Perioperative Nursing

PERIOPERATIVE NURSING

Nelia B. Perez RN, MSN

Northeastern College

Santiago City, Philippines 3311

SURGERY

Planned alteration of the human body designed to:

• Arrest

• Alleviate

• Eradicate some pathologic process

Operating Room Nursing

• Oldest nursing specialty on record.

• Dates back to 1875 with 1st lecture to nurses “ Surgical Instrument Preparation for Surgery”.

• Given at John Hopkins University in Baltimore

Highlights in the Evolution of OR Nursing• Request of the Chief Operating Room

Nurse at Boston Training School.

• Ward Nurse-OR Nurse Role

• Dr. Joseph Bell recognized the specialized training of nurses assisting in the OR.

• 1894, Dr Hunter Robb introduced the “Team Concept”.

Team Concept in 1894

• Senior Nurse in the Scrub Role

• Junior Nurse or Student to assist with dispensing sterile supplies to the surgical field

• Physician Assistant, usually an intern, trained to assist the attending surgeon.

• In 1910, Senior nurses start to function as circulating nurses.

• 1919, Establishment of the OR Rotation.

• 1933, NLN ( National League for Nursing) has outlined a master curriculum plan for advance courses in OR Theory and technique.

1940 – 1945 : The War Years

Emergence of Nursing Aides and Orderlies.Training of Surgical Technician.Medical Corpsmen were trained and role of

Nurses expanded to include giving anesthesia and 1st assistant during surgery.

Shift from general practitioners to specialist began to emerge.

1946 to 1960 : Post-War Changes

• Need to train OR nurses became the lowest priority of the NLN.

• OR Rotation was phased-out.

• In 1949, OR Rotation was eliminated from the Nursing Curriculum.

• OR Nursing was no longer mandatory.

Emergence of OR Nursing As A Specialty• 1949, Association of Operating Room

Nurses (AORN) was established. • Edith Dee Hall - Founder• Spearheaded OR Nurses to form groups

to share knowledge, motivate experienced OR Nurses to teach the neophytes, and promote and benefit professional operating room nursing to a level of specialization.

Perioperative Nursing Practice

• Roles of the nurse

1. prepare the patient and family for surgery.

2. provide comfort and support to patient and family

3. use sound nursing judgment and problem solving techniques to assure a safe and effective surgical experience.

Duties and Responsibilities

• Assess patients physiologic and psychologic status before, during and after surgery.

• Identify priorities and implementing care based on sound nursing judgment and individual patient needs.

• Function as a role model of a professional perioperative nurse for students and colleagues.

• Function as a patient advocate by protecting the patient from incompetent, unethical or illegal practices during the perioperative period.

• Coordinate all activities associated with the implementation of nursing care by other members of the health care team.

• Demonstrate a thorough knowledge of aseptic principles and techniques to maintain a safe and therapeutic surgical environment.

• Direct or assist in the care and handling of all supplies, equipment, and instruments to ensure their economic and efficient function for the patient and personnel under both normal and hazardous conditions.


• Perform as the scrub or circulating nurse as needed, based on knowledge and expertise for a specific procedure.

• Participate in continuing education programs directed toward personal and professional growth and development.

• Participate in professional organizational and research activities that support and enhance perioperative nursing practice.


Professionalism and Perioperative Nursing

INTRAOPERATIVE PHASE

POSTOPERATIVE PHASE

PREOPERATIVE PHASE

Careg

iver

Leader change agent

Researcher Te

ache

r

Client Advocate

Education in University setting and scientific

background in nursing

DEMOGRAPHICS OF THE SURGICAL SUITE• PROCEDURE ROOMS

• STORAGE AREAS

• ANCILLARY SUPPORT AREAS

Three Zone Concept

• The Unrestricted Area

• Semirestricted Area

• The restricted Area

Traffic Patterns : Controlling the Environment• All personnel entering the surgical suite

should follow a well-delineated traffic pattern.

• Movement of patients, supplies and / or equipment should be along the most direct route that prevents cross-contamination and / or undue exposure by either space or time.

Supplies and Equipment• Separation of clean and dirty item is essential to

maintain aseptic environment.• Remove items from corrugated paper boxes before

they enter the surgical suite.• Equipment coming from outside areas must be

damp-dusted with the recommended germicidal solution.

• Soiled instruments and items used during a surgical procedure that require reprocessing must leave the procedure room covered or contained in some manner to prevent cross-contamination during transport to the designated areas.

Supplies and Equipment

• Items such as linen and trash should be double bagged for proper containment, sealed and tied, and taken to a a designated area for pick-up and disposal by appropriate personnel.

• Practice good handwashing technique.

Environmental Safety

• Size of the Procedure Room- standard size is 20 X 20 X 10 with a minimum floor space of 360 square feet.- should contain the following:

1. communication system, internal and external

2. oxygen and vacuum outlets3. mechanical ventilation assistance

equipment4. Respiratory and cardiac monitoring

equipment.

5. X-Ray film illumination boxes

6. Cardiac Defibrillator with synchronization capability

7. High efficiency particulate air filters

8. Adequate room lighting

9. Emergency lighting system

10.Entry and exit from substerile area for personnel

Others

• Temperature and Humidity Controls

• Ventilation and Air Exchange Systems

• Electrical Safety

• Communication Systems, Internal and External

Infection Control: Principles and Practices

• Scrub Suit

• Headgear

• Shoe Cover

• Surgical Masks

• Additional Recommendations

Operating Room AttireOperating Room Attire

Environmental Sanitation

• Effective environmental sanitation programs must be established to reduce the possibility of cross-contamination, which may lead to surgical wound infections, as well as the protection of personnel within and without the surgical unit.

• Concept of universal precaution.

• Appropriate cleaning and disinfection procedures can reduce the possibility of transmitting pathogens.

• Careful attention is given to the preparation of a procedure room by the surgical team and the principles of contain and control become primary importance to all personnel associated with the surgical procedure.

Preliminary Cleaning

• Responsibilit of the Scrub and Circulating nurse to see that everything is ready prior to the acceptance of a patient.

• Remove unnecessary equipments not needed for the procedure.

• During the procedure, all efforts must be made to contain and confine the contaminated items. If an instrument falls to the flow, and requires immediate sterilization, the item should be washed first to reduce the number of contaminated microogranisms on the instrument.

• At the conclusion of the case, gross soil and debris should be removed from the instruments if necessary, and the tray covered and taken to the appropriate area for decontamination and reprocessing.

• IF a case cart system is used, all reusable items and equipment are placed inside the cart. The cart is closed and taken to the decontamination area.

Interim Cleaning

• After the surgical procedure, all items that have come in contact with the patient or sterile field should be considered contaminated.

• Adequate time must be allowed for proper disinfection and set-up of the procedure room.

Terminal Cleaning

• At the conclusion of the day’s schedule, each procedure room, scrub / utility area, corridors, furnishings and equipment should be terminally clean.

• The cabinets in the room should be restocked with sterile supplies, with the cleaning personnel being careful to rotate the stock of “in-hospital” sterilized items to reduce the risk od using “out-dated” sterile supplies.

Weekly or Monthly Cleaners

• Should be established in the surgical suite.

• It should include thorough cleaning of ceilings, walls, floors, air-conditioning grills, sterilizers, and solution dispensers. Kick buckets should be washed and sterilized, and cleaning equipment routinely used should be disassembled and disinfected.

Organizational Structure : The Team Concept

Functions of the Surgical Team

• Performance of the operative procedure according to the needs of the patient.

• The primary decision maker regarding surgical technique to use during the procedure.

• May assist with positioning and prepping the patient or may delegate this task to other members of the team.

The SurgeonThe Surgeon

The First Assistant to the Surgeon

• Amy be a resident, intern, physician’s assistant or a perioperative nurse.

• Assists in retracting, hemostasis, suturing, and any other tasks requested by the surgeon to facilitate speed while maintaining quality during the procedure.

Anesthesiologist

• A physician who specializes in the administration and monitoring of anesthesia while maintaining the overall well-being of the patient.

The Nurse Anesthetist

• An advanced registered nurse practitioner who after additional training and certification in anesthesia may administer and monitor the anesthesia using the anesthesiologist as a consultant if necessary.

The Scrub Assistant

• May either be a nurse or a surgical technician.

• Responsible for assisting the surgeon and assistant with instrumentation, et-ups, suture presentation, sponges, etc, while maintaining the sterility of the surgical field through aseptic practices.

The Circulating Nurse

• Must be a registered nurse, who after additional education and training, is specialized in perioperative nursing practice.

• Responsible and accountable for all activities occurring during a surgical procedure, including but not limited to management of personnel, equipment, supplies, and the environment.

• Patient advocate, teacher, research consumer, leader and role model.

• May be responsible for monitoring the patient during local procedures.

Paraprofessionals

• Sterilization, rpocessing and distribution technicians.

• Orderlies / nursing assistants

• Environmental services personnel

• Clerical personnel