OPERATING

ROOM
PREPARATION

Philipp Acaso
Ralph Arco
 LEARNING By the end of 2 hours of reporting and
discussion the student nurses will be able
OBJECTIVE to gain a broader knowledge in how to
perform surgical hand scrub, gown and
gloving technique, operating room
preparation, and the different type of
surgical instruments used in the operating
room and also develop skills on how to
perform all three procedures while also
develop an understanding in perioperative
nursing.
 SPECIFIC At the end of two hours of lecture and
reporting the student nurse will be able to:
OBJECTIVES • Define perioperative nursing
• Discuss the 3 phases of perioperative
nursing
• Discuss the surgical areas within the
operating room
• Enumerate the members of the surgical
team
• Discuss the responsibilities for each
member of the surgical team
 6. Discuss the initial nursing assessments that
have to be done in perioperative nursing
SPECIFIC
7. Discuss the initial nursing management that
OBJECTIVES has to be performed in perioperative nursing
8. Define and discuss the purposes of surgical
hand scrub
9. Define and discuss the purposes of gowning
and gloving technique
10. Define and discuss the purposes of operating
room preparation
11. Enumerate and discuss the different surgical
instruments used in the operating room and
their purposes
PERIOPERATIVE
NURSING
PERIOPERATIVE Perioperative nursing consists of three
NURSING phases:
• Preoperative
• Intraoperative
• Postoperative
PREOPERATIVE Extends from the time the client is
NURSING admitted in the surgical unit, to the time
he/she is prepared for the surgical
procedure, until he is transported to the
operating room
INTRAOPERATIVE Extends from the time the client is
PHASE
admitted to the OR, to the time of
administration of anesthesia, surgical
procedure is done, until he/she is
transported to the RR/PACU
POSTOPERATIVE Extends from the time the client is
PHASE admitted to the recovery room, to the
time he is transported back into the
surgical unit, until the follow-up care.
 MAJOR TYPES
OF PATHOLOGIC
PROCESS
 4 MAJOR OPET
TYPES OF • Obstruction – impairment to the flow
PATHOLOGIC of vital fluids (blood, urine, CSF, bile)
PROCESS • Perforation – rupture of an organ.
REQUIRING • Erosion – wearing off of a surface or
SURGERY membrane
• Tumors – abnormal new growths
 EXAMPLES

• Hydrocephalus OBSTRUCTION
• Burn EROSION
• Cholelithiasis OBSTRUCTION
• Intussusception OBSTRUCTION
• Ruptured aneurysm PERFORATION
• Benign prostatic hyperplasia TUMOR
CLASSIFICATION OF SURGICAL
PROCEDURE
ACCORDING • DIAGNOSTIC – To establish the
TO PURPOSE presence of a disease condition (e.g.
BIOPSY)

• EXPLORATORY – to determine the

extent of the disease condition(e.g.
EXPLORATORY LAPORASCOPY)
ACCORDING • CURATIVE – To treat a disease
TO PURPOSE condition.
– Ablative – removal of an organ
“ectomy” (e.g. mastectomy)
– Constructive – repair of congenitally
defective organ “plasty, oorhaphy,
prexy” (e.g. rhinoplasty)
– Palliative – to relieve distressing sign
and symptoms, not necessarily to cure
the disease.
 EXAMPLES

• Pap smear DIAGNOSTIC

CURATIVE – ABLATIVE
• Tonsilectomy
CURATIVE – ABLATIVE
• Nephrocapsulectomy
CURATIVE – CONSTRUCTIVE
• Osteoplasty CURATIVE – RECONSTRUCTIVE
• Perineorraphy CURATIVE – CONSTRUCTIVE
• Trachelorrhaphy CURATIVE – RECONSTRUCTIVE
• Skin grafting
CLASSIFICATION OF SURGICAL
PROCEDURE BY URGENCY
 CLASSIFICATION INDICATION FOR SURGERY EXAMPLES

Emergent – patient requires WITHOUT DELAY • Severe bleeding

immediate attention, life • Gunshot / stab
threatening condition wound
• Fractured skull
Urgent/ Imperative – patient WITHIN 24 TO 30 • Kidney / ureteral
requires prompt attention HOURS stones
Required – patient needs to PLAN WITHIN A FEW • Cataract
have surgery WEEKS OR MONTHS • Thyroid d/o
Elective – patient should have FAILURE TO HAVE • repair of scar
surgery SURGERY NOT • Vaginal repair
CATASTROPHIC
Optional – patient’s decision PERSONAL • Cosmetic surgery
PREFERENCE
ACCORDING • MAJOR Surgery
TO DEGREE – High risk/Greater risk for infection

OF RISK – Extensive
– Prolonged
– Large amount of blood loss
– Vital organ may be handled or
removed
ACCORDING • MINOR Surgery
TO DEGREE – Generally not prolonged

OF RISK – Leads to few serious complications

– Involves less risk
AMBULATORY ADVANTAGES:
SURGERY/ • Reduces length of hospital stay and
SAME-DAY cuts costs
SURGERY/ • Reduces stress for the patient
OUTPATIENT
• Less incidence of hospital acquired
SURGERY
infection
• Less tine lost from work by the patient;
minimal disruptions on the patient’s
activities and family life.
AMBULATORY DISADVANTAGES:
SURGERY/ • Less time to assess the patient and
SAME-DAY perform preoperative teaching
SURGERY/ • Less time to establish rapport
OUTPATIENT
• Less opportunity to assess for late
SURGERY
postoperative complications
EXAMPLES OF • Teeth extraction
AMBULATORY • Circumcision
SURGERY
• Vasectomy
• Cyst removal
• Tubal ligation
PREOPERATIVE PHASE
GOALS • Assessing and correcting physiologic
and psychological problems that may
increase surgical risk
• Giving the person and significant
others complete learning/ teaching
guidelines regarding surgery
• Instructing and demonstrating
exercises that will benefit the person
during postop period
 • Presence of pain
Physiologic • Nutritional and fluid and electrolyte

assessment of balance
• Cardiovascular / pulmonary function
patient • Renal function
undergoing • Gastrointestinal / liver function

surgery • Endocrine function

• Neurologic function
• Hematologic function
• Use of medication
• Presence of trauma and infection
TEST PURPOSE
BUN/CREATININE To evaluate renal function

ALT/AST/LDH and Bilirubin To evaluate liver function

Serum and albumin and total Evaluate nutritional status

CHON
Urinalysis Determine urine composition

Chest XRAY Evaluate respiratory status/heart size

ECG Identify preexisting cardiac problem

INFORMED CONSENT
PURPOSES • To ensure that the patient understands the
nature of the treatment including the
potential complications
• To indicate that the client’s decision was
made without pressure
• To protect the patient against unauthorized
procedure
• To protect the surgeon and hospital against
legal action by a patient who claims that an
authorized procedure was performed
 Circumstances • Any surgical procedure where scalpel,
requiring consent scissors, suture, hemostats of
electrocoagulation may be used.
• Entrance to the body cavity
• Radiologic procedures, particularly if a
contrast material is required
• General anesthesia, local infiltration
and regional block
 Essential • The diagnosis and explanation of the
condition
elements of • A fair explanation of the procedure to be
informed done and used and the consequences
• A description of alternative treatment or
consent procedure
• A description of the benefits to be
expected
• The prognosis, if the recommended
care, procedure is refused
Requisites for • Written permission is best and legally
accepted
validity of • Signature is obtained with the client’s
informed complete understanding of what is to
consent occur:
– Adults sign their own operative permit
– Obtained before sedation
Requisites for • For minors, parents or someone standing
in their behalf gives the consent
validity of – Note: for a married emancipated
informed minor parental consent is not needed
consent anymore, spouse is accepted
Requisites for • For the mentally ill and unconscious
patient, consent must be taken from
validity of the parents or legal guardian.
informed • If the patient is unable to write, an
consent “X” is accepted if there is a witness
to his mark.
• Secured without pressure and threat
Requisites for • What an emergency situation exists, no
consent is necessary because inaction
validity of at such time may cause greater injury
informed (permission via telephone/cellphone is
accepted but must be signed within 24
consent hrs)
PREOPERATIVE CARE
 Physical Before Surgery:
• Correct any dietary deficiencies
Preparation • Reduce an obese person’s weight
• Correct fluid and electrolyte imbalances
• Restore adequate blood volume with BT
• Treat chronic diseases
• Halt or treat any infectious process
 Physical • Treat an alcoholic person with vitamin
supplementation, IVF or fluids if
Preparation dehydrated
Preoperative • Incentive spirometer

teaching • Diaphragmatic breathing

• Coughing
• Splinting
• Turning
• Foot and leg exercise
• Early ambulation
GUIDELINES FOR PREOPERATIVE
FASTING
LIQUID AND FOOD INTAKE MINIMUM FASTING
PERIOD

Clear liquids 2 hours

Breast milk 4 hours

Nonhuman milk 6 hours

Light meal 6 hours

Regular/ Heavy meals 8 hours

Preparing the AM Care:

person on the • Awaken one hour before the preop

medication
day of • Morning bath, mouth wash
surgery • Provide clean gown
• Remove hairpins, braid long hair &
cover with cap if available
• Remove dentures, colored nail polish,
hearing aids, contact lenses, and
jewelries
Preparing the AM Care:

person on the • Take baseline vital signs before preop

medications
day of • Check ID bang, skin prep
surgery • Check for special orders – enema, IV
line
• Check NPO
• Have client void before preop
medication
• Continue to support emotionally
INTRAOPERATIVE PHASE
GOALS • Asepsis
• Homeostasis
• Safe administration of anesthesia
• Hemostasis
SURGICAL SETTING
Unrestricted • Provides an entrance and exit from the
surgical suite for personnel, equipment
Area and patient
• Street clothes are permitted in this
area, and the area provides access to
communication with personnel within
the suite and with personnel and
patient’s families outside the suite
 Semi- • Provides access to the procedure
rooms and peripheral support areas
restricted area within the surgical suite
• Peripheral support areas consists of:
storage areas for clean and sterile
supplies, sterilization equipment and
corridors leading to the procedure
room
Restricted • Includes the procedure room where
surgery is performed and adjacent
Area substerile areas where the scrub sinks
and autoclaves are located
• Personnel working in this area must be
in proper operating room attire
EVIRONMENTAL SAFETY
Environmental • The size of the procedure room
Safety • Temperature and humidity control
• Ventilation and air exchange system
• Electrical safety
• Communication system
Temperature and • The temperature in the procedure
humidity control room should be maintained between
68F – 75F (20 – 24 degrees C)
• Humidity level between 50 – 55% at all
times
THE SURGICAL TEAM
 THE • The patient

SURGICAL • The anesthesiologist or anesthesist

• The surgeon
TEAM • The scrub nurse
• The circulating nurse
• RNFA (Reg. Nurse First Assistant)
• Surgical technologists
 THE RESPONSIBILITIES:

SURGEON • Primary responsible for the preoperative

medical history and assessment
• Performance of the operative procedure
according to the needs of the patient
• The primary decision maker regarding
surgical technique to use during the
procedure
• May assist with positioning and preparing
the patient or may delegate this task to
other members of the team
 FIRST RESPONSIBILITIES:

ASSISTANT • May be a resident, intern, physician’s

assistant or a perioperative nurse
TO THE • Assists with retracting, hemostasis,
SURGEON suturing and any other tasks requested
by the surgeon to facilitate speed while
maintaining quality during the
procedure
Anesthesiologist RESPONSIBILITIES:
• Selects the anesthesia, administers it,
intubates the client if necessary, manages
technical problems related to the
administration of anesthetic agents, and
supervises the client’s condition
throughout the surgical procedure
• A physician who specializes in the
administration and monitoring of
anesthesia while maintaining the overall
well-being of the patient
SCRUB RESPONSIBILITIES:

NURSE • May either be a nurse or a surgical

technician
• Reviews anatomy, physiology and the
surgical procedures
• Assists with the preparation of the
room
• Scrubs, gowns and gloves self and
other members of the surgical team
SCRUB • Prepares the instrument table and
organizes sterile equipment for functional
NURSE use
• Assists with the draping procedure
• Passes instruments to the surgeon and
assists by anticipating their need
• Counts sponges, needles, and instruments
• Monitor practices of aseptic technique in
self and others
• Keeps track of irrigations used for
calculations of blood loss
Circulating RESPONSIBILITIES:

Nurse • Must be a registered nurse who, after

additional education and training,
specialized in perioperative nursing
practice
• Responsible and accountable for all
activities occurring during a surgical
procedure including the management
of personnel equipment, supplies and
the environment during a surgical
procedure
Circulating • Patient advocate, teacher, research
consumer, leader, and role model
Nurse • May be responsible for monitoring the
patient during local procedures if a
second perioperative nurse is not
available
• Responsible for recording the time the
surgery started and ended and the
counting of all instruments, sponges,
and sharps
 VERY • Ensure all equipment is working
properly
DEFINED • Guarantees sterility of instruments and
ACTIVITIES supplies
DURING • Assists with positioning
SURGERY • Monitor the room and team members
for breaks in the sterile technique
• Handles specimens
• Coordinates activities with other
departments, such as radiology and
pathology
 VERY • Documents care provided
DEFINED • Minimizes conversation and traffic
within the operating room suite
ACTIVITIES
DURING
SURGERY
SURGICAL ASEPSIS
Medical vs. Surgical Asepsis
Principles of • Sterile objects remain sterile only when
touched by another sterile object
Surgical • Only sterile objects may be placed on
Asepsis the sterile field
• A sterile object or field out of range or
vision or an object held below a
person’s waist is considered
CONTAMINATED
Principles of • When a sterile surface comes in contact
with a wet, contaminated surface, the
Surgical sterile object or field becomes
Asepsis CONTAMINATED by capillary action
• Fluid flows in the direction of gravity
• The edges of a sterile field or container
are considered to be CONTAMINATED
COMMON SURGICAL INCISION
INCISION SITE
Butterfly
Limbal
Halstead/elliptical
Subcoastal
Paramedian
Transverse
Rectus
McBurney
Pfannenstiel
Lumbotomy
POSITIONS DURING SURGERY
 SUPINE Used for:
(dorsal • Abdominal, extremity, vascular,
chest, neck, facial, ear, and breast
recumbent) surgery
 PRONE Used for:
POSITION • Surgeries involving the posterior
surface of the body (spine, neck,
buttocks, and lower extremities)
Trendelenburg Used for:
Position • Surgeries involving lower
abdomen, pelvic organ when
there is a need to tilt abdominal
viscera away from the pelvic area
 Reverse Used for:
Trendelenburg • Upper abdominal head, neck, and
Position facial surgery
Lithotomy Used for:
• Perineal, vaginal, rectal surgeries;
combined abdominal vaginal
procedure
Modified Used for:
Fowler • Otorhinology (ear and nose),
neurosurgery
(Sitting
position)
Jack Knife Used for:
Position • Rectal procedures,
sigmoidscopy, and
colonoscopy
NURSING MANAGEMENT
 Nursing • ASSESSMENT
Management • DIAGNOSIS
• PLANNING
• INTERVENTION
• EVALUATION

ADPIE
POSTOPERATIVE CARE
GOALS • Restore homeostasis and prevent
complications
• Maintain adequate respiratory function
• Maintain adequate cardiovascular and
tissue perfusion
• Maintain adequate fluid and electrolyte
balance
• Maintain adequate renal function
• Promote adequate rest, comfort and
safety
GOALS • Promote adequate wound healing
• Promote and maintain activity and
mobility
• Provide adequate psychological
support
Transport of • Avoid exposure

client from • Avoid rough handling

• Avoid hurried movement and rapid
OR to RR changes in position
INITIAL NURSING ASSESSMENT
 • Verify patient’s identity, operative
Initial nursing procedure and the surgeon who
assessment performed the procedure
• Evaluate the following, sign and verify
their level of stability with the
anesthesiologist:
– Respiratory status
– Circulatory status
– Pulses temperature
– Oxygen saturation level
– Hemodynamic values (CBC)
 • Evaluate, lines, tubes, or drains, estimate
Initial nursing blood loss, condition of wound,

assessment medication used, transfusions and output

• Evaluate the patient’s level of comfort and
safety
• Perform safety check; side rails up and
restraints are properly in place
• Evaluate activity status, movement of
extremities
• Review the health care provider’s orders
INITIAL NURSING INTERVENTIONS
 Maintain a • Allow the airway (ET tube) to remain in
place until the patient begins to waken
patent airway and is trying to eject the airway
• The airway keeps the passage open
and prevents the tongue from falling
backward and obstructing the air
passages
• Aspirate excessive secretions when
they are heard in the nasopharynx and
oropharynx
 Assessing • Take VS per protocol, until patient is
well stabilized
status of • Monitor intake and output closely
circulatory • Recognize early symptoms of shock or
system hemorrhage
Maintaining • Place the patient in lateral position
with neck extended and upper arm
adequate supported on a pillow
respiratory • Turn the patient every 1 to 2 hours to
function facilitate breathing and ventilation
• Encourage the patient to take deep
breaths, use an incentive spirometer
• Assess the patient to take deep breaths
Assessing • Monitor temperature per protocol to
be alert of malignant hyperthermia or
thermo- to detect hypothermia
regulatory • Report a temperature over 37.8 C or
status under 36.1 C
• Monitor for postanesthesia shivering,
30-45 minutes after admission to PACU
• Provide a therapeutic environment
with proper temperature and humidity
 Maintain • Administer IV solutions as prescribed

adequate fluid • Monitor evidence of F&E imbalance

such as N&V
volume • Evaluate mental status, skin color and
turgor
 Minimize • Perform handwashing before and after
contact with the patient
complication • Inspect dressings routinely and
of skin reinforce them is necessary
impairment • Record the amount and type of wound
drainage
• Turn the patient frequently and
maintain good body alignment
Maintaining • Keep the side rails up until the patient
is fully awake
Safety • Protect the extremity into which IV
fluids are running so needle will not
accidentally dislodge
• Avoid nerve damage and muscle strain
by properly supporting and padding
pressure areas
• Check dressing for constriction
Maintaining • Keep the side rails up until the patient
is fully awake
Safety • Protect the extremity into which IV
fluids are running so needle will not
accidentally dislodge
• Avoid nerve damage and muscle strain
by properly supporting and padding
pressure areas
• Check dressing for constriction
SURGICAL HAND SCRUB
DEFINITION • The surgical scrub is an important
procedure required to reduce the risk
of contamination by microorganisms
during operative procedures
PURPOSES • Remove debris and transient
microorganisms from the nails, hands
and forearms
• Reduce resident microbial count to a
minimum
• Inhibit rapid rebound growth of
microorganisms
MATERIAL • Providone-iodine (feminine wash)
• Small brush
• Orange pick
PROCEDURE 1. Wash hands and arms with soap and
water, rinse well
2. Pick one brush using forceps provide
for and rinse of disinfectant under
running water
3. Saturate brush with betadine and get
enough solution to spread over both
hands and arms
PROCEDURE 4. Scrub left hand from fingernails 3
inches well above for 3 minutes
paying particular attention to corners
and crevices. The nails and fingers,
between fingers and knuckles
5. Transfer to right hand and repeat
no.4 scrub right hand. Saturate brush
with solution PRN to make a thick
lather
PROCEDURE 6. Rinse brush and both hands and arms
keeping hands higher than elbows
7. Saturate brush with betadine and
spread solution to both hands and
forearms
8. Scrub left hand from fingertips to
forearms for 2 minutes
9. Transfer brush and scrub hand in
same manner
PROCEDURE 10. Drop brush without splashing with
plastic portion hitting bottom of
scrub sink first
11. Rinse hands allowing water to flow
from fingertips down to elbows
12. Enter major room holding hands up in
front of you
13. Pick sterile hand towel at one end
with right hand without touching
table cover and other contents
therein
PROCEDURE 14. Step back from table and slightly
leaning forward, wipe left hand from
fingertips to elbow line, wiping each
portion dry before proceeding to wipe
next arm.
15. Take hold of the other end of the
towel and wipe right hand in same
manner using the other side of the
towel
16. Discard the towel
GOWN AND GLOVE TECHNIQUE
DEFINITION • A surgical aseptic technique that
involves aseptically wearing sterile
gloves and gown
PURPOSE • To maintain aseptic technique
• To avoid contaminating the sterile
field within the operating room
• To avoid contaminating the
patient being operated on
MATERIALS • Self
• Sterile Gown
• Sterile Gloves
• Cap
• Surgical Mask
PROCEDURE 1. Take hold of the gown below neckline
using one hand in lifting the gown
and avoid touching other parts of the
gown
2. Lift gown from table and step back a
few spaces away from non-sterile
objects to give a wide margin of
safety
3. Allow lower end of gown to drop
PROCEDURE 4. Slip hands into perspective arm holes,
keeping hands in an extended
position in front while circulating
nurse helps adjust the back of the
gown
5. Circulating nurse ties the belt
PROCEDURE CLOSED GLOVE TECHNIQUE:
1. Put on sterile gown with technique
2. Then slide hands into sleeves until
cuff slams can be grasped between
fingers and thumbs
3. With protected left hand, under the
gown cuff pick up sterile right hand
glove
PROCEDURE 4. With glove palm facing down and
fingers pointing towards the gowned
elbow, place glove over covered cuff
in level with the middle half of the
sleeve stockinette
5. Stretch cuff over opening of sleeve to
cover gown wistlet entirely and at the
same time grasp glove cuff and sleeve
stockinette together and pull them
towards the wrist
PROCEDURE 6. Adjust to fit snugly and neatly
7. With gloved right hand pick up left
hand glove and follow the same
technique for gloving on the left hand
8. Arrange table neatly
a. Discard used glove envelopes
b. Set aside sterile packs of powder until
all of the scrub team have been
gloved
c. Check on needed doctor’s gloves
PROCEDURE ASSISTING DOCTOR WITH THE GOWN:
1. Offer hand towel to the doctor
2. Insert gloved hand under the neckline
with the gown rough edge facing you
3. Lift gown from table and slightly
shake it to loosen gown
4. Spread gown and extend to doctor
5. Adjust sleeves so wrist cuffs are well
fitted
 ASSISTING DOCTOR WITH GLOVES:
PROCEDURE a. Open glove envelope
b. Pick pack of powder on doctor’s hands
c. Remove right hand glove from envelope
and inflate
d. Serve glove to the doctor
a. Hold glove with the palm facing the
doctor
b. Insert fingers under folded cuff and
extend thumbs out
c. Stretch cuff sufficiently for doctor to
insert his/her hand
PREPARING ROOM FOR MAJOR
SURGERY
DEFINITION • Sterilization and preparing the
operating room for a scheduled surgery
PURPOSE • To minimize incompletion of
instruments, sponges, and sharps
during surgery
• To keep track of all the instruments
prepared
 SHARPS:
Instruments • Scalpel: (2 sets) 1st for skin and 2nd for
used in the subcutaneous inward
• Mayo scissors: for tough tissue
operating • Metz scissors: slender and for delicate
room tissue and peritoneum
• Stitch scissors: with hook
• Mayo curve
• Needles:
– Round: delicate
– Curve: Cutting, rough, cuts through
– Straight: tough
 SCALPEL

MAYO SCISSORS
NEEDLES

METZENBAUM
CURVE
Instruments GRASPERS:

used in the • Thumb Forcep: toothless, for delicate

• Tissue forcep: toothed, for tough
operating
• Allis: for rough tissues, like tendon,
room bone and fascia
• Bobcock: for tubular organs (fallopian
tubes, ureter, vas deferens), for
delicate, Kelly clamp can replace
Bobcocks
TOWEL CLAMP
BABCOCK CLAMP

ALLIS CLAMP
Instruments CLAMPS:

used in the • Mosquito: fully serrated, may be

curved or straight, shortest clamp, for
operating minor surgeries, pediatrics, superficial
room layers
• Crile: 50% serrated, may be curved or
straight, medium size, for shallow
layers
MOSQUITO CRILE
FORCEPS FORCEPS
Instruments CLAMPS:

used in the • Kelly: Fully serrated, may be curved or

straight, long in size, for deep layers &
operating cavities
room • Ochsner: Toothed, fully serrated, long
in size
• Randall: For gallstones, kidney stones
• Tonsil: Long in size, used for
tonsillectomy
 TONSIL
RANDALL

KELLY

OCHSNER
Instruments RETRACTORS:

used in the • Balfour: Bladder retractor, self

retaining, for deep abdominal activity
operating • Mastoid: For small operative sites
room • Wetlanear: Used to expose thyroid in
thyroidectomy
• Vaginal spectrum
• Army navy: Not same in size, for
superficial layers
 MASTOID
ARMY NAVY

BALFOUR

VAGINAL
SPECULUM
Instruments SKIN RETRACTORS:

used in the • Richardson: Double bladed or single

bladed, used for deeper layers
operating • Deaver: Used for deep cavities, from
room skin to peritoneum
• Malleable: Ribbon
 MALLEABLE

DEAVER

RICHARDSON
PROCDEURE 1. Turn on the air conditioner
2. Do dump dusting of furniture and
lights
3. Move glove, instruments, and lap
tables, basin stand, anesthetic and
major prep stands one foot away
from the wall
4. Adjust height of the mayo within
elbow level
PROCDEURE 5. Survey major room and determine
what packs are to be brought in
6. Bring in two buckets and place one
near the lap table the other near the
sponge table. Place necessary foot
stools
7. Wash hands
8. Bring in the needed sterile packs and
put them on their respective tables or
stands
PROCDEURE 9. With bare hands untie and open the
first wrapper of all packs
10. Open second wrapper of gown pack
11. Remove diack and check indications
12. Place the necessary number and
correct sizes of gloves for people
scrubbing for the operation
13. Transfer one nurse’s gown with hand
towel over instrument nurse’s gloves
PROCDEURE 14. Cover gown and glove table and fold
back the edge of cover in front just to
keep it in line with table edge
15. Open second wrapper of the lap pack
16. Remove diack/examine accordingly
17. Open second wrapper of basin set
18. Transfer 2 bowls, kidney basin; 2
sponge basins and prep cup to the lap
table
PROCDEURE 19. Cover basin leaving enough opening
for pouring sterile water into basin
20. Pour sterile water into one of the
bowls and into the sponge basins and
into the wash basin
21. Fully cover wash basin
22. Pour betadine antiseptic top prep
cup, add the following into the lap
pack: blade #20, sutures, and rubber
tubing
PROCDEURE 23. Cover lap pack fully leaving a flap
24. Open second wrapper of the major
prep set. Add the following: 1 single
glove, 4*4 sponges, cotton
applicators, 1 sterile towel
25. Scrub nurses enter the room and
proceed to gowning and gloving
26. Instrument nurse opens the lap
aseptically
 27. Drape mayo table:
PROCDEURE
a. Insert both hands, right over left, into
the folds of the mayo table cover
b. Pull side of mayo cover held by right
hand over left hand
c. Keep folded fast of cover over forearms.
Carry the technique near the mayo table
d. Place foot on base of mayo stand to
stabilize it
e. Fit drape into mayo table (circulating
nurse may assist by pulling flap of mayo
cover over the end or table)
PROCEDURE 28. Line mayo table with 3*3 lap towel
29. Receive basic instrument set from the
circulating nurse and place them on
the table
 30. Transfer the following through their proper
PROCEDURE places on the lap table:
a. 2 straight kelleys
b. 2 blade holders
c. 3 pairs of Richardson retractors
d. 1 pair of army navy retractor
e. 2 needle holders
f. 8 towel clips
g. 1 suction tip
h. 3 bobcocks
i. 1 allis
j. Suture scissor
PROCEDURE 31. Transfer sponges (squares and strips)
into the basin placed on the lap table
32. Remove suture book and rolled towel
from the bulk of linen on the lap table
33. Prepare sutures; complete suture
book and set aside
34. Fit blades into holder. Transfer to
mayo table together with the rest of
the sharps and the prepared ties
PROCEDURE 35. Arrange basic instruments on mayo
table
36. Prepare 2 wet strips and place on top
of the instruments
37. Cover instrument table
38. Assist surgeons in gowning and
gloving
39. Inspect sheet in relation to the
patient’s anatomical position
 40. Drape paint sheet
PROCEDURE a. Hold rolled side of patient sheet and place it
2” below edge of sterile laparotomy towel
and drop the folds on the opposite side of the
table. Keeping the gloved hands protected by
the folds of paint sheet
b. Pick sheet under then tuck in paint sheet
c. Place one hand on top to hold sheet in place
d. Place the other gloved hand turned back fold
marked “feet” and spread to cover the lower
extremities of the patient
PROCEDURE 41. Give allis and prep cup to surgeon
42. Hand one at a time four lap towels to
surround operative area
43. Drape laparotomy sheet
44. Take your place to assist in the
surgical procedure (circulating nurse
moves away from the mayo table, lap
table and sponge table near the
operative field)