Duties of a scrub nurse

a. Table count
- Scrub nurse & circulating nurse
count all items in the instrument table &
mayo stand.
b. Floor count
- Circulating nurse counts sponges &
other items that are recovered from the
floor. Be verified by the staff nurse.
c. Field count
- Circulating nurse totals floor & table
count. Then inform surgeon if sponge
count is correct.
- Counts all over again before
subcuticular closure. If sponges are
intentionally retained for packing or
instrument remains with the patient,
this should be documented in the
patient’s chart.
 Duties of a scrub nurse
INCORRECT count
a. Entire count is repeated
immediately.
b. Circulating nurse looks at
trash receptacles, under
furniture, linen hamper or
throughout the room.
c. Staff nurse looks over
drapes & under items on the
table & mayo stand.
d. Surgeon rechecks field &
wound
 Duties of a scrub nurse
e. Circulating nurse should
call Head nurse to
check the count
f. X-rays must be taken
before the patient
leaves OR whenever a
sponge or instrument
count is incorrect
g. Circulating nurse makes
an incident report.
 Duties of a scrub nurse
B. After Surgeon & Assistant scrub
1. Gown & glove the surgeons &
assistants as soon as they enter
the room.
2. Assist in draping the client
according to the routine
procedure
- offer towel & towel clips, and
drapes.
3. Bring mayo table into position
after draping is completed.
Position the table at right angle
to operating table.
 Duties of a scrub nurse
C. During the operation
1. Hand skin knife to surgeon &
hemostat to assistant
- When handing knife, hold the handle
blade down & pointed towards your wrist.
Never towards the surgeon.
2. Watch field & anticipate the
needs of the surgeon. Keep one
step ahead of him in offering
instruments, sutures or
sponges. Notify circulating
nurse quietly for supplies not in
the table.
- Pass instruments in a positive manner.
When surgeon extends hand, instruments
should be slapped firmly into palm in proper
position for use.
 Duties of a scrub nurse
Hemostat
- bleeding
Scissor
- needs to cut tissues
Mayo scissors
- cuts sutures
> Keep instruments clean as
possible, wipe blood with
moist sponge
> Return instruments to
mayo stand promptly after
use or cleaning.
 Duties of a scrub nurse
3. Save all tissue specimens
- Never use a large clamp for
small specimens. It may crash
- Put in a specimen bottle,
basin, wrapper or towel.
NEVER in a sponge. Tell
circulating nurse what
specimen it is, if not sure ask
the surgeon.
4. Maintain sterile technique.
Watch for any breaks.
 Duties of a scrub nurse
D. DURING CLOSURE
1. Count sponges, needles, &
instruments w/ circulating nurse
when surgeon begins closure of the
wound.
2. Clear off mayo stand as time
permits leaving a knife handle with
blade, tissue forceps, scissor, 4
hemostats & 2 allis forceps.
3. Have a damp sponge ready to wash
the blood from the area surrounding
the incision as soon as skin closure is
completed
4. Have betadine, dressings & plaster
ready.
 Duties of the Circulating nurse
• Circulating nurse washes
hands & arms 5 minutes
at the beginning of the
day before entering the
OR but does not use
gown or gloves.
• Circulating nurse must
assist the sterile scrub
nurse by providing the
sterile supplies needed.
 Duties of the Circulating nurse
A. After scrub person/nurse scrubs
1. Fasten back of scrub person’s gown.
2. Open packages of sterile supplies
like syringes, sutures, sponge, gloves.
- If a sterile package wrapped in
porous material drop to the floor,
DISCARD, if it can no longer be
considered sterile.
3. Flip suture packets onto the
instrument table or open over wraps
for scrub nurse to take packets.
- Do not open sutures unless you
are sure patient is to be operated on.
Just have it on hand & let it be served
when surgeon is about to suture.
 Duties of the Circulating nurse
4. Pour Normal Saline
(NSS) into the round
basin for sponges on
the instrument table.
5. Count sponges,
needles, & instruments
with the scrub nurse &
record immediately.
 Duties of the Circulating nurse
B. After the patient arrives
- Circulating nurse attends to the
patient.
1. Greets & identify the
patient. Check wristband.
2. Check patients chart for
pertinent information
including CONSENT.
3. Be sure patient’s hair is
covered with cap to prevent
dissemination of
microorganisms.
 Duties of the Circulating nurse
4. Assist the patient in moving
from the stretcher to the OR
table. Use proper body
mechanics.
5. Apply restraint straps over legs
& arms. Keep patient covered
with blanket for privacy &
provide warmth.
a. Patient’s legs should not be
crossed.
b. Put arm board on left &
right arm if IV is to be infused.
 Duties of the Circulating nurse
C. During the Induction of General
Anesthesia
1. Stay in the room & near the
patient to provide comfort &
assist the anesthesiologist in the
event that patient gets excited.
Patient must be guarded during
induction to prevent possible
injury or fall from the OR table.
2. Be quiet as much as possible.
3. Excitement may occur during
induction from tactile or
auditory stimulation especially
in alcoholics.
 Duties of the Circulating nurse
D. After the client is anesthesized
1. Reposition patient only after
the anesthesiologist says so.
2. Attach anesthesia screen &
other table attachments.
3. If cautery is to be used,
place inactive dispersive
electrode plate in contact with
patient’s skin to ground the
patient properly. Avoid scar
tissues, hairy or bony areas.
 Duties of the Circulating nurse
5. Expose appropriate area for
the skin preparation.
6. Turn overhead spotlight
over site of incision.
- Bright light should not be focused on the
patient before he/she is asleep because
pre-op meds affect the pupils. Dim light is
less irritating.
7. Arrange sterile preparation
tray & pour solutions if this
has not been done yet.
8. Cover the preparation tray
immediately after use.
 Duties of the Circulating nurse
E. After Surgeon & assistants
scrubs
1. Be alert to anticipate needs of
the sterile team.
- Circulating nurse watches
closely the operation &
anticipate the needs w/o having
the team ask for them.
- Should know where all supplies
are to facilitate time & get them
quickly.
2. Stay in the room. Inform scrub
nurse if you must LEAVE.
 Duties of the Circulating nurse
3. Keep discarded sponges carefully
collected, separated by sizes &
counted. Use sponge forceps or
gloves. NEVER W/ BARE HANDS to
handle & count sponges.
4. Assist in monitoring blood loss.
Weigh sponges if requested by
surgeon.
- Measure blood volume from suction
container.
5. Obtain blood products for
transfusion as necessary from the
refrigerator or from the blood
bank.
 Duties of the Circulating nurse
6. Know the condition of the patient
at all times

7. Prepare & label specimens for

transportation to the laboratory.

8. Complete the patient’s chart,

permanent operating room
records, & requisitions for
laboratory test, etc..

9. Be alert to any break in sterile

technique
 Duties of the Circulating nurse
F. During Closure
1. Count sponges, sharps, &
instruments with scrub nurse.
- report counts as correct or incorrect
to surgeon.
- Complete count records.
2. If another patient is scheduled to
follow:
- Circulating nurse should call the ward
for the next patient at least 45 minutes
before the scheduled time of operation
to request that pre-op medication be
given.
- Ask transport aide to fetch client from
the ward 30 minutes before operation.
 Duties of the Circulating nurse
G. After the operation is
completed
1. Open neck & back closures of
gowns of surgeons & assistants
so they can remove the gowns
w/o contaminating themselves.
2. Assist w/ dressing. Scrub
nurse should roll drapes off the
patient before outer laye of
dressing is applied.
3. Connect all drainage systems
as indicated
 Duties of the Circulating nurse
4. See to it that the client is
clean- wash off blood, feces.
Put on a clean gown & blanket.
5. Have transport aide bring a
clean recovery room stretcher.
6. Help move patient to stretcher
or bed. Place patient to
stretcher with a 4-man carry.
7. Be sure chart & proper records
accompanying patient.
 Duties of the Circulating nurse
8. Final completion of the client’s chart
should include documentation of:
a. Assessment of client’s skin
condition prior to and at completion
of operation.
Example:
- skin discoloration
- rashes
- pressure sores
- burns
b. Urine output & blood loss- I & O
c. Type of dressing used.
d. Time patient was discharged
from OR
 Duties of the Circulating nurse
• 9. Have nursing
assistant help transport
patient to recovery
room (RR) or post
anesthetic care
unit(PACU)
 Functions of Basic Instruments
• CUTTING INSTRUMENTS:
1. Metzenbaum Scissors
- These are used for tissue dissection & are delicate. Tips are
curved for easy use.
 Functions of Basic Instruments
2. Mayo Scissors
- These are used to cut suture materials when suturing, might
be straight or curved.
 Functions of Basic Instruments
3. Blade handles/ scalpel
- A metal handle w/ a range of single use sterile blade used for
incising the skin & for sharp dissection.
 Functions of Basic Instruments
GRASPING INSTRUMENTS:
1. Tissue/ Thumb Forceps
- These are used for precision holding. Used to pick up
delicate tissue for suturing.
- THUMB FORCEPS- Theses are used to grasp tough tissue
(fascia, breast)
 Functions of Basic Instruments
Tissue forcep
 Functions of Basic Instruments
3. Adson Forceps w/ teeth
- These are used for many heavy duty clasping such as w/ the
skin & suturing
 Functions of Basic Instruments
4. Adson Pick- ups
- Smooth> Used to grasp delicate tissue
 Functions of Basic Instruments
GRASPING/ CLAMPING INSTRUMENTS
1. Babcock
- Used to grasp delicate tissue (Ovary)
- Available in long & short sizes
 Functions of Basic Instruments
2. Kocher
- Used to grasp heavy tissue
- May also be used as a clamp
- The jaws may be straight or curved
- Other name: Ochsner
 Functions of Basic Instruments
3. Straight Clamp
- It is used to clamp off superficial arteries, vessels on the
muscle layers & an all-purposes hemostat.
 Functions of Basic Instruments
4. Allis forceps
- It has teeth to hold tissue firmly but can cause damage.
- It is only used on tissue w/c will be excised
- It is used to grasp tissue
- Available in short & long size.
 Functions of Basic Instruments
5. Mosquito Clamps
- Used to hold sutures aside for pedia patients.
 Functions of Basic Instruments
6. Towel Clips
- These are used to keep towels w/c restricts the surgical field
attached to the patient.
- A backhaus towel clip is used to hold towels & drapes in
place.
 Functions of Basic Instruments
ACCESSORY INSTRUMENTS
1. Needle holder
- It is used to hold suture needles firmly & push them
through tissue.
- Used to secure scalpel blades to handles.
 Functions of Basic Instruments
RETRACTORS
1. Malleable or Ribbon Retractor (Manual)
- Used to retract deep incisions; may be bent to various
shapes
 Functions of Basic Instruments
2. Balfour with Bladder blade (Self retaining)
- Used to retract wound edges during deep abdominal
procedures
 Functions of Basic Instruments
3. Deaver retractor
- is used to retract deep abdominal or chest incisions.
- available in various widths
 Functions of Basic Instruments
4. Richardson Retractor
- it is used to pull layers of tissues aside in deep abdominal or
chest incisions to better visualize the surgery site.
 Functions of Basic Instruments
6. Army-Navy Retractor (Manual)
- It is held in one end to shallow or superficial incisions