O PE RAT I N G

ROOM
NURSING
PERIOPERATIVE NURSES ALSO
CALLED OPERATING ROOM (OR)
NURSES ARE REGISTERED NURSES

 relied upon for their professional

judgment and critical thinking
skills.
 work closely with the surgical
patient, family members, and
other health care professionals.
• HELP PLAN, IMPLEMENT, AND
EVALUATE TREATMENT OF THE
PATIENT. IN THE OPERATING ROOM,
THE PERIOPERATIVE NURSE MAY SERVE
AS A:
 Scrub nurse
 Circulating nurse
 RN First Assistant
OTHER POSITIONS:
 OR Director, managing budgets,
staffing, and other business aspects
of the operating room
 consider a career in business as a
management consultant, clinical
educator, researcher, or medical
sales professional.
 With advanced education and
training, some perioperative nurses
elect to pursue the role of a nurse
anesthetist. 
  PREPARATION
 Two areas that can give you
some applicable experience
are critical care and
emergency room care.
 what it is like to work in a
fast-paced environment
where you can participate
in life-saving decisions that
make a difference
 OPPORTUNITIES FOR
EMPLOYMENT
 may work in hospital surgical departments;
day-surgery units (ambulatory surgery);
clinics and physician’s offices
 With an aging population and rising health
care costs, nurses are expected to be in high
demand
 Much of this demand will come because the
number of older people is projected to grow
very rapidly, and older people are more likely
than younger ones to need medical care.
GENERAL FUNCTIONS:
 To provide quality operating room services
to patients with potential and evident
surgical disorders as well as to medical staff
needing such services for their patients.
 To provide quality operating room and
recovery room (PACU) services to patients
with potential and evident surgical disorders
as well as to medical staff needing such
services for their patients.
 To provide quality services in the operating
room.
SPECIFIC FUNCTIONS:
A. Service:
 To provide quality operating room services to
medical staff needing such services for their
patients.
 To provide quality operating room and
perioperative nursing services to patients with
potential and evident surgical disorders.
>To provide quality delivery room,
operating room and perioperative nursing
services to patients with potential and evident
obstetrical and gynecological disorders.
>To provide quality operating room and
perioperative nursing services to
patients with potential and evident
gynecologic disorders.
>To provide quality operating room and
perioperative nursing services to
patients with potential and evident
ophthalmologic disorders.
>To provide quality operating room and
perioperative nursing services to
ambulatory patients with potential and
evident surgical disorders.
 >To provide quality operating
room and perioperative nursing
services to inpatients with
potential and evident surgical
disorders.
>To provide quality operating
room and perioperative nursing
services to patients needing
endoscopic procedures.
B. TRAINING:
 To provide continuing
professional education to all
staff of the Operating Room
and all concerned
paramedical staff so as to
maintain and improve
quality of service.
C. RESEARCH:


To engage in research in
the field of operating room
services that will improve
quality of service.
 WHAT DO OR NURSES DO?
I. DUTIES OF A SCRUB NURSE:
A. Before the Surgeon Arrives
 Do a complete scrub according to
accepted practice.
 Put sterile gown and glove.
 Drape tables as necessary.
 Drape the mayo stand.
 Count sponges, instruments, needles
and sharps.
 Arrange the instruments on mayo stand
for making and opening initial incision.
 Count surgical needles with circulating
nurse.
 Count all sponges with circulating nurse.
Circulating nurse should immediately
record it.
 Counts before the start of the operation.
 Counts before the surgeon starts closure
of the body cavity or deep or large
incision.
TABLE COUNT
 Scrub nurse and circulating
nurse count all items in the
instrument table and mayo
stand.
FLOOR COUNT
 Circulating nurse counts
sponges and other items that
are recovered from the floor.
Be verified by the staff nurse.
FIELD COUNT
 Circulating nurse totals floor and
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.
INCORRECT COUNT
 Entire count is repeated immediately.
 Circulating nurse looks at trash receptacles, under
furniture, linen hamper or throughout the room.
 Staff nurse looks over drapes and under items on
the table and mayo stand.
 Surgeon rechecks field and wound.
 Circulating nurse should call HEAD NURSE to check
the count.
 X-rays must be taken before the patient leaves OR
whenever a sponge or instrument count is
incorrect.
 Circulating nurse makes an incidence report.
B. AFTER SURGEON AND
ASSISTANT SCRUB
 Gown and glove the surgeons and
assistants as soon as they enter the
room.
 Assist in draping the patient according
to the routine procedure. Offer towel
and towel clips and drapes.
 Bring mayo table into position after
draping is completed. Position the table
at right angle to operating table.
C. DURING THE OPERATION
 Hand skin knife to surgeon and
haemostat to assistant.
>When handling knife, hold the handle
blade down and pointed towards your
wrist, NEVER towards the surgeon.
 Watch field and anticipate the needs of
the surgeon. Keep one step ahead of
him in offering instruments, sutures and
sponges. Notify circulating nurse quietly
for supplies not in the table.
>Pass instruments in a positive
manner. When the surgeon
extends hand, instruments
should be slapped firmly into
palm in proper position for use.
>Keep instruments clean as
possible, wipe blood with moist
sponge.
>Return instruments to mayo
stand promptly after use or
cleaning.
 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.
 Maintain sterile technique. Watch
for any breaks.
D. DURING THE CLOSURE
 Count sponges, needles and
instruments with circulating
nurse when surgeon begins
closure of the wound.
 Clear off mayo stand as time
permits leaving a knife handle
with blade, tissue forceps,
scissor, a haemostats and 2
allis forceps.
 Have a damp sponge ready
to wash the blood from the
area surrounding the
incision as soon as the skin
closure is completed.
 Have betadine, dressings
and plaster ready.
II.DUTIES OF THE CIRCULATING
NURSE
 Circulating nurse washes hands
and 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.
A. AFTER SCRUB PERSON /
NURSE SCRUBS
 Fasten back of scrub person’s gown.
 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.
 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 and let it be
served when surgeon is about to
suture.
 Pour normal saline solution into the
round basin for sponges on the
instrument table.
 Count sponges, needles, and
instruments with the scrub nurse
and record immediately.
B. AFTER THE PATIENT ARRIVES
 Greets and identify the patient. Check the
wristband.
 Check NCP and patient’s chart for
pertinent information including CONSENT.
 Be sure patient’s hair is covered with cap
to prevent dissemination of
microorganisms.
 Assist the patient in moving from the
stretcher to the OR table. Use proper
body mechanics.
 Apply restraint straps over legs
and arms. Keep patient covered
with blanket for privacy and
provide warmth.
a. Patient’s legs should not be
crossed.
b. Put arm board on left and right
arm if IV is to be infused
 6. Help anaesthesiologist , surgeon
or assistant as needed.
C. DURING THE INDUCTION OF
GENERAL ANESTHESIA
 Stay in the room and near the patient to
provide comfort and assist the
anaesthesiologist in the event that patient
gets excited. Patient must be guarded
during induction to prevent possible injury
or fall from the OR table.
 Be quiet as much as possible.
 Excitement may occur during induction
from tactile or auditory stimulation
especially in alcoholics.
D. AFTER THE PATIENT IS ANESTHESIZED
 Reposition the patient only after the
anaesthesiologist says so.
 Attach anesthesia screen and other table
attachments.
 Note patient’s position. All safety
measures must be observed.
 If cautery is to be used, placed inactive
dispersive electrode plate in contact with
patient’s skin to ground the patient
properly. Avoid scar tissues, hairy or bony
areas.
 Expose appropriate area for the skin
preparation.
 Turn overhead spotlight over sight of
incision.
 Bright light should not be focused on the
before he/she is asleep because pre-op
meds affect the pupils. Dim light is less
irritating.
 Arrange sterile preparation tray and pour
solutions if this has not been done yet.
 Cover the preparation tray immediately
after use.
E. AFTER SURGEON AND ASSISTANTS
SCRUBS
 Be alert to anticipate needs of sterile
team.
>Circulating nurse watches closely the
operation and anticipates the needs
without having the team ask for them.
>Should know where all supplies are to
facilitate time and get them quickly.
 Stay in the room. Inform scrub nurse if
you must leave.
 Keep discarded sponges carefully
collected, separated by sizes and
counted. Use sponges, forceps or
gloves NEVER WITH BARE HANDS to
handle and count sponges.
 Assist in monitoring blood loss. Weigh
sponges if requested by surgeon.
>Measure blood volume from suction
container.
 Obtain blood products for transfusion
as necessary from the refrigerator or
from blood bank.
 Know the condition of the
patient at all times.
 Prepare and label specimens for
transportation to the laboratory.
 Complete the patient’s chart,
permanent operating room
records, and requisitions for
laboratory test. Etc.
 Be alert to any break in sterile
technique.
F. DURING CLOSURE
 Count sponges, sharps, and instruments with
scrub nurse
>Reports counts as correct or incorrect to
surgeon.
>Complete count records.
 If another patient is scheduled to follow:
>Circulating nurse should call the ward for the
next patient atleast 45 minutes before the
scheduled time of operation to request that
prep-op medication be given.
>Ask transport aide to fetch patient from the
ward 30 minutes before operation.
G. AFTER THE OPERATION IS COMPLETED
 Open neck and back closures of
gowns of surgeons and assistants so
they remove the gowns without
contaminating themselves.
 Assist with dressing. Scrub nurse
should roll drapes off the patient
before outer layer of dressing is
applied.
 Connect all drainage systems as
indicated.
 See to it that the client is clean--
wash off blood, feces. Put on a
clean gown and blanket.
 Have transport aide bring a clean
recovery room stretcher.
 Help move patient to stretcher or
bed. Place patient to stretcher
with a 4-man carry.
 Be sure chart and proper records
including NCP accompanying
patient.
 Final completion of the client’s chart
should include the documentation of:
>Assessment of patient’s skin
condition prior to and at completion
of operation.
>Urine output and blood loss- I&O
>Type of dressing used
>Time patient was discharged from OR
 Have nursing assistant help transport
patient to recovery room or post
anesthetic care unit.
ISSUES:
 1.Retaining aging OR nurses
 physical demands of
standing for long periods of
time and handling heavy
equipment, and it’s easy to
see how perioperative
nursing can exact a
physical, mental, and
emotional toll.
2. WHY IS OR COLD? ARE
OPERATING ROOMS COLD TO
PREVENT INFECTION?
 The real reason operating rooms
are kept so cool is for the comfort
of OR personnel,specifically the
surgeon.
 When wearing a sterile gown for a
length of time,especially while
standing under warm OR lights,
your surgeon can become quite
hot.
3. ROBOTS
INVADE THE
OPERATING
ROOM
(MACHINES
HELP
SURGEONS
PIONEER NEW
PROCEDURES)
4. ISSUES SURROUNDING
VIDEOTAPING SURGERIES IN THE
OPERATING ROOM
Given that a whole procedure may
be recorded in some way, where
should the recording start and end?
As the patient is wheeled in, and
then wheeled out?
 Who “owns” the recording? The
hospital, on whose equipment the
recording is invariably made, the
doctor, or the patient? Who
controls the recording – the owner?
 Can, or should, the recording be edited,
cut or deleted in any way, particularly
when things go wrong?
 Does a surgeon have the right to refuse
being recorded, or to turn it off when the
surgery does not go to plan?
 Consent to record must be taken, but does
a patient have the right to refuse?
 What about procedures on intimate areas
of the body? What controls on recorded
data should be in place to protect patient
dignity?
 Does the doctor have a right to
refuse his patient’s access to
the recorded data?
 Does the presence of a
procedure recording enhance
or suppress potential litigation?
 How do the malpractice
insurers feel about this
technology? Do they embrace
it, or warn against it?
CONCLUSION
 The RN specializing in Perioperative
Nursing practice performs nursing activities
in the preoperative, intraoperative, and
postoperative phases of the patients'
surgical experience. Registered nurses
enter perioperative nursing practice at a
beginning level depending on their
expertise and competency to practice. As
they gain knowledge and skill, they
progress on a continuum to an advanced
level of practice.