Professional Documents
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NCM 109 RLE OR TECHNIQUE F 3 Final Output
NCM 109 RLE OR TECHNIQUE F 3 Final Output
College of Nursing
Mandaue City, Cebu
OR TECHNIQUE
Group F-3
Papa, Mechiella
Perandos, Eunice
Prestosa, Rheanne
Resgonia, Angela
Ruiz, Dylan
Ruste, Geneva
Salinas, Vince
Secretaria, Realm
Semblante, Joji
Sibal, Bonzee
Sta. Cruz, Lance
Sulapas, Danielle Jayne
2.1 Personnel
2.1.1 sterile
2.1.2 unsterile
2.2 Physical lay-out
2.3 Attire
2.3.1 basic components
2.3.2 protective
2.4 Set-up (equipment and apparatus)
3. cite the:
4. enumerate the:
6. discuss the:
7. Differentiate:
i. Pre-operative Phase
1. Extends from the time the client is admitted to the surgical unit, to
the time he/she is prepared for the surgical procedure, until he/she
is transported into the operating room (OR).
ii. Intra-operative Phase
1. Extends from the time the client is admitted to the operating room,
to the time of administration of anesthesia, surgical procedure is
done, until he/she is transported to the recovery room (RR)/ post
anesthesia care unit (PACU).
iii. Post-operative phase
1. Extends from the time the client is admitted to the RR/PACU, to
the time the patient is transported back into the surgical unit,
discharged from the hospital, unit follow up care.
9. Hemostasis - is a process which causes bleeding to stop, meaning to keep blood within
a damaged blood vessel (the opposite of hemostasis is hemorrhage).
10. Medical Asepsis - destroying pathological organisms after they leave the body.
Procedure used to reduce the number of microorganisms and prevent their spread.
11. Resident bacteria - indigenous flora. It can be removed by medical hand washing or
surgical handwashing.
13. Sterilization - process to eradicate all forms of live microorganisms from a substance,
including pore-forming bacteria.
14. Surgery - specialty of medicine that treats disease and disorder by cutting, removing, or
changing the body with an operative procedure that opens the body for therapy.
15. Surgical asepsis - exclusion of all microorganisms before they can enter and open
surgical wound or contaminate a sterile field during surgery.
17. Surgical team - a team that consists of scrubbed and unscrubbed team who perform
surgery and related tasks composed of; surgeon, anesthesiology or nurse
anesthesiologist, scrub nurse, circulating nurse.
2.1 Personnel
● Surgeon
○ The Surgeon is the MC Officer in charge of the treatment
given to the patient during the course of an operation.
○ Establishes diagnosis and provides preoperative, operative
and post-operative care.
○ A professional who is trained and qualified by knowledge
and experience for the performance of a surgical
operations
○ Performs the actual surgery; treats injuries, diseases, and
deformities through operations
○ Qualifications of surgeons include a bachelor’s degree, a
medical degree, 3 to 7 years internship and residency
programs as well as a medical license to operate as a
surgeon (ex. United States Medical Licensing Examination
or USMLE)
● Surgeon Assistant
○ Helps to maintain the visibility of the surgical site; also
helps control the bleeding, close wounds and apply
dressing
○ Surgeon assistants require a graduate degree in surgical
assisting and licensing to work in the field (ex. Physician
Assistant National Certifying Exam or PANCE)
○ A surgeon assistant’s duties may include:
■ Confirming the operation with the surgeon
■ Advising, informing and comforting the patient
before surgery
○ Surgeon assistants minimize patients' risks for issues like
nerve damage and decreased circulation.
● Scrub Nurse
○ Maintain the integrity, safety and efficiency of the sterile
field throughout the surgical procedure
○ Scrub nurses require an associate's or bachelor’s degree
in nursing and licensing to work in the field
○ They are either an RN or surgical technologists who are
often certified (CST).
○ The scrub nurse must have a thorough knowledge of each
step of a surgical procedure and the ability to anticipate
each and every instrument and supply needed by the
surgeons (Rothrock, 2015)
● RN First Assistant
○ An expanded role in the OR that requires formal education
(AORN, 2012)
○ They collaborate with the surgeon by handling and cutting
tissue, using instruments and medical devices, providing
exposure of the surgical area and hemostasis, and
suturing (Rothrock, 2015)
2.1.2 Unsterile
● Anesthesiologist
○ Administers the anesthesia to the patient before the
operation
○ Continuously monitors the patient's vital signs and
condition
○ Recognizes potential life-threatening emergencies
○ Qualifications needed for an anesthesiologist include an
undergraduate degree, medical degree, and 4 years
residency program as well as a medical degree
○ An MC Officer who is certified as a specialist in the
administration of anesthetics is an anesthesiologist
○ In actual practice in the surgical suite, the person who
gives the anesthetic is usually referred to as the
anesthetist, even though he may be certified as an
anesthesiologist.
● Circulating Nurse
a. The operating rooms should have ample space for performing the
procedure and moving around the room.
b. Each room should be sufficiently flexible to provide for the needs
during operation
c. Certain types of surgeries require big, bulky equipment and others
may need minimal equipment.
d. Sufficient floor space should be provided so that breaks in aseptic
technique due to overcrowding will be avoided.
D. Four Zone Concept
● The designations in the four zone concept may not be necessarily
used in some hospitals but whenever feasible the surgical suite is
segregated into four areas for traffic control.
● The purpose of such control is to assure maximum protection
against infections.
● Traffic control design is aided by designation of the four-zone
concept: the interchange area, semirestricted area, restricted
area, and dirty area.
IV. Dirty area- the dirty area is the disposal area, where all utilized
materials and linen are gathered, packaged, and sent to
appropriate areas.
E. Arrangement of areas
b. Workroom areas are situated near the center of the suite, and
storage and supply rooms nearby are positioned to avoid waste in
time and energy of personnel.
● Surgical Caps
● Surgical Masks
- protects the wearer from inhaling contaminants or particulate
matter generated in the operative field
○ Note: Busting False Claims
“when protecting the nurse, wear the mask with the blue
side in and white side out; when protecting the patient,
wear the white side in and blue side out”
● Cover Shoes
● Surgical Caps
- may help contain hair and its bacteria away from sterile field
● Masks or Visors
● Surgical Gowns
● Blanket Warmers - used to store and warm intravenous fluids, linens, and
blankets
● Scrub Sinks - station for “scrubbing in” before surgery
● Microbiology
○ Know the medications used during the surgery and how much to
administer.
○ Sharp instruments, other delicate equipment and certain catheters
and tubes can be sterilized by exposure to formaldehyde, glutaral
or chlorhexidine.
● Sociology
● Body Mechanics
■ Crushing Clamp
- Used to crush the diseased part of the gut in resection
anastomosis.
■ Scissors
● Surgical scissors
- Used for cutting multiple things in the surgical/ operative
setting
● Bandage scissors
- Used for sizing dressings and removing circumferential
bandages
● Metzenbaum scissors
- Surgical scissors designed for cutting delicate tissue and
blunt dissection
● Mayo scissors
- Use to cut heavy tissues such as fascia, muscle,
uterus, breasst, often use this during OB-Gyne
Procedure
● Tissue dissecting scissors
- Use to cut tissues at the surface or inside the human body.
● Wire scissors
- Used to cut wire sutures in plastic and orthopedic surgery.
Also used to cut metallic mesh.
● Bone cutters
- Used to cut or remove bones.
● Non-toothed
■ Babcock Forceps
- Utilized to grasp delicate tissue such as intestine, fallopian tube,
ovary, appendix, also available in long size
■ Backhaus Towel Clamp
- Used for grasping tissue, securing towels or drapes , and holding
and reducing small bone fractures
■ Stone Forceps
● Kidney stone forceps
- used for grasping and removing kidney stones, gall stones,
or polyps.
■
■ Self-retaining retractors (Weitlaner retractors)
- Use to set against the edges of the wound or the tissue needed to
be held apart and then ratcheted handles are locked manually
while the blades remain apart holding the edges with no
assistance.
■ Army Navy retractors
- Used to retract shallow or superficial incisions
■ Handheld retractors
● Richardson-Kelly handheld retractor
- is used to retract deep abdominal or chest incisions.
■ Skin hook
● is a simple and practical instrument for use in dermatologic
surgery. This instrument has been utilized by plastic
surgeons for a long time.
■ Bone hook
● are used to grasp and stabilize skin and tissue, ligaments,
tendons, and bone fragments.
■ Malleable retractor
● Allows shorter incisions to be used in relation to implant size
without sacrificing precision in preparation of the cavity.
■ Needle holder
- is a surgical instrument, similar to a hemostat, used by doctors
and surgeons to hold a suturing needle for closing wounds during
suturing and surgical procedures.
■ Crosshatched serrations
are used for grasping, holding firmly or exerting traction upon
objects.
■ Nasal Speculum
- This two-bladed instrument is inserted into the nostrils. It lets
doctors examine the inside of the nose.
■ Rectal Speculum
- to diagnose and treat conditions such as: hemorrhoids.
abscesses. tears in the anus (anal fissures)
■ Endoscope
● Hollow
- to examine the interior of a hollow organ or cavity of the
body.
● Lensed
use special glass rods with optically finished ends, providing
images with higher brightness, contrast and colour reproduction
than conventional lenses.
➢ suctioning and aspirating
○ These tools are used to remove blood and other fluids from a surgical field
○ These instruments include:
■ Frazier tip
- This is a thin instrument used for the removal of fluid or debris
from confined surgical spaces.
■ Yankauer tip
- It is typically a firm plastic suction tip with a large opening
surrounded by a bulbous head and is designed to allow effective
suction without damaging surrounding tissue. This tool is used to
suction oropharyngeal secretions in order to prevent aspiration.
■ Trocar
- The trocar functions as a portal for the subsequent placement of
other instruments, such as graspers, scissors, staplers, etc.
Trocars also allow the escape of gas or fluid from organs within
the body.
■ Cannula
- is a tube that can be inserted into the body, often for the delivery
or removal of fluid or for the gathering of samples.
■ Suction machine
- is a pump used to maintain an airway by removing secretions from
the mouth, throat, or lungs. It is particularly important in
neurological diseases where the ability to cough or swallow is
impaired.
■ Speculum
- A speculum is a duck-bill-shaped device that doctors use to see
inside a hollow part of your body and diagnose or treat disease.
One common use of the speculum is for vaginal exams.
➢ Measuring
○ These tools are used to measure body parts during surgical procedures
○ These instruments include:
■ Ruler
- is used for measuring aspects in operating room
■ Caliper
is a device used to measure the dimensions of an object.
● Neuro caliper
- Neuro Caliper Measures up to 127mm, Graduated Measure
in Inches and Millimeters with 90mm Delicate Blades
● Castroviejo caliper
is a commonly used tool in strabismus and other procedures
involving muscles of the eye. The caliper measures the exact
distance for muscle recession or resection
■ Goniometer
is essentially a protractor with two arms extending from it, used to
measure a joint's range of motion. They're most often used in physical
therapy to track the progress of a joint's movement.
● Eye
- Don sterile gloves.
- Going from medial to lateral canthus, paint operative eye, cheek, forehead and
nose on correct side, using ½ circle motions above and below the eye.
- Cover the eye with a 4x4 gauze and massage eye gently especially the
fornices.
- For corneal transplantation, glaucoma surgery
● Face
- Ensure a cap or towel is covering the patient’s hair, and use waterproof
tape if necessary to ensure hair is tucked away. The hairline is considered
a contaminated area
- Begin prep at the incision site and extend to the periphery of hairline and
neck.
- Prep the external ear if necessary.
- Repair of cleft palate, Rhinoplasty
● Ear
-Ensure a cap or towel is covering the patient’s hair, and use waterproof tape if
necessary to ensure hair is tucked away. The hairline is considered a
contaminated area.
-Place absorbent cotton into the external ear canal.
-Perform paint
-Cleanse the external ear.
- Extend the prep to the edge of the hairline, face and jaw.
- Remove the absorbent cotton from the external ear canal.
● Neck
- Ensure a cap or towel is covering the patient’s hair and use waterproof
tape if necessary to ensure hair is tucked away. The hairline is considered
a contaminated area
- The area to be prepped includes the neck laterally to the table line and up
to the mandible, tops of the shoulders, and chest almost to the nipple line.
- Tracheostomy, Thyroidectomy
Torso preparations
● Shoulder
-Elevate the patient’s arm prior to proceeding with prep. Be careful not to pull the
patient’s shoulder laterally to expose the scapular area to avoid dislocation and
further injury to the patient.
- Area to be prepped includes the chest, neck and shoulder, upper arm, scapula
and axilla on the affected side. Prep the axilla last. Hand may be excluded if
surgeon wraps in occlusive drape after the prep.
● Chest/breast
-Area to be prepped includes from the top of the shoulder to below the diaphragm
and from the edge of the non-operative breast to the table-level of the operative
side, including the upper arm to elbow circumferentially and the axilla of the
operative side.
- Prep the axilla last.
- Prep both sides of the chest for a bilateral procedure.
- If incision is in axilla, use a separate sponge for the axilla.
- Mastectomy, lung biopsy, drainage of pleural effusions
● Abdomen
-you will be given general anesthesia.
-A tube to help you breathe will be placed in your throat
-A catheter will be inserted into your bladder to drain urine and to
monitor the amount of urine coming out during surgery.
-Compression stockings will be placed on your legs to prevent blood clots in your
legs and lungs during surgery.
● Back
-Apply a generous amount of surgical scrub solution to the clipped area and
scrub the skin with gauze sponges or a surgical brush.
-Local anesthetic agent should be administered after the preliminary skin
preparation but before the final preparation.
-Sterile surgical gloves should be worn for the final skin preparation. Supplies,
including solutions, must be sterile.
● Vagina/Perineal/Perianal
-First: prep pelvis, labia, perineum, and thighs as follows:
○ Start prep at the pubis and prep to iliac crest using back and forth strokes.
○ Prep labia majora using downward strokes, including perineum.
○ Use fresh sponge to prep inner thigh of first leg starting at labia majora and
moving laterally using back and forth strokes. Discard sponge when periphery
reached.
○ Use fresh sponge to prep inner thigh of second leg starting at labia majora and
moving laterally using back and forth strokes. Discard sponge when periphery
reached.
- Next: prep vaginal vault using a separate sponge mounted on a forcep.
- Prep anus last.
- Vaginal Reconstruction, clitoral unhooding, Perineorrhaphy
Extremities
○ Upper
■ Arm
- Elevate limb for prep
- Hand and fingernails may require pre-cleaning prior to skin prep.
-The area to be prepped includes: the hand to mid forearm.
-Begin prep at the incision site and complete one side of the hand,
continue prep on the opposite side of the hand, working in a
circular motion towards the elbow.
- During the prep, the nurse wearing sterile gloves may hold the
patient’s painted fingers to assist in the manipulation of hand
during the prep.
- Examples for Upper Extremities Surgeries: Carpal Tunnel
Release, Shoulder replacement
● Arm
-Elevate limb for prep.
- The area to be prepped includes: entire circumference of the arm
to the mid forearm, over the shoulder, scapula and axilla (prep
last).
- Begin the prep at the incision, prep from proximal to distal
boundaries.
○ Lower
■ Hip
-Elevate limb for prep.
- Area to be prepped includes: abdomen on the affected
side, thigh to below the knee, the buttocks on the affected side,
the groin, and the pubis.
- Begin the prep at the incision site. Proceed to periphery which is
abdomen midline, inferior rib cage, below knee. Prep the groin and
perineum last.
- Hip Replacement Surgery
● Trendelenburg
- Used for abdominal hysterectomy and procedures on the pelvic area
- is a variation of the supine position.
- The upper torso is lowered and the feet raised, allowing for optimal
visualization of the pelvic organs during laparoscopy and lower abdominal
procedures.
● Reverse trendelenburg
- For neck procedures and laparoscopic procedures
- Commonly known as the head-up and feet-down position, the reverse
Trendelenburg is often used in head and neck procedures
● Fowler’s
- Fowler’s is used for posterior craniotomy and select ENT procedures
(ears, nose, throat)
- facilitates the relaxing of tension of the abdominal muscles,
allowing for improved breathing.
- used for neurosurgery and shoulder surgeries.
● Dorsal lithotomy
- Used for obstetric, gynecologic, perineal, anorectal, and urologic
procedures
- While in the lithotomy position, the patient is in supine position and their
legs are raised and abducted. Stirrups are needed for this position.
● Prone
- Used for adrenalectomy and spinal surgeries and anorectal procedures
- In this position, the patient lies flat on their stomach and their head is
turned to the side. This position is most commonly used for cervical spine,
back, and rectal area procedures
● Lateral kidney
- Used for procedures on the upper urinary tract (ex. kidney) and structures
in the retroperitoneal space
- is much like the lateral position except the patient's abdomen is
placed over a lift in the operating table that bends the body to allow
access to the retroperitoneal space.
● Lateral chest or posterolateral thoracotomy
- Used for procedures needing thoracoabdominal access
- The lateral position places the patient on the non-operative side to that
surgery can be performed on the hip, chest, or kidney.
● jackknife
- For anorectal and coccygeal surgeries
- The safety belt is placed below the knee. It is important to return the
patient slowly to horizontal from this unnatural position. Used in anorectal
procedures .
6. Discuss the:
6.1. Classification of surgery according to:
6.1.1. Major or Minor
Major Surgery - usually requires extended stay in a hospital and specialized
care, has a higher degree of risk, involves major body organs or life threatening
situations, has a greater risk for postoperative complications, and an extended
recovery period.
Examples:
○ Open Cholecystectomy
○ Nephrectomy
○ Hysterectomy
○ Radical mastectomy
○ Laparotomy
○ Cesarean section
○ Organ, Joint replacement
Minor Surgery - is usually brief, carries a low risk and results in few
complications.
- Minor surgeries are mostly elective.
- Generally superficial and do not require penetration of a body
cavity.
- Does not involve assisted breathing or anesthesia.
● Examples:
○ Teeth extraction
○ Cataract extraction
○ Removal of warts
○ Repair of cuts or small wounds
6.1.2. Purpose
Surgeries based on purpose:
1. Diagnostic Surgery - surgeries that confirm or establish a
diagnosis.
Examples: Biopsy, Bronchoscopy, Endoscopy
2. Ablative Surgery - surgeries that remove a diseased body part.
Examples: Appendectomy, Amputation, Pharyngectomy
3. Palliative Surgery - surgeries that relieves or reduces pains or
symptoms of a disease. It is not curative.
Examples: Colostomy, Nerve root resection
4. Reconstructive Surgery - surgeries that restore function to
traumatized or malfunctioning tissue or to improve self concept.
Examples: Scar revision, Plastic surgery, Internal fixation
of a fracture, Breast reconstruction
5. Transplant Surgery - surgeries that replace diseased or
malfunctioning organs or structures.
Examples: Kidneys, lives, heart transplantation.
6. Constructive Surgery - surgeries that restore functions or
appearance in congenital anomalies.
Examples: Cleft lip repair, Closure of atrial septal defect
● Shock
○ Elevate patient’s feet about 12 inches above the head level
○ Begin CPR as necessary
○ Keep patient warm and comfortable
● Hemorrhage
○ Assess vital signs and monitor signs of shock
○ Monitor blood loss
○ Administer IV fluids, medications and blood products as necessary
● Risk for Infection
○ Assess skin color, texture, elasticity, and moisture
○ Check patient’s immunization history
○ Encourage adequate rest
○ Encourage a balanced diet
○ Encourage to increase fluid intake
● Urinary Retention
○ Provide fluids prior to voiding
○ Place the patient in an upright position to promote voiding
○ Catheterization if incomplete urination
● Reaction to anesthesia
○ Continue monitoring for any signs of post-anesthetic reactions following
surgery (e.g. pneumonia)
○ Provide comfort measures (pain relief, skin care)
○ Monitor vital signs
● Midline Incision
○ Allows the majority of the abdominal viscera to be accessed
○ It is used for a wide array of abdominal surgery
○ This incision will cut through the skin, subcutaneous tissue, and fascia,
the linea alba and transversalis fascia and the peritoneum before
reaching the abdominal cavity
○ Causes minimal blood loss or nerve damage
○ Can be used for emergency procedures
● Paramedian Incision
○ Used to access the lateral viscera (kidneys, spleen, and the adrenal
glands)
○ Runs 2-5 cm away from the midline cutting through the skin,
subcutaneous tissue and the anterior rectus sheath
○ It offsets vertical incision to right or left, providing access to lateral sutures
such as spleen or kidney.
○ This incision takes a long time and is difficult
○ It may damage the muscles lateral blood and nerve supply which may
result in the atrophy of the muscle medial to the incision
● Transverse incision
○ Provide adequate access to the pelvis and pelvic regional nodes, but
relatively poor access to the upper abdomen.
○ Made to run parallel to the costal margin
○ May heal more securely than vertical ones and more easily concealed
under clothing than the more versatile vertical midline incision.
● Pfannenstiel Incision
○ Curved incision 10 to 15 cm long and 2 cm above the symphysis pubis
○ Skin and rectus sheath are opened transversely and the fascia is
dissected along the rectus muscles
○ The patient’s position for this incision can be lithotomy, supine, or
modified dorsal supine lithotomy.
● Sutures
○ Classified into two types of sutures: Absorbable and Non-absorbable
■ Absorbable
●Will break down harmlessly in the body over time without
intervention
● Degrade, loses tensile strength within 60 days
➢ Types of absorbable sutures:
● Gut
● Polydioxanone (PDS)
● Poliglecaprone (MONOCRYL)
● Polyglactin (VICRYL)
■ Non-absorbable
● Does not break down in the body
● Need to be removed by the doctor at a later date or in
some cases left in permanently
➢ Types of nonabsorbable sutures:
● Nylon
● Polypropylene
● Silk
● Polyester (Ethibond)
● Suture Needles
○ Taper Point
○ Blunt Taper Point
○ Reverse Cutting Edge
○ Cutting Edge
○ Micro-Point Spatulated Curved
● Blades
❏ No. 10
● Blade is generally used for making small incisions in skin and
muscle
● Blade with curved belly
❏ No. 11
● Is an elongated triangular blade sharpened along the hypotenuse
edge with a strong pointed tip which is ideal for stab incisions
● A blade with a straight and an angled edge with a pointed end.
❏ No. 12
● Is a small, pointed, crescent shaped blade sharpened along the
edge of the curve.
● Used in removing sutures, parotid and cleft palate surgeries.
❏ No. 15
● has a small curved cutting edge (short and precise incisions)
❏ No. 23
● A blade with a curved cutting edge.
● The opposite side is blunt
● Used in making long incisions
❏ No. 26
● A blade with a straight cutting edge.
● The opposite side is straight and blunt with a downward angle.
7. Differentiate:
7.1. Sterilization process as to its:
7.1.1. Types:
7.1.1.1. Radiation - the use of a radioactive substance in the diagnosis or
treatment of the disease.
Documentation of the information found on the pre-operative checklist is valuable for preventing
errors in caring for the patient during the surgery and it provides an extra measure of the
patient’s safety. It also allows to detect difficulties or problems in preoperative which can
endanger the patient’s life or the expected result of the surgery. Is there where you must
generate protocols that ensure safety for patients, decreasing the maximum errors and comply
with the premise made by WHO in 2008: “Safe surgery saves lives”.
8.3 WHO Surgical Safety Checklist
The WHO Surgical Safety Checklist was made to decrease errors and adverse events during
the procedure and to increase teamwork and communication in surgery, in order to significantly
reduce both morbidity and mortality rates. The designated checklist coordinator, which is most
often the circulating nurse, is responsible for checking the boxes on the list, but it can also be
any other clinician or healthcare professional who is part of the operation.