SURGICAL TEAM

• Sterile Team

1. Surgeon
- captain of the ship (OR)
- decides the type of operation
- explains the procedure
- secures the consent
- perform the operation
- post-op orders / dressing

SURGEON
- explain the procedure
- secures the consent
"A signed consent form doesn't guarantee that the pt fully understood the procedure".

NURSE (Ward)
- makes sure the procedure is understood before the consent is signed
"What does your surgeon told you about the procedure?" Tell me more.
- makes sure that the consent is signed before the procedure is performed
- acts as a witness and countersigns (role as a witness) -> the nurse saw that the pt signed the consent

2. Assistant Surgeon
- assist the surgeon during the operation
- it can be an intern, resident physician, or OR nurse

3. Scrub Nurse
- assists in instrumentation
- anticipates the needs of the surgeon
- prepares the OR
- coordinates with the members of surgical team

• Non-sterile Team
4. Anesthesiologist
- induction of anesthesia
- monitors vs (or hemodynamic status)
- updates the surgeon of pt's condition
- transfers the pt from recovery room to the room of choice *(he is the one responsible for allowing the
pt to be transferred to his room of choice. Even if the surgeon haven't signed yet, but the
Anesthesiologist already did for transferring of pt, the pt can now be transferred to his room)

5. Circulating Nurse
- guardian of sterility
- maintains sterility of OR field
- OR manager *(aids outside sterile field)
- patient safety (responsible for restraint)
- counting of instruments (w/ scrub nurse)
- documentation of instruments
Note: Res Ipsa Liquotor (instrument left inside the pt)
- responsible for adjusting the lights and the height of the table

PRINCIPLES OF STERILITY
1. Sterile person touches only sterile field.
° Anything outside sterile the field is the responsibility of circulating nurse
° NLE Question: What is the normal distance of circulating nurse to the sterile field? Answer:
Maintain 1 arm length

2. Sterile Body Areas:

• Shoulder to Waist
° front - sterile
° back - unsterile
• 2 inches above the elbow
° sterile person -> hands above the elbow

3. Two sterile persons passing each others:

• Front-to-Front
• Back-to-Back (most ideal due to height differences of surgical team members)

4. OR Table
• top - sterile
• below - unsterile
*NLE Question: When did the doctor broke the sterility? Answer: When he adjusted the height of the
table
*Anything below is considered unsterile (ex. still intact suture pack slipped on the floor)

5. Linen / Drapes: "Once Placed Never Readjust"

• top - sterile
• edge - unsterile
• bottom - unsterile
*If the linen becomes wet (spilled w/ liquid or water) or there's a presence of hole:
° remove the instruments
° do not put again the instruments on that area (if wet)
° cover that area with another drape

6. Once a Bottle is Opened it is Considered Unsterile already

7. Package
• top - sterile
• edge - unsterile
• bottom - unsterile
• Indicator Strip: white turns into black / brown -> package is now considered sterile when autoclaved
• Must be opened away or opposite from your body

8. When in Doubt, Discard (throw it out)

OPERATING ROOM ZONES
Unrestricted
1. OR station
2. OR lobby
3. Receiving area

Semi-Restricted
1. Central supply
2. Autoclave
3. Instruments and supplies are stored
4. OR cap and gown

Restricted
1. Surgery is performed
2. Sterility is maintained
3. Complete OR suit

*NLE Question: What divides the 3 OR zones? Answer: Red Line divides the 3 zones
*NLE Question: Surgical Conscience - adherence to the principle of asepsis, even when not observed

PERI-OPERATIVE PHASES
Pre-operative
- starts upon admission up to before the surgery begins
- Priority:
A. Prior to Surgery (in AM / This Afternoon)
1. Stable Vital Signs *(because even if there's consent, the surgery will not proceed if the pt's vs
is unstable)
2. Normal Lab Results

B. Upon Receiving in the OR

1. Secure Consent *(where is the consent)
2. Patient Verification
° Asking the patient’s name
° ID band / medical wrist band *(most reliable because the pt might lie with his name or
he have decreased LOC)
° 2 Client's Identifier (most accurate)

C. Refusal to Treatment
• Document and report to the supervisor
D. Attire:
• OR cap
 • OR gown
• Leggings
Remove:
• jewelries
• nail polish
• dentures
Retain:
• Hearing aids (because you will orient the pt post-op)
• Religious items (secured by taping on the hands and wrapping with a cloth)

E. Post-op Exercises
• Deep-breathing exercise
• Coughing exercise
• Splinting
• Incentive Spirometer
° Purpose of Post-op Exercise: Prevent Atelectasis (most common complication for the
first 24 - 48 hours after surgery; because the pt will be scared to breathe due to pain)

Intra-operative
- starts upon induction of anesthesia up to the closure of the wound

Stages of General Anesthesia:

Complications:
• Disorientation
• Respiratory Depression
• Hypotension

Stage 1: Stage of Induction

- induction up to loss of consciousness

Stage 2: Stage of Excitement

- from the loss of consciousness up to loss of eyelid reflex
- LOC is lost
- laughing episode

Stage 3: Stage of Surgical Anesthesia

- from loss eyelid reflex up to decrease in respiration
- Loss of eyedlid reflex

Stage 4: Stage of Danger

- from decreased respiration up to respiratory arrest (absence of respiration)
- Respiration is lost
TYPES OF SURGERY
• According to Purpose
1. Diagnostic - to determine the cause of disease (ex. Biopsy)
2. Palliative - to alleviate or remove symptoms (ex. Rhizotomy—removal of trigeminal nerve like in
cases of trigeminal neuralgia/Tic Doulourex) blink reflex, facial sensation, mastication; severe pain facial
sensation
3. Ablative - to remove disease part (ex. Appendectomy; Cholecystectomy)
4. Transplant - to replace damaged organ (ex. Kidney transplant)
5. Restorative - to restore function of organs (ex. Eye surgeries)
6. Explorative - to determine the extent of damage area (ex. Ex-lap)

• According to Degree of Urgency

1. Emergent - life-threatening; cannot be delayed (ex. ABC conditions)
2. Urgent - planned within 24 - 30 hours (ex. Sepsis; Appendectomy; Cholecystectomy)
3. Required - planned within weeks or months [ex. Lumphectomy (removal of breast mass);
Mastectomy]
4. Elective - is not life-threatening (ex. Cleft Palate Repair; Cleft Lip Repair; Circumcision; War)

Post-operative
- recovery room (PACU) up to room of choice (ROC)