MEDICAL- SURGICAL NURSING

PERIOPERATIVE NURSING
- “Plasty, oorhaphy, pexy”

 Nursing specialty that takes care surgery 1.4 Reconstructive

 Nursing care provided in total experience.
- To restore the function of
3 PHASES traumatized/ malfunctioned tissue.

1. Pre-operative Phase 1.5. Palliative

- From the time the decision is made for
surgical intervention until the transfer of - To relieve distressing sign and
the patient to the operating table. symptoms, but not necessarily to
2. Intra-operative Phase cure the disease.
- From the time the patient is received in - (Colostomy)
the OR until admitted to the post 1.6. Cosmetic
anesthesia unit.
3. Post-operative Phase - To improve physical features
- Begins from the time of admission to within normal range.
the PACU and ends when healing is - (Breast augmentation)
complete.

INDICATION OF SURGERY
2. URGENCY
- To remove, repair
- To make diagnosis/ confirmation 2.1 Emergency
- To treat organ/ disease tissue - Immediate attention without delay-
life threatening.
CLASSIFICATION OF SURGICAL - (Cesarean delivery, control
PROCEDURES BASED ON: hemorrhage, perforated ulcer,
intestinal obstruction, repair of
1. PURPOSE trauma, tracheostomy)

1.1. Diagnostic 2.2 Urgent

- These kinds of surgeries are done
to determine cause of illness and /
or make/ confirm a diagnosis.
- (Biopsy, papsmear)
1.2 Ablative/ Curative
- Patient requires prompt attention.
- 24-48 hrs.
- (removal of gall bladder,
amputation, colon resection,
coronary artery bypass)

- These kinds of surgeries are 2.3 Elective

performed to remove a diseased - Pre-planned
part or organ (removal of an organ - Can be schedule in advanced based
“ectomy”) on the client’s choice.
- (Gastrectomy, thyroidectomy, and - (Tonsillectomy, hernia repair,
appendectomy) cataract extraction, cesarean
1.3. Constructive delivery)

- To restore function in congenital 2.4. Optional

anomalies, cleft palate repair - Patient’s preference
(Palatoplasty), closure of atrial-
- (circumcision)
septal defect.

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4. TUMORS
3. DEGREE OF RISK
3.1. Major - Abnormal new growths
- Invasive - (Benign Prostatic Hyperplasia)
- Higher risk for infection
- Extensive
PRE-OPERATIVE PHASE
- Prolonged
- Large amount of blood loss
GOAL: To prepare the patient mentally and
- Vital organ may be handled or
physically
removed
- (Exploratory laparotomy) SURGICAL RISKS
3.2. Minor 1. Obesity
2. Poor nutrition
- Minimally invasive
3. Fluid and electrolyte imbalances
- Procedure without damaging 4. Age
extensive amounts of tissue. 5. Presence of disease
- (Incisions and drainage, breast 6. Concurrent or prior pharmacotherapy
biopsy, cataracts extraction)
Examples of Medications with the Potential to
Affect the Surgical Experience
4. EXTENT

4.1 Simple
- Mastectomy involves removing the 1. ANTIBIOTICS
breast along with an ellipse of skin. - May mask symptoms of infection.
2. ANTIARRHYTHMIC AGENTS
4.2. Radical - Depresses cardiac function and
affects tolerance to anesthesia
- Procedure which the entire breast is
removed. Example:

- Propanolol HCI
4 MAJOR TYPE OF PATHOLOGIC PROCESS
- Qunidine Gluconate
REQUIRING SURGICAL INTERVENTION
- Procainamide HCI
3. ANTIHYPERTENSIVE
- May cause intraoperative/ postoperative
1. OBSTRUCTION hypotensive crisis.
- Impairment to the flow of vital Example:
fluids (blood, urine, CSF)
- Hydrocephalus, cholelithiasis) - Methyldopa
- Aldomet
2. PERFORATION 4. CORTICOSTERIODS
- Delays wound healing
- Rupture of an organ
- (Ruptured Aneurysm) Example:
3. EROSION - Prednisone
- Dexamethasone
- Wearing off of a surface of
5. ANTICOAGULANTS
membrane
- Increase risk of Intra op/ post op
- (Burn)
hemorrhage.

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Example: NURSING DIAGNOSES

- Heparin Na 1, Anticipatory grieving r/t perceived loss of body

- Warfarin Na image
- Aspirin
2. Anxiety r/t fear of death
- NSAIDs
6. GALUCOMA MEDICATIONS 3. Ineffective airway clearance r/t surgery
- Pilocarpine HCI may cause respiratory
or cardiovascular collapse during 4. ineffective individual coping
surgery. 5. knowledge deficit r/t unfamiliar surgical
7. ANTIDIABETIC AGENTS experience
- Insulin needs decrease when client is on
NPO.
8. TRICYCLIC ANTIDEPRESSANTS (TCA) LEGAL ASPECT
- Amitriptyline (Elavil) lowers BP, thus
increasing risks of shock INFORMED CONSENT (Operative Permit)
9. THIAZIDE DIURETICS
- Furosemide (Lasix) can deplete K+ and - Process of informing the patient about
cause electrolyte imbalances the surgical procedure; that is, risks and
10. STREET DRUGS possible complication of surgery and
- Increase tolerance to narcotics, anesthesia.
requiring more anesthetic agents. - Consent is obtained by the surgeon and
the anesthesiologist to be witnessed by
Example: Cocaine, Heroin the nurse.

Purpose of the informed consent

TESTS RATIONALE  To ensure that the client understand
CBC RBC, HgB, Hct are the nature of the treatment
important to the oxygen including the potential
carrying capacity of blood.
complications and disfigurement.
WBC are indicator of
immune function.  To indicate that the client’s
BLOOD GROUPING/ X Determined in case blood decision was made without
MATCHING transfusion is required pressure.
during or after surgery  To protect the client against
SERUM ELECTROLYTE To evaluate fluid and unauthorized procedure.
electrolyte status
PT, PTT Measuring time required for Circumstances Requiring Consent
clotting to occur
 Any surgical procedure where
FASTING BLOOD High level may indicate
scalpel, scissors, suture, hemostats
GLUCOSE undiagnosed DM
of electrocoagulation may be used.
BUN/ CREATININE Evaluate renal function
ALT/ AST/LDH & Evaluate liver function  Entrance into body cavity
BILIRUBIN  Radiologic procedures, particularly
SERUM ALBUMIN AND Evaluate nutritional status if a contrast material is required.
TOTAL CHON
URINALYSIS Determine urine
composition  DBE (DEEP BREATHING EXERCISES
CHEST XRAY Evaluate resp. Status/ heart - Use of diaphragmatic- abdominal
size
breathing done 5-10 times in post
ECG Identify preexisting cardiac
operative period.
problem.
 COUGHING EXERCISES

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-Deep breathe exhale trough mouth then
follow with a short breath, while
coughing “splint” thoracic and
abdominal incision to minimize pain.
 TURNING OR REPOSITIONING
CLIENT
- Done every 1-2 hours post op to prevent
venous stasis and decubitus ulcers.
 AMBULATION
- If the patient is already able (no more
residual effects of anesthesia) & it is not
contraindicated early ambulation
prevents circulatory problems and
promotes early recovery.
PHYSICAL PREPARATION
ON THE NIGHT OF SURGERY
 Make sure that the name tag of the client is
in place
 Preparing the patient skin
- Shave against the grain of hair shaft to
insure close shave. Most of the time in
actual practice this is done before the
patient is transferred to OR.
 Preparing the GIT
- Patient is on NPO after midnight
- Administration of enema
 Promoting rest & sleep
- Use of drugs to promote sleep
a. Barbiturates – secobarbital sodium
(Seconal); pentobarbital sodium (Nembutal)
b. Non-Barbiturates – Chloral hydrate;
flurazepam (Dalmane)
*Given at least 4 hours before pre-op
medications is due.
ON THE DAY OF SRUGERY
Early Morning Care
(About 1 hour before the pre-op medication schedule)
 VS taken and recorded promptly
 Provide oral hygiene
 Remove jewelry and dentures
 Remove nail polish
 Make sure that the patient has not taken food
by asking the patient.
PRE-OPERATIVE MEDICATIONS
 Generally administered 60-90 minutes
before induction of anesthesia
 To allay anxiety
 To decrease the flow of pharyngeal
secretions
 To reduce the amount of anesthesia to be
given
 Create amnesia for the events that precede
surgery.
1. Sedatives
2. Tranquilizer- lowers a patient’s anxiety
3. Narcotic Analgesics – given to reduce anxiety and
to reduce the amount of narcotics given during
surgery (Morphine Sulfate)
4. Vagolytic or drying Agents – to reduce the amount
of tracheobronchial secretions which may clog the
pulmonary alveoli and may produce atelectasis (lung
collapse) (atropine sulfate)
IMPORTANT NOTE:
Nursing Intervention after giving pre-op meds
immediately raise the side rails of the bed for
patient’s safety.
RECORDING
- All final preparation and emotional
response before surgery are noted down.
TRANSPORTATION TO OR
- Make sure that the name tag of the
client is in place. While transferring the
patient on the stretcher make sure that
the side rails are up.
INTRA-OPERATIVE PHASE
Begins from the reception of the patient to the OR to
the the transfer of the client to the PACU or RR.
GOAL: maintain client safety
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 Passes instruments to the surgeon and

SURGICAL TEAM
SURGEON
 Primary responsible for the preoperative
CIRCULATING NURSE
medical history and physical assessment
 Performance of the operative procedure
according to the needs of the patients
 The Primary decision maker regarding
surgical; technique to use during the
procedure.
 May assist with positioning and prepping the
patient or may delegate this task to other
members of the team.
FIRST ASSITANT OF THE SURGEON
 A surgical first assistant, also referred to as a
surgical assistant or simply a first assist,
anticipates the needs of the surgical team
and during an operation, assist the surgeon
with tasks such as selecting equipment,
holding open incisions, stopping bleeding,
closing the incision, among many other
technical tasks.
assistants by anticipating their need.
 Counts sponges, needles, and instruments.
 Monitor practices of aseptic technique in
self and others.
 Must be a registered nurse who, after
additional education and training,
specialized in perioperative nursing practice.
 Responsible and accountable for all
activities occurring during a surgical
procedure including the management of
personnel equipment, supplies and the
environment during a surgical procedure.
 Patient advocate, teacher, research
consumer, leader and a role model.
 May be responsible for monitoring the
patient during local procedures if a second
perioperative nurse is not available.
SURGICAL INCISION SITE

ANESTHESIOLOGIST

 Select the anesthesia, administers it,

intubates the client, if necessary, manages
technical; problems related to the
administration of anesthetic agents, and
supervises the client’s condition throughout
the surgical procedure.
 A physician who specializes in the
administration and monitoring of anesthesia
while maintaining the overall well-being of
the patient. POSITION DURING SURGERY
THE SCRUB NURSE

 May be either a nurse or a surgical

technician
 Reviews anatomy, physiology and the
surgical procedures.
 Assists with the preparation of the room.
 Scrubs, gowns and gloves self and other
members of the surgical team.
 Prepares the instrument table and organizes
sterile equipment for functional use.
 Assists with the draping procedure

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1. SUPINE OR DORSAL RECUMBENT SURGICAL ATTIRE

- Abdominal, extremity, vascular, chest, neck, facial,
ear, breast surgery
2. PRONE POSITION
- Surgeries involving posterior surface of the body
- spine, neck, buttocks and lower extremities.
 Unrestricted Zone – street clothes are
allowed
 Semi restricted Zone – attire consist of
scrub clothes and caps
 Restricted Zone – scrub clothes, shoe
cover, caps, and masks are worn.

3. TRENDELENBURG POSITION Principles of Surgical Asepsis and Sterile

Technique
- lower abdomen, pelvic organ when there is a need
to tilt abdominal viscera away from the pelvic area. Surgical Asepsis
4. REVERSE TRENDELENDBURG POSITION - Prevents contamination of surgical
- upper abdominal, head, neck, and facial surgery. wounds.

5. LITHOTOMY Sterile Technique

- perineal, vaginal, rectal surgeries, combined - The area is free of living

abdominal vaginal procedure. microorganisms.

6. MODIFIED FOWLER (SITTING POSITION)

TYPES OF ANESTHESIA AND SEDATION
- otorhinology (ear and nose), neurosurgery

7. JACK-KNIFE POSITION GENERAL ANESTHESIA

- Rectal procedure, sigmoidoscopy and colonoscopy. - Anesthesia is a state of narcosis,

ADDITIONAL INFORMATION FROM BOOK:
NURSING MANAGEMENT FOR OLDER
SURGICAL PATIENT
 Application of intraoperative warming
techniques to reduce unintentional
hypothermia.
 Careful transfer and positioning on the OR
bed. Protect pressure points and bony
prominences with extra padding. Support the
back and neck to prevent stiffness while
maintaining respiratory and circulatory
support
 Use of antiembolic stockings or a sequential
compression device to prevent VTE
formation
 Careful fluid and electrolyte monitoring via
accurate blood loss measurement, urinary
output, and blood gases.
analgesia, relaxation, and reflex loss.
- Patient under GA are not arousable, not
even to painful stimuli.
- They lose the ability to maintain
ventilatory function and require
assistance in maintaining a patent
airway,
FOUR STAGES
Stage 1: Beginning Anesthesia
- Dizziness and a feeling of
detachment may be
experienced during induction.
- The patient may have a
ringing, roaring, or buzzing in
the ears and although still
conscious, may sense an
inability to move the
extremities easily.
Stage 2: Excitement
- Struggling, shouting, talking, singing,
laughing, or crying, is often avoided if IV

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anesthetic agents are given smoothly and
quickly.
- The pupils dilate, but they constrict if
exposed to light.
- The pulse rate is rapid
- Respirations may be irregular
Stage 3: Surgical Anesthesia
- Administration of anesthetic vapor or gas
and supported by IV agents, as necessary.
- The patient is unconscious and lies quietly
on the table.
- Pupils are small but constricts when
exposed to light.
- Respirations are regular, the pulse rate and
volume are normal, and the skin is pink or
slightly flushed.
Stage 4: Medullary Depression
- Too much anesthesia has been given.
- Respiration become shallow, the pulse is
weak and thready, and the pupils become
widely dilated and no longer constrict
when exposed to light.
INHALATION
- Inhaled anesthetic agents include volatile
liquid agents and gases. Volatile liquid
anesthetic agents produce anesthesia when
their vapors are inhaled.
- Given in combination with oxygen and
usually nitrous oxide as well.
MULTIMODAL ANESTHESIA
- Multimodal Analgesia regimens in
surgical patients often use a combination
of scheduled, nonopioid analgesic agents
and regional anesthesia techniques.
REGIONAL ANESTHESIA
- Injected around nerves so that the region
supplied by these nerves is anesthetized.
EPIDURAL ANESTHESIA
- Achieved by injecting a localanesthettic
agent into the epidural space that
surrounds the dura mater of the spinal
cord.
SPINAL ANESTHESIA
- An extensive conduction nerve block that
is produced when a local anesthetic agent
is introduced into the subarachnoid space
at the lumbar level, usually between
L4and L5.
- Produces anesthesia of the lower
extremities, perineum, and lower
abdomen.
MODERATE SEDATION
- Conscious sedation. Is a form of
anesthesia that involves the IV
administration of sedatives or analgesics
medications to reduce patient anxiety and
control pain during diagnostic or
therapeutic procedures.
- Commonly used for many short-term
surgical procedures in hospitals and
ambulatory care centers.
MONITORED ANESTHESIA CARE
- Also referred to as monitored sedation, is
monitored sedation given by an
anesthesiologist or CRNA who must be
prepared and qualified too convert to
general anesthesia if necessary.
LOCAL ANESTHESIA
- Injection of a solution containing the
anesthetic agent into the tissues at the
planned incision site.
- Often combined with a local regional
block by injecting around the nerves
immediately supplying the area.
Advantage:
 Simple, economical, and nonexplosive
 Equipment needed is minimal.
 Postoperative recovery is brief.
 Undesirable effects of GA are avoided.
 Ideal for short and minor surgical
procedures.
LOCAL ANESTHETIC SYSTEMIC TOXICITY
 Potentially life-threatening event.
 Occurs when bolus of LA is inadvertently
injected into peripheral tissue or venous or
arterial circulation during a PNB or spinal
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nerve block procedure and is rapidly Phase II PACU

absorbed into systemic circulation, resulting
in cardiovascular or neurologic collapse. - The patient is prepared for transfer to an
inpatient nursing unit, an extended care
Signs and Symptoms of LAST are: setting, or discharge.
- Recliners rather than stretchers or beds are
 Metallic taste standard.
 Oral numbness
 Auditory changes Admitting the Patient to the Postanesthesia Care
 Slurred speech Unit
 Arrhythmias
 The anesthesia provider remains at the head
 Seizure
of the stretcher (to maintain the airway).
 Respiratory arrest
 Surgical team member remains at the
opposite end.
 Transporting the patient involves special
POTENTIAL INTRAOPERATIVE consideration of the incision site, potential
COMPLICATIONS vascular changes, and exposure.
 The nurse who admits the patient to the
 Nausea and Vomiting
PACU reviews essential information with
 Anaphylaxis
the anesthesiologist or CRNA and the
 Hypoxia and other Respiratory
circulating nurse.
Complications
 Hypothermia Nursing Management in the Postanesthesia
Care Unit
POSTOPERATIVE NURSING MANAGEMENT - Provide care until the patient has recovered
from the effects of anesthesia.
The time the patient leaves the operating room (OR)
until the last follow-up visit with the surgeon.  Assessing the Patient
FOCUS: Reestablishing the patient’s physiologic  Maintaining a Patent Airway
equilibrium, alleviating pain, preventing  Maintaining Cardiovascular Stability
complications, and educating the patient about self-
care.
Hypotension and Shock

Hypotension can result from:

POSTANESTHESIA CARE UNIT (PACU)
 Blood loss (exceeds 500 ml)
 Located adjacent to the OR suite.
 Hypoventilation
 Patient still under anesthesia or recovering
from anesthesia are placed in this unit for  Position changes
easy access to experienced, highly skilled  Pooling of blood in the extremities
nurse, anesthesia providers, surgeons,  Side effects of medications and anesthetic
advanced hemodynamic and pulmonary Types of Shock
monitoring and support, special equipment,
and medications.  Hypovolemic
PHASES OF POSTANESTHESIA CARE - associated with hemorrhage from
the surgical site
Phase I PACU
SIGNS:
- Used during the immediate recovery phase,
intensive nursing care is provided. -pallor; cool, moist skin

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-rapid breathing  return the patient to the OR for ligation of

-cyanosis of the lips, gums, and
tongue
-rapid, weak, thready pulse
bleeding veins and arteries, hematoma
TYPES OF HEMORRHAGE
evacuation, or other necessary surgical
interventions top stop the bleeding.

-narrowing pulse pressure

-low blood pressure TIME FRAME

- concentrated urine Primary Hemorrhage occurs at the
 Cardiogenic time of the surgery
Intermediary Hemorrhage occurs during
 Neurogenic
the first few hours after
 Anaphylactic surgery when the rise of
 septic blood pressure to its normal
when the rise of blood
pressure to its normal level
HEMORRHAGE dislodges insecure clots
from nonanastomosed
 uncommon yet serious complication of vessels
surgery that can result in hypovolemic shock Secondary Hemorrhage may occur
and death. sometime after surgery if a
suture slips because a blood
Signs & Symptoms vessel was not securely
anastomosed, became
 hypotension infected, or was eroded by a
 rapid and thready pulse drainage tube.
 disorientation
 restlessness
TYPES OF VESSELS
 oliguria
 cold and pale skin Capillary Hemorrhage is
characterized by slow,
The early phase of shock will manifest: general ooze
Venous Darkly colored blood flows
 feelings of apprehension
quickly
 decreased cardiac output Arterial Blood is bright red and
 vascular resistance appears in spurts with each
 breathing becomes labored and “air hunger” heartbeat
will be exhibited
 feel cold (hypothermia)
 may experience tinnitus VISIBILITY
 laboratory values may show sharp drop in Evident Hemorrhage is on the
hemoglobin and hematocrit levels surface and can be seen
Concealed Hemorrhage is in a body
If bleeding is evident:
cavity and cannot be seen.
 sterile gauze pad and a pressure dressing is
applied *Notes from ppt
 the site of the bleeding is elevated to heart
level if possible
ASEPTIC TECHNIQUE
 the patient is placed in the shock position

Severe bleeding requires immediate action

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SCRUBBING, GOWNING AND GLOVING

 Proper aseptic techniques is one of the most 2. SEMI RESTRICTED AREA

fundamental and essential principles of
infection control in the clinical and surgical  Peripheral support areas within
settings theatre complex, includes corridors
leading to operating rooms, work
areas (storage) etc.
 Aseptic Techniques are those which:  All persons must wear scrub attire
which should be made of low
 Remove/reduce or kill microorganisms from
linting material that minimizes
hands and objects
bacterial shedding, comfortable,
 Employ sterile instruments and other sterile clean and provides a professional
items appearance

 Reduce patients’ risk of exposure to

microorganisms that cannot be removed
3. RESTRICTED AREA

 Includes operating rooms, scrub

 Aseptic technique also encompasses areas and ante-rooms
practices performed immediately before and
 Personnel must wear full surgical
during a surgical procedure to reduce
attire, hair coverings, masks where
postoperative infection:
open sterile supplies and scrubbed
 Hand washing persons are present

 Surgical Attire  Masks are worn to reduce the

dispersal of microbial droplets from
 Surgical scrub, sterile gowning & gloving the mouth and naso-pharynx of
 Patients surgical skin prep personnel – high filtered

 Using surgical barriers, including sterile  Masks must cover the mouth and
surgical drapes and PPE nose entirely, and be tied securely
to prevent venting
 Maintaining a Sterile Field
 Metal strip in the top hem of the
 Using safe operative technique masks produces a firm contoured
kit over the bridge of the nose
 Maintaining a safe environment in the OR

OPERATING ROOM COMPLEX DIVIDED INTO OPERATING ROOM ENVIRONMENT

3 AREAS CONTROL

The surgical suite should be

1. UNRESTRICTED AREA
designed in such a way as to
 Areas outside the theatre complex minimize and control the
including control point to monitor spread of infectious organisms
the entrance of patients, personnel,
SURGICAL ATTIRE
visitors, etc
 To provide effective
 Street clothes are permitted in the
barriers that prevent
area
the dissemination of
 Traffic is not limited microorganisms to
patients
 To protect personnel
from contamination
from blood and body
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 Proper attire is a part of
 MEDICAL- SURGICAL NURSING

SHOE COVER

 Unprotected street shoes can increase floor

contamination

 Shoes restricted to wear in the OR are

 Proper attire must be worn within the semi-
restricted and restricted areas of the OR suite
 Clean fresh attire is donned daily on arrival
to the OR and intermittently when necessary
if suit becomes wet or grossly soiled-source
of cross-contamination.
 OR attire should not be worn outdoors-this
protects the OR environment from
microorganisms inherent in the outdoor
environment and vice-versa.
 Before leaving the institution, everyone
should change to street clothes/uniforms
preferable in reducing microbial transfer
from the outside into the OR suite
 Shoe covers may be worn as needed to
protect from blood and body fluid
 Some surgeons wear plastic or rubber boots
during procedures wherein extensive fluid
irrigation and/or blood loss can be
anticipated
 Shoe covers can inadvertently become soiled
and harbor microorganisms and should be
removed before leaving the OR

 On occasion a cover gown may be worn

over OR attire outside the suite

 The practice of wearing cover gowns is Not

encouraged

HEAD CAP/COVER

 Hair is a gross contamination

ASEPTIC TECHNIQUE
 Cap or hood is put on before
the scrub suit to protect the  METHODS BY WHICH
garment from contamination by CONTAMINATION WITH
hair. MICROORGANISMS IS
PREVENTED (ALTERNATE TERM:
 All facial and head hair is ASEPTIC PRACTICE TO
completely covered in the semi MAINTAIN ASEPSIS).
restricted and restricted areas.
ASEPSIS
 Light weight caps/hoods made
of disposable, lint-free fabric

 Reusable caps should be

freshly laundered daily

 Skull caps do not cover the

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 MEDICAL- SURGICAL NURSING

 ABSENCE OF MICROORGANISM THAT SURGICAL OR STERILE ASEPSIS

CAUSE DISEASE, FREEDOM FROM
INFECTION.  Aims to eliminate microorganisms from a
given area.
STERILE

 FREE OF MICROORGANISMS.
INCLUDING ALL SPORES. FACTORS COULD INFLUENCE INFECTION
PROCESS
STERILISATION
 AGE
 THE PROCESS OF KILLING OR
INACTIVATING ALL  NUTRITIONAL STATUS
MICROORGANISMS.  DEBILITATING DISEASE
UNSTERILE  IMMUNO SUPPRESIVE DRUGS
 INANIMATE OBJECT THAT HAS NOT  PATIENT UNDERGOING SURGERY OR
BEEN SUBJECTED TO A INVASIVE PROCEDURES
STERILISATION PROCESS.
 NUMBER OF MICROORGANISMS
SURGICALLY CLEAN PRESENT
 MECHANICALLY CLEANED BUT NOT  VIRULANCE OF THE
STERILE. MICROORGANISMS PRESENT

PRINCIPLES OF ASEPSIS SURGICAL HANDWASHING

THE PROCESS OF REMOVING AS MANY

ORGANISMS AS POSSIBLE FROM THE HANDS
 ARE THE EFFORTS TAKEN TO KEEP
AND ARMS BY MECHANICAL WASHING AND
THE PATIENT AS FREE FROM
CHEMICAL ANTISEPTIC BEFORE
HOSPITAL MICROORGANISM AS
PARTICIPATING IN AN OPERATION.
POSSIBLE.

 IT IS A METHOD USED TO PREVENT

CONTAMINATION OF WOUNDS AND
OTHER SUSCEPTIBLE SITES BY
ORGANISMS THAT COULD CAUSE
INFECTION…
HOW??
 THROUGH ENSURING THAT ONLY
STERILE EQUIPMENTS AND FLUIDS
ARE USED DURING INVASIVE
MEDICAL/SURGICAL PROCEDURES.
PURPOSES OF HAND WASHING
 To remove soil, debris, natural skin oil, hand
lotions, and transient microorganisms from
the hands.
 To reduce number of resident
microorganisms on skin.
 To suppress the growth of the resident
microorganisms.

 To reduce the hazard of microbial

CATEGORIES OF ASEPSIS contamination of the operative wound by
skin flora.
MEDICAL OR CLEAN ASEPSIS  To reduce the risk of infection among other
health care workers.
 Aims to reduce the number of organisms and
prevent their spread.

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 To reduce the risk of transmission of  Chlorohexidine gluconate.

infectious organisms to yourself
 Iodophors.

 Triclosan.
PREPARATIONS BEFORE SCRUB
 Alcohol.

 Hexachlorophene.
 INSPECT HANDS FOR CUTS AND
ABRASIONS.

 REMOVE ALL FINGER JEWELRY. GOWNING AND GLOVING(CLOSED

METHOD)
 BE SURE ALL HAIR IS COVERED BY
HEADCAP.

 ADJUST THE MASK FIRMLY AND

COMFORTABLY OVER NOSE AND
MOUTH.

 CLEAN EYEGLASSES IF WORN.

 ADJUST WATER TO A COMFORTABLE

TEMPERATURE.

PASSING OF SURGICAL INSTRUMENTS

PART 1

PASSING OF SURGICAL INSTRUMENTS

DURATION OF HAND WASHING

 Surgical hand washing should not be less

than 3 minutes.
PART 2

AGENTS FOR ANTISEPSIS

 A broad-spectrum antimicrobial agent. PRINCIPLES OF ASEPSIS

 Fast-acting and effective.
 Nonirritating and nonsensitizing.
 Prolonged acting.
 All articles used for surgical procedures are
sterilized prior to surgery.
 Gowns are considered sterile only from
waist to shoulder level in front and sleeves.

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 Personnel who are sterile only touch sterile
articles; personnel who are not sterile only
touch unsterile items.
 Sterile touching sterile remaining sterile.
are either "self-retaining" (stay open on their
own) or "manual" (held by hand).  When
identifying retractors, look at the blade, not
the handle.

 Sterile touching unsterile contaminates all.

 Arms not to be folded under axillae.

 If in doubt about the sterility of any item,

consider it unsterile.

 Nonsterile personnel must avoid reaching

over a sterile field, sterile personnel must
avoid leaning over a sterile field.

 The area approximate 2.5cm around the • A DEAVER retractor (manual) is used to
edge of the sterile field is considered retract deep abdominal or chest incisions. 
unsterile. Available in various widths.

 Sterile personnel must be close to the sterile

area, unsterile personnel must be away from
the sterile area.

 Moisture may cause contamination.

 Pouring should be done at the edge of the

table.

 When passing in a sterile field, remember

sterile to sterile. • A RICHARSON retractor (manual) is used
to retract deep abdominal or chest incisions
 The sterile field must be kept insight all the
time.

 The gloved hands must be kept insight all

the time.

 Once in position, drapes are never moved or

shifted.

 Avoid coughing, sneezing or unnecessary • An ARMY-NAVY

talking over a sterile field. RETRACTOR(manual) is used to retract
shallow or superficial incisions.  Other
BASIC SURGICAL INSTRUMENTS names: USA, US Army.

• Basic instruments are essential to

accomplish most types of general surgery. 
Each instrument can be placed into one of
the four following basic categories:

Retracting and Occluding Instruments

• A GOULET (manual) is used to retract
 used to hold back or retract organs or tissue shallow or superficial incisions.
to gain exposure to the operative site.   They

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Cutting and Dissecting Instruments

• are sharp and are used to cut body tissue or

surgical supplies.

• A malleable or ribbon retractor (manual) is

used to retract deep wounds.  May be bent to
various shapes. 

Knife Handle, Scissors

(left to right)

• #7 handle with 15 blade (deep knife) -

• A Weitlaner retractor (self-retaining) is Used to cut deep, delicate tissue.
used to retract shallow incisions.
• #3 handle with 10 blade (inside knife) –
Used to cut superficial tissue.

• #4 handle with 20 blade (skin knife) -

Used to cut skin.

• A Gelpi retractor (self-retaining) is used to

retract shallow incisions. 

#7, #3, #4
(left to right)

• A Balfour with bladder blade (self- • Straight Mayo scissors - Used to cut suture
retaining) is used to retract wound edges and supplies.  Also known as: Suture
during deep abdominal procedures. scissors.

EX:  Straight Mayo scissors being used to

cut suture.

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• Curved Mayo scissors - Used to cut heavy
tissue (fascia, muscle, uterus, breast). 
Available in regular and long sizes.
• METZENBAUM SCISSORS- Used to cut
delicate tissue.  Available in regular and
long sizes.
Clamping and Occluding Instruments
 HEMOSTATS are used to compress blood
vessels or hollow organs for hemostasis or to
prevent spillage of contents.
• A MOSQUITO is used to clamp small
blood vessels.  Its jaws may be straight or
curved.
hemostat, mosquito (left to right)
• A KELLY is used to clamp larger vessels
and tissue.   Available in short and long
sizes. 
• Other names: Rochester Pean.
Kelly, hemostat, mosquito (left to right)
• A BURLISHER is used to clamp deep
blood vessels.   Burlishers have two closed
finger rings.  Burlishers with an open finger
ring are called tonsil hemostats.
• Other names: Schnidt tonsil forcep, Adson
forcep.
A hemoclip applier with hemoclips applies metal
clips onto blood vessels and ducts which will remain
occluded
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be straight or curved.  Other names:

Ochsner.

hemoclip applier with hemoclips

• A Foerster sponge stick is used to grasp

Grasping and Holding Instruments sponges.  Other names: sponge forcep.
• are used to hold tissue, drapes or sponges.

Foerster sponge stick

• An ALLIS is used to grasp tissue. 
Available in short and long sizes.  A "Judd-
Allis" holds intestinal tissue; a "heavy allis"
holds breast tissue.

EX:  Sponge sticks holding a 4 X 4 And

probang.

• A dissector is used to hold a peanut.

A Babcock is used to grasp delicate tissue
(intestine, fallopian tube, ovary).  Available
in short and long sizes.

dissector

• A Kocher is used to grasp heavy tissue.  

May also be used as a clamp.  The jaws may

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EX:  Dissector holding a peanut

• A Backhaus towel clip is used to hold

towels and drapes in place.  Other name: • Russian tissue forceps are used to grasp
towel clip. tissue.

• Adson pick ups are either smooth: used to

grasp delicate tissue; or with teeth: used to
grasp the skin.  Other names: Dura forceps.

Backhaus towel clip

• Long smooth pick-ups are called dressing

forceps.   Short smooth pick-ups are used to
grasp delicate tissue.

Large & small towel clips

• Pick ups, thumb forceps and tissue • DeBakey forceps are used to grasp delicate
forceps are available in various lengths, tissue, particularly in cardiovascular surgery.
with or without teeth, and smooth or serrated
jaws.

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• Thumb forceps are used to grasp tough

tissue (fascia, breast).   Forceps may either
have many teeth or a single tooth.    Single
tooth forceps are also called "rat tooth
forceps."

single tooth forceps,  many teeth forceps

(top to bottom)

• Mayo-Hegar needle holders are used to

hold needles when suturing.  They may also
be placed in the sewing category.

short, medium & long

(top to bottom)

EX: Needle holder with suture

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