CHAPTER 3

MEDICAL AND SURGICAL PROCEDURE AND FACILITIES

Introduction
The word “medical” refers to the study and practice of
medicine, which is the science of and ability to heal.
Generally, it refers to the specialty concerned with the
diagnosis, management and particularly, non-surgical
treatment of diseases, either of one particular organ
system or of the body as a whole. Examples of medical
procedures include observation (visually inspecting the
patient’s skin color, weight, teeth, temperature, blood
pressure and pulse rate) and specific therapeutic treatment
(prescribing drugs, dialysis, chemotherapy, wound therapy,
etc.).
● Primary care is care provided by health professionals
who have first contact with a patient seeking treatment.
This contact most often occurs in a doctor’s office, clinic,
nursing home, school, etc

● Secondary care is provided to patients who are generally

referred to hospitals, specialists and specialized clinics by
primary care providers, either for diagnosis or further
specialist treatment.

● Tertiary care is specialized, highly technical care that

includes diagnosis and treatment of disease and disability. The
patient is usually referred by primary or secondary medical
care personnel for specialized care, for example intensive
care, advanced diagnostics, long-term care, etc.
Procedures and techniques
When a cure is unlikely naturally over time or through
medication alone, various medical, diagnostic and
surgical procedures can be performed to identify causes and
alleviate disease and suffering
Class 1: considered low risk and include most types of
non-invasive devices, meaning that they do not penetrate
through or into the body. Examples can include:
surgical lights, surgical tables, examination gloves,
packaging materials and stethoscopes.

Class 2: considered medium risk, which can include

various types of most invasive devices (or even
products that are used with such devices) that
penetrate into or through the body, but also the
length of time used. Note: in some countries this is
even sub-divided further into sub-classes such as
Class 2a and 2b)

Class 3: considered the highest risk, which can include

various types of implantable devices (those that can
remain in the body long term or even per manently).

● Elective procedures – these may not be essential but

may improve the quality of life. The patient can choose if
and when to have the procedure.
● Required procedures – these need to be done to prevent
future complications, but do not necessarily have to be done
immediately.
● Emergency procedures – often a matter of life or death
and are required due to an urgent medical or traumatic
event.

Medical disciplines and common procedures

Medical procedures are generally performed and/or
supported by a medical team in hospitals, doctor’s offices,
clinics, dental offices, etc. The medical team consists of
experts in various disciplines of medicine.
The medical team
The hospital medical team consists of a consultant,
registrars, head nurse, senior nurse, bedside nurse,
pharmacist, dietician and physiotherapists, with possible
support from microbiologists, or surgeons.
Medical and diagnostic equipment

● A stethoscope used to listen to breathing, lung and

heart sounds
● A Baumanometer/blood pressure machine used to
check a patient’s blood pressure (BP)
More complicated examples can include:
● Therapeutic equipment used to assist with patient
treatment, including infusion pumps and dialysis equipment.
● Life support equipment is used to maintain a patient’s
basic bodily functions (breathing, kidney function) and
includes medical ventilators, anesthetic machines, heartlung
machines, extracorporeal membraneous oxygenation (ECMO),
and dialysis machines.
● Diagnostic equipment, such as electrocardiography
(ECG), a non-invasive trans-thoracic recording of the
electrical activity of the heart captured and externally
recorded by skin electrodes and direct imaging devices.
The range of diagnostic imaging equipment that is available,
giving the ability to look into the body without the need for
surgery, is an example of some of the greatest advances in
medicine in recent years.X-rays were used for this purpose, in
particular to view
damaged (broken or fractured) bone. But technological
advances now include:
● Magnetic resonance imaging (MRI) is an imaging
technique used in radiology to visualize detailed internal
structures. The imaging makes it possible to differentiate
between healthy and unhealthy/abnormal tissue, it is
especially useful in brain, muscles, heart and cancer
diagnosis
● Computed tomography (CT) is a medical imaging
X-ray procedure which uses ionizing electromagnetic
radiation (tomography) for processing the X-rays.

● Positron emission tomography (PET) is a nuclear

medicine imaging technique which produces a
threedimensional image or picture of functional processes in
the body.

● Cardiac catheterization is now considered a common

and routine medical procedure in many parts of the
world. It uses a number of device types in order to
Surgical procedures

● Pre-operative care is the preparation and management

of a patient prior to surgery. It can include both physical
and psychological preparation.

● Intra-operative care is the management of the patient

during the operative procedure whilst in the operating
room. The intra-operative period begins when the patient
is transferred onto the theatre table in the operating room
and ends when the patient is transferred to the recovery
area. During this period the patient may be anesthetized,
prepped and draped, and the operation is performed.

● Post-operative care is the management of the patient

after the procedure until discharge.
Surgical team members

Surgical team members can include a few or many

qualified persons, depending on the complexity of the
surgical procedure. These generally include the surgeon,
an anesthesiologist and various nursing staff.

Surgical techniques

There are many different surgical techniques that may be

used depending on the type of surgery to be performed,
available equipment, the surgeon or patient’s preference and
the patient’s anatomy or physiological condition at the time.
A summary of the major different types is given in Table 3.3.
Surgical disciplines and common procedures

● General surgery – general surgeons operate on almost

any part of the body. They confirm the diagnoses
provided by primary care or emergency physicians, then
perform the necessary procedures to correct or alleviate
the problem. If a specialized procedure is involved they
will often refer the patient to a relevant specialist.

● Cardiothoracic surgery – this is a common surgical

specialty and often with very high demands. The
cardiothoracic surgical team treats pathological conditions
within the chest, including the heart and its valves, the lung,
esophagus, and chest wall and blood vessels.
● Neurosurgery – neurosurgical teams specialize in surgery of
the nervous system, including the brain, spine and peripheral
nervous system, and their supporting structures.

● Oral and maxillofacial surgery – maxillary facial surgical

teams deal with surgical problems of the head and neck, that
is, the ears, sinuses, mouth, pharynx, jaw, and other
structures of the head and neck.

● Reconstructive and plastic surgery – performs surgery

on abnormal structures of the body due to injury, birth
defects, infection, tumors, or disease. They also perform
cosmetic surgery to improve a patient’s appearance.
● Transplantation – specializes in specific organ transplant
techniques, such as heart and heart-lung transplants, liver
transplants and kidney/pancreas transplants. These highly
intricate surgeries require very advanced training and
technological support.

● Urology and renal transplantation – deals with the

kidneys, kidney stones, bladder, urethra and ureters and
coordinate with transplant team members.

● Gastrointestinal surgery – the team specializes in problems

of the digestive tract (stomach, bowels, liver and gall bladder).
● Vascular surgery – diagnosis and treatment of arterial
and venous disorders such as aneurysms, lower extremity
revascularization and other problems.

● Pediatric surgery – specially trained to perform procedures

on infants and children. They work closely with specially
trained anesthesiologists, and are experts in childhood
diseaseswith training in birth defects and injuries.

The operating/procedure room

Medical procedures, due to their nature and range, can be

conducted in a variety of settings, ranging from at home,
general practice doctor office, clinics, dedicated hospitals
rooms, etc.
Operating room set-up

Each theatre should have an adjacent preparation (or

“scrub”) room or have access to a scrub area common to
a few theatres. It is designed to allow staff to prepare to
enter the operating room (theatre), but is also used for
storage and pre-warming (in a warming cabinet) of supplies
used during surgery (including fluids, blankets, sterile surgical
supplies, etc.).
Principles of aseptic (or “sterile”) ttechnique

Any medical or surgical procedure should be performed using

an aseptic technique, and particularly
within designated operating rooms. Aseptic technique
refers to practices and procedures to prevent microbial
contamination and to maintain an essentially “sterile” or
“clean” area.
● Unrestricted
General area outside the operating room complex
Street clothing is worn
Patient receiving area, changing rooms, office
● Semi-restricted
Mid-way between an unrestricted and restricted area
Restricted to authorized personnel only
Theatre attire must be worn
Operating Room complex passages/corridors, reprocessing
area (if present)
● Restricted
Where procedures are performed
Authorized personnel only
Scrub area, procedure room, sterile supplies stores
The actual restricted procedure room is further subdivided
into three area.
Pre-operative procedures
Pre-operative care is the preparation and management of a
patient prior to surgery. It can include both the physical and
psychological preparation of the patient, including reviewing
medical history, checking for any allergies, skin disinfection,
physical/medical examination, etc.
Intra-operative procedures

The patient is the “core” or centre of the sterile area. This

will also include any theatre staff directly involved in the
procedure wearing sterile surgical attire, the operating
table, other accessory equipment and any furniture that is
covered with sterile drapes such as trolleys and stands.
Post-operative procedures

Similar to pre-operative procedures, there are a series of

procedures performed post-surgery to ensure the wellbeing of
the patient. On completion of the actual procedure, but
typically before the surgical opening is closed (“sutured”), the
scrub sister should check that all instruments, sponges or any
other items used during the
surgery are present.
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