PREPARING ROOM FOR MAJOR SURGERY
Definition: The assembling and setting up of all articles and equipment in the operating suite in preparation
for a major operation.
Purposes:
1. To provide a sterile field for the operation.
2. To ensure sterility of all articles that are used in the operating field and related procedures.
3. To ensure optimum safety for the surgical patient.
Equipment:
I. Furniture and Equipments
Gown pack table Arm board
Lap pack towel IV poles
Mayo or instrument table Arm straps
Basin stand Portable sphygmomanometer
2 sitting stools Stethoscope
2 bucket stands Suction apparatus
Footstools Operating table
Electrocautery machine
II. Special Equipment and Supplies for General Anesthesia
Anesthesia Machine and its Accessories: Magil forceps
➢ Rebreather bag
➢ Corrugated tubings Sterile hypo-tray containing:
➢ Endotracheal tubes (different sizes) ➢ 1 pc. 10 cc syringe
➢ Nasotracheal tubes (different sizes) ➢ 1 pc. 5 cc syringe
➢ Bite blocks/airways ➢ 2 pcs. withdrawal needle
Wire guide KY jelly as lubricant
Laryngoscope 1 pc. clean 5 cc plastic disposable syringe
Stethoscope 1 full oxygen tank (color coded white)
1 full nitrous oxide tank (color coded blue)
III. Basic Sterile Packs
Lap pack (laparotomy linen pack) Additional sterile circulating packs:
Gown pack ➢ Poole drain tubing
Gloves ➢ Electrocautery
Basic instrument set ➢ Big retractors
Basin set ➢ Abdominal squares
Major prep set ➢ Sponges
Spinal set
IV. Special packs – as needed depending on the type of surgery and to a certain extent what the surgeon
prefer.
STEPS KEY POINTS, PRECAUTIONS,
RATIONALE
Important: OR Circulator nurse must be in ➢ Persons suffering from cough, cold or with
her/his proper OR attire and must have cuts or wounds on skin are not allowed inside
washed her/his hands before doing any the OR.
procedure.
1. Turn on the air conditioner.
2. Do damp dusting of furniture and lights.
3. Move glove, instrument and lap tables, basin To provide a good margin of safety.
stands, spinal tray and major prep stands one
foot away from the wall.
4. Adjust the height of the mayo stand within
elbow level.
5. Survey major room and determine what packs
are to be brought in.
6. Bring in two buckets and place one near the
lap table, the other near the sponge table
(earlier used as the gown table).
7. Bring in needed foot stools and position them The number and height of the footstools depend
near the operating table. on the people scrubbing. Sitting stools are used
as spinal set and major
prep stands.
8. Bring in needed packs and put them on their
respective tables or stands. Place packs at the
middle of the table stand.
9. With bare hands untie and open first wrapper Open wrapper away from you. Loose ends
of all packs. Tuck loose ends of ties under the may touch floor and invite contamination.
pack.
Note: Two sterile forceps are used from here on.
GOWN PACK:
10. Open second wrapper (inner wrapper) of
gown pack.
In SUMC, Sterigage is used- the transparent part
11. Check sterilization indicator strips. will become dark indicating that pack has been
subjected to sterilizing temperature.
12. Add to the gown table the number and correct Gloves for scrub nurses are placed at the left
sizes of gloves for the scrub team. (Refer to lower corner of the table and the rest of the
preference cards for sizes of gloves for the gloves at the right lower corner. Doctor’s
surgeon) gowns are placed with the neckline facing you.
STEPS KEY POINTS, PRECAUTIONS,
RATIONALE
13. Transfer one nurse’s gown with hand towel on To prevent crossing over sterile field and
the left lower side of the table over the scrub facilitate gowning and gloving without the
nurse’s gloves. help from the circulating nurse.
14. Cover gown and glove table and fold back Ensure that gowns and gloves are fully covered.
edge of cover in front keeping the fold in line Observe draping away from you in covering
with table edge. the table.
LAP PACK and BASIN SET:
15. Open inner wrapper of lap pack.
16. Remove and check indicators accordingly.
18. Remove and place topmost drawsheet to left
upper side of the table.
19. Remove rolled towel from the pack and place
in middle front part of the table.
17. Open inner wrapper of basin set. Basin set is wrapped in 2 dressing
towels in T-form. Fan-fold upper half
18. Transfer 2 bowls, kidney basin, 1 sponge of dressing towel to open set.
basin and the prep cup to the lap table.
19. Cover basin set leaving enough opening for
pouring sterile water into the basin. Use long, heavy transfer forceps. Set prep cup
near right lower corner of lap table to facilitate
20. Pour sterile NSS into one of the bowls. pouring of antiseptic.
21. Pour betadine antiseptic into prep cup.
22. Add the following to the kidney basin on the Observe correct technique in pouring.
lap table:
a. 2 pcs. Scalpel (#20,10,15 or 11) Observe correct technique.
b. sutures
c. rubber tubing (Poole drain) Blades and sutures are removed from the
d. electrocautery foil wrappers before adding them to the lap
e. others table. Small sterile packs (rubber tubing,
electrocautery, etc.) are removed from
24. Cover the lap pack (once all the instruments, outer wrapper before being added to the lap
lap squares, sterile strips are transferred) fully table.
leaving a flap in front.
MAYO TABLE:
25. Drape mayo table: Use long, heavy transfer forceps.
a. Insert forceps into the folds of the mayo table
cover. Spread the opening of the cover.
b. Carry with technique near mayo table. Observe correct technique.
c. Place foot on base of mayo table to stabilize it.
d. Place the opening of the cover to end nearest
you and insert it into the mayo table. Drape the first towel away from you and the next
towel towards you.
26. Line the covered mayo table with 2 3 x 3 lap
towels.
27. Place the sterile basic instrument set on the Observe aseptic technique.
mayo table.
28. Open instrument set and transfer the following The retractors are placed in the left side of the lap
instruments/supplies to their proper places in table. The towel clips, babcocks, needle holders,
the lap table: kelly forceps and pean forcep are placed in the
a. 2 pairs of Richardson retractors rolled towel in the lap table. Transfer the pean
b. 1 pair army-navy retractor forcep beside the prep cup. The long ovum forcep
c. 1 straight pean forcep is placed together with the retractors.
d. 2 straight Kelly forceps The lap squares and sterile strips are placed in the
e. 2 needle holders medium-size basin.
f. 2 babcocks
g. 6 towel clips
* These are threaded thru one long
sponge/ovum forcep
h. 2 lap squares
i. 5 sterile strips
29. Arrange the rest of the instruments in the Follow institutional set-up.
mayo table:
a. 6 mosquito forceps, curved
b. 6 kelly forceps, curved
c. 6 allis forceps
d. 6 pean forceps, curved
e. 2 scalpels (from the lap table)
f. 1 metzenbaum scissor
g. 1 mayo scissor
h. 1 suture scissor
i. 1 bandage scissor (for Caesarean Section
procedures)
j. 2 thumb forceps
k. 2 tissue forceps
30. Cover the mayo table fully leaving a flap in
front.
MAJOR PREP SET:
31. Open inner wrapper of the major prep set. Add Major prep set is wrapped in folded lap towel.
the following: Fan-fold upper half of lap towel in opening set.
a.1 pair of sterile glove
b. Extra sponges
c. Cotton applicator (if needed) Observe aseptic technique.
d. Foley catheter (if for catheterization)
32. Pour betadine cleanser to the bowl.
33. Bring fan-folded half of towel over set to fully
cover set.
SPINAL ANESTHESIA SET:
34. If the patient is for spinal anesthesia, perform
the following:
a. Open spinal set with technique. Spinal set is wrapped in 2 dressing
b. Add 5 cc /1 cc sterile syringes. towels in T-form. Fan-fold upper half
c. Bring fan-folded half of dressing towel of dressing towel to open set.
over set to fully cover set. Sizes of spinal needle depends on the age of the
d. Pour betadine antiseptic on small container patient.
with cherry balls.
e. Add spinal needle.
f. Add ampule for anesthetic use.
STEPS KEY POINTS, PRECAUTIONS,
RATIONALE
OR SCRUB NURSE:
35. Scrub nurses enter the room and proceed to Observe aseptic technique. Keep gloves and gown
gowning and gloving. uncontaminated.
36. Instrument nurse open lap table aseptically. Do not allow drape to fall below waistline.
37. Prepare 2 wet strips and place on top of the These are given to the surgeon right before
instrument. incision.
37. Prepare the drapes.
38. Inspect the sheet in relation to the patient’s
anatomical position.
39. Drape paint sheet: Keep reasonable distance between nurse and
a. Hold rolled side of paint sheet and place it OR table:
2” below edge of sterile laparotomy towel and i. Laparotomy towels are draped over the
drop the folds on the opposite side of the operative site after it was prepared.
table. Keeping the gloved hands protected by ii. Be careful not to touch side of patient.
the folds of the pain sheet. iii. Surgeon proceeds to painting the area with
b. Pick sheet under the tuck-in plain sheet. betadine antiseptic.
c. Place one hand on top to hold sheet in place.
d. Place the other gloved hand under turned-
back fold with marked “feet” and spread to cover
the lower extremities of patient.
40. Give straight pean and prep cup to surgeon. Surgeon does this.
41. Hand one at a time four lap towels to surround
operative area.
42. Give 4 towel clips to secure towels in place.
43. Drape laparotomy (fenestrated) sheet:
a. Hold rolled side of sheet and place its
openings (fenestrated) directly over the site of
proposed incision and drop the folds at the
opposite side of the table.
b. Keeping the gloves hands protected by the
folds, open the sheet over the feet area. Anchor
the sheet with opposite hand to prevent
dragging it off position.
44. Take your place to assist in the surgical
procedure. (Circulating nurse moves the mayo Note: Sponge counting must be done by the
table: lap table and sponge table near the sponge nurse and circulating nurse before the
operative field). operation starts and properly accounted for before
closure of the peritoneum and then the
subcutaneous part. Use the SIN format (Sponges,
Instruments and Needles counting sequence).
WHO Operating Checklist will also be done by
the Circulating nurse before the start of the
operation.
(Adapted from Silliman University Medical Center Foundation, Inc. (SUMCFI) Operating Room practice.
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