Operation Room

Technique

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 Objectives:
 At the end of this topic you will be able to:

Describe the physical environment of the

operating room.
Differentiates the types of surgery.
Explain the responsibility of each member of the
operating room.

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 INTRODUCTION

 The treatment of a wide variety of illnesses and

injuries need some types of surgical interventions.

 Surgery: is invasive method of treatment that may be

planned or unplanned, minor or major and that may
involves any body parts or systems.

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 Types of surgery
Based on timing:
Elective surgery: is done to correct a non-life-
threatening condition, and is carried out at the
patient's request, subject to the surgeon's and the
surgical facility's availability.
Emergency surgery: is surgery which must be done
promptly to save life, limb or functional capacity.

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 • Based on purpose:
Exploratory surgery is performed to aid or
confirm a diagnosis.

Therapeutic surgery: performed to treats a

previously diagnosed condition.

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 Based on type of procedure
 Amputation: involves cutting off a body
part, usually a limb or digit.
 Replantation :involves reattaching a cut off
body part.
 Reconstructive: involves reconstruction of
an injured, mutilated, or deformed part of
the body.

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 Cont...
 Cosmetic: is done to improve the appearance
of normal structure.
 Excision: is the cutting out or removal of an
organ, tissue, or other body part from the
patient.
 Transplant: is the replacement of an organ or
body part by insertion of another from
different human (or animal) into the patient.

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 Based on body part
 When surgery is performed on one organ
system or structure, it may be classed by the
organ, organ system or tissue involved
Cardiac surgery, gastrointestinal surgery, etc.

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 Based on equipment used;
Laser surgery: involves use of a laser
for cutting tissue instead of a scalpel or
similar surgical instruments.

Microsurgery: involves the use of an

operating microscope for the surgeon
to see small structures.

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 Terminology
 -ectomy: refers removing or cutting out or
excising. E.g.. hysterectomy
 -otomy: refers into surgical incision into an organ
or tissue. E.g.. Gastrotomy
 -ostomy: formation of a permanent or semi-
permanent opening. E.g.. Colostomy
 -oscopy: involving small incisions through which
an endoscope is inserted. E.g. endoscopy

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 Cont..
-oplasty: artificial reconstruction of an organ.
E.g. rhinoplasty
-rrhaphy: surgical sewing, suturing.
E.g. herniorrhaphy

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 Perioperative periods

Preoperative
Phase
 Begins when the decision
for surgery is made and
ends when the client is
transferred to the
operating room
 3 Phases

Intraoperative
Phase
 Begins with the client’s entry
into the operating room and
ends with admittance to the
post anesthesia care unit
(PACU)
 3 Phases

Postoperative
Phase
 Begins with the client’s
admittance to PACU and
ends with the client’s
complete recovery from
the surgical intervention
 Organization of areas in the operating
room.
Design of the operating room
 Architects follow two principles in planning the
physical layout of the OR suite.
 Exclusion of contamination from outside .
 Separation of clean areas from
contaminated areas.

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 Basic design principles which are common to all
operating rooms must fulfill the following criteria:

 Simple and easy to keep it clean.

 Wall and floor surfaces should be smooth and made
of nonporous materials.
 There should be separate rooms for clean or sterile
instruments and soiled ones.
 There should be sufficient space to ensure the safe
transportation.
 The recovery room should be near the operating
room.

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 Traffic Pattern within the Operation
Room
 The surgical unit is often divided into four designated
areas:

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 Unrestricted Area
 This area is the entrance from the main corridor and is
isolated from other areas of the surgical unit.
 This is the point through which staff, patients and
materials enter the surgical unit.
 Street clothes are permitted.

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 Transition Zone
 This area consists primarily of dressing
rooms and lockers.
 It is where staff put on surgical attire that
allows them to move from unrestricted to
semi restricted or restricted areas in the
surgical unit.
 Only authorized staff should enter this area.

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 Semi restricted Area

 This is the peripheral support area of the

surgical unit and includes preoperative and
recovery rooms and different storage units.
 Limit traffic to authorized staff and patients
at all times.
 Staffs who work in this area should wear
surgical attire and a cape.

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 Restricted Area
 This area consists of the operating room(s) and
scrub sink areas.
 Limit traffic to authorized staff and patients at all
times.
 Keep the door closed at all times, except during
movement of staff, patients, supplies and
equipment.
 Scrubbed staff must wear full surgical attire and
cover head and facial hair with a cap and mask.

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 Cont.…

 Staff should wear clean, closed shoes that will

protect their feet from fluids and dropped items.
 Masks are required when sterile supplies are open
and scrubbed staff is operating.
 Patients entering the surgical unit should wear
clean gowns or be covered with clean linen, and
have their hair covered.

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 Areas within the operating room:
 Supervisor’s Office (A); has direct access to the outside of
the operating room, supervisor may receive visitors and
others who are not dressed in scrub attire.
 Dressing rooms (B) ; have a door to the outside corridors,
change into scrub attire and go directly into the operating
room.
 Holding area (C); for parking of stretchers with patients
awaiting surgery, ensure all preoperative cares are carried
out and data are in the patient’s chart.
 Scrub sink areas (D); are located in several places close
the operating suites; Scrub brushes, Caps, Soaps, masks
are located at each scrub station.
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 CONT..

 Workroom (E); is located away from the direct traffic of the

operating suites; two separate areas, one for clean instruments
and supplies and other for soiled equipment.
 Sterile supply room (F); depot for wrapped sterile articles.
 Storage areas (G) ; for extra equipment and supplies are used to
store these extra instruments and supplies for each unit
 Recovery room (H) ; has an access to the outside for
transporting patients back to their rooms.
 Operating rooms (I); are rooms where surgery is performed.

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 Operating Room Equipment and Furniture

 Wall Clock
 X-ray Viewing Boxes
 Lights
 The Operating Table
 Mayo Stands
 Back Table
 Ring Stand
 Kick Bucket
 Anesthesia Equipment
 Suction machine
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Lights

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The Operating Table

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Mayo Stands

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Back Table

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Ring Stand

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Anesthesia Equipment

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Operating Room Personnel Organization
 Operating Room Team
 Surgeon
 Assistants to the surgeon
 Scrub nurse
 Anesthetists
 Circulator/ Runner nurse
 Others: students, cleaners and those who may be needed to
set up and operate specialized equipment or monitoring
devices.

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 Personnel In ORT
The operating room team is subdivided according to the
functions of its members:
1. Sterile team
 Surgeon
Assistant surgeon
Scrub nurse
2. Unsterile team
Anesthesia provider
Circulating (runner) nurse
Others, such as students, cleaners
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 Responsibilities of Each Member

Responsibilities of the Surgeon:

 Preoperative diagnosis and care
 Selection and performance of the surgical procedure
 Postoperative management of care

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 Responsibilities of the Assistant
Surgeons:
 Maintain visibility of the surgical site
 Control bleeding
 Close wounds
 Apply dressings

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 Responsibilities of the Scrub Nurse:

 Reviews anatomy, physiology, and the surgical procedure.

 Assists with preparation of the room.
 Scrubs, gowns, and gloves self and other members of the sterile
surgical team.
 Passes instrument to the surgeon in a prescribed manner.
 Maintains sterile and an orderly surgical field.
 Assists with the draping procedure.
 Takes part in sponge, needle, and instrument counts.
 Identifies and preserves specimens properly.

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 Responsibilities of the Circulating Nurse:
 Reviews anatomy, physiology, and the surgical procedure.
 Assists with preparing the room, observes aseptic.
 Keeps the "scrub" nurse with supplies e.g. suture materials,
dressings etc.
 Opens sterile supplies before and during the case.
 Assists the anesthetist when required
 Takes part in sponge and instrument counts and their
documentation,
 Ties the gowns of scrubbed personnel
 Adjusts the surgical lights; attaches the suction apparatus
and check to see its function.

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 Cont.…
 Accompanies the patient to the recovery room.
 Checks the chart and relates pertinent data.
 Measures blood and fluid loss.
 Documents and preserves any specimens received
during surgery.
 Reports pertinent information to the recovery area
nurses.

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 Responsibilities of the Anesthesia
Providers:
 Positions the patient on the surgery table.
 Monitoring vital functions and parameters.
 Fluid and electrolyte administration.
 Administering anesthetic agent/anesthesia.
 Maintaining anesthesia at the required levels.
 Managing untoward reactions to anesthesia throughout
the surgical procedure.

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 Sponge, Sharp, and Instrument Count

 Items are counted before and after use

Purpose
 To prevent foreign body left in the patient’s body that may
cause infection.

 For personnel safety :

 A contaminated sponge or needle that is
unaccounted for at the close of procedure could also
in advertently come in contact with the personnel who
clean the room.

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 Cont.…

 Instruments such as towel clips and scissors are not

accidentally thrown away or discarded so with the
drapes can Injure laundry and
housekeeping/environmental services personnel by
the contaminated sharp edges of surgical instruments,
blades, and needles.

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 Counting Procedure

First Count:
 The person who assembles and wraps items for
sterilization will count them. In commercially
prepackaged sterile items, the count is performed by the
manufacturer.

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 Second Count:
 The scrub nurse and the circulator together count all
items before the surgical procedure begins and during
the surgical procedure as each additional package is
opened and added to the sterile field.

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 Third Count
 Counts are taken in three areas before the surgeon
starts the closure of a body cavity or a deep/large
incision.

Field Count. Either the surgeon or the assistant

assists the scrub nurse with the surgical field count.
Additional items are accounted for at this time.

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 Cont.…
 Table Count. The scrub nurse and the circulating nurse
together count all items on the Mayo stand and
instrument table.

 Floor Count. The circulating nurse counts sponges and

any other items that have been recovered from the floor
or passed off the sterile field to the kick buckets. These
counts should be verified by the scrub nurse.

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 Principles of Economical Use of Hospital
Supplies, Equipment and Time
 The varieties and numbers of instruments and supplies needed
for each surgical procedure can be kept to a minimum.
 Items to “have available” are not opened unnecessarily.
 Do not open another packet of sutures for the last stitch unless
absolutely necessary. A few leftover pieces are usually long
enough to complete the closure.
 Supplies should be opened only as needed, not routinely “just
in case” they may be needed.
 Turnoff lights when they are not needed.
 Use time efficiently.

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 Quality of operating room theatre personnel
1. Stamina
2. Emotional stability
3. Respect
4. Stable Health
5. Team spirit

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 Tips for students to practice on OR
 Wear only necessary jewelry.
 Wear minimal make-up.
 Dot not wear perfume or cologne.
 Do not chew gum.
 Always wear name badge.

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Don’t Faint!
 Eat breakfast!
 If you feel faint, light headed or very warm,
please tell someone.
• It is fairly common for a student to have a
fainting spell.
• If this happens, u will be taken somewhere
private until you feel better.

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END

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