1. Foundations of Nursing
Surgical Techniques
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Get the sterile brush with the right hand in such a
way that it faces up.
Saturate the brush with soap and water and start
scrubbing from the fingertip, to the four corners
of each finger, to the dorsum, palm and wrist. Do
this for 2 1/2 minutes, rinse.
Transfer the brush to your left hand. Saturate it
FOUNDATIONS OF NURSING again with soap and water and do the same as in
no 3 (5 minute for both hands).
Surgical Techniques
Transfer the brush to your right hand. Saturate it
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N again with soap and water and brush the left arm
from the wrist up to 2 inches above the elbow.
SURGICAL SRUB and HANDWASHING Rinse, Do this for 2 ½ minutes.
Transfer the brush to your left hand and do the
same as in no. 6 (5 minutes for both arms) hence
Surgical Scrub a total of ten (10) minutes, from the tip of the
Surgical scrub is the removal of as many bacteria fingers up to 2 inches above the elbow.
as possible from the hands and arms by Drop the brush in a pail provided for used
mechanical washing and chemical disinfection brushes. Rinse both hands and arms well taking
before taking part in a surgical procedure. care the flow of water is from the hands down
Purpose the elbows.
Surgical Scrub helps prevent the possibility of
contamination and infection of the operative POINTS TO REMEMBER IN SURGICAL SCRUB:
wound by bacteria on the hands and arms. Rinse as often as possible using one direction
only. Start from the hand going to the arm taking
Types care not to touch the faucet and the sink.
A person with cut or burn should not scrub
Complete Scrub – it usually takes 10-15 minutes. This
time may vary in different hospitals, depending upon the because of the high bacterial count.
frequency of the scrubs. This is done: The hands and arms can never be rendered sterile
1. Before the first gowning and gloving. no matter how long or how strong the
2. Following a clean case if the gloves have holes in them. antiseptics.
3. Following a clean case if the gloves have been removed Surgical scrub is most effective when firm
inadvertently before the gown. motion is applied. Short horizontal or circular
4. Following a clean case if hands been contaminated in
stroke could be used.
ay other way.
5. Following a contaminated case, before starting the next Use an ample supply of antiseptics
case. Since the hands are to be cleaner than any other
area, after the initial hand wash, they are held
Short Scrub – it is usually takes 5-10 minutes. This scrub higher than the elbows during the rest of the
is done following a clean case if the hands and arms have procedure to prevent water from running back
not been contaminated. It is done to remove bacteria that the scrubbed hands.
have emerged from the pores and multiplied while the
gloves were worn.
How to perform surgical scrub
PREPARATION BEFORE DOING SURGICAL
SCRUB: Step 1 :Remove all jewelry on your hands and wrists.
Attend to your personal needs. Step 2 : Adjust the water to a warm temperature and wet
your hands and forearms thoroughly.
Adjusts your cap and mask properly. The hair
Step 3 : Clean under each fingernail with a stick or brush.
should be confined inside the cap. The mask It is important for all surgical staff to keep their
should cover the nose, mouth, cheek and chin. fingernails short.
Roll up sleeves of the uniform 3 inches above Step 4 : Holding your hands up above the level of your
the elbow if sleeves are long elbow, apply the antiseptic. Using a circular motion,
Check on the liquid soap and brush dispenser. begin at the fingertips of one hand and lather and wash
Remove your jewelry. between the fingers, continuing from fingertip to elbow.
Repeat this for the second hand and arm. Continue
Check on your fingernails. They must be kept
washing in this way for 3-5 minutes.
clean and short to reduce the bacteria count and Step 5 : Rinse each arm separately, fingertips first,
to prevent the puncturing or tearing of gloves. holding your hands above the level of your elbow.
Step 6 : Using a sterile towel, dry your arms--from
SCRUB-UP TECHNIQUE fingertips to elbow--using a different side of the towel on
Take note of the time you started scrubbing each arm.
Wash hands and arms with soap and water to Step 7 : Keep your hands above the level of your waist
remove superficial dirt and bacteria. and do not touch anything before putting on sterile
surgical gloves.
Foundations of Nursing Abejo
2. Foundations of Nursing
Surgical Techniques
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
PREPARATION FOR STERILIZATION
The gown is folded lengthwise with the wrong side out and
facing the wearer
A. Unassisted (Self-service)
Grasp the gown at the center or you may
receive it from the circulating nurse
Step one or two feet away from the sterile
field to have an adequate working space.
Unfold the gown and expose the hemline
portion. Dry your hands and arms with
this small portion. Use each side of the
folded gown in drying each hand and arm.
Continue unfolding the gown and locate
for the armhole.
Slip your hands into each armhole and
hold your hands and arms straight and
obliquely upward. The circulating nurse
will fix it.
Stop and swing your body to the right,
then to the left. The circulating nurse will
catch the belt of its ends as you swing.
B. Assisted
This is done by the scrub nurse when she
is already completely sterile, i.e. she has
donned the gown and the gloves.
Pick up the gown directly from the table
or receive it from the circulating nurse.
Unfold the gown slowly and serve the
hemline portion to the surgeon.
Continue unfolding the gown while the
GOWNING surgeon is drying his hands and arms
When serving the gown, your gloved
Gowning hands should come in contact with the
The sterile gown is put on immediately following right side portion of the gown under the
the surgical scrub. protecting cuff made.
Show the opening and armholes to the
Purpose surgeon.
The sterile gown is worn in order to permit the As soon as the surgeon inserted his hands
wearer to come within the sterile field and carry out through the armholes, leave it. The
sterile technique during an operative procedure circulating nurse will fix it.
RESPONSIBILITY OF THE CIRCULATING NURSE
IN THE APPLICATION OF STERILIZATION
She places hands inside of the gown near the
shoulder of scrub nurse and aids her in putting on
the gown.
She grasps ends of the gown’s belt without
touching the upper part of sleeves of the gown.
She ties the belt at the back of the gown, keeping
belt ends away from the sterile part of the gown.
She ties the back ties after trying the belt.
POINTS TO REMEMBER IN GOWNING:
This is done after the surgical scrub.
Use an oscillating motion pat dry in drying the
hands and arms. Start from the hand going to the
arms
Do not dry hand then arms and return to the same
hand
In drying the hand and arms, the hemline portion of
the gown or a towel could be used. If a towel is
Foundations of Nursing Abejo
3. Foundations of Nursing
Surgical Techniques
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
used, dry one hand and arm on one end of the towel
and use the opposite end to dry the other hand and
arm. CLOSED METHOD OF GLOVE TECHNIQUE
This is the method with the least possibility of
In serving the gown, do not turn your back on the
contamination.
sterile field to prevent contamination.
In picking the gown from a sterile line pack, be With your right hands inside the gown’s sleeves,
careful not to touch any other articles in the pack lift the glove by the cuff.
with the bare hands. Put thumb down or your upturned left palm, fingers
of glove pointed toward your elbow.
At this time, move your left hand so that your
fingers are halfway down the cuff of your gown.
GLOVING
Do not let them protrude from our gown cuff or
touch the end of the cuff.
Gloving
This is done after the gowning technique. With your right hand still inside the sleeve, take
hold of the folded cuff of the left glove and pull it
Purpose: out and over the left hand and well over the cuff of
Gloves are worn to complete the sterile dress in the left sleeve.
order that the one who wears them may handle Take the right hand, still inside the sleeve, and
sterile equipment. grasp the left glove and gown cuff at the wrist and
pull glove unto the hand.
PART OF A GLOVE: Proceed to the right hand the same way.
1. Palmar Surface
2. Dorsal Surface POINTS TO REMEMBER IN GLOVING:
3. Finger Holes Take care not to contaminate the outside surface of
4. Cuff
the glove
5. Wrist
In serving the gloves, the nurse must have a wide
TYPE OF A GLOVE TECHNIQUE: base of support by putting her foot apart.
Always serve the right hand glove first.
OPEN METHOD OF GLOVE TECHNIQUE In serving, get the right glove with the left and the
Unassisted (Self-service) left hand glove with the right hand.
Get the right hand gloves with the left hand by Always keep gloved hands at waist level or above.
holding it at the edge of everted cuff. Step back Keep gloved hands away from your mask.
from the sterile field.
Explore the finger holes before inserting the whole REMOVING THE GOWN AND THE GLOVES
hand completely. Leave the everted cuff as is. Regardless of whether the scrub nurse assists in a
Slip the gloved right hand under the fold of the case or contaminated case remove first the gown
everted cuff. Insert the left hand by exploring the and then the gloves. Wash the gloved hands if they
fingerholes before inserting the whole hand are grossly contaminated before removing the
completely. Leave the folded cuff. gown.
Make a pleat at the cuff of the gown and secure this
is place with your right thumb. Removing the Gown:
Slip the four fingers of the right hand under the fold With the gloves still in, ask the circulating nurse to
of the glove and pull it up over the pleated cuff of loosen the ties and the belt.
the sleeves. Fix the glove firmly. Grasp the right shoulder of the gown and slip off
Repeat for the right hand. the arm allowing use sleeves to turn inside out.
Repeat the same procedure for the opposite
Assisted (Serving Others) shoulder.
Get the right hand glove and inflate it first for easy Discard the gown in the hamper.
insertion and to detect for holes.
In serving the gloves, the palmar surface or the Removing the Gloves:
thumb portion should be facing the one who is With the gloved right hand, remove the left glove
being served/ facing the surgeon. by holding it at its outer surface and pull off.
Evert the cuff one inch wide. Insert four fingers (This is the glove to glove technique).
inside the everted cuff. To remove the right glove, insert your thumb or
Stretch the glove well outward. Put your thumbs three fingers between the skin and the glove and
out. pull off. (This is the skin to skin technique).
Allow the surgeon to explore the fingerholes
When the surgeon jerks his hand downward,
release and pull upward so that the cuff of the
glove covers the cuff of the gown.
Repeat the same procedure for the left hand.
Foundations of Nursing Abejo
