NCM 107 A LECTURE

By: CONTESSA M. GABRIEL RN,MAN

1) A. B. C. D.

Organizational goals include: Goals to be followed by the organization Personal goals Always short term Future endeavors of the society.

2) Management resources includes the following except: A.Money B.Membership C.Machine D.Materials

3) A good leader is all of the following, except: A.Able to inspire followers B.Able to judge people C.Able to lift staff morale D.Able to motivate people

4) A manager is all of the following, except: A.Officially appointed B.Relates to people according to their roles C.Relates to people personally D.Implement predetermined policies

5) The following statements are true of management, except: A.Management is the art of getting things done through people B.Managers are also considered leaders. C.The role of managers is more simple than leaders D.Managers are vested with power and authority

Scrub duties

 Perform surgical hand scrub.

Gown and glove using closed glove technique. Re-gown and glove when breaks in technique occur. Assist the 1st scrub in setting up case (back table, mayo stand and O.R. basins).

 Arrange instruments and supplies (back table, mayo stand and O.R.).
Count needles, instruments and sponges.

Check instruments for proper functions

 Prepare irrigating solution.

Draw medications properly.

Gown and glove surgeon and assistant. Assist with draping.

 Prepare electric cautery, suction and light handles for proper use. Prepare necessary sutures. Pass instruments to surgeon and assistant. Retract, sponge, and suction during case as necessary. Proper identification and handling of specimen.

 Prepare instruments for decontamination at completion of case.

Dispose of sharps properly.

Discard soiled drapes and trash properly.

Transport soiled drapes and trash properly

 Anticipate the surgeon and assistant needs.

Anticipate the operative procedure needs.

Help apply wound dressing.

CIRCULATING RESPONSIBILITIES

 Clean operating room and discard suction prior to case. Gather all supplies, instruments and equipment necessary for case. Arrange O.R. furniture properly.

Open and flip sterile supplies for the surgical procedure

 Assist with IV therapy.

Assist the anesthesiologist. Assist with the skin preparation. Tie gowns of the scrub nurse and surgeon.

 Provide scrub personnel with sitting stools and foot stools as necessary.
Turn and help adjust lights as necessary.

Supply the scrub nurse with necessary supplies

 Receive and label specimen properly.

Log and deliver specimen to pathology properly.

Help apply wound dressing.

Pull case for following procedure

SCRUBBING, GOWNING , SKIN PREPARATION, DRAPING & COUNTING OF INSTRUMENT

 Before each operation, all members of the surgical team that is, those who will touch the sterile surgical field, surgical instruments or the wound should scrub their hands and arms to the elbows. Scrubbing cannot completely sterilize the skin, but will decrease the bacterial load and risk of wound contamination from the hands.

 Every hospital should develop a written procedure for scrubbing that specifies the length and type of scrub to be undertaken. It is usual that the first scrub of the day is longer (minimum 5 minutes) than any subsequent scrubs between consecutive clean operations (minimum 3 minutes).

When scrubbing
Remove all jewelry and trim the nails Use soap, a brush (on the nails and finger tips) and running water to clean thoroughly around and underneath the nails Scrub your hands and arms up to the elbows After scrubbing, hold up your arms to allow water to drip off your elbows

HANDWASHING

SURGICAL HANDWASHING

EQUIPMENTS

 Perform a surgical hand wash before performing any surgical or other highly invasive procedure. Surgical hand washing provides a higher level of decontamination than routine hand washing. You can use the same aqueous antiseptic solutions and alcohol-based products that you use for routine hand washing (refer to your local policy). The main differences are that you need to decontaminate your wrists and forearms and increase the time taken.

 Clean each hand and forearm using rotational rubbing. Hold your hands higher than your elbows while you do this, so that water and debris drip away from your hands into the sink. You may use sterile disposable nailbrushes to clean the fingernails (refer to your local policy). You do not need to scrub your skin, especially if you use an alcohol-based product. You may use a brush for the first surgical hand wash of the day1.

Wash your hands and forearms with an aqueous antiseptic solution for 3 to 5 minutes and dry your hands and forearms completely. Wash your visibly clean hands and forearms with an alcohol-based product for three minutes. Use an antiseptic hand wash for three minutes, dry your hands and forearms completely and then apply an alcohol rub or gel for 4 to 5 minutes.

 After applying the alcohol-based product as recommended, allow your hands and forearms to dry completely before donning sterile gloves.

ALWAYS ENSURE
THE WATER TEMPERATURE IS COMFORTABLE THE FLOW OF WATER IS GENTLE TO AVOI EXCESSIVE SPLASHING HANDS ARE ALWAYS HELD HIGHER THAN THE ELBOW

NEVER
VIGOROUSLY SHAKE HANDS AND ARMS

THE SCRUB
THERE ARE 3 DISTINCT PHASES TO A FORMAL SCRUB THIS SHOULD TAKE APPROXIMATELY 5 MINUTES TO PERFORM CORRECTLY

THE SCRUB PHASE 1

WASH YOUR HANDS AND FOREARMS UP TO THE ELBOW USING A SKIN ANTISEPTIC FOR

1 MINUTE

ALWAYS RINSE FROM FINGER TIP TO ELBOWS USING THE FLOW OF WATER

THE SCRUB PHASE 2

WET THE NAIL BRUSH WITH ANTISEPTIC SCRUB ONLY THE NAILS FOR 2 MINUTES
Scrub each nail individually, not all finger nails in a bunch

 DISCARD THE NAIL BRUSH RINSE FINGERS

THE SCRUB PHASE 3

A FURTHER WASH UP TO THE WRIST ONLY THIS FINAL PHASE TAKES ABOUT 2 MINUTES

Scrub, Gown, and Glove Procedures

SURGICAL GOWNING

SURGICAL GLOVING

SURGICAL MASKS
A surgical mask protects health care providers from inhaling respiratory pathogens transmitted by the droplet route.

 Hands must be thoroughly washed:

before wearing the mask;

before removing the mask after use, and after discarding the mask. There are many different types (Surgical mask-2 ply, 3 ply; N95, N99 etc) of masks available. Their use is recommended based on type and degree of protection required.There are also many different brands of masks available.

CONE MASK

The classic cone mask has a soft knitted head band that offers greater comfort and a secure fit. The classic cone mask is convenient to use and provides excellent filtration at over 95% efficiency

Elastic ear loops

Ways to Wear Masks

Wrong way to wear a mask

SURGICAL SHOE COVERS

SURGICAL GLASSES & VISOR

Surgical Caps & Hoods

These surgical caps and hoods are designed to provide comfort as well as the appropriate coverage during medical situations.

Bouffant Cap

SURGICAL GOWNS

SKIN PREP
The patient should bathe the night before an elective operation. Hair in the operative site should not be removed unless it will interfere with the surgical procedure. Shaving can damage the skin so clipping is better if hair removal is required; it should be done in the operating room.

 Just before the operation, wash the operation site and the area surrounding it with soap and water. Prepare the skin with antiseptic solution, starting in the centre and moving out to the periphery. This area should be large enough to include the entire incision and an adjacent working area, so that you can maneuver during the operation without touching unprepared skin

 Chlorhexidine gluconate and iodine are preferable to alcohol and are less irritating to the skin. The solution should remain wet on the skin for at least two minutes.

DRAPING THE PATIENT

DRAPING
The procedure of covering a patient and surrounding areas with a sterile barrier to create and maintain a sterile field during a surgical procedure PURPOSE - is to eliminate the passage of microorganisms between nonsterile and sterile areas.

DRAPING
Scrub, gown and glove before covering the patient with sterile drapes. Leave uncovered only the operative field and those areas necessary for the maintenance of anaesthesia. Secure the drapes with towel clips at each corner

 Draping exposes the area of the operative field and provides a sterile field for the operative staff to work. This is designed to maximize surgical exposure and limit potential for contamination. There are many approaches to draping, some of which depend on the kind of drapes being used

 Do not place drapes until you are gowned and gloved, so as to maintain the sterility of the drapes. It is important to secure good exposure and a large sterile area. When laying out the drapes, the edges and folds (which hang below the operating table) are considered to be non-sterile.

TYPES OF DRAPES
Disposable drapes are generally paper or plastic or a combination and may or may not be absorbent. Nondisposable drapes are usually doublethickness muslin. Drapes, of course, must be sterile.

STEPS IN DRAPING

 The first step in draping is the placing of a drape sheet from the foot to the knees. The scrub will select the sheet and hand one end to the surgeon across the operating table, supporting the folds, keeping it high, and holding it taut until it is opened, then drop it (open fingers and release sheet). The second drape sheet is handled in the same manner. This sheet is placed below the incision site with the edge of the sheet just below the incision site. This draping sheet provides extra thickness of material under the area from the Mayo tray to the incision where instruments and sponges are placed. It also closes some of the opening in the laparotomy sheet, if necessary.

 When disposable drapes are used, the towels usually have a removable strip with an adhesive on the folded edge. The third step in draping is placing the four sterile towels around the line of incision. The scrub unfolds first towel, passes the towel drape to the surgeon with the strip side facing the scrub, and then removes the adhesive strip. The surgeon places the towel within the scrubbed area on the near side of the line of incision, leaving only enough exposed skin for the incision.

 The second towel is placed in the same way, except the towel is placed on the lower side (toward feet) of the line of incision. The third towel is passed the same way, except the towel is placed on the upper side (toward head) the line of incision. The last towel is passed to the surgeon with the adhesive strip facing the surgeon and is placed on the far side of the line of incision. The adhesive area holds the towel drapes in place.

 NOTE:
The only procedure changes that are made with non-disposable, muslin drapes (for example, hand towels) are as follow. The towels are cuffed by the scrub about 3 inches and the folded edge goes next to the line of incision. The first three towels are cuffed toward the scrub; the fourth towel is cuffed toward the surgeon. The towels are held in place by towel clips rather than by adhesive.

 Finally, the scrub will select the surgical drape (lap sheet). This lap sheet has a fenestration (opening) in the drape for the incision. The scrub places the opening directly over the skin area outlined by the drape towels and in the direction indicated for the foot or head of the table. The lap sheet will have an arrow or some other indication to identify the head or foot portion of the drape. Drop the folds over the sides of the table, then open it downward over the patient's feet and upward over the anesthetist screen.

 Aseptic technique must be observed at all times in the draping process.

YOU SHOULD:
(1)Handle the drapes as little as possible. (2) Never reach across the operating table to drape the opposite side; go around the table. (3) Hold the drapes high enough to avoid touching nonsterile area but avoid touching the overhead light.

 (4) Hold the drape high until it is directly over the proper area, then drop (open fingers and release sheet) it down where it is to remain. NEVER ADJUST ANY DRAPE. If the drape is incorrectly placed, leave it in place and place another drape over it. (5) Protect the gloved hands by cuffing the end of the sheet over them. Do not let the gloved hand touch the skin of the patient.

 (6)In unfolding a sheet from the operative site toward the foot or head of the table, protect the gloved hand by enclosing it in the turned back cuff of the sheet.
(7) If a drape becomes contaminated, discard it immediately.

 (8) If the end of a drape falls below waist level, do not handle it further. Drop it and use another drape.
(9) If in doubt about sterility, discard the drape. (10) If a hole is found in a drape after it is laid down, cover the hole with another drape or discard the entire drape.

SPONGE AND INSTRUMENT COUNTS

It is essential to keep track of the materials being used in the operating room and during any complicated procedure in order to avoid inadvertent disposal or the potentially disastrous loss of sponges and instruments in the wound.

It is standard practice to count supplies (instruments, needles, screws and sponges):

Before beginning a case Before final closure

On completing the procedure

 The aim is to ensure that materials are not left behind or lost. Pay special attention to small items and sponges. Create and make copies of a standard list of equipment for use as a checklist to check equipment as it is set up for the case and then as counts are completed during the case. Include space for suture material and other consumables added during the case.

 When trays are created with the instruments for a specific case, such as a Caesarean section, also make a checklist of the instruments included in that tray for future reference.

INSTRUMENTS

Surgical scalpel blades

Shape:
Straight - The needle is straight and usually has a cutting surface. Half-curve or Ski - the needle is straight and curves near the point. Curved - The needle is formed in an arc of 1/4, 3/8, 1/2, or 5/8 of a circle

NEEDLES

SURGICAL BLADE HANDLE

Surgical Needle Holder

Needle Holders are used to suture deep areas where hands cannot reach comfortably or where high precision and clear visibility is required. The holders may be with or without a catch. All needle holders have a firm grip.

Sponge Forceps
Sponge forceps or sponge holding forceps are often used in gynecological procedures. They may be straight or curved and have smooth or serrated jaws. The jaws are rounded and provide an atraumatic grip.

SPONGE FORCEP

Dressing Forceps
Dressing forceps are also a type of tissue forceps. They are used for dressing wounds and pealing off the dressing. They have scissor-like handles for grasping lint, drainage tubes, etc. Dressing Tweezers may be curved or straight tipped with serrated beak. In some cases it may be smooth.

Dressing Forceps

Suture Forceps
Needle holder forceps hold needles while suturing. Suture Forcep is also called a needle holder forceps. The typical needle holder has two short, rather blunt, serrated beaks with a groove in each beak. The grooves provide space for the placement and retention of the needle. At the end of the handles, there is a locking mechanism that lets the secure the suture needle in the correct position so as the needle appears to be an extension of the needle holder.

Suture Forceps

Tubing Forceps
Also termed as vessel cannulation forceps or tubing introducer forceps, they are useful when a fine plastic tube/ micro catheters have to be introduced into a small blood vessel of almost equal size for medication or diagnostic purposes .

 The hollowed beak holds the tubing without deforming it. The tip of the tubing is directed exactly into the vessel opening with a sturdy hand so as not to cause any damage to the vessel from unwanted movement.

Tubing Forceps

Brain Forceps
Also called Obstetrical Forceps, they are Smoothly shaped and curved, obstetrical forceps. The instrument has two blades and a handle designed to aid in the vaginal delivery of a baby. Though there are many different kinds of brain forceps, the most commonly used ones are thin metal curving into a ring at its tip. This tip fastens the baby's head to protect from damage during the delivery. The use of these forceps is as safe /dangerous as any other surgical tool or drug. They are used for saving babies' lives, when delivery is prudent during fetal distress

Brain Forceps

SIMPSON Obstetrical Forceps

SIMPSON-LUIKART Obstetrical Forceps

NAEGELE Obstetrical Forceps

Surgical Hemostats
They are also called blood vessel forceps and are used for controlling hemorrhage. They are also called Hemostats. They look like needle-holder forceps. The main difference is that the beaks of the hemostatic forceps are longer and more slender.

 Hemostatic forceps may have both curved and straight tips or beaks, and there is a locking device on the handle to keep them closed as they are used as vessel clamps. They have transverse serration on beak tips. They have a box hinge and a locking mechanism by the finger rings. all the hemostatic forceps are designed to grab, hold, and crush

 Used for holding blood vessels, and for blunt dissection. Used to control hemorrhage by clamping or constricting blood vessels. Used to remove bits of bone chips or parts of teeth, from the oral cavity during the tooth removal.

Surgical Hemostats

Towel Clamps
Towel-clamp forceps are used to maintain surgical towels and drapes in the correct position during an operation. They secure drapes to the patients skin and may be used for holding the tissue as well. They are locking type forceps with curved ends. The beak may be pointed or blunt and flat. They may even overlap in closed position.

Towel Clamps

Towel Clips

Crile Hemostat

Kelly Hemostats

Allises

Babcocks

Grasping Forceps
Grasping forceps are used to remove stones and retrieve foreign objects under direct vision. These forceps are three pronged with hooked tips. This typical design allows the objects to be released easily. The hooks facilitates secure grasping of both large and small objects. The prong wires are rounded to allow atraumatic manipulation. They can be easily passed through the flexible endoscopes.

Grasping Forceps

Mixter Forceps
Mixter forceps are the threading forceps used for hemostatic purposes. Hemostatic Forceps are used to wrap the thread around the vessel to stop bleeding. Its beak is such that it grips the thread well.

Mixter Forceps

Mosquito Forceps
Mosquito forceps are used for more delicate tissues. They are very fine and small hemostats used during the surgery to control the bleeding of finer vessels.

Mosquito Forceps

Splinter Forceps
Splinter forceps are fine tipped forceps used to remove the finest splinters from the body. The may be curved or straight and may also have an attached magnifying glass for better vision. It is an essential first aid instrument.

Splinter Forceps

Tongue Forceps
Tongue forceps are sturdy tools used for holding the tongue while piercing it. They can be locked for a secure grip. They may be slotted or the standard type. Once the piercing is done and the baebell is in place, the forcep can be removed

Tongue Forceps

Tilley's forceps
dressing or packing forceps, generally used in the nose You are likely to use them to pack noses and remove foreign bodies

Tilley's forceps

tongue depressor
The wooden ones are disposable and also the most common. Metallic instruments can be used is more force is required. There are different sizes of metallic tongue depressor, and small ones can be used in children or infants.

Tissue Forcep

Debakey Tissue Forceps

Plain Tissue Forceps Long and Short

Russian Tissue Forceps Long and Short

Ferris Smith Tissue Forceps

Toothed Tissue Forceps Long and Short

Adison Tissue Forceps Toothed and Plain

#3 Knife Handles Long n Short

SURGICAL SCISSOR STRAIGHT

SURGICAL SCISSOR CURVED

Bandage Scissor

Mayo Scissors Curved and Straight

Metzenbaums "Mets" Large and Medium

Retractors

ARMY NAVY RETRACTOR

SENN Muller Retractor

MATHIEU Retractor

CRILE Retractor

Balfour Retractor Fenestrated end Blades

Harrington Retractor

Deaver Retractors

Richardson Retractors

Malleable Ribbon

Balfour Retractor

Bladder Blade for Balfour Retractor

Goulet Retractor

Army Navy Retractors

Gelpi Perineal

tongue depressor

laryngeal mirror
It is used to see over the back of the tongue and into the larynx

local anaestietic spray