1) The document provides guidance on properly assisting at surgical operations, including proper conduct, safety protocols, roles of operating room personnel, surgical stages, and use of instruments.
2) Guidelines cover sterile technique, respecting the sterile field, understanding tissue planes, and methods for providing traction and counter-traction during surgery.
3) After surgery, assistants can help by tasks like putting away equipment, transferring the patient, and filling out forms to aid in the patient's post-operative care.
1) The document provides guidance on properly assisting at surgical operations, including proper conduct, safety protocols, roles of operating room personnel, surgical stages, and use of instruments.
2) Guidelines cover sterile technique, respecting the sterile field, understanding tissue planes, and methods for providing traction and counter-traction during surgery.
3) After surgery, assistants can help by tasks like putting away equipment, transferring the patient, and filling out forms to aid in the patient's post-operative care.
1) The document provides guidance on properly assisting at surgical operations, including proper conduct, safety protocols, roles of operating room personnel, surgical stages, and use of instruments.
2) Guidelines cover sterile technique, respecting the sterile field, understanding tissue planes, and methods for providing traction and counter-traction during surgery.
3) After surgery, assistants can help by tasks like putting away equipment, transferring the patient, and filling out forms to aid in the patient's post-operative care.
[Taken from Assisting at Surgical Operations A Practical Guide (Cambridge Clinical Guides)] Introduction to the operating theatre General conduct in the operating theatre • Relationship with theatre staff • The middle course is safest and best: • Activity versus passivity • Stress • Talking in the operating theatre • Pagers and mobile (cell) phones • Food and drink • If you feel faint • Know dimensions Universal Precautions • Transmissible disease in the operating theatre • If you suffer a needle-stick injury • If you suffer an eye splash Clothing in the operating theatre • Scrubs • Other operating theatre clothing • Hat • Face mask • Eye protection • Footwear • Jewellery • Re-entering the operating suite Personnel: who’s who in the operating theatre • Doctors • Nurses • Instrument nurses or ‘scrub nurses’ • Scout nurses or circulating nurse • Anaesthetic nurses • Other personnel • Theatre orderlies • Radiographers The operation itself Preparing for the operation • read up in advance about the operation you will be assisting at • Familiarise yourself with the patient • ensure you understand the key points about the patient • put relevant X-rays up on light box • Check the shave • Insert a urinary catheter • Help position the patient • Ensure the diathermy plate is in place safely General intra-operative principles • Concentrate on your task • Anticipation • Sharps • Adjusting the light source • Steady hands • Improving the surgeon’s view General stages common to operations • Preparation by the anaesthetist • Setting up (positioning the patient and equipment) • Patient positioning • Applying anti-thromboembolic devices • Shaving • Skin preparation • Draping • Marking the incision with a surgical skin-marking pen • Entry General stages common to operations • Mobilisation • The key therapeutic objective • Incision • Excision: • Investigation • definitive treatment • Evacuation • Exploration • Manipulation • Implantation: General stages common to operations • Reconstruction • Haemostasis (‘stopping the bleeding’) • Washing out (also known as irrigation or lavage) • Drain insertion • Closure of the wound • Local anaesthetic instillation • Dressings Sterility and the ‘sterile zone’ • do not enter the ‘sterile zone’ • do not walk between two sterile areas (between the scrub nurse’s trolley and the draped patient) • if your gloved finger accidentally touches something unsterile stop using that hand request a new glove • Waterproof gowns • Scrubbing • When to scrub • Scrub technique Sterility and the ‘sterile zone’ • Drying the hands • Where to put your hands • Gowning • Shaving, antiseptic painting and • Gloving draping • Glove size • Clipping the drapes • Glove type • Setting up instruments • Donning gloves • Incise drapes Tissue planes: traction and counter-traction • If you can see the correct tissue plane, you will greatly help the surgeon by gently retracting the tissue on one side of it countertraction • Counter-traction can be achieved by several different methods: • mainly using instruments • occasionally the fingers Surgical instruments: their names and how to use them • Types of surgical instruments • Basic instruments • Cutting instruments • Scalpels: Barron and standard handles • Scissors • The correct scissor grip • Cutting sutures • Placing clips on sutures • To cut or to clip? • Handling multiple clipped sutures Surgical instruments: their names and how to use them • Types of surgical instruments • Types of surgical instruments • Basic instruments • Basic instruments • Gripping instruments • Non-ratcheted: forceps (never • Ratcheted ‘tweezers’) • Atraumatic • Retractors • ‘Heavy’ • hold themselves in place • Clips • must be held in place by the • Types of ratcheted clips hand of the assistant • Non-ratcheted: forceps (never • Special equipment ‘tweezers’) • Suture material • Suckers • The sump sucker • Fine suckers (e.g.Yankaeur) Surgical instruments: their names and how to use them • Types of surgical instruments • Types of surgical instruments • Diathermy • Haemostatic techniques • Types of diathermy • Assisting with the different • ‘Touching’ with the diathermy haemostatic techniques • Clip and tie • Haemostatic techniques • Removing ligature clips • Assisting with the different • Loaded ties haemostatic techniques • Clip and double-tie • Simply ignore it • Suture • Diathermy Dabbing • Transfixion-ligation • Gauze swabs, • The ‘peanut’, • The swab-on-a-stick • Types of surgical instruments • Haemostatic techniques • Preventing suture material from tangling • ‘Following’ a suture line • Placing packs to protect suture material • Drains • Prosthetic materials Immediately after the operation Immediately after the operation • it is better to help with some of the innumerable small jobs: • Put the X-rays back in their packet • Help wheel in the patient’s bed • help transfer the patient onto it from the operating table • Fill in forms (histopathology request forms) • prescribe the patient’s drugs or non-drug treatment orders • The usual custom is for the doctor who does the operation, to write the formal operation record • If the surgeon you are assisting is ignoring this custom, you may be asked to write it. THANK YOU