OR TECHNIQUE

Scrubbing, Gowning and Arranging Instruments

1. Define the following terms : - During this phase, the patient will be prepped
and typically given some form of anesthesia,
Peri - operative Nursing either general anesthesia (for complete
- Perioperative nurses help plan, carry out, and unconsciousness) and local anesthesia (to
assess treatment for patients undergoing prevent pain while awake
surgery. Working in hospital surgical - As the surgery begins, the patient's vital signs
departments, ambulatory surgery units, (including heart rate, respiration, and blood
clinics, or physicians’ offices, these RNs are oxygen) will be closely monitored. In addition
involved in the care of patients before, during, to the roles of the surgeon and
and after surgery. anesthesiologist, other team members will be
responsible for assisting the surgeon,
ensuring safety, and preventing infection
during the course of the surgery.

● Pre-operative phase
- Begins with the decision to have surgery and
ends when the patient is wheeled into ● Post- operative phase
surgery. This phase can be extremely brief,
- Is the period immediately following surgery.
such as in the cases of acute trauma, or
As with the preoperative phase, the period
require a long period of preparation during
can be brief, lasting a few hours, or require
which time a person may be required to fast,
months of rehabilitation and recuperation.
lose weight, undergo preoperative tests, or
await the receipt of an organ for transplant. - Once the patient is awake and ready to
- One of the goals of the preoperative phase is leave PACU, the post-anesthesia nurse will
to manage the anxiety that may arise, either typically transfer the responsibility of care
as a result of an emergency situation or back to the perioperative nurse. (In smaller
having to wait for inordinately long periods of hospitals, the same person may be tasked
time. Once a person is admitted into a with both responsibilities.)
hospital, patient care and oversight will
typically be coordinated by one or several - Postoperative care is mainly focused on
monitoring and managing the patient's
physiological health and aiding in the post-
surgical recovery. This may include ensuring
hydration, monitoring urination or bowel
movements, assisting with mobility, providing
appropriate nutrition, managing pain, and
preventing infection.

perioperative nurses.

● Intra-operative phase
- Involves the surgery itself. It starts when the
patient is wheeled into the surgical suite and
ends when the patient is wheeled to the post-
anesthesia care unit (PACU).
1.2 analgesia - It comes from the prefix of
“an-” which means without, and the suffix of “-
algesia,” which means sensitivity to pain. The
1.6 consent - A permission for something to
word only implies without sensitivity to pain.
happen or agreement to do something.
The relief of pain by altering perception of
Consent to treatment means a person must
painful stimuli. that results from an
give permission before they receive any type
interruption in the nervous system pathway
of medical treatment, test or examination.
between sensory organs and brain.

1.7 disinfection - The process of killing

(inactivating) harmful and objectionable
bacteria, cysts and other microorganisms
(pathogenic) by various agents such as
1.3 anesthesia - It is a medical treatment that chemicals, heat, ultraviolet light, ultrasonic
prevents patients from feeling pain during waves, or radiation.
surgery. A state of controlled, temporary loss
of sensation or awareness that is induced for
medical purposes
.

1.8 hemostasis - A
process to prevent and stop bleeding,
meaning to keep blood within a damaged
blood vessel (the opposite of hemostasis is
hemorrhage). The stoppage of blood flow
through a blood vessel or organ of the body
with the use of a clamping instrument
1.4 antiseptic - It is a substance that stops or (hemostat).
slows down the growth of microorganisms.
They’re frequently used in hospitals and other
medical settings to reduce the risk of infection
during surgery and other procedures. It is
applied to skin surfaces or mucous
membrane for their anti-infective effects.

1.5 asepsis - The absence of disease causing

contaminants such as bacteria, viruses, fungi
and parasites.
 the surface of an article or in a fluid to prevent
disease transmission associated with the use
1.9 medical asepsis - Referred to as “clean
of that item.
technique”.The state of being free from
disease causing microorganisms. Medical
asepsis is concerned with eliminating the
spread of microorganisms through facility
practices.

1.13 surgery - A branch of medicine that is

concerned with the treatment of injuries,
diseases, and other disorders by manual and
instrumental means. Involves cutting,
abrading, suturing, or otherwise physically
1.10 resident bacteria - Consists of bacteria
changing body tissues and organs.
living in a specific area of the body. These are
organisms normally present on the skin and
are not easily removed by handwashing.

1.14 surgical asepsis - Referred to as “sterile

technique”. This involves the elimination of all
pathogens. The exclusion of all
microorganisms before they can enter an
open surgical wound or contaminate a sterile
field during surgery.

1.11 sterile - Free from bacteria and other

living organisms. Completely clean and not
containing any bacteria that might cause
infection.

1.15 surgical conscience - A professional

behavior that demonstrates understanding
and application of principles of surgical
surgery and legal, ethical and moral
responsibilities to patient and team members
for which each practitioner is accountable.

1.12 sterilization - Any process that

eliminates, removes, kills, or deactivates all
forms of life and other biological agents on
 1.16 surgical team - A team of medical staff
that helps the surgeon during the operation. ●
Roles in the team include surgeon, surgical
S
assistant, surgical technologist, nurse,
radiographer and anesthesiologist. They’re
also composed of sterile and unsterile
personnel.

urgical Assistant - These professionals can

do all the work that surgical technologists do,
but they often have a more hands-on role
1.17 surgically clean - Mechanically or during the procedure. They help in
physically cleaned, but not sterile. maintaining visibility of the surgical site,
sponging, suturing, suctioning, holding
retractors, and hemostasis (staunching

1.18 transient bacteria - Also known as

temporary skin flora. These are
microorganisms attached to the skin when a bleeding).
person comes in contact with surfaces,
substances or people during normal activities
● Scrub Nurse - Also called as perioperative
of living.
nurse, are registered nurses who assist in
surgical procedures by setting up the room
before the operation, and arranging the
needed instruments and equipment for

2. describe the operating room as to its:

2.1 personnel (sterile and unsterile)
Sterile Operating Room Personnel:
● Surgeon - Is looked upon as the leader of the
surgical team. Surgeons perform the actual
surgical procedures.
incisions involved in an operation. In addition,
surgeons make the critical decisions involved
in directing the course of a procedure.
 2.2 physical lay-out
Non-sterile Operating Room Personnel: There are three zones in the surgical
● Anesthesiologist - Also called as the area and these are:
anesthesia provider, is the person who ● Unrestricted Zone - are those in which
administers anesthesia during a surgical personnel may wear street clothes and traffic
procedure. They provide pain relief before, is not limited. This area is isolated by doors
during and after surgery. He/she can be a from the main hospital corridor, elevators, and
physician or a certified registered nurse form the areas of the OR suite.
anesthetist (CRNA).

● Semi-

●● Circulating Nurse - Is particularly the

registered nurse. The circulating nurse is
responsible for charting what is happening in
the operating room and tracks the supplies restricted Zone - This area is entered
and equipment needed for the surgical directly from the unrestricted area past a
procedure. nurse’s station or from other areas. Personnel
in the semi-restricted area should wear
surgical attire and cover all head and facial
hair. The area may include scrub sink areas,
storage areas for clean and sterile supplies,
work areas for processing surgical
instruments, and corridors leading to the
surgical suite.

● Restricted Zone - This includes the operating

rooms and the scrub sink areas. Surgical
masks and attire are required in these areas
when there are open sterile supplies or
scrubbed persons in the area.
 sight lines for surgeons.
2.3 attire (basic components and ● Masks - These masks cover the wearer’s
protective) mouth and nose, and decrease the risk of
introducing nasal and respiratory
Operating room attire consists of body microorganisms into the sterile environment,
covers, such as scrub dress, aprons, head thus protecting the patient. These are worn in
cover, mask, and shoe covers. Sterile gown semi-restricted and restricted areas to protect
and gloves are also added to this basic attire the environment.
for scrubbed team members. OR attire has
been shown to reduce particle count of
shedding from the body from over 10,000
particles per minute to 3,000 per minute, or
from 50,000 microorganisms per cubic foot to
500.

Basic Appropriate Attire

● Shoe Covers - These are worn in semi-
● Body Cover - These surgical attire are worn in
restricted and restricted areas to minimize the
the semi-restricted and restricted areas of the
spread of infection especially during surgical
surgery department. These are comprised of
procedure. Shoe covers should be worn on a
a short-sleeve, v-neck shirt and loose-fitting,
single-use basis.
drawstring pants.
One-piece jumpsuits with attached
hoods and boots are convenient garb for
visitors whose presence of the OR is brief.

Personal Protective Attire

● Surgical Gowns - Sterile gowns are worn over
scrub attire to permit the wearer to create and
to come within the sterile field, in order to
● Head Cover - All facial and head hair must be carry out sterile
covered in the semi-restricted and restricted technique during an
areas. These caps serve three basic operative procedure.
purposes: keeping the medical personnel’s This protects patients
hair clean of from the bacteria of
surgical fluids, operating room
prevents hair and personnel and also
sweat from protect staff members
contaminating an from the lethal viruses
open surgical site in the blood of
and maintain clear patients.
 operating light or surgical lighthead – is a
medical device intended to assist medical
● Surgical Gloves - Sterile gloves complete the personnel during a surgical procedure by
attire for scrubbed team members. They are illuminating a local area or cavity of the
patient.
worn to permit the wearer to handle sterile
supplies and tissues of the operative wound.

● Lead Apron - a type of protective clothing that ● OR Table

acts as a radiation shield. It is constructed of - the table on which the patient lies during a
surgical operation.
a thin rubber exterior and an interior of lead
- The purpose of a surgical table is to keep the
and is only effective when it is worn properly, patient in place while the surgical team
matched with the appropriate radiation energy operates, and may move various parts of the
and is used in a safe and regularly inspected body using surgical table accessories for
easier access to the surgical site.
environment.

● OR Shelves
- Operating room storage/shelves purpose is to
● Protective Eyewear - to protect against blood
ensure
and other infectious material spatter, medical
splashes, droplets and spray products are
readily
available at
the point of
use. Hospital
Operating
Room
Storage
Cabinets
promote
cleanliness,
as well as
flexibility and
2.4 set-up (equipment and apparatus)
easy
● OR Light
adjustability
- A surgical light – also referred to as an
to meet the changing requirements of today's
 hospitals.

● Surgical Instrument Tables

1.Mayo Stand
- designated to overhang the operating table and
hold instruments and other sterile items for
immediate use within easy reach of the scrub
2. FootStool
- are designed to help provide safe
elevation in the OR.

2.Back Table
- used by the scrub nurses for sterile supplies
needed during such as drapes, extra
instruments and sutures ● Anesthesia Machine
- a continuous flow machine which
provides a continual flow of the medical
gases: nitrous oxide, oxygen, and
anesthetic agent

● Kick Bucket
- large pail placed in a carriage with wheels and
serves as a disposal such as soiled sponges
and visceral packs

● Electronic and cardiac monitor

- The purpose of cardiac monitoring is to
obtain a picture of the heart's electrical
activity that can be observed
dynamically, in real time as the image
progresses across the screen of a
cardiac monitor. Early recognition of
● Stools potentially fatal dysrhythmias allows for
1. Revolving Stools prompt interventions that may save
- furnished for the anesthetist, who works
in a sitting position
 surgical hand washing, strong rotary
motion should be followed to remove
any microorganisms.

5. Pharmacology- There are certain

drugs given before the operation such
as antibiotics

6.Psychology- The nurse must explain

lives. the expected duration of the operation
and recovery.
● X-ray viewer
- A device made of lights placed behind a 7.Body Mechanics- The nurse must
translucent screen and used to provide explain the different position of clients
backlighting for a radiographic image. It during operation.
helps clinicians see the brightness,
contrast, and details of an image. 8.Sociology- Nurses must be able to
- This can be recessed into the wall. The reassure patient and lessen anxiety
best location is in the line of vision of the prior to procedure.
surgeon standing at the operating bed.
9.Safety and Security- use of WHO
safety checklist.

3.2 basic rules of surgical asepsis

3. cite the: 1. Identify which is sterile and non-sterile.
3.1 scientific principles involved
in OR Technique 2.All equipment used in a sterile field must be
sterile.
1.Anatomy and Physiology -Know the
structures of the body being performed 3.A sterile object becomes non-sterile when
on, sites and skin preparation, organ/ touched by a non-sterile object.
pathology to be removed, and layers of
abdomen so the nurse may most 4.Sterile items that are below the waist level, or
effectively assist the surgeon during items held below waist level, are considered to
operations. be non-sterile.

2.Chemistry-When 5.Sterile fields must always be kept in sight to

disinfecting/sterilizing tools, be considered sterile.
environment, and areas of incision on a
patient, know which chemical to use. 6.When opening sterile equipment and adding
supplies to a sterile field, take care to avoid
3.Microbiology-Nurses are responsible contamination.
for the upkeep of a clean environment
and maintaining the sterility of tools 7.Any puncture, moisture, or tear that passes
used in the OR. through a sterile barrier must be considered
contaminated.
4.Physics- When performing medical or
8.Once a sterile field is set up, the border of
one inch at the edge of the sterile drape is
considered non-sterile.

9.If there is any doubt about the sterility of an

object, it is considered non-sterile.

10.Sterile persons or sterile objects may only

contact sterile areas; non-sterile persons or
items contact only non-sterile areas.

11.Movement around and in the sterile field

must not or contaminate the steril
 3.3 duties and responsibilities of the scrub and the circulating nurse
RESPONSIBILITIES OF THE SCRUB NURSE
PRE-OPERATIVE INTRA-OPERATIVE POST-OPERATIVE

1.Prepare all the instruments and 1.Serve instrument according to sequence and need 1.Do after care.
back table. of the surgeon.

2.Perform medical and surgical hand 2.Anticipate surgeon's needs and assist in serving 2.Prepare OR room for
washing. instrument. the next surgery.

3.Don gowns and gloves. 3.Keep the instruments and supplies in order.

4.Prepare the back table and mayo 4.Secure the specimen and prepare for sending to
stand. the laboratory.

5.Does the first counting. 5.Anticipate irrigation (rinsing).

6.Serve gowns and gloves to the 6.Does the partial counting (2nd counting).
surgeon.

Assist in draping. 7.Discards operative sponges in the kick bucket.

8.Does the final counting before closure of a cavity.

RESPONSIBILITIES OF THE CIRCULATING NURSE

PRE-OPERATIVE INTRA-OPERATIVE POST-OPERATIVE

1.Perform medical handwashing. 1.Assist the anesthesiologist in the 1.Endorse the patient to the
Prepare the operative theatre and its induction of anesthesia. Serve the sterile Recovery Room.
equipment needed for the operation. supplies needed.

2.Receive endorsement from the floor 2.Assist in FBC insertion. 2.Report to the charge
nurse. Review the OR checklist and the nurse for the next
preparation of the patient from the floor assignment.
nurse.

3.Check the consent to operation, signed 3.Do skin preparation based on the site
by the patient. involved.

4.Review with the floor nurse the pre- 4.Initiate Time-Out following the guide
operative orders, medications, and other question written in the WHO Surgical
special endorsement. Safety Checklist.

5.Transfort the patient from receiving 5.Take note of the time of the first
area to the operating room. incision made by the surgeon.

6.Orient the patient to the set-up, 6.Anticipate the needs of the sterile
especially the Recovery room for post- team.
operative management.

7.Position the patient comfortably on the 7.Assist the anesthesiologist as to what

operating table. Attach various medications are needed
monitoring devices, like the cardiac
monitor.

8.Check the preparation of the 8.continuously monitor the patient's vital

instruments/supplies made by the scrub signs and cardiac status. Note for any
nurse. unusualities.

9.Prepare the materials/equipment to be 9.Do partial and final counting at proper

used by the anesthesiologist on the intervals.
table. Cover the table with a sterile drape
.

10.Position the patient according to the 10.Finalize the operative record.

type/method of anesthesia to be
inducted.

11.Do initial sponge and instrument 11.Assist the anesthesiologist in

count with the scrub nurse. transferring the client to the Recovery
Room.
 4. enumerate the:
4.1 basic instruments in the Basic Set as to:
4. enumerate the:
4.1 basic instruments in the Basic
Set as to:
4.1.1 clamping and occluding- are used to
compress blood vessels or hollow organs for
hemostasis or to prevent spillage and contents.
Kelly Curve and Kelly Straight- are larger and
less delicate than mosquito forceps. These forceps
have transverse serrations along the distal half of
the jaws only. Are often selected for the occlusion
of small to medium sized blood vessels

Mosquito-The jaw of the mosquito forceps

contains transverse striations along its entire length
making it a good choice for the occlusion of small
vessels.

4.1.2 cutting and dissecting- are sharp and are

used to cut body tissue or surgical supplies.
Blades - are used for cutting skin and
tissues during a surgical procedure.
Blade Number 10- The No.10 blade
with its curved cutting edge is one of the more
traditional blade shapes and is used generally
for making varying sizes of incision in skin and
muscle.

Blade Number 20- - A large curved blade

commonly used for cutting tissue and other
procedures that require a puncture or cut.

Blade Handles- Holds the blade in place.

 Mayo Scissors- The scissors are heavy Suture Scissors- are typically used to remove
and are built to cut tough structures. The skin sutures after the incision has healed. A notch in
handles and blades are of same length. The one of the blades allows the loops of suture to be
blades of the scissors are usually blunt and easily hooked and prevents excessive lifting of the
rounded. Moreover they may be curved or tissues during cutting.
straight.
The straight scissors are used for cutting
sutures and ligatures or trimming the skin
around the wound, hence it is also known as
‘suture scissors’.

The curve blades are ideal to cut tough

tissue like fascia, tendons and ligaments.

Bandage Scissors- have a large

4.1.3 grasping and holding- are used to hold
bottom blade with a blunt nodule at the tip. This
tissues, sponges and drapes.
configuration reduces the likelihood of tissue
Allis Tissue Forceps- is very important. It has
injury when the scissors are introduced
sharp teeth It is used to grasp soft tissue. But it can
between skin and bandage material. These
cause damage to the tissue ,Slightly traumatic
scissors are very sturdy and are constructed
therefore it's used in tissue about to be removed. They
specifically for bandage removal.
are used to hold the tissue edges to facilitate deeper
exposure of the underlying organs or tissues.
Available in short and long sizes.

Surgical Scissors- Scissors

Surgeons use surgical scissors during an
operation in order to cut tissues at the surface Babcock Forceps- More delicate than Allis .
or inside the human body. The blades can be Broad, flared ends with smooth tips . It is used to
grasp delicate tissue specially tubular structures
(intestine, fallopian tube, ovary , ureter , appendix,
lymph nodes ). The tip is atraumatic as there is no
sharp tooth . Available in short and long sizes.

either curved or straight.

Metzenbaum- typically have a long handle to

blade ratio. They are available with a straight or
curved blade Are used for cutting delicate tissues and
for blunt tissue. Dissection. Tissue Forceps- Pick ups, thumb forceps
and tissue forceps are available in various lengths,
with or without teeth, and smooth or serrated jaws.
Tissue forceps has teeth which prevents it from
slipping. Thumb forceps are commonly held
between the thumb and two or three fingers of one
hand Thumb forceps are used to grasp tough tissue
. Forceps may either have many teeth or a single
tooth. Single tooth forceps are also called "rat tooth
forceps."
Sponge Forceps- Foerster clamps are
commonly used for removing small amounts of
fluids from the operative area using a grasped
surgical sponge. Also used for holding sponge or a
gauze piece for painting the area before operation.
Stapling
3. Skin Staplers
US Army Navy - with different lengths
used in many minor procedures is used to retract
shallow or superficial incisions.

4.1.6 viewing
4.1.5 suturing and stapling - Used to examine the interior of body
Suturing cavities, hollow organs, or structures
1. Needle holders- A needle holder, also and can perform many procedures
called needle driver, is a surgical through them.
instrument, similar to a hemostat, used ● Speculums
by doctors and surgeons to hold a 1. Nasal speculum
suturing needle for closing wounds
during suturing and surgical procedures.

2. Ear speculum

2. Tungsten carbide jaws - eliminate the

twisting and turning of the needle
3. Auvard vaginal speculum

4. Graves vaginal speculum

3. Webster Needle Holder

- is used with small needles and fine
suture material, commonly in plastic
surgery or subcutaneous procedures.
 ● Frazier tip
● Yankeur tip
● Trocar
● Canulla

4.1.8 dilating and probing

- Probing instruments are used to enter
natural openings, such as the common
bile duct, or fistulas.
- Dilating instruments expand the size of
● Endoscopes an opening, such as the urethra or
1. Fiberoptic flexible endoscopes - cervical os
permits viewing in a forward ● Hank dilator
direction, with a light carrier ● Hawkins dilator
supplied by a fiberoptic cable 4.1.9 measuring
provides illumination. - Used to determine the precise size
needed for an implant, such as joint or
breast prosthesis.

● Rulers

2. Rod-lens rigid endoscopes - have

either rigid or flexible sheaths,
used in combination with video
assisted technology, can record
action videos and still digital
photography.

● Depth gauges

4.1.7 suctioning and aspirating

- Used to remove blood, body fluids,
tissue and irrigating solutions.
● Poole abdominal tip

4.2 contents of the major pack and minor pack

Pictures Minor Pack Pictures Major Pack

6 Surgical Gowns 6 Surgical Gowns

6 Hand Towels 6 Hand Towels

6 Draping Towels 6 Draping Towels

2 Plain Sheets 1 Mayo Cover

1 Laparotomy Sheets
 5. list the various

5.1 Sites for skin preparation

● Head preparation:
- Hair removal may or may not occur; long hair may be parted along the incision line and
hair secured away from the incision with elastic bands or short hair may have a thin strip
of hair clipped along the incision line.
- Do not use chlorhexidine on eyes, ears or mucous membranes.
- Begin prep at incision site and extend to the periphery of hairline and neck.

● Neck Preparation :
- Ensure a cap or towel is over the patient’s hair and use waterproof tape if necessary to ensure hair is
tucked away. The hairline is considered a contaminated area.
- The area to be prepped includes the neck laterally to the table line and up to the mandible, tops of the
shoulders, and chest almost to the nipple line.

● Chest / breast Preparation :

- Area to be prepped includes from the top of the shoulder to below the diaphragm and from the edge
of the non-operative breast to the table-level of the operative side, including the upper arm to elbow
circumferentially and the axilla of the operative side.
- Prep the axilla last.
- Skin prep for thoracic surgery requires an extension bilaterally of the boundaries for radical breast
surgery .
- Prep both sides of the chest for a bilateral procedure.
- If incision is in axilla, use a separate sponge for the axill

● Abdominal Preparation:

- Umbilicus is prepped first using sterile cotton-tipped applicators dipped in antiseptic solution.
Discard applicators after use.
- Area to be prepped will vary depending on surgery to be performed (ie appendectomy, inguinal
hernia repair).
- Area that may be required to be included is from nipple line to upper 1/3 of thighs

● Vaginal Preparation :
- Place drip towel or impervious drape under buttocks to prevent prep solution from pooling
under the patient’s coccyx. Ensure towel or impervious drape is removed following completion
of the prep.
- First: prep pelvis, labia, perineum, and thighs as follows: Start prep at the pubis and to iliac
crest using back and forth strokes. Prep labia majora using downward strokes, including
perineum. Use fresh sponge to prep inner thigh of first leg starting at labia majora and moving
laterally using back and forth strokes. Discard sponge when periphery reached. Use fresh
sponge to prep inner thigh of second leg starting at labia majora and moving laterally using
back and forth strokes. Discard sponge when periphery reached.
- Prep anus last.

● Upper Extremities Preparation :

A. Shoulders
- Elevate the patient’s arm prior to proceeding with prep. Be careful not to pull the patient’s
shoulder laterally to expose the scapular area to avoid dislocation and further injury to the
patient.
- Area to be prepped includes the chest, neck and shoulder, upper arm, scapula and axilla on
the affected side. Prep the axilla last

B. Forearm / Hand

- The area to be prepped includes: entire circumference of the arm to the mid forearm, over the
shoulder, scapula and axilla (prep last).
- Begin the prep at the incision, prep from proximal to distal boundaries.
- Hand and fingernails may require pre-cleaning prior to skin prep.
● Lower Extremities

A. Hips:
- Area to be prepped includes: abdomen on the affected side, thigh to below the knee, the
buttocks on the affected side, the groin, and the pubis.
- Begin the prep at the incision site. Proceed to periphery which is abdomen midline, inferior rib
cage, below knee. Prep the groin and perineum last
 B. Legs and Foot

- Elevate limb.
- Area to be prepared may vary depending on surgery to be performed.
- Prepping the foot should include a scrub prior to paint/packaged single unit applicator in order
to reduce the bacterial counts between the toes If top of leg prepped, place a drip towel
between the groin and the fold of the upper thigh to prevent pooling in the area

.
5.2 Operative positions

● Prone position - is where the patient lies face down and is commonly used for access to the
posterior head, neck, and spine during spinal surgery, access to the retroperitoneum and upper
urinary tracts and access to posterior structures when required during plastic surgery.

● Supine positon - or dorsal decubitus position is the most common position used in the operating
room. Typically, the head is rested on a foam pillow, keeping the neck in a neutral position. The
patient's arms are either tucked at their side or abducted to less than 90 degrees on padded arm
boards

6. discuss the:

6.1 classification of surgery according to:

6.1.1 major or minor
Major Surgery
● A major surgery is a surgery in which the invasiveness is vast, involving the extensive reconstruction
or alteration in body parts and involves major organs such as the heart, lungs, kidneys, the brain.
● Associated with a blood loss exceeding 500 ml and a recovery lasting at least one night in the
hospital.
● Complications tend to be more severe and more common, such as extensive hemorrhage and the
occurrence infection can lead to life threatening scenarios.
● Anesthesia used is GENERAL anesthesia which means that the client is induced into a coma.
● Examples of major surgeries:
○ Open cholecystectomy (gallbladder removal from an open incision in the abdomen)
○ Laryngectomy (Removal of the larynx)
○ Amputation (Removal of a limb)
○ Mediastinoscopy (A procedure that allows for the visualisation of the mediastinum, the space
between the lungs which houses the heart)
Minor surgery
● A surgery is considered minor if it poses little risk to the patient’s life, and if the surgery is done on
superficial structures such as the skin or making minor alterations to body parts,
● Major organs are not operated on in minor surgeries as superficial structures are the focus.
● Minor surgeries often pose less of a threat in terms of surgical complications and blood loss is
anticipated to be less.
● The type of anesthesia used is local or regional anesthesia, both of which maintain the client’s
consciousness compared to general anesthesia.
● Examples of minor surgeries:
○ Tooth extraction (the removal of a tooth)
○ Vasectomy (Surgical alteration of the vas deferens as a form of contraception)
○ Bunionectomy (a surgical procedure to excise, or remove, a bunion)
○ Rhinoplasty (Plastic surgery procedure for correcting and reconstructing the nose)

6.1.2 purpose
● Diagnostic
○ A surgical procedure done to allow the physician to confirm a diagnosis, such as in the case of
cancer patients in which removal of tissue is conducted for further testing.
○ Examples:
■ Biopsy (extraction of cells or tissues for examination)
● Re- Constructive
○ A surgery done to restore the form or function of the body or body part(s).
○ Repairs physical abnormalities, or improves appearance for cosmetics.
○ Examples:
■ Rhinoplasty (a procedure for reconstructing or reshaping the nose)
■ Skin grafting (transplantation of skin to an injured area)
● Ablative
○ A procedure in which diseased or damaged tissue is ablated (destroyed), removed, or repaired.
○ Examples:
■ Gastrectomy (partial or complete removal of the stomach)
■ Appendectomy (the surgical removal of the appendix)
● Palliative
○ A surgical procedure done to lessen the degree of symptoms in a patient, even if it may not cure
the underlying disease or condition. Ergo, it is more focused on improving the quality of the
patient’s life rather than increase their chances of survival.
○ Examples:
■ Nerve-Block procedures in cancer patients to relieve pain.
■ Removal of metastatic tumor mass

6.1.3 category of surgery based on urgency

● Elective Surgery
○ A procedure which is planned in advance. Even though these are done “electively” or
because the client wants it, they can also be potentially life-threatening.
○ The most common examples involve cosmetic surgery such as breast augmentation or
liposuction but also surgeries such as scoliosis surgery or tonsillectomies.

● Emergency Surgery
 ○ Surgery must be done immediately to keep the patient alive.
○ An example is emergency pericardiocentesis which treats a cardiac tamponade.
● Urgent Surgery
○ Surgeries which must be done within the next 24 hours, or until the patient is medically stable,
otherwise life-threatening consequences may occur.
○ Examples include the amputation of a gangrenous limb and an appendectomy

6.2 common surgical complications

● Post- Operation
○ Hemorrhage/ Bleeding: Rapid blood loss from the site of surgery, common in major surgeries where
incisions are much larger.
■ Treatments: IV fluid administration, Blood transfusion
○ Infection: Microbial growth on the site of surgery which can greatly dampen the rate of healing.
Complications are likely if infection spreads to nearby structures or travel through the bloodstream.
■ Treatments: Antibiotics as prescribed, wound drainage, patient teaching on proper wound hygiene.
○ Deep vein thrombosis: A blood clot that forms in a deep vein such as those in the lower leg. If the
vein swells it is Thrombophlebitis, and if the clot detaches it becomes an embolus which can cause
pulmonary embolism.
■ Treatments: Anticoagulants (blood thinners), compression stockings to improve venous return
○ Pulmonary Arrest: A condition in which the patient ceases to breathe or has ineffective breathing. It is
considered a respiratory arrest if the heart is beating normally but the breathing is still ineffective or
absent.
■ Treatments: Intubation in which a tube is inserted into the airways to help with breathing,
breathing exercises, surgery to remove possible obstruction
○ Urinary retention: Inability to partially or completely empty the bladder
■ Treatments: Catheterization until full bladder control is regained, drugs which can relax the
urinary sphincter to ease the flow of urine.

6.3 different layers of abdomen

Different Layers of the Abdomen

Abdominal Wall
- represents the boundaries of the abdominal
cavity.
- It is split into the posterior (back), lateral
(sides) and anterior (front) walls.
- These layers include (from superficial to
deep):
1. Skin (Epidermis and Dermis)
2. Subcutaneous Tissue
3. Superficial Fascia
4. Peritoneum
Skin
 - is the soft outer tissue covering of vertebrates with three main functions: protection, regulation,
and sensation.
- Two Primary Layers:
1. Epidermis - provides waterproofing and serves as a barrier to infection.

-The upper or outer layer of the two main layers of cells that make up the skin.
2. Dermis - serves as a location for the appendages of skin.
-The thick layer of living tissue below the epidermis which forms the true
skin, containing blood capillaries, nerve endings, sweat glands, hair follicles, and other
structures.

Subcutaneous Tissue

- is the lowermost layer of the integumentary system in vertebrates.

- is beneath dermis which is beneath epidermis. It is used mainly for fat storage.

Superficial Fascia

- is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches,
stabilizes, encloses, and separates muscles and other internal organs.
- is a general coating of the body beneath the skin, made up of loose areolar tissue with varying
amounts of fat. It is the layer that primarily determines the shape of the body. In addition to its
subcutaneous presence, the superficial fascia surrounds organs , glands and neurovascular
bundles.
Peritoneum

- is a closed cavity that contains all of the abdominal organs except for the kidneys and the
adrenal glands. The parietal peritoneum covers the abdominal wall and diaphragm. The
visceral peritoneum covers the abdominal organs.
 - supports many of the abdominal organs and serves as a conduit for their blood vessels,
lymphatic vessels, and nerves.

6.4 common abdominal incisions

1. Kocher
- Also called Subcostal or Lateral Oblique incision
- A subcostal incision used to gain access for gallbladder and biliary tree
- The incision is made to run parallel to the costal margin, starting
below the xiphoid and extending laterally. The incision will
then pass through the rectus sheath and rectus muscle,
internal oblique and transversus abdominis, before
passing through the transversalis fascia and peritoneum to
enter the abdominal cavity.

2. Midline
- is used for a wide array of abdominal surgery, as it allows the
majority of the abdominal viscera to be accessed.
- can run anywhere from the xiphoid process to the pubic
symphysis, passing around the umbilicus. The incision will cut
through the skin, subcutaneous tissue, and fascia, the linea
alba and transversalis fascia, and the peritoneum before
reaching the abdominal cavity.
- this incision causes minimal blood loss or nerve damage, and
can be used for emergency procedures.

3. McBurney
- Also called Grid Iron Incision or Muscle-Split Incision
- Popular incision for appendicitis
- Is made at the junction of the middle
third and outer third of a line running from umbilicus to anterior iliac spine.
- Also used in the left lower quadrant to deal with certain lesion of sigmoid
colon such as drainage of an abscess.

4. Lanz
- Also commonly used to access appendix and cecum.
- A variation of Mcburney’s that is made at the
same point but in a transverse plane
- Gives a cosmetically good scar since it may be
hidden beneath the bikini line
5. Battle
- A lower right paramedian incision but
placed more laterally than the standard
paramedian incision
- Suitable for dealing with acute appendicitis
and pathologies in the right lower quadrant
of the abdomen.

6. Paramedian
- An incision placed 2-5 cm lateral to
midline, allowing lateral structures such as
the kidneys, adrenals and spleen.
7.Rutherford
- Also called oblique muscle cutting incision
- A variation of Mcburney which extends the incision by division of
the oblique fossa

8. Pfannenstiel Incision
- A semi-circular incision that is about 12 cm long and is
approximately 5 cm above the symphysis pubis.
- Used commonly by gynecologist and
urologist for access to pelvic organ, bladder, prostate
and for c-section.
- It has a good cosmetic effect

9. Maylard
- Gives excellent exposure of the
pelvic organs
- The skin incision is placed above
but parallel to the traditional placement of the
Pfannenstiel incision.
- Also commonly used by gynecologists to gain access for the pelvic
organs and for c- section.

10. Thoracoabdominal
- The Right incision is particularly for elective and emergency
hepatic resections while the left incision is most effective for the
resection of the lower end of the esophagus and proximal
portion of the stomach.
- The incision is extended along the line of the eighth interspace, the space immediately distal to
the inferior pole of the scapula.
- The patient is placed in the “corkscrew” position. The abdomen is tilted about 45° from the
horizontal by means of sand bags, and the thorax twisted into fully lateral position.
6.5 different types of:
6.5.1 suture
1. absorbable suture
- Sutures that don’t require a doctor to remove them since the body’s cells and fluids in the area
naturally digest them during the healing process.
- Typically used internally
- Absorbable sutures:
a. Catgut - usually manufactured from highly purified connective tissue derived from the intestine of
sheep beef, or goat.This suture is usually used for repairing internal soft tissue wounds or

lacerations.
b.Polydioxanone (PDS) - a synthetic monofilament suture which can be used for many types of soft
tissue wound repair (such as abdominal closures) as well as for pediatric cardiac procedures.

c. Poliglecaprone (MONOCRYL) - a synthetic monofilament suture that is for general use in soft tissue
repair. It is used to close skin in an invisible manner.

d. Polyglactin (Vicryl) - a synthetic braided suture that is good for repairing hand or facial lacerations.

e. Polyglycolic Acid - absorbable, synthetic, usually braided

suture, made for use in ophthalmic practice. It is indicated for soft tissue approximation and
 ABSORBABLE SUTURES

Advantages Disadvantages

● Broken down ● Consideration of

by body wound support time
● No foregin
body left

2. non-absorbable suture
- Cannot be naturally digested in the body, thus, must be removed at a later date by the doctor.
- Typically used for external cuts and incisions
- Non-absorbable sutures:
a. Nylon - a natural monofilament suture.

b. Polypropylene (Prolene) - a synthetic monofilament suture.

c. Silk - a braided natural suture.

 d. Polyester (Ethibond) - a braided synthetic suture.

NON-ABSORBABLE SUTURES
6.5.2 suture needle
- a needle designed to carry sutures when Advantages Disadvantages
sewing tissues.
- Types: ● Perman ● Foreign body left
ent ● Suture removal can
a. Taper needle - they gradually taper to the
wound be costly and
point, and a cross-section anywhere along support inconvenient
the shaft would reveal a round shaft, as ● More visible
shown in the inset. Taper needles are used scarring
for tissue that is easy to penetrate, such as
bowel or blood vessels.

b. Conventional Cutting needle - the tip of cutting needles is triangular in shape, and the apex
forms a cutting surface, which facilitates penetration of tough tissue, such as skin. Cutting
needles make it much easier to penetrate tough tissue.

c. Reverse Cutting - is similar to a conventional cutting

needle, except that the cutting edge faces down
instead of up. This may decrease the likelihood of
sutures pulling through tissue.

6.5.3 blades
Scalpel
- is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry
and various arts and crafts.
- may be single-use disposable or reusable. Reusable scalpels can have permanently attached blades
that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually
have a plastic handle with an extensible blade and are used once, then the entire instrument is
discarded.
- are usually individually packed in sterile pouches but are also offered non-sterile.

Types of Scalpel Blades

 Blade no. 10
- curved cutting edge with an unsharpened back edge. A more traditional blade shape.
- generally for making incisions in skin and muscle. Commonly used to cut the skin in abdominal
operations.
Blade no. 11
- triangular blade with sharp point, flat cutting edge parallel to the handle and flat back.
- for precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the
X-Acto knife blade.
Blade no. 12
- a small, pointed, crescent-shaped blade sharpened on the inside edge of the curve.
- used within Dental surgery for raising skin flaps and for removing excess polymerised
composite resin on the facial and interproximal region of the tooth during restoration
procedures.
Blade no. 15
- a smaller version of the #10.
- for the same general use as the #10 blade.
Blade no. 20
- A larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back
edge.
- Used in general surgery and orthopaedic surgery.
Blade no. 22
- A slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back
edge
- Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung
resection surgery.

7. differentiate:
7.1 sterilization process as to its:

7.1.1 types
All items (e.g. instruments, supplies, and equipment) that come in contact with the sterile field must
be sterile. Sterilization is achieved by the following methods: physical, chemical, and radiation.

a.) Physical Method - physical methods are those methods which do not contain any chemical
interaction or reaction.
● Dry heat - Dry heat sterilization (killing or removal of all microorganisms, including bacterial
spores) technique requires longer exposure time (1.5 to 3 hours) and higher
temperatures than moist heat sterilization. Various available methods of dry
heat sterilization are; hot air oven, incineration, flaming (wire loop) etc.

1.) Hot air oven - When sterilizing glassware such as bottles, petri dishes and
test tubes, dry heat is required and this is carried out in a hot air oven.
The ideal temperature of the oven needs to reach is at least 160°C and
the contents need to be regulated at this heat for 45 to 60 minutes. The
heat is absorbed by the outside surface of the item, then passes towards
 the centre of the item, layer by layer. The entire item will eventually reach the temperature
required for sterilization to take place.

2.) Incineration - Incineration is a waste treatment process that involves the combustion of organic
substances contained in waste materials. This method also burns any organism to ash. It is
used to sterilize medical and other biohazardous waste before it is discarded with non-
hazardous waste.

3.) Flaming - Flame sterilization is a technique of high

temperature, short time processing that is applied to
sealed metal cans. It is a simple method used in killing
microorganisms on an inoculating loop or needle
● Moist heat - Moist heat sterilization is a procedure in
which heated, high-pressure steam is used to sterilize an
object. This sterilization technique does not involve any
toxic liquids or fumes, and it is relatively inexpensive,
quick, and effective in killing and eliminating potentially
infections bacteria, viruses, and spores. Hospitals use moist heat sterilization to sterilize medical
equipment, such as surgical scalpels. Bacteria and viruses are made up of proteins, and moist
heat sterilization works by denaturing these proteins. Denaturation is a process in which the
structures of the proteins are disrupted and altered, and once the bacteria and viruses are
denatured, they will be unable to cause infection.
1.) Autoclave - autoclave is used to sterilize surgical equipment, laboratory instruments,
pharmaceutical items, and other materials. It can sterilize solids, liquids, hollows, and instruments
of various shapes and sizes. Autoclaves vary in size, shape and functionality. The optimal
composition of steam within an autoclave is 3% liquid and 97% gas. Any change in the percentage
of moisture increases or decreases sterilization time. In practice, sterilization time is calculated
according to optimum steam conditions and steam's ability to transfer energy to the non-sterile
load prior to sterilization. Autoclave requires considerably less time and heat than a dry heat
sterilizer, due to steam’s capacity to transfer energy. To be effective, the autoclave must reach and
maintain a temperature of 121° C for at least 30 minutes by using saturated steam under at least
15 psi of pressure.

b.) Chemical method – Chemical sterilization is the

elimination of all viable microorganisms and their spores using liquid or gaseous compounds. Liquid
sterilization involves submerging equipment in a chemical fluid for enough time to kill all viable
microorganisms and their spores. Gas sterilization involves exposing equipment to chemical gases in an
enclosed heated or pressurized chamber. The common liquid chemicals are glutaraldehyde, ortho-
phthalaldehyde, peracetic acid, hydrogen peroxide, and hypochlorite.

1.) Glutaraldehyde - Glutaraldehyde, sold under the brand name Cidex and Glutaral among others, is a
disinfectant, medication, preservative, and fixative. As a disinfectant it is used to sterilize surgical
instruments and other areas of hospitals.

2.) Ortho-pthalaldehyde - an aromatic dialdehyde, used as a high-level antimicrobial disinfectant for

 medical equipment which is sensitive to normal heat or steam sterilization processes, including
endoscope, cystoscopes, and certain dental instruments.

3.) Peracetic Acid - Peracetic acid is an effective bactericide, fungicide, and virucide, which is used in
the sterilization of gnotobiotic equipment.

4.) Hydrogen Peroxide - A very pale blue, clear liquid, slightly more viscous than water. It is used as an
oxidizer, bleaching agent, and antiseptic.

5.) Hypochlorite - most commonly used for bleaching, disinfection, and water treatment purposes

6.) Ethylene Oxide - Ethylene Oxide (EtO) is a common gas used for low temperature sterilization.It is
most commonly used to sterilize instruments with long lumens such as endoscopes and all materials
that have to be sterilized but cannot withstand higher temperatures. EtO process temperatures from
25 - 55°C are used

ADVANTAGES DISADVANTAGES
c.) Radiation - Radiation sterilization
with high energy gamma rays or Physical Effective method Dry heat is
accelerated electrons has proven to be a Method for controlling relatively slow and
useful method for the industrial sterilization microbial growth. many objects
of heat sensitive products. It is applied to moist-heat cannot withstand
sterilization is the high
surgical instruments sutures, prostheses,
typically the more temperatures. The
unit dose ointments, plastic syringes and effective protocol disadvantage of
dry pharmaceutical products. There are 2 because it moist heat is that
general types of radiation used for penetrates cells substances like
sterilization, ionizing radiation and non- better than dry powders and oils
ionizing radiation. Ionizing radiation is the heat does. cannot be sterilized
use of short wavelength, high-intensity by boiling or with
steam. These
radiation to destroy microorganisms. This
substances can be
radiation can come in the form of gamma damaged by
or X-rays that react with DNA resulting in a repeated exposure
damaged cell. For example, sutures, to steam.
surgical gloves, gowns, face masks,
Chemical Low temperature, Long cycle,
syringes, sticking plasters, dressings and
Method destroys flammable,
other single use healthcare supplies are all microorganisms carcinogenic to
processed using gamma including resistant humans, requires
radiation.Radiation sterilization is spores, large special room
particularly popular for such products since sterilizing volume conditions and
it can be applied to the fully packaged, capacity, non- safety equipment.
sealed item, thus limiting the potential for corrosive to
plastic, metal &
recontamination by eliminating post-
rubber materials
sterilization packaging steps. The
compatibility of medical device components Radiation No degradation of Requires highly
and packaging materials with radiation media during specialized
requires consideration. sterilization, thus equipment
it can be used for
thermally labile
media, and
leaves no
chemical residue
7.1.2 advantages and disadvantages
7.2 types of anesthesia

The anesthesia that are utilized in the Operating Room

are the ff:

1. General Anesthesia

-General anesthesia is administered by a physician

 anesthesiologist through a mask or an IV placed in the vein. General anesthesia works by interrupting
nerve signals in your brain and body. While the anesthesia is working, you will be unconscious and
many of your body’s functions will slow down or need help to work effectively. A tube may be placed in
your throat to help you breathe. During surgery or the procedure, the physician anesthesiologist will
monitor your heart rate, blood pressure, breathing and other vital signs to make sure they are normal
and steady while you remain unconscious and free of pain. general anesthesia is most commonly
used for major operations, such as knee and hip replacements, heart surgeries and many types of
surgical procedures to treat cancer.

2.) Regional anesthesia

- is a type of pain management for surgery that numbs a

large part of the body, such as from the waist down. The
medication is delivered through an injection or small tube
called a catheter and is used when a simple injection of
local anesthetic is not enough, and when it’s better for the
patient to be awake. This type of anesthesia, including
spinal blocks and epidurals, is often used for childbirth. In
fact, an epidural is the most common type of pain control
used for labor and delivery. It allows the mother to be awake, able to push when it’s time to deliver the
baby, but numbs the pain. Another type of regional anesthesia — a spinal block — is stronger and is
used during procedures such as cesarean deliveries, also known as C-sections. Spinal blocks and
epidurals allow the doctor to surgically deliver the baby without causing pain to the mother, and without
subjecting the baby to sedating drugs that might be harmful. Regional anesthesia is very safe and
doesn’t involve the potential complications and side effects that can happen with sedation and general
anesthesia.

3. Local anesthesia

- also called local anesthetic, is usually a one-time injection of medicine that numbs a small area of the
body. It is used for 6procedures such as performing a skin biopsy or breast biopsy, repairing a
broken bone or stitching a deep cut. You will be awake and alert, and you may feel some pressure,
but you won’t feel pain in the area being treated. Local anesthetics produce anesthesia by inhibiting
excitation of nerve endings or by blocking conduction in peripheral nerves.
8. Show the common Operative Checklists needed for surgery:
8.1 Consent Form 8.2 Preoperative Checklist
8.3 WHO Surgical Safety Checklist