INTRAOPERATIVE NURSING

PHYSICAL FACILITIES (areas in OR)

Unrestricted area- where you will receive the patient

Semi-restricted area- should wear scrubs and head covers, *require staffs to wear mask, and scrub shoes

Restricted area- properly attired, sterile gown *circulating nurse attire: like in semi-restricted, *shoe
cover

*-sometimes

PREOPERATIVE ADMISSION AND HOLDING UNIT

- area to change the patient clothes with personal locker for safe keeping
- Holding with families and provided with privacy
- Intravenous line maybe inserted in here

*surgical nurse’s responsibility to always align the IV line

OPERATING ROOM

Room temp: 20-24 degrees, always cold because of the comfort of the team, especially because the
microorganisms/bacteria grow in warm areas

Materials:

- Operating table
- Surgical instruments: usually in a pack and already sterile
- Anesthetic equipment (anesthesia machine, intubation set, oxygen regulators and other gases)
- Kick bucket
- Stool: to elevate the height
- IV stands
- Suction machines
- Sponge count boards and equipment
 - Emergency cart (emergency medicines during surgery
- Piped-in-gases
o Green- oxygen
o Blue- Nitrous oxide
o White- pressurized air

SPECIAL PROCEDURE ROOMS

- Interventional radiography room (angioplasty, TACE- liver cancer)

- Minimally invasive surgery rooms (CS delivery)

SURGICAL TEAM IN OR

- Surgeon
- First assistant (residents, RN): the assist to clear the field, retracting, provide hemostasis, wound
closure, handle, manipulate, suctioning, etc/ scrub nurse)

*Second assistant

- Scrub nurse

*student nurse

UNSTERILE TEAM

Anesthesiologist

Circulating nurse

Periaanesthesia nurse

Others: cleaners after the surgery

GOALS OF CARE

- Maintain surgical conscience

- Maintain aseptic technique
- One foot away

Asepsis- absence of microorganism that cause disease, freedom form infection

*always protect yourself

Rationale of googles- preventing any contact to the eyes

Prevention of puncture injuries: NEEDLE-STICK: let it bleed, wash, report (hep B, Ig, screen for HIV, will
give anti-tetanus, will give prophylaxis)

Deep: scrub out

Prick: change of gloves, remove, then ask for new pair of gloves

CARE OF SPECIMEN: properly label, logged in OR logbook

DECONTAMININATION: clean by cleaners

LAUNDRY: usually leave the soiled linens on the floor; makes sure there is no needles

WASTE: body fluid:yellow, etc

TRANSMISSION OF MICROORGANISM

Airborne: <5mm, varicella, TB, measles, COVID is considered as airborne (N95 mask)

Droplet: Cough hygiene, hand hygiene, social distancing (3ft), medical mask (FDA approved, medical &
cloth mask)

Contact: gloves, gown

Carriers of infection: skin, hair, nasopharynx, human error, cross infection, formites, air

Sources: community acquired, communicable infection. Spontaneous- requires surgical intervention to

alleviate infection, HAI- nosocomial

SIGNS OF INFECTION

- Fever (beyond 37.5)

- Redness (maybe beginning of infection)
- Chills
 - Shortness of breath
- Pus/discharge (yellow/whitish)
- Swelling
- Foul smell
- pain

SURGICAL SITE INFECTION

 Maintain nail short, no jewelry, light makeup, personal hygiene handwashing, always clean OR
every after surgery

COMPONENTS OF APPROPRIATE ATTIRE

Head cover: Bouffant style: disposable

*Shoe cover: less contamination on floor

Masks: double loop, only touch the string then disinfect your hands

Sterile gown: waist above should be sterile; gloving: cuffs should be inside the glove

Surgical gloves:

Nursing skill (once/twice a month)

- Gloving
- Gowning
- VS
STEPS IN SURGICAL HANDWASHING

Remove accessories

Inspect for wounds (place a band-aid)

Check nails

Perform medical handwashing

Continued

Surgical handwashing: 2in above elbow, usually use a scrub, 3-5 mins, rinsing hands should be below
elbow

Skin prepping: to reduce number of microorganism, do not back to what you already did

Mechanical cleansing: reduce number of microorganism by shampooing and bathing

Hair removal: to gain better visualization

-shaving

-Clipping

Preparation on the surgery table

-sterile
 Ethylene oxide(EO)

: highly flammable, gas, sensitive to heat, carcinogenic

Hydrogen peroxide plasma sterilization- hydro peroxide will be converted to plasma, sporicidal, adv: dry,
non-toxic, corrosion does not happen, dadv: cotton, clothe will be brittle

Sterilization indication

Mechanical: temp, pressure, time already on the item

Chemical: on the tape: black strip if sterilized

Biologic: done once a month through culture; positive=malfunctioning negative=functioning

ENDOSCOPIC: Examination of body cavity using optical system

Essential elements of endoscopy

- Access portal
- Working space
- Elimination
- vision

complications of endoscopy

- perforation
- bleeding
- hypothermia
- preperitoneal insufflation
- gas embolism
- incidental iatrogenic injury
general consideration of endoscopy

- monitor for any drug interaction (usually not RN)

- topical anesthetic agent

robotic assisted surgery

- not usually done in PH, expensive, need training

THERMOREGULATION

Core: 36.5-37.5

Intraoperative: hypothermia

hyperthermia: Malignant hypothermia (body’s reaction to anesthesia)