Everything should be new (if available)

to avoid cross contamination.

• To make sure na sa right client ka ga

do sa procedure
• In case na ma puncture ang gloves, it
decreases the client's risk of infection

NCM 112 - RLE Page 2

Page 2
Monday, July 13, 2020 11:56 AM

1. Full name
2. Birthday

Avoid cross contamination

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NCM 112 - RLE Page 5
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NCM 112 - RLE Page 15
PRICIPLE OF STERILE TECHNIQUE
Monday, July 13, 2020 2:56 PM

The center of the sterile field is the patient, which also includes the areas of the patient, the operating
table, and furniture covered with sterile drapes and the personnel wearing the OR attire. More
importantly, strict adherence to principles of sterile technique must be observed for the safety of the
patient. This adherence reflect one's surgical conscience. The principles of sterile technique are applied
in the;
1. Preparation for operation by proper sterilization of needed materials and supplies.
2. Preparation of the operating team to handle sterile supplies and intimately contact wound.
3. Creation and maintenance of the sterile field, including the preparation and draping of the
patient to prevent contamination of the surgical wound;
4. Maintenance of sterility and asepsis throughout the operative procedure
5. Terminal sterilization and disinfections at the conclusion of the operation.
Principles
Sterile persons have scrubbed and are gowned and gloved; unsterile persons have not.

1. Only sterile items are used within the sterile field.

○ Proper packaging, sterilizing, and handling should be observed
○ If you are in doubt about the sterility of anything, consider it not sterile
○ If sterilized package is found in a nonsterile area, considered it unsterile
○ If unsterile person comes into close contact with a sterile table
○ If sterile table is not in constant observation
○ If sterile package falls to the floor, it must be discarded

2. Tables are sterile only at table level.

○ Edges and sides of drape extending below table level are considered unsterile.

3. Persons who are sterile touch only sterile items or areas; persons who are not sterile touch only
unsterile items or areas;
For example:
○ sterile team members maintain contact with sterile field by means of gowns and gloves
○ nonsterile circulating nurse does not directly come in contact with the sterile field.
○ Additional supplies needed for sterile team members must be open by circulating nurse and
pass to scrub nurse maintaining safe distance from the sterile field.
4. Unsterile persons avoid reaching over a sterile field; persons avoid leaning over an unsterile
area.
○ Unsterile circulating nurse never reach over a sterile field to transfer sterile items
○ In pouring solution into sterile basin, circulating nurse holds only lip of bottle over basin to
avoid reaching over a sterile area
○ Circulating nurse stands at a distance from the sterile field to adjust light over it to avoid
microbial fallout over field
○ Surgeon turns away sterile field perspiration removed from brow
○ Scrub nurse drapes a nonsterile table towards self first to protect gown
○ Scrub nurse stands back from nonsterile table when draping it to avoid leaning over an
unsterile area

5. Edges of anything that encloses sterile contents considered unsterile.

NCM 112 - RLE Page 16

5. Edges of anything that encloses sterile contents considered unsterile.
The following precautions should be taken;
a. In opening sterile packages, a margin of safety is always maintained. Ends of flats are
secured in hand so they do not dangle loosely. The last flat is pulled toward the person
opening package thereby exposing package, contents away from nonsterile hand
b. Sterile person lift contents from packages by reaching down a lifting item straight up,
holding elbows high.
c. Steam reaches only the area within gaskets of a sterilizer. Instrument trays should not
touch the edge of the sterilizer outside the gasket.
d. Flaps on peel - open packages should be pulled back, not torn, to expose sterile
contents. Contents should be flipped or lifted upward and not permitted to slide over
edges. Inner edge of the heat seal is considered the line of demarcation between
sterile and sterile portion.
e. If a sterile wrapper is used as a table cover, it should simply cover the entire surface.
Only the interior surface level of the covered are considered sterile.
f. After a sterile bottled is opened, contents must be used or discarded. Cap cannot be
replaced without contaminating pouring edges.

6. Sterile field is created as close as possible to time of use.

Degree of contamination is proportionate to length of time sterile items are uncovered and
expose to the environment, precaution must be taken as follows:
1. Sterile table are set up just prior to the operation
2. It is difficult to uncover a table of sterile contents without contamination. Covering
sterile tables for later use is not recommended.

7. Sterile areas are continuously kept in view.

Unintentional contamination of sterile areas must be readily visible. To ensure this principle:
a. Sterile persons face sterile areas
b. When sterile packs are opened in a room, or a sterile is set up, someone must remain
in the room to maintain vigilance.

8. Sterile persons keep well within the sterile area.

Allow a wide margin of safety when passing unsterile areas and follow these rules:
1. Sterile persons stand back at a safe distance from the operating table in draping the
patient
2. Sterile persons pass each other back-to-back
3. Sterile persons turn back to sterile person or area when passing
4. Sterile persons face sterile area to pass it
5. Sterile person asks nonsterile individual to step aside rather than risks contamination
6. Sterile persons stay within and around a sterile field. They do not walk around or go
outside room
7. Movement within and around a sterile area is kept to a minimum to avoid
contamination of sterile items or persons.
8. Sterile persons keep contact with sterile areas to a minimum.
The following rules are observed:
□ Sterile persons do not lean on sterile tables and on draped patient
□ Sitting or leaning against a nonsterile surface is a break in technique. If the sterile
team sets to operate, they do so without proximity to nonsterile areas

9. Unsterile persons avoid sterile areas

a wide margin of safety must be maintained when passing sterile areas by following these
NCM 112 - RLE Page 17
 a wide margin of safety must be maintained when passing sterile areas by following these
rules:
1. Unsterile persons maintain at least one-foot distance from any area of sterile field
2. Unsterile persons face and observed a sterile area when passing it to be sure that they
do not touch it
3. Unsterile persons never walk between 2 sterile areas
4. Circulating nurse restrict to a minimum all activity near sterile field

10. Destruction of integrity of microbial barriers results in contamination

 Integrity of a sterile package of sterile drape is destroyed by perforation, puncture or
strike through
 The integrity of a sterile package, its expiration, date and appearance of process
monitor must be checked for sterility just prior to opening.
To ensure sterility:
□ Sterile packages are laid on dry surfaces
□ If sterile package becomes wet, it is re-sterilized or discarded
□ If solutions soak through sterile drape to nonsterile area the wet area is covered
with impervious sterile drapes
□ Sterile items are stored in clean dry areas
□ Undue pressure on sterile packs is avoided to prevent forcing sterile tie out and
pulling unsterile air into the pack

11. Microorganisms must be kept to an irreducible minimum

All microorganisms cannot be eliminated but this does not hinder or prevent necessity for
strict sterile technique
- To prevent entrance of microorganisms into wound:
□ Transient and resident flora are removed from skin and operative site by
mechanical hand washing and chemical asepsis
□ Gowning and gloving of operating team is accomplished without contamination
of sterile exterior of gowns and gloves
□ Sterile gloved hands do not directly touch skin
□ If globe is pricked or punctured by needle, gloves are changed immediately.

From <http://elearn.xu.edu.ph/mod/page/view.php?id=30511>

NCM 112 - RLE Page 18

OR ATTIRE
Monday, July 13, 2020 3:06 PM

Description
- Consists of the scrub dress, head cover, mask and shoes/shoe cover
- Sterile gowns and gloves are added for the members of the Scrub Team
- Aprons and eye shields are worn under special considerations

PURPOSES:
- To provide effective barriers that prevent dissemination of microorganisms to the patient
- To protect personnel from infected patients

COMPONENTS OF OR ATTIRE
1. Clean OR Attire
○ Scrub suit
 Sanitary clothing worn by OR staff
 Short-sleeved, collarless and loose-fitting, drawstring pants
 Should be done on designated room in the OR, not anywhere
 Simple design that minimizes places where contaminants can hide
 Used SS should not be worn again
○ Head cover/Cap
 Cover hair completely
 Prevent shedding of hair in the scrub suit
 If someone has scalp infected, one is not allowed to report and must be treated first.
 If contaminated with blood, replace immediately
○ Pair of OR shoes or Shoe cover
 Protects our feet from contact of blood and body fluids
 Sandals and open-toed should not be worn in OR
 Rubbers boots and leather closed shoes are recommended
 Comfortable, supportive, and breathable
 Shoe covers protects the footwear from exposure to blood and body fluid
 Fluid-resistant disposable shoe covers = if anticipated that contact with blood and
body fluid splashes and spills may occur
 To remove: use nonsterile gloves to protect hands to prevent cross contamination
○ Mask
 Must be room at all times in the OR
 Only effective if properly worn
 Worn to minimize airborne infection
 Should cover both the nose and the mouth and is stretched gently over the chin and fit
snugly over the face
 Should be changed if it becomes wet or damaged.
○ Face or Eye Shield (optional)
○ Apron (optional)

2. Sterile OR Attire
○ Sterile Gown
 Full sleeve, full length, collarless, buttonless gown, round neck, front closed and back
opened, and closed with strings at the back
 Worn over the scrub suit to permit the wearer to enter the sterile field
NCM 112 - RLE Page 19
  Worn over the scrub suit to permit the wearer to enter the sterile field
 Prevents the penetration of blood and body substances from the patient to the scrub
suit and skin of the wearer
○ Sterile Gloves
 Complete the attire of the scrub team
 Combat infection
 Prevent contamination
 Permit wearer to handle sterile supplies and tissues of the surgical sites
 MAINTAIN STERILITY
3. Other OR Attire (does not need to be sterile)
○ Apron
1. Liquid Apron
 Worn over the scrub suit before wearing sterile gown
 Protects the member from extensive blood splashes
 Protects you from liquids and cleaning agents when cleaning
2. Lead apron
 When operation involves radioactive implants
 Worn to protect against radiation
○ Face Shield and Eye Wear
1. Eye wear
 Protects the eyes
 When a risk exist of blood or body substances from the patient splashing into the eyes
of sterile team members
□ Ex. When assisting orthopedic procedure = surgical manipulation of bone, bone
chips and splatter
 Protect eyes from splashing waters when cleaning

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SURGICAL SCRUB PROCEDURE
Monday, July 13, 2020 3:32 PM

PURPOSES:
- Surgical hand washing, or scrub, is used to remove soil and microorganisms from the skin
- To decrease client's risk from infection (when sterile gloves tear/break, skin of the nurse's hand should
be free from lesions)
- Gowns and gloves should be put in a way that ensures that nothing nonsterile touches their outer
surface.

EQUIPMENTS:
1. Deep sink (with foot/knee controls)
2. Antimicrobial agents approved by agency
3. Surgical scrub brush with plastic nail file
4. Paper face mask, cup, or hood and surgical shoe covers
5. Sterile towel
6. Protective eyewear

PROCEDURE:
STEPS RATIONALE
1. Prepare yourself:
a. Put on a surgical attire ("scrub" Prevents bringing outside organisms into
garments) the area
Mask provides a respiratory barrier
b. Put on a cap or hood, shoe covers, and
mask. All facial and head hair must be
completely covered. The mask should
cover both nose and mouth. They can contaminate surgical wounds
c. Examine hands and forearms for cuts or
blemishes. Do not scrub if there are any
open lesions or breaks in skin integrity. They harbor microorganisms beneath them
d. Remove watches, rings, and bracelets. Decreases resident and transient
e. Remove nail polish or artificial nails if microorganisms
worn, and clip nails so they are no
longer in length than the fingertips.
Fingernails should not reach beyond
the fingertips to avoid glove puncture. Preparing the sterile items before the scrub
f. Before beginning the surgical scrub: decreases the risk of contaminating the
- Open the sterile package scrubbed hands.
containing the gown; using
aseptic technique, make a sterile
field with the inside of the gown's
wrapper
- Open the sterile towel and drop it
onto the center field
- Open the outer wrapper from the
sterile gloves and drop the inner
package of gloves onto the sterile
field beside the folded gown and
towel
2. Perform the prescrub (medical handwashing) A short prescrub wash/rinse removes gross
debris and superficial microorganisms and
is an essential step before surgical
a. Turn on water and adjust temperature antisepsis.
so that it is comfortably warm a. Warm water emulsifies fat more
effectively than cold water does, and
b. Using one of the surgical hand agents, hot water is harsh to the skin
moisten hands and arms, keeping your b. So that water will drain off your
hands higher than your elbows. elbows, flowing from cleanest to less

NCM 112 - RLE Page 21

 hands higher than your elbows. elbows, flowing from cleanest to less
c. Lather hands and arms for 1 minute clean area.
d. Remove a reusable brush from
dispenser and clean nails, rinsing after c. Removes dirt and organic materials From VIDEO:
each nail. that harbor a large number of a. Fingertips together use a
microorganisms light firm pressure to stroke
e. Rinse hands and forearms thoroughly, d. Water runs from fingertips to elbow by the nails in a back and forth
passing them through water in one gravity; hands are maintained as the motion
direction only from fingertips to elbow. cleanest part of the upper extremity b. Brush approximately 30
Do not move your arms back and forth times
through the water, keeping hands c. Scrub the outside surface of
higher than elbows. the thumb, from base to the
tip of the thumb with 5
strokes
3. Scrub: Counted brush-stroke method Ensures removal of resident
d. Continue 5 strokes to the
microorganisms on all surfaces of hands
other side of thumb and
1. Select sterile brush or sponge, adding and arms
each side of fingers, do the
liquid cleanser if necessary.
same to the other digits
2. Scrub nails of left hand 30 strokes and
e. Place fingers side by side
all skin surfaces 20 strokes, using
including thumb, scrub the
anatomic patterns outlines
palmar 10 strokes (circular)
a. 4 surfaces of each finger, thumb
f. Then scrub the dorsal side
to pinky finger
10 strokes
b. Over dorsal surface of hands,
g. Then scrub your arms,
pinky to thumb
mentally divide arms (up to
c. Over palmar surface of hand,
2 in above elbow) in 3 parts
pinky to thumb
h. Start from top then sides,
3. Repeat step 2 for the right hand and
then around, then bottom.
arm.
When scrubbing DO NOT
4. Rinse GO BACK UP
a. Rinse hands and arms, keeping hands Allow flow of water to cleanse from the
above elbows. Always keep elbow in a area of least contamination to areas of To avoid contamination keep
90 degree angle. most contamination. Water conducts away from scrub attire and
b. Keep your hands in front of you, above microorganisms and keeping the uniform nonsterile surfaces. Do not
the waist and not higher than the axilla, dry aids maintaining sterility of the gown. shake or wave arms to
and move to location of sterile towel. remove excess water. Walk
5. Dry hands and arms. When drying stand Prevents contamination by drying from backwards to the operating
away from objects and people. To eliminate cleanest to the least clean area room door.
unnecessary movements of the towel, move
the hand that is being dries rather than the
towel.
a. When picking up the towel, do it with a
swift, efficient motion.
b. Take the towel in the middle, being
careful not to contaminate the sterile
gown under it.
c. Bend at the waist to help prevent the
sterile towel from toughing unsterile
gown while drying your hands and
arms.
d. Dry hand to mid-lower arm; then
transfer dry end of towel to other hand
e. Do not dry hand then arm and return to
same hand
f. After the second hand and mid lower
have been dried. Fold towel in thirds
and dry elbows
g. Be sure hand is well covered. When
transfer of towel is made from hand to
hand, do not allow hand to touch
where elbow has touched

NCM 112 - RLE Page 22

 where elbow has touched
h. Discard towel in linen hamper

NCM 112 - RLE Page 23

SURGICAL GOWNING AND GLOVING
Monday, July 13, 2020 6:37 PM

FOR DRYING HANDS

A. Pick up sterile towel to dry hands from
gown pack
B. Unfold towel
C. Place a third over right hand; two thirds will
be hanging toward left hand
D. Dry left hand
E. Dry left arm
F. Transfer dry end of towel to left hand, a
third over left hand, two thirds toward right
hand
G. Dry right hand
H. Dry right arm
I. Fold towel into thirds
J. Dry right elbow area
PROCEDURE FOR GOWNING AND CLOSED
GLOVING
- After you have scrubbed and dried your hands,
you are ready to put on a sterile gown.
Remember to keep your hands above your wrist
and higher than your elbows at all times to
make sure they do not touch anything nonsterile
- Gowning is a two-person procedure. You will
need an assistant to put on a sterile gown
safely, and your assistant will need sterile
forceps.
- The closed gloving techniques in widespread
use because it provides a way to put on gloves
without the possibility that they will be touched
on the outside by the bare hands. You will put
on the right glove first, and then the left glove - The inside surface of the gown will
1. Facing the sterile field, hold gown by the contact the skin's surface and is thus
inside top neckline, lift folded gown considered contaminated
directly upward, and step back, away from - Provides gown from touching
the table. Allow it to unfold contaminated object
2. Position the gown so that you are facing - Careful application prevents
the back opening contamination. Gown covers hands to
3. Work hands and arms carefully into the prepare for closed gloving.
gown and into the sleeves, as far as the
seam between the sleeve and the cuff.
Take our time and proceed slowly. Do not
push your hands out through the ends of
the sleeves.
4. Turn your back to assistant, who will now
grasp the inside of the back, pull it

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 grasp the inside of the back, pull it
securely onto your shoulders, and tie the
neck and back waistline ties.

5. Using closed-glove technique, put on sterile

gloves.
a. Use left hand inside the gown to pick
up folded edge of the right glove
b. Hold right hand out, with the palm up,
still inside the sleeve.
c. Lay the right glove on the right palm
(still inside sleeves) position it with the
glove fingers pointing toward the
elbow and the cuff end pointing
toward the fingertips. The thumb of
the glove should be over the thumb of
your right hand
d. Use right hand (still inside the gown
sleeve) to grasp the bottom fold of the
cuff end of the right glove. You are
touching sterile gown to sterile glove
e. With your left hand (still inside the
gown) grasp the right glove cuff by the
top fold of the cuff end, and pull the
right glove cuff up and cover right cuff
f. Adjust right glove over right gown cuff
as necessary, keeping the left hand
inside the gown.
g. Work right hand down into the glove.
If the fingers are not in place, do not
be concerned. You can correct them
when both gloves are on.
h. Using gloved right hand, pick up left
glove.
i. Hold left hand, palm up, inside gown
j. Place the left glove on the left palm
(still inside the gown) with the glove
fingers pointing toward the elbow and
the cuff end pointing toward your
fingertips. Position the glove thumb
over the left thumb of your hand
k. Use left hand inside gown to grasp
fold of glove cuff
l. Use gloved right hand to grasp top
fold and pull glove cuff over gown cuff
m. Work left hand into glove
n. Turn up and adjust cuffs
o. Reposition fingers as needed.

6. Working in sterile attire:

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6. Working in sterile attire:
a. Keep your hands in front of you and
above waist level, bellow axilla
b. Do not turn your back on sterile field
c. Pass front to front or back to back with
others in sterile attire
d. Change attire when contaminated
e. Change or cover attire if wet
f. Warn others of your movements

7. Gowning another person

- A team member in sterile gown and gloves
may assist another team member in
gowning by taking the following steps
1. Give the towel to the surgeon, being
careful not to touch the hand
2. Unfold gown, holding it at the
neckband
3. Keep the hands on the outside part of
the gown under the protective cuff and
shoulder area. Offer the inside of the
gown to the surgeon. The surgeon slip
into the sleeves.
4. Release the gown. The surgeon holds
arms outstretched while the circulating
nurse pulls the gown onto the
shoulders and adjusts the sleeves and
cuffs.

8. Gloving another person

a. Pick up the right glove, grasp it firmly,
with fingers under the everted cuff.
Hold the palm of the glove toward the
surgeon (waist level, thumbs out)
b. Stretch the cuff sufficiently for the
surgeon to insert the hand. Avoid
touching the hand by holding your
thumbs out
c. Exert upward pressure as the surgeon
plunges the hand into the gloves.
Unfold the everted glove cuff over the
cuff of the sleeves
d. Repeat for the left hand

9. Changing Gown During Operation

a. Circulating nurse unfastens neck and
waist. By grasping it at shoulders, the
gown is pulled off inside out. The
gown is always removed first before
the gloves. If only the sleeves is
NCM 112 - RLE Page 26
 the gloves. If only the sleeves is
contaminated, a sterile sleeve may be
put on over the contaminated one

10. Removing Gown

- The gown is always removes before the
gloves. It is pulled downward from
shoulders, turning the sleeves inside out as
it is pulled of the arms.
- Sequence of scrub nurse removing soiled
gown:
○ Clean arms and scrub dress are
protected from contaminated outside
part of gown.
a. With gloves on, loosen cuffs of gown
and shake them down over wrists.
Then grasps right shoulder of gown
with left hand
b. In pulling gown of arms, turn arm of
gown away from the body with flexed
elbow
c. Then grasp the other shoulder with the
other hand and remove gown entirely,
pulling it off inside out, thus arms are
kept clean.

11. Changing Glove during operation

- If a glove becomes contaminated for any
reason during operative procedure, it must
be changed immediately. If you cannot step
away at the moment. Hold the
contaminated hand away from the sterile
area. To change the glove:
a. Turn away from the sterile field.
b. Extend contaminated hand to the
circulating nurse who grasp the
outside of the glove about 2 inches
below the top of the glove and pulls
the glove off, inside out.
c. Preferably a sterile team member
gloves another. If this is not possible
step aside and glove the hand using
the open glove technique.
i. Closed glove technique cannot
be used without contamination

12. Removing Gloves

- Glove is removed after the gown. Gloves
are turned inside out, using glove-to-glove
then skin-to-skin technique
NCM 112 - RLE Page 27
then skin-to-skin technique
○ Use glove-to-glove, then skin-to-skin
technique to protect "clean" hands
from the contamination outside the
glove, which bear cells of the patient.
○ Turn gloves inside out when removing
them, keeping hands "clean".

NCM 112 - RLE Page 28

Skin Preparation
Monday, July 20, 2020 11:28 AM

PRINCIPLES OF PATIENT SKIN PREPARATION

I. Purpose of Skin Preparation
○ To render the surgical site as free as possible from transient resident microorganisms, dirt, skin oil
○ So incision can be made through the skin with minimal danger of infection
○ The patient should be advised to avoid the use of emollients, oils, creams and lotions after washing
(decrease the efficacy of antimicrobial soap)
○ The perioperative nurse should access the patient's skin before, during, after the prepping process
○ It is important to document the condition of the patient's tissues, noting lesions and other markings as
appropriate.
II. Preliminary Preparation of the Patient's Skin
○ THE HAIR
 Hair removal can injure the skin
 Break in the skin surfaces -> opportunity for entry of microorganisms -> potential source of
infection
 Hair removal of the site may be so thick that removal is necessary and may be done by shaving
with razor
 Hair may interfere with exposure, closure, or dressing
○ SHAVING
 Should be performed as near as the time of incision as possible
 Avoid making nicks and cuts in the skin
 Nick made immediately before the surgical procedure (up to 30 mins) are considered clean
III. Basic preparation Procedure for Clean Areas
○ After patient is anesthetized and/or positioned on the operating bed, the skin of the surgical site area
surrounding it is mechanically and chemically cleansed with an antiseptic agent
○ Immediately before draping

PROCEDURE
I. Materials
○ Containers of solution for skin prep
 Cherry balls with betadine cleanser
 Cherry balls with alcohol
 Cherry balls with antiseptic solution
○ Picking forceps
○ Small sterile container
○ Sterile gloves
II. Procedure
1. Don sterile gloves
2. Scrub skin, starting from the incision site, with a circular motion or over widening circle to periphery
(outer edge). Use enough pressure and friction to remove dirt and microorganisms from skin and
pores
3. Discard sponge after reaching periphery. Never bring a soiled sponge back toward center area (Do
this 3 times)
4. Repeat scrub with a separate sponge for each round and apply antiseptic
5. Paint area with solution from incision site to periphery
*umbilicus, stoma, draining sinuses, skin ulcers, vagina, anus, colostomy (scrub LAST the most
contaminated area or with a separate scrub)
III. Areas for Skin Prep
1. Abdominal antiseptic Skin Preparation
 Supine position

NCM 112 - RLE Page 29

III. Areas for Skin Prep
1. Abdominal antiseptic Skin Preparation
 Supine position
 Breast line to upper third of thighs
 From table line right to table line left
2. Lateral Thoracoabdominal antiseptic Skin Prep
 Lateral position
 Axilla, chest, abdomen
 From neck to iliac crest
 Extends beyond midline, anteriorly and posteriorly

NCM 112 - RLE Page 30

Side Notes:
 Circulating - prepare the px for skin preparation
 Betadine, alcohol, antiseptic
 Cover should be placed upside down
 Use picking forcep
 Prepare 3 cherry balls each
 Rinse after every solution
 Different sponge for each round
 3 Betadine -> 3 alcohol -> 3 antiseptic

NCM 112 - RLE Page 31

Draping
Monday, July 20, 2020 12:39 PM

DRAPING
- The procedure of covering the patient and surrounding areas with a sterile barrier to create and
maintain and adequate sterile field.
- And effective barrier eliminates or minimizes passage of microorganisms between nonsterile and
sterile areas.
I. Types of Drapes
○ Used to outline the surgical site after prepping the skin
○ The folded edge of each towel is placed towards the line of incision to square it off
○ Packed in groups of four and can be secured with non-perforating towel clips or may be
sutured or stapled to the skin
1. Towel
2. Fenestrated Sheets
 Has an opening that is placed to expose the anatomic area where the incision will be
made
 This sheet is long enough to cover the anesthesia screen at the head and extend down
over the foot of the operating bed
 Laparotomy sheet / lap sheet (most common)
 Others:
□ Thyroid Sheet
□ Chest Sheet
□ Perineal Sheet
□ Laparoscopic sheet
3. Separated Sheets
 For taking specimens for biopsies
 For procedure in hand and feet
 Exposed only small surgical area
 For providing additional drapes on the surgical field
 Example:
□ Split sheet
□ Minor sheet
□ Medium sheet
□ Single sheet
□ Leggings
II. Principles of Draping
1. Place drapes on a dry place
2. Allow sufficient time to permit careful application
3. Allow sufficient space to observe sterile technique. Do not reach across the non sterile area
4. Handle drapes as little as possible
5. Never reach across the operating bed to drape the opposite side; go around it
6. Take towels and towel clips to the side of the operating bed from which the surgeon is going
to apply them before handling to him or her.
7. Carry folded drapes to the operating bed. Watch the front of the sterile gown. Stand well
back from the non sterile operating bed
i. Hold drape high enough to avoid touching nonsterile areas, but avoid touching the
overhead operating light
ii. Once a sheet is placed, do not adjust it, be careful not to slide the sheet out of place
NCM 112 - RLE Page 32
 ii. Once a sheet is placed, do not adjust it, be careful not to slide the sheet out of place
when opening the folds
iii. Protect gloved hand by cuffing the end of sheet over them. Do not let gloved hands
touch the skin and the patient
8. If a drape becomes contaminated, do not handle it further. Discard it without contaminating
gloves or other items.
i. If the end of the sheet falls below waist level, do not handle it further. Drop it. If the
drape is incorrectly placed, discard it.
ii. The circulating nurse peels it from the operating bed without contaminating other
drapes or the prepped area
9. A towel clip has been fastened through a drape has its points contaminated. Removed it only
if absolutely necessary, and then discard it from the sterile set-up
10. If a hole is found in a drape after it has been laid down, the hole must be covered with
another piece of draping material or the entire drape discarded/
11. A hair found on a drape must be removed, and the area must be covered immediately.
Although hair can be sterilized, the source of a hair is usually unknown when it is found on a
sterile drape. It would cause a foreign body tissue reaction in a patient if it got into the
wound.
III. Procedure for Draping
○ Draping procedure establish the sterile field
○ All flat, smooth areas are draped in the same manner as the abdomen.
1. Hand 4 towels and towel clips. The surgeon places these towels within the prepped area
leaving only the surgical area exposed
2. Hand one end of the fan fold medium sheet across the operating
bed to the assistant, supporting the folds, keep the sheet high,
and holding it taut until its opened; then lay it down
 Place this medium sheet below surgical site with
the edge of it at the skin edge, covering the draping
towel
 Provides extra thickness of material under
the area from the mayo stand to the incision,
where instruments and sponges are placed, and
closes some of the opening in the laparotomy
sheet if necessary.
3. Place laparotomy sheet with the opening directly over the
prepped area outlined by the towels, in the direction
indicated for the foot or head of the operating bed
 Drop the folds over the sides of the table.
 If an arm board is in place, hold the folds at the
table level until the sheet is opened all the way
 Open it downward over the patient's feet first then
upward over the anesthesia screen

SIDE NOTES:
 Hide the towel clips under

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Instrumentation
Monday, July 20, 2020 2:57 PM

I. Cutting and Dissecting

- Used to dissect, incise, separate, or excise tissues
- Demand careful handling at all times to prevent injury to the handler and damage to sharp edges.
a. Scalpels
 Used to have reusable handle with a disposable blade
 Blades vary by size and shape
 Handles vary by width and length
1. Scalpel holder #3 and #7 - blade no. 10, 11, 12, and 15
2. Scalpel holder #4 - blade no. 20, 21, 22, 23
 Putting scalpel blade on knife handle
 The blade is attached to the handle by slipping the slit in the blade into the
grooves on the handle.
 To avoid injury: NEVER use your FINGERS alone
 Hold it down and away from eyes, with strong needle holder
 Grasp blade at its WIDEST, strongest part and slip into groove on handle.
 Needle holder must not touch cutting edge (prevent damage to blade)
b. Knives - usually have a blade at one end

c. Scissors - used to dissect tissues

 Blades of scissors may be straight, angled, or curved
 Tips may be pointed or blunt
 Handles may be long or short
i. Mayo Scissors - used for dissecting heavy tissue / used for cutting sutures, dressing and
drains
ii. Metzenbaum - used for cutting and dissecting delicate tissues
iii. Iris Scissors - used for cutting and dissecting fine tissue
iv. Bandage Scissors - opening uterus during CS

II. Grasping and Holding

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II. Grasping and Holding
○ Tissues should be grasped and help in position so the surgeon can perform the desired maneuver
without injuring surrounding tissue
A. Tissue Forceps - used in pairs to pick up or hold soft tissue and vessels
i. Smooth Forceps
 Thumb forceps or Pick ups
 Tapered with serrations (grooves) at the tip
 Will not injure delicate structures

ii. Toothed Forceps

 They are being serrated
 Single tooth on one side that fits between two teeth the other
 Provide firm hold on tough tissues including skin

iii. Allis Forceps

 Has a SCISSORS action
 Each jaw curves slightly inward with a row of teeth at the end
 The teeth hold tissue gently but securely

iv. Babcock Forceps

 End of the jaw is rounded to fit around a structure
 To grasp tissue without injury
 Rounded section is fenestrated

v. Tenaculum

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 v. Tenaculum
 Curved or angle point on the ends of the jaws penetrate tissue to grasp firmly
 Ex. When a uterine tenaculum is used to manipulate uterus.

III. Clamping and Occluding

○ Instruments that clamp and occlude are used to apply pressure
1. Hemostat - use to occlude blood vessels
a. Mosquito Forceps
 For small blood vessels
 Fully serrated jaw
 Straight & curved
b. Kelly Forceps
 Clamping large blood vessels
 Manipulating heavy tissues
 Half serrated
 Straight and curved
 Bigger than mosquito forceps
c. Pean Forceps
 Clamp bigger blood vessels
 Fully serrated
 Straight and curved
 Bigger than kelly forceps
2. Crushing Clamps - used to crash tissue or clamp blood vessels
a. Kocher Forcep
 Aggressively grasp medium to heavy tissue
 Occlude heavy, dense vessels
 The tip has a tooth
 Fully serrated
 Straight and curved
 Bigger than pean forceps

3. Noncrushing vascular clamps

 Used to occlude peripheral or major blood vessels temporarily
 Minimize tissue trauma
a) Mosquito forceps
b) Kelly forceps
c) Pean forceps
d) Intestinal clamp
◊ Use to occlude intestinal lumen to prevent slipping of content
◊ Control bleeding
◊ Occlude portal vein

IV. Exposing and Retracting

○ Soft tissues, muscles and other structures should be pulled aside for exposure of the surgical site
a. Handheld Retractors e. Army-navy Retractor

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 a. Handheld Retractors e. Army-navy Retractor

a. Malleable Retractor f. Richardson retractor

 Narrow and wide

b. Hooks g. Bladder retractor

c. Self-retaining retractor h. Deaver Retractor (narrow & wide)

V. Suturing
a. Suture
 Absorbable - Chronic, vicryl, plain
 Non-absorbable - Nylon, cotton, silk
 The bigger the number size, the smaller it becomes
b. Needle holder
 Use to grasp and hold curved surgical needles
 Resemble hemostatic forceps
 Has short, sturdy jaw for grasping the needle without damaging it or the suture material

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 VI. Suctioning and Aspirating
○ Body fluids, blood, tissue, and irrigating solution may be removed by mechanical suction or
manual aspiration
○ Reusable suction tip
○ Yankauer Tip and Disposable Suction Tip

HANDLING INSTRUMENTS DURING SURGICAL PROCEDURE

1. Know the name and use of each instrument
2. Handle instruments individually
3. Hand the surgeon or assistant the correct instrument for each particular task
○ Remember principle : USE FOR INTENTED PURPOSE ONLY
a. Avoid placing fingers in the instruments rings as the instrument is passes
b. Many surgeons use hand signals to indicate type of instruments needed. An understanding
of what is taking place at the surgical site is what makes these signals meaningful
c. Select appropriate instruments for locations of surgical sites
 Short instruments = superficial work
 Long instruments = deep in the body cavity
d. Many instruments are used in pairs or in sequence
 When surgeon cuts/clumps tissue -> suture
 After suture, scissors to cut or hemostat to hold the end of strand
4. Pass instruments decisively and firmly.
○ When surgeon extends his/her hand, instruments should be slapped or placed firmly into his
lower palm
○ When passing curved instrument, the curve of the
instrument aligns with the direction of the curve Curve thingy ->
of the surgeon's hand
○ In passing instrument to the surgeon:
a. Surgeon on the opposite side: pass across right hand-to-right hand
and left hand-to-left hand
b. Surgeon on the same side and to right: pass with left hand
c. Surgeon on the same side and to left: pass with right hand
d. Hemostatic forceps are held near the box lock by the scrub person and passed by rotating
the wrist clockwise to place handle directly to surgeon's waiting hand
e. Sharp and delicate instruments may be placed on a flat surface for the surgeon to pick up.
This technique avoids potential contact with items such as cutting blades, sharp points, and
needles in hand-to-hand transfer
5. Watch the sterile field for loose instruments.
○ Remove them promptly after use to the MAYO stand or instrument table
○ The weight of instruments can injure the patient or cause postop discomfort
○ Keep instruments off the field to decrease possibility of it falling to the floor
6. Wipe blood and debris of instruments promptly after each use with a moist sponge
7. Flush the suction tip and tubing with sterile distilled water periodically to keep the lumens patent.
8. Remove debris from electro surgical tips to ensure electrical contact
9. Place used instruments not needed again into tray or basin during or end of surgical procedure
○ Keep instruments accessible for final counts

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