PREPARING ROOM FOR MAJOR SURGERY

Definition: The assembling and setting up of all articles and equipment in the operating suite in preparation
for a major operation.

Purposes:
1. To provide a sterile field for the operation.
2. To ensure sterility of all articles that are used in the operating field and related procedures.
3. To ensure optimum safety for the surgical patient.

Equipment:

I.
Furniture and Equipment
Gown pack table Arm board
Lap pack towel IV poles
Mayo or instrument table Arm straps (Optional)
Basin stand Patient Monitor
2 sitting stools Stethoscope
2 bucket stands Suction apparatus
Footstools Operating table
Anesthesia Machine Electrocautery machine

II. Special Equipment and Supplies for General Anesthesia

Anesthesia Machine and its Accessories: Magil forceps

➢ Rebreather bag
➢ Corrugated tubing Sterile hypo-tray containing:
➢ Endotracheal tubes (different sizes) ➢ 1 pc. 10 cc syringe
➢ Nasotracheal tubes (different sizes) ➢ 1 pc. 5 cc syringe
➢ Bite blocks/airways (different sizes) ➢ 2 pcs. withdrawal needle

Wire guide KY jelly as lubricant

Laryngoscope handle/ 1 pc. clean 10 cc plastic disposable syringe
laryngoscope blocks 1 full oxygen tank (color coded green)
Stethoscope 1 full nitrous oxide tank (color coded blue)
Video Laryngoscope Bougie

III. Basic Sterile Packs

Lap pack (laparotomy linen pack) Additional sterile circulating packs:

Gown pack ➢ Poole drain tubing
Gloves ➢ Electrocautery
Basic instrument set ➢ Big retractors/2 big Richardsons and 2 small
Basin set richardsons
Major prep set ➢ 5 Abdominal squares
Spinal set ➢ 5 Sponges

NOTE: For Ortho set surgery – 3 strips

Lap packs – 3

IV. Special packs – as needed depending on the type of surgery and to a certain extent what the surgeon
prefer.
 STEPS KEY POINTS, PRECAUTIONS,

Important: OR Circulator nurse must be in ➢ Persons suffering from cough, cold or with
her/his proper OR attire and must have cuts or wounds on skin are not allowed inside
washed her/his hands before doing any the OR.
procedure.

1. Turn on the conditioner.

2. Move gown instrument and lap tables, basin To provide a good margin of safety.
stands, spinal tray and major prep stands one foot
away from the wall.

3. Adjust the height of the mayo stand within elbow

level.

4. Determine what packs are to be brought in or

used depending on the type of surgery.

5. Bring/check in two kick buckets and place one

near the lap table, the other near the sponge table
(earlier used as the gown table).

6. Bring in needed foot stools and position them
near the operating table. (optional)
7. Bring in needed packs and put them on their
respective tables or stands. Place packs at the middle
of the table stands.
 Check the autoclave tape
The number and height of the footstools
depend on the people scrubbing. Sitting
stools are used as spinal set and major
prep stands.
 To determine if the packs have been
autoclaved

8. With bare hands untie and open first wrapper of Open wrapper away from you. Loose ends
all packs. Tuck loose ends of ties under the pack. may touch floor and invite contamination.

Note: Two sterile forceps are used from here on.

GOWN PACK:

10. Open second wrapper (inner wrapper) of gown

pack.
In SUMC, Sterigage is used- the transparent part
11. Check sterilization indicator strips (sterigage) will become dark indicating that pack has been
subjected to sterilizing temperature.

12. Add to the gown table the number and correct Gloves for scrub nurses are paced at the left
sizes of gloves for the scrub team. (Refer to lower corner of the table and the rest of the
preference cards for sizes of gloves for the surgeon) gloves at the right lower corner. Doctor’s
gowns are placed with the neckline facing you.
STEPS KEY POINTS, PRECAUTIONS,

13. Transfer one nurse’s gown with hand To prevent crossing over sterile field and
towel on the left lower side of the table over facilitate gowning and gloving without the
the scrubnurse’s gloves. help from the circulating nurse.

14.Cover gown and glove table and fold back Ensure that gowns and gloves are fully
edge of cover in front keeping the fold in line covered. Observe draping away from you in
with table edge. covering the table.

LAP PACK and BASIN SET:

15. Open inner wrapper of lap pack.

16. Remove and check indicators (sterigage)

accordingly

18. Remove and place topmost drawsheet to

left upper side of the table.

19. Remove rolled towel from the pack and

place in middle front part of the table.

17. Open inner wrapper of basin set. Basin set is wrapped in 2 dressing
towels in T-form. Fan-fold upper half
of dressing towel to open set.

18. Transfer 2 bowls, kidney basin, 1 sponge

basin and the prep cup to the lap table.

19. Cover basin set leaving enough opening Use long, heavy transfer forceps. Set prep cup
for pouring sterile water into the basin. near right lower corner of lap table to
facilitate pouring of antiseptic.

20. Pour sterile NSS into one of the bowls.

21. Pour betadine antiseptic into prep cup.

(10%)

22. Add the following to the kidney basin on Observe correct technique in pouring.
the lap table:

a. 2 pcs. Scalpel (#20,10,15 or 11) Observe correct technique.

b. sutures
c. rubber tubing (Poole drain)
d. electrocautery
Others (Asepto syringe/skin
marker/cautery scratch pad, etc
24. Cover the lap pack (once all the
instruments, lap squares, sterile strips are
transferred) fully leaving a flap in front.
Blades and sutures are removed from the
foil wrappers before adding them to the lap
table. Small sterile packs (rubber tubing,
electrocautery, etc.) are removed from
outer wrapper before being added to the lap
table.

MAYO TABLE:

25. Drape mayo table:

a. Insert forceps into the folds of the mayo Use long, heavy transfer forceps.
table cover. Spread the opening of the cover.
STEPS KEY POINTS, PRECAUTIONS,

b. Carry with technique near mayo table. Observe correct technique.

c. Place foot on base of mayo table to stabilize
it.
d. Place the opening of the cover to end Drape the first towel away from you and the
nearest you and insert it into the mayo table. next towel towards you.

26. Line the covered mayo table with 2 3 x 3

lap towels.

27. Place the sterile basic instrument set on Observe aseptic technique.
the mayo table.

28. Open instrument set and transfer the The retractors are placed in the left side of the
following instruments/supplies to their lap table. The towel clips, babcocks, needle
proper places in the lap table: holders, kelly forceps and pean forcep are
a. 2 pairs of Richardson retractors placed in the rolled towel in the lap table.
b. 1 pair army-navy retractor Transfer the pean forcep beside the prep cup.
c. 1 straight pean forcep The long ovum forcep is placed together with
d. 2 straight Kelly forceps the retractors. The lap squares and sterile
e. 2 needle holders strips are placed in the medium-size basin.
f. 2 babcocks
g. 6 towel clips
* These are threaded thru one
long sponge/ovum forcep
h. 5 lap squares
i. 5 sterile strips

29. Arrange the rest of the instruments Follow institutional set-up.

in the mayo table:
a. 6 mosquito forceps, curved
b. 6 kelly forceps, curved
c. 6 pean forceps, curved
d. 6 allis forceps
e. 2 scalpels (from the lap table)
f. 1 metzenbaum scissor
g. 1 mayo scissor
h. 1 suture scissor
i. 1 bandage scissor (for Caesarean
Section procedures)
j. 2 thumb forceps
k. 2 tissue forceps

30. Cover the mayo table fully leaving a

flap in front.

MAJOR PREP SET:

31. Open inner wrapper of the major prep set. Major prep set is wrapped in folded lap towel.
Add the following: Fan-fold upper half of lap towel in opening
set.
a. Extra sponges
b. Cotton applicator (if needed)
c. Foley catheter (if for catheterization) Observe aseptic technique.
32. Pour betadine cleanser to the bowl.
33. Bring fan-folded half of towel over set to
fully cover set.
STEPS KEY POINTS, PRECAUTIONS,

SPINAL ANESTHESIA SET:

34. If the patient is for spinal anesthesia,
perform the following:
a. Open spinal set with technique. Spinal set is wrapped in 2 dressing
b. Add 5 cc /1 cc sterile syringes. towels in T-form. Fan-fold upper half
c. Bring fan-folded half of dressing of dressing towel to open set.
towel over set to fully cover set. Sizes of spinal needle depends on the age of
d. Pour betadine antiseptic on small the patient.
container with cherry balls.
e. Add spinal needle. (Gauge 25)
f. Add ampule for anesthetic use.
STEPS KEY POINTS, PRECAUTIONS,
 RATIONALE
OR SCRUB NURSE:
35. Scrub nurses enter the room and proceed to Observe aseptic technique. Keep gloves and gown
gowning and gloving. uncontaminated.

36. Instrument nurse open lap table aseptically. Do not allow drape to fall below waistline.

37. Prepare 2 wet strips and place on top of the These are given to the surgeon right before
instrument. incision.
37. Prepare the drapes.

38. Inspect the sheet in relation to the patient’s

anatomical position.
39. Drape paint sheet: Keep reasonable distance between nurse and
a. Hold rolled side of paint sheet and place it OR table:
2” below edge of sterile laparotomy towel and i. Laparotomy towels are draped over the
drop the folds on the opposite side of the operative site after it was prepared.
table. Keeping the gloved hands protected by ii. Be careful not to touch side of patient.
the folds of the pain sheet. iii. Surgeon proceeds to painting the area with
b. Pick sheet under the tuck-in plain sheet. betadine antiseptic.
c. Place one hand on top to hold sheet in place.
d. Place the other gloved hand under turned-
back fold with marked “feet” and spread to cover
the lower extremities of patient.

40. Give straight pean and prep cup to surgeon. Surgeon does this.

41. Hand one at a time four lap towels to surround

operative area.

42. Give 4 towel clips to secure towels in place.

43. Drape laparotomy (fenestrated) sheet:

a. Hold rolled side of sheet and place its
openings (fenestrated) directly over the site of
proposed incision and drop the folds at the
opposite side of the table.
b. Keeping the gloves hands protected by the
folds, open the sheet over the feet area. Anchor
the sheet with opposite hand to prevent
dragging it off position.

44. Take your place to assist in the surgical

procedure. (Circulating nurse moves the mayo
table: lap table and sponge table near the
operative field).
Note: Sponge counting must be done by the
sponge nurse and circulating nurse before the
operation starts and properly accounted for before
closure of the peritoneum and then the
subcutaneous part. Use the SIN format (Sponges,
Instruments and Needles counting sequence).
WHO Operating Checklist will also be done by
the Circulating nurse before the start of the
operation.

(Adapted from Silliman University Medical Center Foundation, Inc. (SUMCFI) Operating Room
practice.

/Tjqb2020