OR Review 3 Ppt.

SURGICAL HANDWASHING
Planning/ Implementation
1. Assess the hands & arms for cuts or wounds.
Nails are trimmed & short that is not
extending the finger tips. Nail polish must not
be worn.
2. Ascertains that the scrub suit is properly
folded & tucked in prior to hand washing &
does not touch the sink.
3. Does pre-washing.
4. Get a hold of the surgical brush, utilizes the
knee lever to regulate water.
5. Holds brush under the running water.
6. Saturates the brush with antiseptic solution.
7. Scrubs fingertips of the first hand 20 counts.
Scrubs 4 sides of each finger.
8. Scrubs palmar (20 counts) & dorsal (20
counts).
9. Saturates sponge with antiseptic solution,
scrubs the second hand, same procedure as
with the first hand.(May wet the sponge with
water if needed to lather)
10. Proceeds to scrubbing from wrist to elbow of
the second hand. Dividing the length from
wrist to elbow into 3 parts, brush 5 times each
side of the four sides of the arms. (Wet the
sponge w/water if needed to lather).
11. Saturate the scrub with antiseptic solution,
proceeds to scrubbing the wrist to elbow of the
first hand utilizing the same technique as in the
second hand.
12. Drops surgical scrub to sink.
13. Rinses both arms from fingertips to elbow in
one sweeping direction, avoiding back & forth
rinsing, keeping the hands up all the times to
allow the water to drip from hands to elbows.
Gowning
Planning/ Implementation
1. Locates for the lower hem parts of the gown
& dries the hand in one direction, carefully
avoiding water from dripping on the back
table.
2. Turns the other side of the hemline & dries
the second hand utilizing the same procedure
as in the first hand.
3. Proceeds to twirling of the lower hem of the
gown on one hand (w/o lowering the other
hand). Then locates for the sleeves of the
gown.
4. Upon securing the sleeves appropriately &
according to hospital protocol, locate for the
armhole. Carefully avoiding contamination of
the sterile part.
5. Slip both arms simultaneously in the armhole,
carefully avoiding the face & front portion of
the gown. Hands should not extend pass
through the sleeve hole.
6. Maintain both arms in surgical position.
Gloving (Closed Glove technique)
1. Using the left hand while keeping it well within
the cuff of the left sleeve, picks up the right glove
from the inner wrap of the glove package by
grasping the folded cuff.
2. Extends the right forearm with palm upward
(Hands still covered until sleeve of gown). Place
the palm of the glove against the right hand, the
top edge of the cuff,, above the palm. In correct
position, the glove fingers are pointing towards
the scrub person & the thumb of the gloves down.
3. Using the left hand (Still covered by the sleeve of
the gown), grasps the back of the cuff & turns it
over the end of the right sleeve & had. The cuff of
the glove is now over the stockinet cuff of the
gown, with hand still inside the sleeve.
4. Grasps the tops of the right glove & underlying
gown sleeve still using the covered left hand. Pulls
the glove on over the extended right fingers until it
completely covers the stockinet cuff (while carefully
avoiding the gloves from touching the face).
5. Gloves the left hand in the same manner. Uses
the right gloved hand to pull on the left glove.
Serving surgical Gown
1. The scrub nurse hands the towel to the surgeon
holding one corner of the towel carefully, to
avoid contamination from the surgeon’s hands.
2. Unfold the gown carefully, holding at the
neckband.
3. Keeping the hands on the outside of the gown
under the protective cuff of the neck & shoulder
area, exposing the armhole for the surgeon to
insert hands.
4. Releases the gown upon reaching the surgeon’s
elbow. Scrub nurse backs off as soon as the
gown is placed on the surgeon’s elbow. (Surgeon
hold’s arms outstretched while the circulator
pulls the gown onto the shoulders & adjust the
sleeves so the cuffs are properly placed & hands
properly exposed). Circulator ascertains that
only the inside of the gown is touched at the
seams when pulling the ties at the back.
Serving Surgical gloves
1. Scrub nurse picks up the right glove, slightly
stretching it to expand the fingers of the
gloves. Then grasps it firmly with fingers
tucked under the everted cuff.
2. Hold the palm & the thumb part of the glove
toward the surgeon.
3. Stretches the cuff sufficiently for the surgeon
to introduce the hand. Hold with the thumbs
out, in order to avoid touching the surgeons
bare hands as he inserts it inside the gloves.
4. Exerts upward pressure as the surgeon lunges
the hand into the glove.
5. Carefully unfold the everted glove cuff over
the cuff of the sleeve.
Draping a Mayo Table
1. Handle the mayo cover carefully as the gloved
hand is inserted inside the folded cuff.
2. Support the fold of the drape on the arms, in
the bended elbows to prevent the cover from
falling below the waist level.
3. Slide the cover on the mayo stand, while placing
a foot on the base of the stand to stabilize it.
4. Allow the edged of the mayo table to fall
downward.
5. Place another towel over the mayo cover for
added protection.
Draping a patient for Laparotomy
6. Pass four towels & towel clips carefully &
correctly to avoid the sterile ends of the towel
from touching unsterile areas. The towels
must be folded 2/3rd with the fold facing the
client.
7. Hand the towels one by one to the surgeon.
8. Secure the 4 towel clips & hand it one by one.
Counting of Instruments
1. Arrange on the Mayo stand the instruments
&accessory item; needed to create the
primary incisions (make trochanter rolls).
2. Prepares a suture sponge & places the
needle holder properly (w/ the needle
properly covered).
3. Arranges instruments neatly & properly to
provide ease in counting.
4. Attaches blade correctly to holder using correct
instrument (places it appropriately tucked, w/
the blade facing away from accidental access).
5. As soon as the table is prepared, scrub nurse
signals to the circulator to initiate counting.
6. Passes the skin knife to the surgeon, & pass the
hemostat & suction to the assistant (passes the
knife correctly & safely by holding the hand
pronated, w/ the thumb opposed against the
tip of the index finger & the wrist flexed.
7. Hands instruments to the surgeon,
anticipating the need of the surgeon &
keeping one step ahead of the procedure.
8. Avoid placing fingers in the instrument rings
as the instruments is passed. And hands the
instruments around the incisional area, not
directly over it.
9. Pass instruments decisively & firmly (instrument
must be placed firmly into the surgeon’s hand with
a tapping motion). When passing a curved
instrument, the curve of the instrument aligns with
the direction of the curve of the surgeon’s hand.
10. Using a moist sponge, wipes blood & organic
debris from instruments promptly after each use &
prior to placing the instruments back on the table.
11. As the first layer of the incision is being
sutured, the scrub nurse signals to the
circulator to begin the first counting.
Sequence of instrument/supplies counted:
a. sponges b. needles c. instruments
Sequence of area counted:
a. operative field b. mayo table c. back
table
Removing Gown
1. Scrub nurse signals to the circulator to
unfasten the neck & back closures so the
wearer does not contaminate his/her scrub
suit with the soiled gloves.
2. Grasps the right shoulder of the loosened
gown with the left hand & pulls the gown
down from the shoulder & off the right arm,
turning the sleeve inside out.
3. Turns the outside of the gown away from the
body with flexed elbows.
4. Grasps the left shoulder with the right hand &
removes the gown entirely, pulling it inside
out.
5. Discards the soiled gown in a laundry hamper
or in a trash receptacle if using a disposable
gown.
Removing Gloves
1. The cuffs of the gloves usually turn down as
the gown is pulled off the arms.
2. Use the glove-to-glove & skin-to-skin
technique to protect the clean hands from
contamination.
3. Grasps the cuff of the left glove using the
gloved fingers of the right hand & pulls it off
inside out.
4. Slips the ungloved fingers of the left hand
under the cuff of the right glove & slips it off
inside out.
5. Discards the gloves in proper waste
receptacle.
6. Washes hands to remove the powder & any
possible contamination.

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SURGICAL HANDWASHING

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