OR Basics
Applying warm blankets upon arrival to OR suite and when drapes are removed, limiting amount of skin exposure during prep, adjusting room temperature, and using warm IV irrigation solutions are examples of this
What are measures to reduce intraoperative hypothermia?
Verifying the correct patient, correct procedure, correct side/site, the site marking is visible, and fire risk assessment are of components of this
What is the surgical timeout?
Place the patient supine with the arms extended onto padded arm boards at less than 90 degrees with palms supinated
What is the most common surgical position and technique used to prevent nerve compression to the arm?
The most important activity that you can do to prevent the spread of infection
What is hand hygiene?
Duties of this member of the surgical team include: helping to establishes a base line surgical count with a scrubbed personnel, performing skin prep, proper positioning electrosurgical grounding pad, and giving verbal report to receiving unit
What are responsibilities of the circulating nurse?
Preparing for the case as close as possible to the time of use, securing surgical equipment to the area of use with non-perforating devices, and not contacting unsterile surfaces when scrubbed in are all tasks related to
What is maintaining and monitoring a sterile field?
Asking the patient to say their name and date of birth while checking the arm band and medical record are components of this
What is patient identification?
*******DAILY DOUBLE*********
Two reason for lowering the patient's legs slowly and simultaneously from lithotomy positionWhat is preventing sudden hypotension as blood diverts from the trunk to the legs and preventing hip dislocation or lumbosacral strain?
The process of removing as many microorganisms as possible from the hands and arms by mechanical washing and chemical antisepsis before participating in a surgical procedure
What is surgical scrubbing?
Increasing ETCO2, tachycardia (sudden & unexplained), tachypnea, and unstable blood pressure
What are early signs of Malignant Hyperthermia?
Starting at intended incision site working out to the periphery and working from the area of low bacterial count to highest bacterial count
What are proper surgical skin prep techniques?
Reviewing medication order with the surgeon, checking patient medication allergies, verifying correct medication, dosage, and expiration date, properly labeling medication containers, and verifying drug prior to handing off to surgeon are all components of this
What are medication safety techniques in the OR?
What is included in the intraoperative documentation of patient positioning?
Wounds involving existing clinical infection or perforated viscera and old traumatic wounds (greater than 4 hrs), with retained devitalized tissue, foreign body or fecal contamination would be considered
What is Class IV/Dirty wound classification?
X-ray taken intraoperatively for any incorrect and/or instrument waived count or any emergency case in which a count did not occur preoperatively
What is an operative search x-ray?
Verifying that anesthesia and the surgeon have seen the patient, verifying that the surgeon has marked the site of surgery, confirming the identity, procedure, and site, and confirming that all patient records are all completed and signed are components of this
What are components of the preoperative interview process?
Verifying the correct patient, procedure, and site in Pre-op, performing a surgical time out immediately before incision/injection and following draping, and debriefing at the end of the procedure
What are the three elements of the OR verification process
Placing an axillary roll for the dependent axilla, flexing the lower leg at the hip, keeping the upper leg straight, placing a pillow between the legs, padding between the knees, ankles, and feet, and maintaining spinal alignment
What are safety considerations for the lateral position?
Procedures that enter the respiratory, alimentary genital, or urinary tract under controlled conditions
What is Class II/Clean-contaminated wound classification?
Follow this sequence:
1. Surgical site & surrounding area
2. Mayo stand
3. Back table
4. Area off the sterile field
What is the progression of closing counts?
This is performed to establish a baseline, when additional items are added to the sterile field, at the time of permanent relief, before closure of a cavity within a cavity, before wound closure begins, and at skin closure or end of procedure
What is a surgical count?
Marking the general spinal region of the procedure during pre-op and marking the exact interspace to be operated on using X-Ray intraoperatively
What is the two-stage marking process for spinal surgery?
Neuropathy of obturator nerves, saphenous nerves, femoral nerves, common peroneal nerves, and ulnar nerves
What are injury risks for patients in lithotomy position?
Peripheral support areas of the surgical suite with traffic limited to authorized personnel & patients including storage areas for clean/sterile supplies, corridors to restricted areas, scrub sinks
What is a semi-restricted area?
ACL Reconstruction, Arthroscopy, Breast reduction/implant, Bunionectomy, hernia repair, and thyroidectomy
What is a Class I/Clean wound classification?