TABLE OF CONTENTS:

 Defination of a scrub nurse

 Specific role in OR
 Responsibilities of a scrub nurse
 Video on ASEPTIC TECHNIQUES
 Orientation on SURGICAL NEEDLES
 Orientation on SURGICAL SUTURES
 Orientation on SURGICAL INSTRUMENTS
 Video on INSTRUMENT HANDLING
WHAT IS A SCRUB
NURSE?
 To prepare and drape
sterile drapes,instruements
& supplies
 To assist surgeon &
assistants throughout
operation by providing
instruements & supplies
 To maintain patient’s safety
throughout operation
• Welcoming patient to OR
• Preoperative nursing assesment
• Checklist before scrubbing
• Scrubbing in
• Assembling instruements,counting before surgery
• Assist surgeon by passing over instruements
• Observe patient’s safety
• End of procedure
CHECK CONSENT
CONFIRM SURGICAL PROCEDURE
CHECK INSTRUEMENTS
CHECK SUPPLIES
 “Scrubbing in”
• usually involves thoroughly
washing hands and arms with
an antibacterial soap, then
putting on a sterile mask, hat,
gown and gloves so that
patients cannot be
contaminated when their bodies
are exposed for surgery.
• Open the inner sterile set &
assemble sterile instruments
on mayo tray & trolley
• Perform surgical count
• Assemble surgical blade
• Prepare sutures
• Assist surgeon in cleaning & draping patient
• Bring mayo’s tray over the patient
• Retract tissue gently if
required
• Remove artery tips as
directed by surgeon
• Cut sutures with
scissors,help in suturing
• Assist in cautery
• Anticipate surgeon
need through out
procedure
• keep one step
ahead of surgeon in
passing
instruments,sutures
,sponges etc
• Maintain neat &
orderly sterile field
of operation
• Maintain strict aseptic techniques
• Keep talking to minimum,turn away while
sneezing,coughing

Keep your hands at table level while unengaged

• Perform second surgical count of
sponges,sharps,instruements as surgeon begins closing
• Apply dressing to the wound by non touch technique &
assist in removing the drapes
• Dispose of sharps
• Cover the soiled
instruments before
sending them for
cleaning/autoclave
• Remove gown &
glove and check
documentation
SURGICAL NEEDLES
• Surgical needles
are necessary for
the placement of
sutures in tissues
• NEEDLE
ANATOMY
– Swage
– Body
– Point
NEEDLE SWAGE

Classification by the needle

swage:
• 1. Closed Eye
• 2. French Eye
• 3. Swage
 Body of the needle
• classification by the body of the needle:

¼ circle 3/8 circle ½ circle 5/8 circle

Straight Half Curved (Ski) compound Curved

 Point of the needle
- Conventional cutting
(cutting on the inside)

- Reverse Cutting
(cutting on outside)

- Taper point
(Pierce and spread tissue without cutting it

- Blunt
Pierce and spread tissue without cutting it.
The word "suture" describes any strand of
material used to ligate (tie) blood vessels or
approximate (sew) tissues.

 Absorbable / Nonabsorbable
 Natural / Synthetic
 Braided / Monofilament
 Example Suture Selection
Absorbable Non Absorbable
Natural Natural
Fast Absorbing Gut Silk
Plain Gut Stainless steel
Chromic gut
Synthetic
Synthetic Ethilon*
(nylon)suture
VICRYLRapide* NOROLON*
(polyglactin 910) suture
(nylon) suture
VICRYL* MERSILENE*
( polyglacin 910) suture
(polyester) suture
MONOCRYL* ETHIBOND*
(polyglecaprone 25) suture
(polyester) suture
PDS II* PROLENE*
(polydioxanone) suture
(polypropylene) suture
 Example Suture Selection
Absorbable (Natural)

Fast Absorbing Gut Plain Gut Chromic Gut

Tensile strangth 7 days Tensile strength 7-10 days Tensile strength 28 days
Mass absorption 21- 42 days Mass absorption 60-90 days Mass absorption 90 days
 Example suture selection
Absorbable (Synthetic)

PDS II
VICRYL Rapide Mass absorption 6 months
Mass absorption 42 days

MONOCRYL
VICRYL
Mass absorption 56-70 days
 Example suture Selection

Nonabsorbable
Natural

Silk
Stainless steel
 Example Suture Selection
Nonabsorbable
Synthetic

NUROLON ETHIBOND

ETHILON MERSILENE PROLENE

 Artery Forceps

used as a hemostat for

clamping bleeding vessels.
 For grasping tissue ( Opening and closing
peritoneum) .
 to hold stay sutures.

Allis' Forceps

 for grasping tough structures like Rectus sheath

or fascia in LSCS or Hysterectomy

Babcock's Forceps
for grasping tubular structures like
fallopian tube in tubectomy In
Pomeroy's operation , ureter,
appendix etc.
CUSCO’S SPECULUM

 Self retaining speculum.

 Used in OPD for routine examination.
procedures like taking of Pap smear ,
insertion and removal of Copper T can be
done

Sims' Speculum
for inspection of vagina and cervix in OPD. It
retracts posterior vaginal wall.
Taking Pap Smear , Insertion and removal of
Copper T, Taking swabs,D&C , Cervix Biopsy ,
Vaginal Hysterectomy ,
 Doyen's
Retractor

Deaver's
Retractor

for retraction of deep structures

Right Angle
Retractor

bladder retractor during LSCS/hysterectomy

 Mayo scissors PINNARD’S FETOSCOPE

Curved mayo scissors Straight mayo scissors

Towel clip

For auscultation of fetal heart sounds

 Sims' Anterior Vaginal Wall
Retractor Episiotomy Scissors

Punch biopsy forceps Sponge holding forceps

To take biopsy from the cervix To hold sponges or cervical lips

DISSECTING FORCEPS (TOOTHED AND
NON- TOOTHED

To hold tough
structures like
rectus sheath,
vaginal flaps or
skin margins
during suturing
Toothed Non toothed

LOOP HOOK ELECTRO CAUTERY

To remove IUCD from the uterine cavity Thermal cauterisation of the cervix
when the threads are missing for cervical ectopy
 Foleys Catheter

•self retaining catheter used for drainage of the urinary bladder ,

It has a bulb below the tip.
•This can be inflated by normal saline. It has two channels. One for
inflating bulb and the other for drainage of urine to which urobag
is attached. No 14 or 16 are used in adult

Female metal catheter

•To empty the bladder prior to major vaginal operations

 Uterine sound
It is used for measuring length of the cervix

Hegar's Dilator
For dilatation of cervix

TENACULUM

For grasping the cervix in hysterosalpingography or IUCD

insertion
 Suction Curette Shirodkars Cerclage Needle

This instrument is used for first trimester MTP, This is specially designed needle for putting
suction of vesicular mole. stitch around the cervix.

Khocker’s forceps
•used in hysterectomy /salpingectomy to
clamp fallopian tube
• for clamping umbilical cord of new born or
for artificial low rupture of membranes ( ARM).
Surgical Blades/ Scalpel

Green Armytage Forceps Needle holder

used as a hemostat in LSCS

 Uterine Curette

Flushing curette

Simple curette

Sharman’s curette

Used for diagnostic D&C

 Uterine dressing forceps

MYOMA SCREW
•To swab the uterine cavity following D+E
operation with a small gauze piece

UTERINE HOLDING FORCEPS

•To fix the myoma

•To give traction in a big uterus
requiring hysterectomy

To fix and steady uterus when conservative

surgery is done on the adnexae
SINGLE TOOTHED VULSELLUM

To hold the cervix after opening the vault of

vagina
•To hold new cervical stump after amputation
of the cervix and fothrergill’s operation after
subtotal hysterectomy

MULTIPLE TOOTHED VULSELLUM

•used for grasping the cervix ( Usually
anterior lip of the cervix is grasped)
•in procedures like Insertion of IUCD ,
Cx Biopsy D&C, First trimester MTP
with Suction Evacuation. Cx Biopsy
•Posterior lip of the cervix is grasped for
post. colpotomy
 WRIGLEY'S FORCEPS

Obstetric forceps for out let

forceps delivery. Parts of
the forceps are blades (
which has windows or
fenestrate for firm grip of
the head) ,Shank , Lock(
English lock for Wriglys
forceps) , Handle.

VACCUM (VENTOUSE)

Alternative to forceps
delivery. Causes less
trauma to mother and
fetus

Silastic cup Metallic cup

 Ayre's Spatula UMBILICAL CORD CLAMP

Used for taking PAP smear

RING PESSARY UMBILICAL CORD CUTTING SCISSORS

Used for correction of UV prolapse