Professional Documents
Culture Documents
Or Procedures
Or Procedures
Procedure
1. In the opening of the big pack, place the sterile pack on the back To ensure placement of the gowns and drapes after opening the pack. The
table with the cuff towards the scrub room. gowns are usually positioned near the scrub room to avoid overreaching.
2. Open the pack gradually following the direction of the folded cuff. The folded cuff serves as a line of demarcation between the sterile and
1st flap - use hand; grasp on top unsterile portion of the pack.
2nd flap - use hand, insert in the cuff
3rd flap - hold the edge of the wrapper (Open together with the
C.N.)
Last flap – use 2 hands, spread hands and open it towards you.
3. Open and remove the sterile pick-up forceps from its wrapper. The sterile pick-up forceps will be used to manipulate anything that is
Throw wrapper in the black trash can within the sterile field.
4. With the use of the sterile pick-up forceps, position the drapes and Allows enough space at the center of the table where all necessary
gowns (scrub room) on opposite upper corners of the table. instruments will be placed.
Content of the BIG pack:
● OR gowns (5) for surgeon, assistant to the surgeon,
anesthesiologist, scrub nurse and circulating nurse
● Mayo cover (1)
● OR towels (5) 4 towels to drape the patient and 1 will be
used on top of the mayo cover
● Foot drape (1)
● Head drape (1)
● Lap sheet (1)
After placing the drapes, clip the pick-up forceps on the side of the backup
table on table level.
5. We will now start opening the instruments. Unwrap the following To open the pack easily for aseptic removal of instruments and sponges.
using the banana peel technique and place it on the back table
without causing contamination:
a. Big and heavy individually packed instruments like the
retractors (balfour, beaver, richardson) and should be
placed at the center
b. Abdominal set over the retractors
c. Cutting instruments
d. Accessory instruments
e. Suture basin ( Big and small round basin), place in line
with the drapes, seperate with the use of forcep
f. Suture book - For NON - ATR needles
Major suture book - 12
Minor suture book - 10
6. Open the pack of MS (medium sponge) and place it one by one in Counting each sponge as you place it in the round basin ensures
the big round basin using the sterile pick up forceps. completeness before the start of the surgery.
if you need 10 MS and kulang ang meron sa pack, go to the
Anteroom and check canesther; inform the staff)
7. Open and drop the surgical blades in the small round basin. Provides protection from accidental injury during the preparation of the
Smaller basin - Put ATR needles instruments.
8. Last to prepare is the surgical gloves— these is placed in line with Ensures sterility of the gloves and promotes organization.
the gowns
● Check expiration date, integrity, and size
● Circulating nurse will also put packs in the OR table like
the gloves because they’re the one who knows the sizes
of the gloves of the doctor and other staff; they also put
suture, sharps, cautery, and accessory
● Make sure black bin is beside you, you will throw your
trash/packs
● When opening gloves:
○ Get the gloves and open it on the side then to the
center.
○ Take out the 2nd wrapper w bare hands and open it
halfway
○ With the wrapper, using your thumb, slide down the
lower flap (do not include the upper flap to prevent
the gloves from slipping)
○ Fold the wrapper in the middle
○ Using Non dominant hand to hold the wrapper
○ And using the Dominant hand to use the pick up
forceps. In holding the pickup forceps, Thumb -
insert it with one ring finger. The middle finger in the
other ring finger and lastly, the pointing finger at the
center of the scissors.
○ Use forceps to pick up gloves making sure to pick it
up at the center of the gloves and not the edges
○ Pick up the left gloves first and placed it on the back
up table in line with the gowns
○ Keep in mind that we should not lock the forcep
once you will get the gloves in the wrapper because
sometimes there are teeth in the forceps so it will
cause breakage to the gloves
○ Thumb of the glove should be facing up (left) and on
top place the right glove.
○ Arrangements of gloves in the table: surgeon,
assistant to surgeon, staff, and student nurse
○ You can only interchange the arrangement (left or
right glove) if you are already done with gloving
9. Keep close watch on the open sterile items at all times. Ensures sterility of all the items.
● Wait until there is a signal coming from the CI or staff
nurse that we can proceed in doing surgical handwashing
10. Using the brush, make 20 circular strokes on the nails (starting The scrubbing action loosens resident bacteria and contaminants, thus
with the less dominant hand). facilitating their removal.
Using bristles Circular motion mechanically removes microorganisms.
11. Scrub all skin surfaces using circular strokes: The scrubbing action loosens resident bacteria and contaminants, thus
a. each finger (10 circular strokes each) facilitating their removal.
b. Palm (10 circular strokes each) Circular motion mechanically removes microorganisms.
c. back of the hand (10 circular strokes each)
d. forearms (divide into 2 then 10 strokes on each of the 4 parts of
the first half of the forearm then another 10 strokes on each 4
parts of the second half of the forearm paying extra attention to the
elbow)
Maintain 90 degree angle
12. After scrubbing the less dominant hand, rinse the brush and The brush contains lather that may contain microorganisms. Rinsing will
transfer it to the other hand. remove the lather from the brush.
13. Continue the procedure on the dominant hand following steps 8 to
10.
14. When the scrub is finished on the dominant hand, drop the brush
on the sink
15. With the use of foot, knee or elbow control, turn on the faucet and To avoid contamination of your hands.
rinse the arms starting from the fingertips to the elbow. Water should flow from the area of least contamination to the area of most
contamination.
16. Turn off the water using the foot, knee or elbow control To avoid contamination of your hands.
Maintain position of hands (upperward and above the waist level;
in front of the body)
Make sure to let the water drip
After we are done with surgical hand scrubbing, we can now proceed with the donning of a sterile gown and closed gloving.
Procedure
1. After performing surgical hand scrubbing. Scrubbing eliminates microorganisms from the surface of the hands.
2. Enter the swing door of the OR using the back or the butt. After surgical hand scrubbing, the hands are rendered to be surgically
clean. Therefore, I should not touch any part of the OR door.
3. Stand on the side of the table where the sterile gowns are Contact of outer surface of gown with a dirty or clean surface would result
positioned. Grasp one sterile gown with the dominant hand and in contamination of the gown
stand in an area where the gown may be opened without risk of
contamination. (step back and side ways)
4. Hold the sterile gown away from the body. Hold the bottom part of If a sterile OR towel is not available, the bottom part of the gown can be
the gown with the other hand to be used in wiping the dominant used in wiping the hands, making sure that it will not swing or come in
hand. Bend a little (forward and distance) while wiping each finger, contact with a portion of your body, thus, causing it to be contaminated.
hand, wrist, forearm to the elbow extending about 2 inches.
Make sure that the gown is not swinging to prevent contamination.
Ang nagamove is ang arm hindi ang gown
5. Do the same procedure on the non- dominant hand, this time the
dominant hand holds the bottom part of the gown to wipe the non-
dominant hand, to the forearm, running through the elbow and 2
inches beyond that.
6. Raise up the gown a little higher to locate the armholes. The non- Racing the gown a little higher facilitates easier location of the armholes
dominant hand grasps the armholes by inserting the fingers and prevents the risk of touching the floor.
securely while bringing it up and lowering the bottom part of the
gown
7. Slip the hands inside the armholes while the gown is held away Extension of arms straight ahead keeps the sterile outer surface of the
from the body. Keep the hands at shoulder level and allow it to gown in view and reduces risk of contamination.
unfold with the inside of the gown toward the wearer.
8. Push the hands and forearms into the sleeves of the gown. Since closed gloving technique will be used, keeping the hands at the
Advance the hands only to the proximal edge of the cuff. (sideways proximal edge of the cuff will prevent contamination to the sterile gloves
pag stretch) during donning.
Call for the circulating nurse to pull the gown over the shoulder Working from behind the scrub nurse prevents contamination by the
touching only the inner aspect of the gown and tie the strings of the circulating nurse.
gown.
Since we are done with the gown, we will now proceed to closed gloving.
We have 3 principles to follow in doing closed gloving
1. Palm to palm
2. Thumb to thumb
3. Edge to edge
So let us proceed, the first step is:
9. Lift the first glove and grasp it through the fabric or sleeve. Place Cuff of the glove facilitates easier handling of the glove.
the glove palm down along the forearm of the matching hand, with
thumb fingers pointing toward the elbow. Glove cuff lies over the Only sterile items come in contact with each other.
gown wristlet.
Dominant hand first
10. Hold the glove cuff securely by the hand on which it is placed. Prevents the hands from contaminating the sterile gloves.
Sleeve to cover the gown wristlet entirely.
11. As the cuff is drawn back onto the wrist, fingers are directed into Provides a closed sterile method of donning gloves.
their cots inglove, and the glove is adjusted to the hand.
12. Use the gloved hand to position the remaining glove on the Provides a closed sterile method of donning gloves.
opposite sleeve in the same fashion. Place the glove cuff around
the gown cuff. Draw a second glove onto your hand, and pull the
cuff into place and adjust the fingers of gloves.
Non dominant hand
13. After donning the sterile gown and gloves, position or place the Gloved hands are held above the waist or at the level of the sterile table to
gloved hands at the chest or on the sterile top of the back table. prevent it from becoming unsterile.
Procedure
1. Pick up the sterile mayo cover, unfold, and insert the gloved hand To prevent contamination of the sterile gloved
in the cuff of the drape while holding the edges of the bottom of the hand from the unsterile mayo table.
mayo cover.
2. Slip the mayo cover over the frame of the mayo stand. (A wide To create a sterile area for the instruments.
margin is maintained between the cover and the lower portion of
the scrub person’s gown).
3. Unfold the cover to extend over the upright support of the stand. Sterile drapes should be placed on the patient, furniture, and equipment to
Pull to one side, and then tuck the excess under the mayo tray. be included in the sterile field to prevent transfer of microorganisms.
4. Get one towel and cover the top of the mayo table. To establish an aseptic barrier that minimizes the passage of
microorganisms.
5. Get the Abdominal set and place it on the mayo table top. Remove
the indicator tape (place it on the chest). Unwrap the set slowly.
Remove loose instruments first; place them on the top portion of
the mayo table. The remaining loose instruments such as the ovum
forceps with the tissue clips are held securely while removing the
wrapper.
6. Roll the wrapper neatly and secure each end with a rubber band. Provides organization of the instruments in the mayo table.
Place the rolled wrapper on the left side of the mayo table and
position the Grasping instruments’ handles over the roll. (rolled
sheet)
7. Arrange the loose instruments like knife handles, retractors and
tissue forceps in its proper place.
8. Unlock the towel clip and pull out the ovum forceps from the
handles of the instruments.
9. Place the ovum forceps at the back table while the towel clip is
positioned with the rest of the instruments on the rolled towel.
10. Mount the blades on the knife handles with the use of the needle
holder.
11. The scrub nurse informs the circulating nurse that he/she is ready To reduce the incidence of retained sponges and instruments during
to count. (Initial counting). INS Sequence surgery.
12. Picks up one of the tissue/Addison forceps and uses the tip of the
handle in counting the instruments. Start the counting by stating
the name of the instrument and its quantity.
13. Separate 7 towel clips. Get 4 towel clips and position them
diagonally on one side or opposite side of the scalpels.
14. Place the 3 towel clips at the back table. Get the ancillary To facilitate organization throughout the draping of the patient.
instruments. Attach the suction tip to the tubing as well as the tip
of the cautery to the cautery pencil. Get one towel clip and place it
on top. get 1 towel clip to secure later the ancillary instruments
15. Bring the drapes (foot, head and lap) to the mayo table and place it
over the instruments and accessory items.
16. Take the remaining 4 towels and unfold each towel with the folded
portion facing up. Arrange the towels in a cascading manner.
17. Continue initial counting in the back table. Continue with
instruments and arrange, count the atraumatic suture (Count ATR
first on the small basin and then NON-ATR on the suture book
using an instrument), count the sponges. (INS arrangement)
18. Wait for the surgeon to signal the start of the procedure by draping
the patient.
3. The gown is held until the surgeon’s hands and forearms are in the
sleeves of the gown.
(The circulating nurse then assists the gowned individual by pulling
the gown onto the shoulders, adjusts the back and ties the cords).
4. The scrub nurse grasps the glove under the everted cuff. Checks Checking for holes will ensure that the gloves to be used by the surgeon
for holes by inflating the gloves. are sterile. Inflating will also facilitate easier insertion
- From opening; slide hands to inflate
Stretching the gloves will allow the surgeon to insert his/her hand without
- After cheking, Make a smaller cuff, insert small portion of the
touching the scrub person's gloves.
thumb, invert and stretch, insert forefingers, abduct the thumb The scrub person protects own gloved fingers by holding them beneath
the cuff of the glove, and their thumbs by holding them away from the
partly-gloved hand
5. If you’re ready; inform the surgeon “Right glove Doc” OFFER RIGHT HAND FIRST, BECAUSE YOU DON’T KNOW THE
DOMINANT HAND OF THE SURGEON
6. Serves the dominant glove with the palm and thumb facing towards
the surgeon’s hand.
7. Exerts a slight upward pressure on the cuff while the surgeon
inserts his/her hand into the glove using firm downward thrust.
8. Pull the cuff over the wristlet of the gown while the surgeon slips
his/her hand well into the glove.
9. The procedure is repeated to don the other glove.
Sample:
Initial counting
AFTER CARE
● Attend sharps first
● Remove the blade from the holder and discard it in the sharps receptacle (near the anesthesia machine); make sure that the suture is not
included either
● Do not discard non-atr (reusable)
● Sure all instruments, take everything from the mayo table and place in basin; rinse and
● soak it in a disinfectant solution for 15 mins and rinse it again
REMOVING THE GOWN AND GLOVE
● Request the circulating nurse to untie
● Grab the chest part then pull
● Contaminated side inside
● Roll
● Place in the soiled hamper
○ PUT AT THE YELLOW CELLOPHANE
● Glove to glove
● Skin to skin
● Medical handwashing
FOLDING OF GOWN
● Anterior part- posterior part
● Insert hands sa may shoulder part – inline with the axilla
● Foot part of the gown/ lower part
● Face sideways
● Unfold half
Last: OR and DR separate jotdown notebook: date, full name of pt, case number, time of the procedure, type of procedure (kung ano talaga naperform),
copy post op diagnosis, name of surgeon and anesthesiologist, name of staff nurse dapat RN talaga (hindi sa OR technician; pwede sa scrub
nurse/circulating nurse)
Exhibit notebook: date, time, initial of patient (first name, middle initial, last name), surgical procedure, signatures
Stay and guard the sterile field and wait until there is a signal coming from the CI or staff nurse that we can proceed in doing surgical handwashing