Responsibilities of a Scrub Nurse in the Operation Theatre

1. RESPONSIBILITIES
OF A SCRUB NURSE
ATLAS HOSPITAL, RUWI

3. MODERN OPERATION THEATRE

4. Introduction to Perioperative Nursing
**** All patients consider their surgery a major thing ****
Phases of Perioperative Care
 Pre Operative - begins with the patient’s decision to have
surgery, ends with entry into the operating room
 Intra Operative - begins with entry into the operating room and
ends with admission to the recovery room
 Post Operative - begins with admission to recovery room, and
ends with discharge from care

5. Pre-Operative
Responsibilities of Operating Room
Nurse:
 Patient Assessment
 Physical Problems
 Emotional Aspects
 Understanding of surgery/consent
 Legal requirements for chart
completion
 Read and interpret lab results
 Peri-Operative Teaching

6. Intra-Operative
 Provide for quiet environment during induction
 Assist during intubation
 Observe aseptic technique
 Safe operation of equipment (lasers, electrosurgery unit)
 Position patient safely - CV, nervous, respiratory system
 Document events, patient care given,
 Provide all supplies, equipment, to team during surgery
 Provide for a safe transfer to recovery room

7. Peri-Operative Standards of Care …
 Pre-operative skin prep shall be done without abrading, cutting or
irritating the patient’s skin
 Patient privacy shall be provided at all times
 Any pre-operative drainage tubes shall be placed without tissue trauma
and be completed utilizing sterile techniques when indicated
 All IV infusions shall be monitored to maintain the appropriate flow rate
and type of solution and remain patent without signs of inflammation or
swelling
 The patient shall be provided emotional and educational support to
reduce pre-operative anxiety
 The patients shall be provided a safe and normothermic environment in
the pre-op waiting area
 The patient shall be transferred safely to the OR table and safety straps
appropriately applied

8. Circulating Nurse

9. Unsterile Team Member - Circulating Nurse
 Responsible for nursing care in the operating room
 Responsible for the organization of the workload
 Responsible for the maintenance of policy and
procedures
 Responsible for signing and documentation
 The Circulating Nurse is the professional staff
member in the operating room, representing the
patient (Patient Advocate) and the hospital
administration

10. SURGICAL POSITIONING
 Facilitated through the nursing process
 Patient’s body must remain in physiologic alignment
 Dependent Upon:
 The surgical procedure
 Exposure at the surgical field
 Surgeon’s preference and idiosyncrasies
 Patient’s condition
 Special Considerations:
 Geriatric patients
 Obese patients
 Malnourished patients

11. TYPES OF SURGERY
 MAJOR -- Present a real threat to life
 MINOR -- Present little threat to life

12. Surgical Nurse 1889
 A level head & keen eyes, ever watchful for
all that may be required, a mind not easily
irritated or confused, combined with the
facility of keeping out of the way & still being
of the greatest help……..Thoroughness,
speed, gentleness especially fit the surgical
nurse.
(Asepsis for the Nurse, Clemons, 1889)

13. SCRUB NURSE
“ The nurse who is the immediate
assistant to the surgeon is often
called the “scrub” or “sterile” nurse.
She first scrubs her hands and arms
the required length of time, puts on
sterile gown & gloves, and handles
only sterile material.”
Crawford 1945

17. • PLACE THE BLADE TO THE KNIFE
HANDLE USING NEEDLE HOLDER,
ASSEMBLE SUCTION TIP & SUCTION
TUBE
• BRING MAYO STAND &
INSTRUMENT TABLE NEAR THE
DRAPED PATIENT AFTER DRAPING IS
COMPLETE
• SECURE SUCTION TUBE & CAUTERY
CORD WITH TOWEL CLIPS OR ALLIS
• PREPARE SUTURE & NEEDLE
ACCORDING TO NEED

18. DURING AN OPERATION
• MAINTAIN THE STERILITY
THROUGHOUT THE PROCEDURE
• AWARENESS OF THE PATIENT’S
SAFETY
• ADHERES TO THE POLICY
REGARDING
SPONGE/INSTRUMENTS/NEEDLE
COUNT
• ARRANGE THE INSTRUMENTS ON
THE MAYO & INSTRUMENTS TABLE

19. BEFORE THE INCISION
• PROVIDE SPONGES/MOPS NEAR
OPERATIVE SITE PRIOR TO INCISION
• PASS THE FIRST KNIFE FOR THE SKIN
TO THE SURGEON WITH THE BLADE
FACING DOWNWARD & HEMOSTATS
TO THE ASSISTANT SURGEON
• HAND THE RETRACTOR TO THE
ASSISTANT SURGEON
• WATCH THE FIELD/PROCEDURE &
ANTICIPATE THE SURGEON’S NEEDS
• PASS THE INSTRUMENTS IN A DECISIVE
& POSITIVE MANNER

20. • WATCH OUT FOR HAND SIGNALS - FOR
INSTRUMENTS
• KEEP USED INSTRUMENTS CLEAN BY
WIPING INSTRUMENTS WITH A MOIST
SPONGE
• ALWAYS REMOVE THE CHARRED TISSUE
FROM THE CAUTERY TIP
• NOTIFY CIRCULATING NURSE IN A CLEAR
MANNER IF ADDITIONAL INSTRUMENTS
ARE NEEDED
• KEEP SPONGES ON THE FIELD FOR USE
• SAVE & CARE FOR TISSUE/SPECIMEN
ACCORDING TO HOSPITAL POLICY

21. • REMOVE EXCESS INSTRUMENTS FROM
STERILE FIELD
• ADHERE & MAINTAIN STERILE
TECHNIQUES & WATCH FOR ANY BREAKS

22. END OF OPERATION
• UNDERTAKE COUNT OF SPONGES &
INSTRUMENTS ALONG WITH
CIRCULATING NURSE
• INFORM THE SURGEON THE COUNT
RESULT
• REMOVE INSTRUMENTS & EQUIPMENTS
• AFTER OPERATION HELP TO APPLY
DRESSING
• REMOVE & DISPOSE THE DRAPES (if
disposable)
• COVERS PATIENT BEFORE SHIFTING TO
HDU

24. SCRUB NURSES IN ACTION

25. Dressing for ACTION!
Appropriate attire for restricted area in
preparation for scrubbing

26. About sterility…….
• Unless you are scrubbed, gowned and gloved, do not
enter the ‘sterile zone’.
• For example, do not walk between two sterile areas
(such as between the scrub nurse’s trolley and the
draped patient), and do not touch the drapes. If you
accidentally breach the sterile field, it is essential that
you admit your mistake.
• If your gloved finger accidentally touches something
unsterile when you are scrubbed, you must immediately
stop using that hand in the sterile field (unless removing
the hand will cause a problem), and request a new glove
from the scrub nurse, as soon as the opportunity arises.
No-one should think badly of you for doing this; on the
contrary, they will probably be pleased with your
honesty and respect for the sterile field.

27. About sterility…….contd.
• The degree to which a surgeon will adhere
meticulously to sterility will vary according to
the operation.
• Clearly, meticulous asepsis is much more
important when implanting a new cardiac
valve, than when draining a perianal abscess

28. When to scrub
• The scrub nurse normally scrubs well before
the surgeon, to allow time to set up the sterile
instruments.

29. Gowning….

32. Method for Open Gloving ……..

33. Where to put your hands
 Any area lower than the level of the operating
table is usually considered suspect, even if it
is covered by sterile drapes.
 Firstly, you should keep your hands above
this area
 Rest the hands together against the chest, as
though praying but with fingers interlaced

34. How to keep sterile?
Where to rest your hands once scrubbed. A rectangle
Bounded by the mid-sternum, umbilicus and anterior
axillary line

35. Note these…….

36. How the scrub nurse should move!

37. Assisting properly..

39. SCRUB TEAM @ WORK

41. Contd…

42. Contd…

43. OT Layout
OT LAYOUT

44. PRESENT DAY OPERATION
THEATRE – MAJOR SURGERY

45. Fundamentals of Nursing Care: Concepts, Connections, & Skills
ROBOTIC SURGERY
Copyright © 2011 F.A. Davis
Company

46. Fundamentals of Nursing Care: Concepts, Connections, & Skills
ROBOTIC SURGERY
Copyright © 2011 F.A. Davis
Company

47. The Operating Room of the Future

48. The Operating Room of the Future

49. The Operating Room Personnel of the Future
Surgeon Assistant Scrub Nurse Circulating Nurse
Satava March, 2000