2. TABLE OF CONTENTS:
Defination of a scrub nurse
Specific role in OR
Responsibilities of a scrub nurse
Video on ASEPTIC TECHNIQUES
Orientation on SURGICAL NEEDLES
Orientation on SURGICAL SUTURES
Orientation on SURGICAL INSTRUMENTS
Video on INSTRUMENT HANDLING

3. WHAT IS A SCRUB
NURSE?

4. To prepare and drape
sterile drapes,instruements
& supplies
To assist surgeon &
assistants throughout
operation by providing
instruements & supplies
To maintain patient’s safety
throughout operation

5. • Welcoming patient to OR
• Preoperative nursing assesment
• Checklist before scrubbing
• Scrubbing in
• Assembling instruements,counting before surgery
• Assist surgeon by passing over instruements
• Observe patient’s safety
• End of procedure

6. WELCOMING A PATIENT TO OR
• Welcome patient
• Introduce yourself
• Get personal information
from patient
• Ask if he/she needs any
further help
• Show her around (where
to sit,bathroom,changing
room etc)
• Ask to remove jewelry

7. Preoperative nursing assessment
• Age
• Allergies
• Presence of infections (temp ≥38)
• Vital signs
• Drugs contraindicated
(aspirin,heparin,warfarin)
• Nutritional status
• Physiological state(labs,x-rays)
• Psychological state
• Tolerance to anesthesia
(smoking,alcoholism)

8. CHECK CONSENT
CONFIRM SURGICAL PROCEDURE
CHECK INSTRUEMENTS
CHECK SUPPLIES

9. “Scrubbing in”
• usually involves thoroughly
washing hands and arms with
an antibacterial soap, then
putting on a sterile mask, hat,
gown and gloves so that
patients cannot be
contaminated when their bodies
are exposed for surgery.

10. • Open the inner sterile set &
assemble sterile instruments
on mayo tray & trolley
• Perform surgical count
• Assemble surgical blade
• Prepare sutures

11. • Assist surgeon in cleaning & draping patient
• Bring mayo’s tray over the patient

12. • Pass instruments to
surgeon in a proper
position & safe
manner
• Pass & Receive
scalpel in kidney dish
• Place the skin knife
away from working
field

13. • Retract tissue gently if
required
• Remove artery tips as
directed by surgeon
• Cut sutures with
scissors,help in suturing
• Assist in cautery

14. • Anticipate surgeon
need through out
procedure
• keep one step
ahead of surgeon in
passing
instruments,sutures
,sponges etc
• Maintain neat &
orderly sterile field
of operation

15. • Maintain strict aseptic techniques
• Keep talking to minimum,turn away while
sneezing,coughing
Keep your hands at table level while unengaged

16. • Perform second surgical count of
sponges,sharps,instruements as surgeon begins closing
• Apply dressing to the wound by non touch technique &
assist in removing the drapes

17. • Dispose of sharps
• Cover the soiled
instruments before
sending them for
cleaning/autoclave
• Remove gown &
glove and check
documentation

18. SURGICAL NEEDLES
• Surgical needles
are necessary for
the placement of
sutures in tissues
• NEEDLE
ANATOMY
– Swage
– Body
– Point

19. NEEDLE SWAGE
Classification by the needle
swage:
• 1. Closed Eye
• 2. French Eye
• 3. Swage

20. Body of the needle
• classification by the body of the needle:
¼ circle 3/8 circle ½ circle 5/8 circle
Straight Half Curved (Ski) compound Curved

21. Point of the needle
- Conventional cutting
(cutting on the inside)
- Reverse Cutting
(cutting on outside)
- Taper point
(Pierce and spread tissue without cutting it
- Blunt
Pierce and spread tissue without cutting it.

22. The word "suture" describes any strand of
material used to ligate (tie) blood vessels or
approximate (sew) tissues.
Absorbable / Nonabsorbable
Natural / Synthetic
Braided / Monofilament

23. Example Suture Selection
Absorbable
Natural
Synthetic
Non Absorbable
Natural
Synthetic
Fast Absorbing Gut
Chromic gut
Plain Gut
VICRYL*
VICRYLRapide*
PDS II*
MONOCRYL*
(polyglactin 910) suture
( polyglacin 910) suture
(polyglecaprone 25) suture
(polydioxanone) suture
Stainless steel
Silk
PROLENE*
ETHIBOND*
MERSILENE*
NOROLON*
Ethilon*
(nylon) suture
(nylon) suture
(polyester) suture
(polyester) suture
(polypropylene) suture

24. Example Suture Selection
Absorbable (Natural)
Fast Absorbing Gut Plain Gut Chromic Gut
Tensile strangth 7 days
Mass absorption 21- 42 days
Tensile strength 7-10 days
Mass absorption 60-90 days
Tensile strength 28 days
Mass absorption 90 days

25. Example suture selection
Absorbable (Synthetic)
VICRYL Rapide
PDS II
MONOCRYL
VICRYL
Mass absorption 42 days
Mass absorption 56-70 days
Mass absorption 6 months

26. Example suture Selection
Nonabsorbable
Natural
Stainless steel
Silk

27. Example Suture Selection
Nonabsorbable
Synthetic
NUROLON ETHIBOND
PROLENEMERSILENEETHILON

29. Artery Forceps
used as a hemostat for
clamping bleeding vessels.
 For grasping tissue ( Opening and closing
peritoneum) .
 to hold stay sutures.
Allis' Forceps
for grasping tough structures like Rectus sheath
or fascia in LSCS or Hysterectomy
Babcock's Forceps
 for grasping tubular structures like
fallopian tube in tubectomy In
Pomeroy's operation , ureter,
appendix etc.

30. Self retaining speculum.
Used in OPD for routine examination.
procedures like taking of Pap smear ,
insertion and removal of Copper T can be
done
for inspection of vagina and cervix in OPD. It
retracts posterior vaginal wall.
 Taking Pap Smear , Insertion and removal of
Copper T, Taking swabs,D&C , Cervix Biopsy ,
Vaginal Hysterectomy ,
Sims' Speculum
CUSCO’S SPECULUM

31. Doyen's
Retractor
Deaver's
Retractor
for retraction of deep structures
Right Angle
Retractor
bladder retractor during LSCS/hysterectomy

32. Mayo scissors
Straight mayo scissorsCurved mayo scissors
Towel clip
PINNARD’S FETOSCOPE
For auscultation of fetal heart sounds

33. Sims' Anterior Vaginal Wall
Retractor
To take biopsy from the cervix
Sponge holding forcepsPunch biopsy forceps
To hold sponges or cervical lips
Episiotomy Scissors

34. Toothed
To hold tough
structures like
rectus sheath,
vaginal flaps or
skin margins
during suturing
Non toothed
DISSECTING FORCEPS (TOOTHED AND
NON- TOOTHED
LOOP HOOK
To remove IUCD from the uterine cavity
when the threads are missing
ELECTRO CAUTERY
Thermal cauterisation of the cervix
for cervical ectopy

35. Foleys Catheter
•self retaining catheter used for drainage of the urinary bladder ,
It has a bulb below the tip.
•This can be inflated by normal saline. It has two channels. One for
inflating bulb and the other for drainage of urine to which urobag
is attached. No 14 or 16 are used in adult
Female metal catheter
•To empty the bladder prior to major vaginal operations

36. Hegar's Dilator
It is used for measuring length of the cervix
Uterine sound
For dilatation of cervix
For grasping the cervix in hysterosalpingography or IUCD
insertion
TENACULUM

37. Suction Curette
This instrument is used for first trimester MTP,
suction of vesicular mole.
Shirodkars Cerclage Needle
This is specially designed needle for putting
stitch around the cervix.
•used in hysterectomy /salpingectomy to
clamp fallopian tube
•for clamping umbilical cord of new born or
for artificial low rupture of membranes ( ARM).
Khocker’s forceps

38. Surgical Blades/ Scalpel
Green Armytage Forceps Needle holder
used as a hemostat in LSCS

39. Uterine Curette
Flushing curette
Sharman’s curette
Simple curette
Used for diagnostic D&C

40. Uterine dressing forceps
•To swab the uterine cavity following D+E
operation with a small gauze piece
UTERINE HOLDING FORCEPS
To fix and steady uterus when conservative
surgery is done on the adnexae
•To fix the myoma
•To give traction in a big uterus
requiring hysterectomy
MYOMA SCREW

41. MULTIPLE TOOTHED VULSELLUM
•used for grasping the cervix ( Usually
anterior lip of the cervix is grasped)
•in procedures like Insertion of IUCD ,
Cx Biopsy D&C, First trimester MTP
with Suction Evacuation. Cx Biopsy
•Posterior lip of the cervix is grasped for
post. colpotomy
SINGLE TOOTHED VULSELLUM
To hold the cervix after opening the vault of
vagina
•To hold new cervical stump after amputation
of the cervix and fothrergill’s operation after
subtotal hysterectomy

42. WRIGLEY'S FORCEPS
Obstetric forceps for out let
forceps delivery. Parts of
the forceps are blades (
which has windows or
fenestrate for firm grip of
the head) ,Shank , Lock(
English lock for Wriglys
forceps) , Handle.
Alternative to forceps
delivery. Causes less
trauma to mother and
fetus
VACCUM (VENTOUSE)
Silastic cup Metallic cup

43. Ayre's Spatula
Used for taking PAP smear
RING PESSARY
Used for correction of UV prolapse
UMBILICAL CORD CLAMP
UMBILICAL CORD CUTTING SCISSORS