull 2 strands and serve in the same method.

5. When serving ties, always follow it with Mayo Scissors.

6. When serving a stick tie, clamp the tip with a Kelly curve and offer the handle of the forceps
to the surgeon.

7. When serving the AP, the Circulating nurse pours warm NSS to the kidney basin, making
sure to maintain sterility. Always check the temperature of the NSS using your gloved
fingers. Immerse the AP and squeeze out the solution before serving to the surgeon.

8. Before serving the NSS for intraoperative washing, be sure to check the temperature of the
NSS before serving.

9. When serving needles/ATR, open the ATR pack following the arrow/broken line of the
pack, exposing the needle. Pick up the needle using a needle holder by clamping 2/3s of
the needle.

10. For Left-handed surgeons, pick up the needle with the sharp edge pointing downwards.

11, Make sure that unused ATRs are positioned on the suture towels with sharp ends pointing
downwards.

12. When serving ATRs, always serve the handle of the needle holder to the awaiting hand of
the surgeon making sure that the sharp edge of the ATR/need is pointing away from the
nurse. Hold the other end of the suture while the surgeon performs the suturing.

13. When serving the Cherry balls, clamp it longitudinally using a Kelly clamp.

14. Soiled cherry balls are not discarded into the pail but are placed on the side of the kidney
basin.