OPERATION THEATER TECHNIQUES

An operating theatre (also known as an operating room (OR), operating suite, or operation suite) is a
facility within a hospital where surgical operations are carried out in an aseptic environment. So,
certain technique need to be follow to maintain strict aseptic environment which is known as
operation theatre technique.

SURGICAL SCRUB

Surgical scrub is absolutely essential to achieve surgical asepsis for nurses working in operating
room and while assisting any invasive procedures such as tracheostomy and central venous line
insertion. Method and timing of performing scrub varies based on hospital policy.

DEFINITION

Surgical handwashing or scrub is a procedure by which dirt and microorganisms are destroyed and
removed from hands and fingers by chemical action and mechanical friction.

PURPOSES

1. To remove dirt and transient microorganisms from hands.

2. To prevent surgical site infections.
3. To reduce the risk of transmission of microorganisms to patients.
4. To reduce the risk of cross-infection among patients.
5. To reduce the risk of transmission of infectious agents to oneself.
6. To prevent iatrogenic infections.

INDICATIONS

 Prior to handling sterile equipment.

 Before and after assisting surgical procedure (minor or major surgery) or any invasive
procedures.

ARTICLES

ARTICLES PURPOSE
1. Deep sink with foot or knee controls To dispense with water and soap.
with running warm water.
2. Anti-microbial agent approved by To disinfect the arms.
 agency (dispenser with foot
controls).
3. Surgical scrub brush in anti-septic To remove dirt by friction.
solution.
4 .Plastic nail file. To smoothen the nails.

5. Disposable face mask, cap, surgical Perioperative dress to be worn before

shoe cover, protective eye wear/face performing hand wash.

shield (optional).

6. Sterile towel. To dry hands after handwash.

PROCEDURE
NURSING ACTION RATIONALE

1.Ensure that the nails are short. Remove artificial nails if  Short nails are less likely to harbour
any. organisms, scratch the patient or
puncture gloves.

2. Remove nail polish  Nail polish harbours

microorganisms.
3.Inspect hands for abrasions, cuts, or open lesions.
 These conditions increase likelihood
of more micro-organisms residing on
4.Remove jewellery of any type. skin surfaces.
 Microorganisms accumulate in
5. After medical hand wash, wear cap and mask. jewellery.
 Protective eye wear prevents
exposure to blood or body fluids
6. Turn on water using knee/foot/elbow. splashing from the sterile field.
 Avoids splashing water on surgical
dress. Removes dirt and organic
material that harbour micro-organisms.
7. Wet hands and arms under running lukewarm water and
 Water flows from fingertips to elbows.
lather with soap/detergent to 5 cm above the elbows (Hands Fingertips are considered to be cleaner
need to be raised/held above elbows at all times). Use firm than the elbows.
circular movements to wash palms, back of hands, wrists
forearms and interdigital spaces for 20-25 seconds.
8. Rinse hands and arms thoroughly under running water.  Rinsing removes transient bacteria
(remember to keep hands above elbows). from hands.
9.Clean under nails of both hands with nail pick/nail brush.  Removes dirt and microorganisms.
10 .Scrub nails of each hand with 15 strokes using  Scrubbing loosens resident bacteria
antimicrobial agent. that adhere to skin surfaces.
11.Holding the brush perpendicular scrub palm each side of  Scrubbing is performed from cleaner
thumb and fingers and posterior side of hand with 10 area to less clean area (upper arms).
strokes each.
12.Scrub from wrist to 5 cm above each elbow that is lower  Scrubbing time can be lengthened
arm upper forearm and antecubital fossa to marginal area according to agency policy/according
above elbows. Entire scrub should last for 5 to 10 minutes. to the degree of contamination of
hands.
13. Use nail file if needed.  Smoothens nail edges.
14 Discard brush and rinse hands from fingertips to elbows.
 Tap and sides of sink are considered to
Take care not to touch the dress, tap or sides of the sink
be contaminated.
during the procedure.

 Prevents recontamination of scrubbed

15. Turn off water using foot and knee controls.
hands.

16 Use a sterile towel to dry one hand moving from fingers

 Drying prevents chapping and
to elbow. Dry from cleanest to least clean area. Repeat
facilitates donning of gloves.
drying of the other hand using a different towel.
Use one side to dry one hand and reverse side for other hand
if only one towel is available
18.Discard towel into linen hamper or into circulation
 Avoids contact with unsterile surface.
nurse’s hand before donning sterile gown.
19. Perform alcohol-based hand rub if recommended by the
agency.

 Ensures complete asepsis and

 20.Proceed with sterile gowning. promotes reduction in micro-
organisms on all surfaces of hands and
arms.
NURSING IMPLICATION:
Report any dermatitis to employee health or infection control as per agency policy.

APPLYING MASK AND STERILE GOWN

DEFINITION
This procedure involves wearing of a mask and especially stitched gown in the operation theater to
maintain asepsis and protect from contaminating herself and others around her.

PURPOSES
1.To prevent dispersal of droplet infection from wearer to environment and patient.

2 To prevent contamination of the operating staff’s clothes by blood or body fluids.

3.To enhance easy handling of sterile equipment.

4. To provide a barrier to prevent the transfer of micro-organisms to the patient during the surgical
procedure.

INDICATION
Assisting any surgical procedure (minor or major surgery) or any invasive procedures.

ARTICLES REQUIRED
ARTICLES PURPOSE
1. Sterile pack containing sterile gown To prevent cross-contamination.
and disposable mask.
2. Clean, flat, dry surface on which to To minimize contamination of sterile field.
open gown.
3. Articles of surgical scrub. To perform the procedure.

NURSE RESPONSIBILITY
Check the following:

 Patient's record for any current details of infection.

 Sterile gown and mask of appropriate size and other needed equipment are available.
  Ensure that all perioperative protective wear such as surgical cap, mask, shoe cover, and
eyewear is in place, and hand washing is done before donning the sterile gown.

PROCEDURES
MASKING
NURSING ACTION RATIONALE
1.After performing surgical hand washing take the sterile To prevent contamination.
mask handed to you by the circulating nurse. Hold it by
top two strings keeping top edge above bridge of nose.

2.Tie both top strings at back of head above ears. To secure the mask.
3.Tie the two lower strings snugly around neck well To provide entry of infectious agent
under the chin. under the mask.
4.Gently pinch upper portion around the bridge of nose. Confirms proper fitting.

GOWNING
NURSING ACTION RATIONALE
1. Open sterile gown package on a clean, dry, flat Provides sterile area for gowning.
surface.
2. Pick up gown (folded inside out) from sterile The hands are not completely sterile.
package, grasping the inside surface of gown at The inside surface of the gown will
the collar. contact the skin surface and is thus
considered least clean.

3. Lift folded gown directly upward, and step back, Prevents gown from touching
away from the table. unsterile surface.
4. Hold the gown at the shoulder level from inside Careful application prevents
and put each and directly into the arm-hold contamination.
simultaneously. Do not allow hands to move
through cuff opening.
5. The circulating nurse pull back the gown frontline Touching outer surface of gown may
so that the upper limbs go into the sleeves. The contaminate it.
circulating nurse ties the gown from the back.
 6. If gown is wrapped around style, sterile front flap Secures gown without contaminating
is not touched until the scrub nurse has gloved. it.

REMOVAL OF GOWN AND MASK

GOWN
 The gown wearer person steps back and away from the sterile field.
 The circulatory nurse untie strings at the neck and waist of the soiled gown.
 The gown wearer grasps the front of the gown at the shoulders just below the collar and
Remove gown folding inside out to cover outside of gown rolled away from the body.
 Dispose gown into designated receptacle.

MASK
 Wash hands. Untie lower strings first, then the top strings and pull mask away from face.
 Hold mask by strings and discard into appropriate receptacle.

PERFORMING STERILE GLOVING

Surgical gloves are made of natural rubber latex, synthetic rubber, thermoplastic elastomers,
neoprene, vinyl, or polyethylene. Disposable latex gloves are used more commonly.

DEFINITION
Gloving is defined as donning of pair of sterle gloves to protect one's own hands from
pathogenic microorganisms and to avoid contamination of a sterile area by hand.

Gloving is the technique of donning the sterile gloves to maintain asepsis during the surgical
procedure.

PURPOSES
 To protect the operating personnel from infected body fluids/tissues.
 To handle sterile articles without contaminating.
 To provide a barrier to prevent the transfer of micro-organisms to the patient and the
healthcare professional during surgical or any invasive procedure.

INDICATIONS
o Any invasive/ diagnostic procedure, for example, major and minor surgery, and
endoscopy.
ARTICLES REQUIRED
ARTICLES PURPOSES
1.Soap/antiseptic detergent To wash off dirt and micro-organisms.
2. Running warm water For rinsing.
3. Nail brush in antiseptic lotion. To brush off dirt stucked in nails.
4. Towels (sterile) To dry the wet hands.
5. Mask and cup To wear them after the hands are clean only.
6. A Pair of sterile surgical gloves To prepare for procedures involved in touching sterile
instruments.

PROCEDURE (DONNING OF GLOVES)

NURSING ACTION RATIONALE

 Perform thorough surgical hand wash and  Handwashing deters the spread of
dry hands using sterile towel. microorganism. Gloves are easier to don
when hands are dry.
 The circulating nurse removes the outer  Prevents inner glove package from
glove package by carefully separating and accidentally opening and touching
peeling apart the sides. Scrubbed nurse pulls contaminated objects.
out the inner glove pack taking care not to
touch the outer one.
 Grasp inner package and lay it on clean, flat  Sterile objects held below waist is
surface just above waist level. Open contaminated. Inner surface of glove
package, keeping gloves on wrapper's inside package is sterile.
surface.
 If gloves are not pre-powdered, take packet  Powder is applied for avoiding and
of powder and apply lightly to hands over prevention of sticking of hands and fingers.
sink or waste basket.
 Identify right and left glove. Each glove has  Proper identification of gloves prevents
a cuff of approximately 5 cm wide: Glove contamination by improper fit. Gloving of
dominant hand first. dominant hand first improves dexterity.
 With thumb and first two fingers of non-  Inner edge of cuff will lie against skin and
dominant hand, grasp edge of cuff of glove thus it is not sterile.
of dominant hand. Touch only the inside
 surface of gloves.
 Carefully pull glove over dominant hand  Prevents tearing the glove materials, guiding
making sure the thumb and fingers fit into the fingers into proper places facilitates
the proper spaces of the glove. gloving.
 Slip in the fingers of the gloved dominant  If glove’s outer surface touches hand/wrist,
hand under the cuff of the other glove. Keep then it is contaminated. Cuff protects gloved
thumb of gloved dominant hand abducted fingers maintaining sterility.
back to avoid touching of exposed ungloved
hand.
 Carefully slip the glove onto your  Slipping of the hand helps to avoid touching
nondominant hand making sure that the of the exposed area of the glove.
fingers slip into the proper spaces.
 With gloved hands, interlock fingers to fit  Promotes proper fit over the fingers.
the gloves onto each fingers.

FIGURE: PERFORMING STERILE GLOVING.

REMOVAL OF GLOVES
 Remove the first glove by grasping it on  This keeps the soiled parts of the used gloves
its palmar surface taking care to avoid from touching the skin of the wrist/hand.
touching wrist.
 Pull the first glove completely off by  Outside of gloves does not touch skin surface.
inverting or rolling the gloves inside out.
Discard in receptacle.
 Take fingers of bare hand and tuck  Peeling glove off helps to avoid contamination
inside remaining glove cuff. Peel glove of the hands.
off, inside out. Discard in receptacle.
 Wash hands  To ensure removal of the powder or sweat off
from hands.

FIGURE: REMOVAL OF GLOVES

 CONDUCTING A GENERAL PRE-OPERATIVE ASSESSMENT AND
CHECKLIST
IDENTIFICATION DATA
Name
Age
Sex
IP No
Ward
Bed No
Diagnosis
Surgery proposed
Date of surgery
Type of anesthesia

(a) Day prior to surgery

1. Weight (kg)
2.Height(cm)
3. Known allergy
4.Medications consumed (specify) (Place tick mark (✔) for
items carried out)
5.Consent for surgery is obtained in specified format
6.Teaching about postoperative exercise given
7.Explanation about anesthesia and surgery given
8.Local skin preparation done
9.Nails cut and bath given
10.Enema/bowel wash given
11.Recording done about any cough/alteration in vital
signs/loose teeth/skin infection/menstruation/any others
12.X-rays, scan, ECG, lab reports, etc. collected and attatched
to patient record.
13.Instructions given about fasting
14.Nail polish and make-up removed
 15.Old chart requested and obtained
16.Type and cross-match for blood done
17.Consent for receiving blood transfusion obtained
18.Notified surgeon for any abnormal lab report

Signatures: Date and time

1.Nursing student

2.Staff nurse

3.Ward sister/supervisor

b). Day of surgery

1.Confirm NPO status

2 Enema/bowel wash given (if indicated)
3. Bath given
4 Final skin preparation done
5.Ryle's tube passed (if indicated)
6. Intravenous line in place
7.Clean gown given, hair groomed
8. Jewellery, dentures, glasses, contact lenses hairpins, nail
polish, hearing aids removed
9.Vital signs checked and recorded
10.Bladder emptied (catheterization if indicated)
11.Pre-medication given
12.Identification band and blood band checked for accuracy
13.Siderails put up and bed brought down to lowest level
14.Patient instructed not to get out of bed without nursing
assistance.
15.Lab reports, X-rays, scan reports, ECG reports, blank
prescription form, fresh doctor's order sheet and operation
record attached to patient's chart.
16.Specify materials, such as drugs, articles to be sent with
patient (Ryle's tube, Foley catheter, urosac, medications,
 aseptic syringe)
17.Time when patient left the ward

Signature: Date and time

a). Nursing student

b). Staff nurse

c). Ward sister/supervisor

PERFORMING SKIN PREPARATION FOR SURGERY

DEFINITION
Skin preparation is a preoperative procedure performed to decontaminate and reduce the number of
organisms on skin to eliminate the transference of such organisms into the incision site.

PURPOSES
1. To remove hair from well defined skin area.

2. To prevent wound infection postoperatively.

METHODS OF HAIR REMOVAL

1. Wet shaving.

2 Clipping

3. Use of depilatory cream.

ARTICLES

1. Razor set.

2. New blade.

3. Soap.

4. Bowl with water

5. Rag pieces/Paper tissues

6. Kidney basin

7. Mackintosh/waterproof pad
8. Basin with water

9. Sponge towel

10. Bath towel

11. Duster

12. Depilatory cream-optional

13. Electric clippers if clipping is to be done

14. Clean gloves

15. Scissors

PROCEDURE
NURSING ACTION RATIONALE

1. Inspect general condition of skin.  If lesions, irritation or signs of infection are present
shaving should not be done. These conditions increase
chances of postoperative wound infections.

2.Review physician's order or the  Extent of area for hair removal depends upon site of
agency procedure book for specific incision nature of surgery and physician's preference.
area to be shaved.

3.Assess patient's understanding and  Patient may be anxious regarding removal of hair and
acceptance of the purpose of hair implications regarding change in appearance.
removal.

4. Wash hands.  Reduces risk of transmission of microorganisms.

5. Close room doors or bedside  Provides privacy and promotes good body mechanics.
curtains and raise bed to working
level.
 Shaving and skin preparation can take several minutes.
6 Position patient comfortably with
Nurse should have easy access to hard to reach areas.
surgical site accessible.
 Use of clean gloves safeguards the patient and the nurse
7. Don clean gloves
8. Remove hair minimizing nurse's exposure to blood-borne pathogens.
I. Wet shave
a. Place towel or waterproof pad under  Prevents soiling of bed linen.
body part to be shaved.
b. Drape patient with bath blanket,  Prevents unnecessary exposure of body parts and
leaving only the area to be shaved at reduces patient's anxiety.
one time, exposed.
c. Cut long hair short with scissors.  Lathering with antiseptic soap softens hair and reduces
Lather skin with gauze sponges dipped friction from razor.
in antiseptic soap.
d. Shave small area at a time. With  Shaving small area minimizes chances of cutting skin.
non-dominant hand hold gauze sponge Shaving in the direction of hair growth prevents pulling
to stabilize skin. Hold razor at 45- of hair.
degree angle in dominant hand and
shave in the direction of hair growth.
Use short gentle strokes.
e. Rinse razor in basin of water as soap  Maintains clean sharp razor edge to reduce patient’s
and hair. Maintains clean sharp razor discomfort.
edge to reduce hair accumulate on the
blade. Change and discard blades as
they become dull.
f. Rearrange bath blanket as each  Maintains patient comfort and privacy.
portion of shave is done.
g. Use wash cloth and warm water to  Reduces skin irritation and allows good visualization of
rinse away remaining hair and soap the skin.
solution from skin. Change water as
needed.
 Removes secretions, dirt and other remaining hair
h. If shaved area is over body crevices, clippings which harbor microorganisms.
for example, umbilicus or groin,
cleanse with cotton tipped applicators
or cotton balls dipped in antiseptic
solution.  Reduces maceration of skin from retained moisture.
i. Dry crevices with cotton balls or
applicators.
j. Discard waterproof towel or pad.  Reduces spread of microorganisms.

k. Observe skin closely for any nicks  Any break in skin integrity increases risk of wound

or cuts. infection.

II. Hair clipping

a. Lightly dry area to be clipped with  Removes moisture which interferes with clean cut of
towel. clippers.
b. Hold clippers in dominant hand,  Prevents pulling on hair and abrasion of skin.
about one cm above skin, and cut hair
in direction it grows. Clips small area
at a time.
c. Rearrange drape as necessary  Prevents unnecessary exposure of body parts at a time.
visibility of area being clipped
d. Lightly brush off cut hair with  Removes contaminated hair and promotes comfort.
towel. Improves visibility of area being clipped.

 Removes secretions dirt and hair clippings which

e. When clipped area is over body
harbour microorganisms.
crevices, clean crevices

III. Depilatory hair removal  Hair removal by depilation the primary advantage of

a)Apply depilatory cream to the area leaving skin intact and free from cuts. If the patient is

(before application of cream not sensitive

sensitivity test to be done by applying to the depilatory preparations, it is a safer method of hair
a small removal than shaving.

amount of cream on skin or inner

aspect of forearm or wrist. Check for
any sensitivity reaction like redness
rashes, or itching of skin after 15 to 20  Hair is removed simultaneously with wiping off the

minutes). depilatory cream.

b)Wait for the required number of  Removes microorganisms from the skin.

minutes and wipe off the cream with

rag pieces or paper towel.  To make the patient updated about the procedure done.
c)Wash skin and rinse thoroughly.
 Reduces spread of infection and reduces risk of injury
9.Inform patient that procedure is from razor blades.
completed.

10. Clean and dispose of articles  Reduces risk of spread of micro-organisms.

according to policy, do not re-cover
razor blade. Dispose of gloves.  Documents status of surgical site for comparison over
time.
11. Wash hands.

12. Record procedure, area clipped or  For maintaining comfort to the patient.
shaved and condition.

13. Inspect/check patient to be sure

that sheets are dry, bath blanket is
removed, hospital clothing is being
worn and  Skin problems may pose a serious risk for post-operative
patient is placed in comfortable infections.
position.

14. Report any skin alterations or

nicks or cuts in skin to surgeon.
SITES FOR SURGICAL PREPARATION VARY DEPENDING ON TYPE OF
SURGERY TO BE PERFORMED
Head and Neck
The site extends from above the eyebrows over the top of the head and includes the ears and
both anterior and posterior areas of the neck and face. In females, face is not shaved.

Lateral Neck
Clean the external auditory canal with a cotton swab. Anteriorly, prepare the side of the face
from above the ear to the upper thorax to just below the clavicle. Posteriorly prepare from
neck to the spine including the area above the scapula on of the skin

Chest Surgery

The site extends from the neck to the umbilicus and to the lateral midline clippings.

Abdominal Surgery

The preparation site extends from axilla to the mid thighs extending bilaterally to the lateral
midline. All visible pubic hair should be shaved

Perineal Surgery

Shave all pubic hair and the inner thighs to the mid-thigh. The area starts above the pubic
bone anteriorly and extends beyond the anus posteriorly

Lumbar Spine Surgery

Shave entire back including shoulders and neck to hairline and down to knees including both
axilla.

Rectal Surgery

Shave the buttocks from iliac crest down to the upper third of the thighs including the anal
region. The area extends to the mid-line on each side.

Flank Surgery

Extends anteriorly from the axilla down to the upper thigh including external genital area.
Posteriorly the area extends from mid scapular to the mid gluteal regions.
Hand and Forearm Surgery

The area includes the full circumference of the affected hand from axilla to the fingertips.

Lower Extremity Surgery

The area includes the area from umbilicus anteriorly including the entire leg, toes, and foot of
the affected leg and posteriorly from top of buttocks to the heel.

Lower Leg Surgery

The area to be prepared includes the circumference of the entire leg from mid-thigh to toes of
the affected leg.

FIGURE: SKIN AREAS TO BE PREPARED FOR SURGERY.

PREPARING AN OPERATION THEATER TROLLEY AND PATIENT BEFORE
SURGERY
DEFINITION
Keeping the operating room ready and available for carrying out surgical procedures
PURPOSES
1.To ensure that appropriate equipment and machinery are available in working condition.

2 To clean required equipment and machines.

3. To disinfect room, and work surfaces.

4. To collect necessary supplies of sterile and other items.

ARTICLES
1. Operating room table and accessories like lights cautery, sponge rack, etc.

2 .Instrument trolleys.

3. Articles required for positioning patient.

4. Sterile linen.

5. Instrument sets.

6. Cleaning solutions.

7. Waste disposal containers.

PROCEDURE
NURSING ACTION RATIONALE

1.Acquire information about the surgery to Helps inaccurate easy and quick preparation of
become out. operating room.
2.Assemble necessary equipment and To save time and energy in preparation Provides an
machines Minimize equipment as far as approach to task.
possible.
3.Disinfect room work surfaces walls and Ensures a sterile and maintains sterile field.
floor including equipment and machines.
Carbolize the surfaces and equipment after
wet washing.
4.Collect sterile linen and instrument sets.
5.Account and collect other supplies. To prepare for aseptic technique.
6. Ensure that scrub room is ready with Ensures that preparation is made to save time.
running water and sterile brush. Ensures that arteries are ready for scrubbing.
7. Ensure that air-conditioning lighting and
power supply are adequate. Preparation provides for an organised approach to task.
8. Check table and accessories, lights and
cautery machine for proper functioning To prevent delay of time during operation due to
9.Connect suction apparatus to electric technical problems.
source and check construction equipment. To be ready for facing any consequences requiring the
10.Receive patient from control desk/ use of electric appliances and equipments.
reception to operating room. To enable more easy transfer of the patient.

SPECIAL POINTS
 All personnel working in the operation theater use special dresses and shoes which are
kept for use only for the time of theater work.
 Anyone entering inside the theater after carbolising should wear cap and mask along with
the theatre gown.

STERILE TECHNIQUE OF DRAPING TROLLEY

DEFINITION

Arranging appropriate sterile linen, instruments and supplies on designated trolleys for carrying
out surgical operation using aseptic technique

PURPOSES

 To create a sterile field for carrying out surgical operation

 To ensure successful barrier against bacterial invasion of surgical wound
ARTICLES

1.Instrument trolleys

2. Mayo stand
3.Basin stand.

4.Square trolley.

PROCEDURE

NURSING ACTION RATIONALE

1.Scrub nurse puts on sterile cap, mask, gown and Interrupts chain of infection Protects patient
gloves after scrubbing her hands. and nurse.
2.Check outer labels of all sterile line bundles and Ensures that correct instruments are opened.
instrument.
3.Follow principles of asepsis while sterile packs are Maintain sterile field.
opened.
4.Ensure that whole trolley is dry by using Moisture contamination sterile field.
waterproofing beneath sterile packs.
5.Circulating nurse, opens the sterile drum and hands Prevents cross-contamination and efficient
over the sterile towel with the transfer forceps to the working technique.
scrubbed nurse.
6.Scrubbed nurse spreads the towel very carefully on Maintain sterile field.
the trolley without touching unsterile area
7.Drape distal end of trolley first, then proximal. Moving from distal to proximal prevents
need to reach across the sterile field.
8.The circulating nurse opens the sterile pack using Preparation provides for an organized
transfer forceps and scrub nurse removes the approach to task.
instrument tray and instruments from the sterile pack
and gently places on instrument trolley.
9.Arrange instruments neatly according to the order To prevent chaos while conducting the
of use. operation.
10. Circulating nurse pours sterile saline in sterile Maintain sterile field.
basin which is used in basin stand.
11.Discard unnecessary wrappers and dolls from Maintain sterile field.
sterile field.
12.Discard any contaminated drapes/instruments and A sterile work area promotes proper aseptic
substitute with sterile ones. technique.
 13.After arranging cover the trolley with a sterile Maintains sterile field.
towel till it is over for surgery.

STERILE TECHNIQUE OF DRAPING PATIENT

DEFINITION
Receiving the preoperative patient on the theater table and replacing patients linen with
sterile, theatre linen, exposing operative site for preoperative skin cleaning and placing sterile
mackintosh and towels for barricading operative site from surrounding areas.

PURPOSES

1. To create a sterile field for carrying out surgical operation

2.To ensure successful barrier against bacterial invasion of surgical wound.

3. To prevent contamination of operative site with unprepared skin surfaces

EQUIPMENT

1.Sterile bed linen

2 Big and small mackintosh

3 Surgical towels

4.Towel clips

PROCEDURE

NURSING ACTION RATIONALE

1.Transfer the patient to theater table. To initiate the operation.

2.Replace patients linen with sterile linen. Sterile field is maintained.
3.Expose operative site while adequately covering A neat work area promotes proper techniques.
other areas.
4.Assist surgeon to clean the site with bactericidal Helps to maintain aseptic skin preparation.
solution.
5. Offer sterile, towels and towel clips to surgeon and
assist in draping operative site. Sterile field is maintained.
6.Drape patient according to nature type of surgery
and incision. To avoid unnecessary exposure.
7.Secure towel clips at each corner, via above, below
and sides of operative site. Ensures that the stone towel remain in place.
8.Assist Surgeon to apply “Opsite” evenly without
air pockets etc cleaning and drying operative site. Sterile field is maintained.
Preparation provides for an organized
approach to task
PREPARING AN OPERATION THEATER TROLLEY AND PATIENT BEFORE
SURGERY
DEFINITION

Keeping the operating room ready and available for carrying out surgical procedures

PURPOSES

1.To ensure that appropriate equipment and machinery are available in working condition

2 To clean required equipment and machines

3. To disinfect room, and work surfaces

4. To collect necessary supplies of sterile and other items

ARTICLES

I. Operating room table and accessories like lights cautery, sponge rack, etc.

2 .Instrument trolleys

3. Articles required for positioning patient

4. Sterile linen.

5. Instrument sets

6. Cleaning solutions

7 Waste disposal containers

PROCEDURE
NURSING ACTION RATIONALE

1.Acquire information about the surgery to become Helps inaccurate easy and quick preparation of
out operating room
2.Assemble necessary equipment and machines To save time and energy in preparation Provides
Minimize equipment as far as possible an approach to task
3.Disinfect room work surfaces walls and floor Ensures a sterile and maintains sterile field
including equipment and machines. Carbolize the
surfaces and equipment after wet washing
All equipments used in the operation theatre
 4.Collect sterile linen and instrument sets should be sterile as it is invasive procedure.
Supplies should be available to ensure the
5.Account and collect other supplies smooth running of the operation.
Ensures that arteries are ready for scrubbing
6. Ensure that scrub room is ready with running
water and sterile brush Preparation provides for an organised approach
7.Ensure that air-conditioning lighting and power to task
supply are adequate
8. Check table and accessories, lights and cautery
machine for proper functioning
9 Connect suction apparatus to electric source and
check construction equipment
10.Receive patient from control desk/ reception to
operating room.

SPECIAL POINTS
 All personnel working in the operation theater use special dresses and shoes which are
kept for use only for the time of theater work.
 Anyone entering inside the theater after carbolising should wear cap and mask along with
the theatre gown.

STERILE TECHNIQUE OF DRAPING TROLLEY

DEFINITION

Arranging appropriate sterile linen, instruments and supplies on designated trolleys for carrying
out surgical operation using aseptic technique

PURPOSES

o To create a sterile field for carrying out surgical operation

o To ensure successful barrier against bacterial invasion of surgical wound

ARTICLES

1.Instrument trolleys
 2. Mayo stand

3.Basin stand.

4.Square trolley.

PROCEDURE

NURSING ACTION RATIONALE

1.Scrub nurse puts on sterile cap, mask, gown and Interrupts chain of infection Protects patient and
gloves after scrubbing her hands nurse
2.Check outer labels of all sterile line bundles and Ensures that correct instruments are opened
instrument
3.Follow principles of asepsis while sterile packs are Maintain sterile field
opened
4.Ensure that whole trolley is dry by using Moisture contamination sterile field
waterproofing beneath sterile packs
5.Circulating nurse, opens the sterile drum and hands
over the sterile towel with the transfer forceps to the
subbed nurse
6.Scrubbed nurse spreads the towel very carefully on Maintain sterile field
the trolley without touching unsterile area
7.Drape distal end of trolley first, then proximal Moving from distal to proximal prevents need to
reach across the sterile field
8.The circulating nurse opens the sterile pack using Preparation provides for an organized approach to
transfer forceps and scrub nurse removes the task
instrument tray and instruments from the sterile pack
and gently places on instrument trolley
9.Arrange Instruments neatly according to the order of
use
10. Circulating nurse pours sterile saline in sterile Maintain sterile field
basin which is used in basin stand.
11.Discard unnecessary wrappers and dolls from Maintain sterile field
sterile field
12.Discard any contaminated drapes/instruments and A sterile work area promotes proper aseptic
substitute with sterile ones technique
13.After arranging cover the trolley with a sterile towel Maintains sterile field
till it is over for surgery

STERILE TECHNIQUE OF DRAPING PATIENT

DEFINITION

Receiving the preoperative patient on the theater table and replacing patients linen with sterile,
theatre linen, exposing operative site for preoperative skin cleaning and placing sterile mackintosh
and towels for barricading operative site from surrounding areas

PURPOSES

1. To create a sterile field for carrying out surgical operation

2.To ensure successful barrier against bacterial invasion of surgical wound.

3. To prevent contamination of operative site with unprepared skin surfaces

EQUIPMENT

1.Sterile bed linen

2 Big and small mackintosh

3 Surgical towels

4.Towel clips

PROCEDURE

NURSING ACTION RATIONALE

1.Transfer the patient to theater table

2.Replace patients linen with sterile linen Sterile field is maintained
3.Expose operative site while adequately A neat work area promotes proper techniques
covering other areas
4.Assist surgeon to clean the site with
bactericidal solution
5. Offer sterile, towels and towel clips to Sterile field is maintained
surgeon and assist in draping operative site
6.Drape patient according to nature type of
surgery and incision
7.Secure towel clips at each corner, via Ensures that the stone towel remain in place
above, below and sides of operative site
8.Assist Surgeon to apply Opsite evenly Sterile field is maintained
without air pockets etc cleaning and drying Preparation provides for an organized approach to
operative site. task

POSITIONING PATIENTS FOR SURGERY

DEFINITION

Providing specific positions for patients undergoing surgery, which promote best
visualization, and accessibility to operative site and promote safety and comfort

PURPOSES

 To provide necessary accessibility and exposure for the site to be operated

 To facilitate administration of anesthesia and efficient monitoring
 To ensure safety for the patient and prevent injury
 To promote normal circulatory and respiratory function
 To provide correct skeletal alignment
 To prevent undue pressure on muscles nerves skin over bony prominences and eyes

FACTORS THAT DETERMINE POSITION

 The surgery to be performed

 Type of anesthesia used
 Age, size and physical condition of the patient.
 Surgical approach
 GUIDELINES FOR POSITIONING A PATIENT ON THE OPERATION TABLE
 Explain to the patient in simple understandable terms why the positions and restraints are
necessary and how he will be placed for surgery
 The patient should be in a comfortable and safe position as far as possible, whether asleep or
awake
 Respiration and circulation should not be impeded by any kind of pressure
 Nerves must be protected from undue pressure, as improper positioning can cause serious nerve
injury and paralysis.
 Do not allow the extremities to dangle over the sides of table because this may impair circulation
or cause nerve and muscle damage
 Avoid excessive stress on muscles, bones and soft body organs such as female breast, penis and
eye,
 Be certain that patient's body does not rest on hands or fingers, as circulation may be occluded
 Secure the patient to the table with well-padded safety straps, usually placed 2 inches above knees
 Nerves, muscles and body prominences must be adequately padded to prevent nerve and tissue
damage.
 The physical condition (e.g.arthritis) of the patient may place limitations on the desired position
and should be taken into account
 Obtain sufficient physical or mechanical help to avoid unnecessary straining of self or patient.
 Anesthetized patient is never moved without the anesthetists permission
 Position changes (eg lowering leg from lithotomy should be made slowly to allow the circulatory
system to adjust thereby preventing a drop in blood pressure
 When using an arm board, do not abduct the upper extremity more than 90 degrees as this could
crush the brachial plexus between the first rib and scapula.
 Avoid contact between patient's skin and any metallic parts of operating room equipment
 Make sure that any apparatus which is to support patient's body is fully secure before body is
brought to rest upon it
 Always ways ensure that head and cervical spine are adequately supported.
 position patient in correct alignment and protect patient from pressure and other injuries
 consider normal joint movements while positioning the patient.
 When positioning lift the patient rather than slide, to prevent sheering forces on the skin
 Position the patient correctly before operation starts because it is much more difficult to do so
afterwards.
 The operative site must be adequately exposed. Preserve patient's dignity and avoid undue
exposure

ARTICLES

 Headrest
 Arm board
 Sand bags
 Pillows
 Towel roll
 Mackintosh
 Straps
 Stirrups
 Drapes

INDICATIONS
Commonly used positions

Supine position

 Position the patient flat on back

 Position one arm at the side of table with hand placed palm down
 Position the other arm carefully on an arm board to facilitate infusion of fluids, blood or
medications
 Position head and legs straight
 Check that legs are uncrossed
 Apply well padded safety straps 2 inches above knees
 For surgery on face or neck stabilize head on headrest
 For shoulder operation place a small sand bag or rolled sheet under shoulder
 For operations on upper extremity, radical mastectomy or axillary dissection, arm of
affected side is placed on an arm board at right angle to body
 For saphenous ligations and groin operations, knees are slightly Moved over a pillow with
thighs externally rotated
Indication:
 Abdominal operations
 Thoracic operation
 Abdominothoracic operations
 Operations on hip
 Operations on upper and lower extremities

Prone position
Indication:
Thoracic/lumbar,Laminectomy

 Carefully roll over the patient to prone position after placement of intravenous line and
the administration of general anesthesia
 Support fore head on a horse-shoe device
 Support arms on an arm board angled towards the head end of table

Lithotomy position
Indication:
Cystoscopy, operations on vagina, perineum

 Lower the foot section of table and attach stirrups to table on either side to place patients
legs
 Place a mackintosh over the lower end of table before patient rectum transferred on to it
 Position the patient flat on back
 Gently bring the patient towards foot end of table so that buttocks extend slightly past the
lower edge of table
 Move both lower extremities simultaneously and put them up in stirrups so that hips are
not dislocated or muscles strained
 Position one arm on an arm board and secure the other arm cross patient's abdomen
 Protect pressure points
 Secure patient safely using safety straps.

Trendelenburg position
Indication:

a. Operations on lower
b. abdomen and pelvis
 Place the patient flat on back
 Lower the foot end of the table so that patients knees are flexed slightly
 Tilt the table in such a way that the head end of tablets slightly lower than the foot end
and operating table at an angle of 45 degree to the floor.
 Pad the pressure points
 Secure the patient in position.

Lateral position
Indication:

Renal surgery

 Position the patient on the nonoperative side with an air pillow 12.5 to 15 cm under the
loin or on a table with a kidney
 Position the legs in such a way that the underneath leg is fully flexed at the knees with
foot placed under upper leg
 Support the upper most arm on padded hand rest and the underneath arm is pulled little
away from the body
 Pad the pressure point
 Secure the patient safely

Rose position/Neck position

 Place the patient flat on the back

 Place a rolled sheet or small sand bag between the scapulae to extend the neck
 Lower shoulders for better exposure of the operative site
 Stabilize head on a head ring
 Arms may be extended on an arm board

Indication:

 Thyroidectomy
 Tracheostomy
 Parathyroidectomy
 BIBLIOGRAPHY
1.Annamma Jacob.Rekha R.Jadhav Sonali Tarachand. Clinical Nursing Procedures: The Art
of Nursing Practice. 3rd edition. Jaypee Brothers Medical Publisher(P) Ltd,

2. Brunner and Sudderth, Medical and Surgical Nursing, 11th edition, Wolters Publication,
2005.

3. Sr. Alicen Mathias “Father Muller Manual of Nursing Procedure, Emmess Medical
Publisher.

4.Omayal Achi College of Nursing, Manual of Nursing Procedures and Practice, 2 nd edition,
Wolters Kluwer, 2018.

5.Scrubbing, Gowning, and Gloving - TeachMeSurgery

6.1-02. PREPARATION OF THE OPERATIVE SITE | Surgical Methods

(brooksidepress.org)

7.9781284157994_ch05_141_174.pdf (jbpub.com)

8.Surgical draping (slideshare.net)