OPERATION THEATURE MANAGEMENT FOR NURSES

1. OPERATION THEATURE MANAGEMENT BY DR SHANZA AUROOJ

2. TABLE OF CONTENTS:   Defination of a scrub nurse Specific role in OR Responsibilities of a scrub nurse Video on ASEPTIC TECHNIQUES Orientation on SURGICAL NEEDLES Orientation on SURGICAL SUTURES Orientation on SURGICAL INSTRUMENTS Video on INSTRUMENT HANDLING

3. What is a scrub nurse? A scrub nurse is a medical professional who assists surgeons and other healthcare experts in the operating room.

4. Specific Role in the Operating Room T o prepare and drape sterile drapes,instruements & supplies T o assist surgeon & assistants throughout operation by providing instruements & supplies T o maintain patient’s safety throughout operation

5. Welcoming patient to OR Preoperative nursing assesment Checklist before scrubbing Scrubbing in Assembling instruements,counting before surgery Assist surgeon by passing over instruements Observe patient’s safety End of procedure Responsibilities of a scrub nurse

6. WELCOMING A PATIENT TO OR Welcome patient Introduce yourself Get personal information from patient Ask if he/she needs any further help Show her around (where to sit,bathroom,changing room etc) Ask to remove jewelry

7. Preoperative nursing assessment Age Allergies Presence of infections (temp ≥38) Vital signs Drugs contraindicated ( aspirin,heparin,warfarin ) Nutritional status Physiological state( labs,x -rays) Psychological state Tolerance to anesthesia ( smoking,alcoholism )

8. Check consent Confirm surgical procedure Check instruements check supplies Checklist before scrubbing

9. “SCRUBBING IN” “ Scrubbing in ” usually involves thoroughly washing hands and arms with an antibacterial soap, then putting on a sterile mask, hat, gown and gloves so that patients cannot be contaminated when their bodies are exposed for surgery.

10. ASSEMBLE INSTRUEMENTS Open the inner sterile set & assemble sterile instruments on mayo tray & trolley Perform surgical count Assemble surgical blade Prepare sutures

11. Assistance during surgery Assist surgeon in cleaning & draping patient Bring mayo’s tray over the patient

12. Assistance during surgery Pass instruments to surgeon in a proper position & safe manner Pass & Receive scalpel in kidney dish Place the skin knife away from working field

13. Assistance during surgery Retract tissue gently if required Remove artery tips as directed by surgeon Cut sutures with scissors,help in suturing Assist in cautery

14. Assistance during surgery Anticipate surgeon need through out procedure keep one step ahead of surgeon in passing instruments,sutures,sponges etc Maintain neat & orderly sterile field of operation

15. Assistance during surgery Maintain strict aseptic techniques Keep talking to minimum,turn away while sneezing,coughing Keep your hands at table level while unengaged

16. End of procedure Perform second surgical count of sponges,sharps,instruements as surgeon begins closing Apply dressing to the wound by non touch technique & assist in removing the drapes

17. End of procedure Dispose of sharps Cover the soiled instruments before sending them for cleaning/autoclave Remove gown & glove and check documentation

18. SURGICAL NEEDLES Surgical needles are necessary for the placement of sutures in tissues NEEDLE ANATOMY Swage Body Point

19. NEEDLE SWAGE Classification by the needle swage: 1. Closed Eye 2. French Eye 3. Swage

20. Body of the needle classification by the body of the needle: ¼ circle 3/8 circle ½ circle 5/8 circle Straight Half Curved (Ski) compound Curved

21. Point of the needle Conventional cutting (cutting on the inside) Reverse Cutting (cutting on outside) Taper point (Pierce and spread tissue without cutting it Blunt Pierce and spread tissue without cutting it.

22. Suture The word "suture" describes any strand of material used to ligate (tie) blood vessels or approximate (sew) tissues . CLASSIFICATION OF SUTURES Absorbable / Nonabsorbable Natural / Synthetic Braided / Monofilament

23. Example Suture Selection Absorbable Natural Synthetic Non Absorbable Natural Synthetic Fast Absorbing Gut Chromic gut Plain Gut VICRYL* VICRYLRapide* PDS II* MONOCRYL* (polyglactin 910) suture ( polyglacin 910) suture (polyglecaprone 25) suture (polydioxanone) suture Stainless steel Silk PROLENE* ETHIBOND* MERSILENE* NOROLON* Ethilon* (nylon) suture (nylon) suture (polyester) suture (polyester) suture (polypropylene) suture

24. Example Suture Selection Absorbable ( Natural) Fast Absorbing Gut Plain Gut Chromic Gut Tensile strangth 7 days Mass absorption 21- 42 days Tensile strength 7-10 days Mass absorption 60-90 days Tensile strength 28 days Mass absorption 90 days

25. Example suture selection Absorbable ( Synthetic) VICRYL Rapide PDS II MONOCRYL VICRYL Mass absorption 42 days Mass absorption 56-70 days Mass absorption 6 months

26. Example suture Selection Nonabsorbable Natural Stainless steel Silk

27. Example Suture Selection Nonabsorbable Synthetic NUROLON ETHIBOND PROLENE MERSILENE ETHILON

28. Gynecological and obstetrics Instruments

29. Artery Forceps used as a hemostat for clamping bleeding vessels. For grasping tissue ( Opening and closing peritoneum) . to hold stay sutures. Allis' Forceps for grasping tough structures like Rectus sheath or fascia in LSCS or Hysterectomy Babcock's Forceps  for grasping tubular structures  like fallopian tube in tubectomy In Pomeroy's operation , ureter , appendix etc.

30. Self retaining speculum. Used in OPD for routine examination. procedures like taking of  Pap smear , insertion and removal of Copper T can be done for inspection of vagina and cervix in OPD. It retracts posterior vaginal wall.   Taking Pap Smear , Insertion and removal of Copper T, Taking swabs,D&C , Cervix Biopsy , Vaginal Hysterectomy , Sims' Speculum CUSCO’S SPECULUM

31. Doyen's Retractor Deaver's Retractor for retraction of deep structures Right Angle Retractor bladder retractor during LSCS/hysterectomy

32. Mayo scissors Straight mayo scissors Curved mayo scissors Towel clip PINNARD’S FETOSCOPE For auscultation of fetal heart sounds

33. Sims' Anterior Vaginal Wall Retractor To take biopsy from the cervix Sponge holding forceps Punch biopsy forceps To hold sponges or cervical lips Episiotomy Scissors

34. Toothed To hold tough structures like rectus sheath, vaginal flaps or skin margins during suturing Non toothed DISSECTING FORCEPS (TOOTHED AND NON- TOOTHED LOOP HOOK To remove IUCD from the uterine cavity when the threads are missing ELECTRO CAUTERY Thermal cauterisation of the cervix for cervical ectopy

35. Foleys Catheter self retaining catheter used for  drainage of the urinary bladder  , It has a bulb below the tip. This can be inflated by normal saline. It has two channels. One for inflating bulb and the other for drainage of urine to which urobag is attached. No 14 or 16 are used in adult Female metal catheter To empty the bladder prior to major vaginal operations

36. Hegar's Dilator It is used for measuring length of the cervix Uterine sound For dilatation of cervix For grasping the cervix in hysterosalpingography or IUCD insertion TENACULUM

37. Suction Curette This instrument is used for first trimester MTP, suction of vesicular mole. Shirodkars Cerclage Needle This is specially designed needle for putting stitch around the cervix.  used in hysterectomy / salpingectomy to clamp fallopian tube for clamping umbilical cord of new born or for artificial low rupture of membranes ( ARM). Khocker’s forceps

38. Surgical Blades/ Scalpel Green Armytage Forceps Needle holder used as a hemostat in LSCS

39. Uterine Curette Flushing curette Sharman’s curette Simple curette Used for diagnostic D&C

40. Uterine dressing forceps To swab the uterine cavity following D+E operation with a small gauze piece UTERINE HOLDING FORCEPS To fix and steady uterus when conservative surgery is done on the adnexae To fix the myoma To give traction in a big uterus requiring hysterectomy MYOMA SCREW

41. MULTIPLE TOOTHED VULSELLUM used for  grasping the cervix  ( Usually anterior lip of the cervix is grasped) in procedures like  Insertion of IUCD , Cx Biopsy D&C, First trimester MTP with Suction Evacuation. Cx Biopsy Posterior lip of the cervix is grasped for post. colpotomy SINGLE TOOTHED VULSELLUM To hold the cervix after opening the vault of vagina To hold new cervical stump after amputation of the cervix and fothrergill’s operation after subtotal hysterectomy

42. WRIGLEY'S FORCEPS Obstetric forceps for out let forceps delivery . Parts of the forceps are blades ( which has windows or fenestrate for firm grip of the head) ,Shank , Lock( English lock for Wriglys forceps) , Handle. Alternative to forceps delivery . Causes less trauma to mother and fetus VACCUM (VENTOUSE) Silastic cup Metallic cup

43. Ayre's Spatula Used for taking PAP smear RING PESSARY Used for correction of UV prolapse UMBILICAL CORD CLAMP UMBILICAL CORD CUTTING SCISSORS

44. THE END & THANK YOU