UNIT 2
Operating Team and Relationships
Prepared by Abas(BSc.N, Candidate of MSc.)
Objectives
At end of this unit students will able to:-
Discuss the surgical team composition
Discuss the responsibilities of each surgical team members
List the responsibilities of Unsterile team members
Identify the responsibilities of sterile team members
List the responsibilities of scrub nurse
List the responsibilities of circulator nurse
Surgical Team
Definition:
• A group of professionals providing the continuum of care during:-
Pre-operative, Intra-operative, Postoperative and recovery
OR Team Contains specialized members including:
Surgeon, Assistants (One or two),
Anesthesia provider (Anesthetist/Anesthesiologist),
Scrub, Circulator/runner,
Janitor/cleaner, Others
OR team subdivided according to the functions of its member as:-
Sterile vs Unsterile
Sterile Team
Wash (scrub) their hands and arms,
Put on (don) a sterile gown and gloves, and
Enter the sterile field, Handle only sterile items.
Work within limited area (only sterile field) and Consists:-
o Surgeon and Assistant surgeon
o Scrub nurse
o The patient
Non-Sterile/Clean Team
Work together outside and around the sterile field in the OR.
Handle supplies and equipment that are not considered sterile.
Keep the sterile team supplied, and Provide direct patient care.
Handle other requirements that arise during the surgical procedure.
• Non sterile team consists:
Anesthetist/anesthesiologist, Circulator/Runner, Cleaner/janitor.
Others, such as students, Biomedical technician etc...
Responsibilities of Each Surgical Team Members
Responsibilities of the Anesthesia Provider
Anesthesiologist:- Is a physician specialized in anesthesia.
Anesthetist:- A university or college graduate in anesthesia.
Nurse anesthetist:- Nurse who is trained administering anesthetic.
Anesthesia and surgery
Are two distinct, but inseparable disciplines;
Are two parts of one entity.
Responsibilities of Anesthesia provider
Functioning as a guardian of the patient,
Adequate communication b/n surgeon
Fluid and electrolyte administration
Selecting the anesthetic and Administering anesthetic agents
Intubating the patient, if necessary,
Providing a smooth induction of anesthesia – to prevent pain.
Maintaining anesthesia at the required levels
Monitoring vital functions and parameters
Responsibilities of the surgeon
Is team leader
Has ultimate responsibility for performing the surgery in an
effective and safe manner.
Is dependent upon other members of the team.
Must do every thing possible to ensure the safety of the patient.
Reduce the stress of the operation.
Pre op Dx, care and Post op mgt
Selection & performance of the surgical procedure
Responsibilities of the Assistant Surgeons
Under the direction of the operating surgeon, one or two
assistants help to:
Maintain visibility of the surgical site
Control bleeding
Close wounds and
Apply dressings
Responsibilities of the Scrub Nurse
Assists the surgeon by providing sterile instruments, sutures, and
supplies within the sterile field.
Perform check list before scrubbing
Check consent
Confirm surgical procedure
Check instruments
Check supplies
• Work with the surgeon.
• guided and directed constantly by what the surgeon is doing.
• Must have a constant attention to the operation field.
• Check internal sterilization indicator controls.
Responsibilities of the Scrub Nurse…
Works primarily with instruments and equipment.
Assemble instruments
Arrange instruments $ sterile supplies on back table and Mayo
tray.
Selecting instruments, equipment, and other supplies for surgery.
Prepares the setup and the sterile field
Setting up the sterile table
Prepare and drape mayo stand.
Responsibilities of the Scrub Nurse…
Separate and arrange sterile basins.
Assist surgeon in cleaning & draping patient
Arrange linen on double-ring stand next to sterile basin.
Identify and prepare appropriate suturing materials and ligatures.
Maintaining the integrity and sterility of the sterile field.
Assisting the surgeon and surgical assistant.
Anticipating the surgeon’s needs.
Preparing sterile dressings and Assist surgeon with dressing.
Responsibilities of the Scrub Nurse…
Keeping the track of time
Dispose of sharps
Cover soiled instruments before sending for cleaning/autoclave
Remove supplies from room and put in proper place.
Prepare instruments and supplies, used and unused, for clean up.
Cleaning and preparing instruments for terminal sterilization.
Assist circulator in preparing for next operation.
Responsibilities of the circulator Nurse
The surgical team who works outside the sterile field,
Providing patient care and procedures needed supplies.
Dons conductive shoes, cap, mask, and greens (pants & shirt).
Maintaining a neat, quiet, well-organized OR,
Anticipating & meet the needs of the other team members such as:-
• The scrub nurse, The anesthesia provider, The surgeon
Assembles & brings all packs, supplies, & equipment needed
Ties gowns for "sterile" members,
Sets up unsterile items of equipment; Performs other unsterile duties
Responsibilities of the circulator Nurse…
• Liaison b/n scrubbed personnel and those outside of the OR.
• Teaches students
• Manages the OR and protects the patient’s safety and health by
Monitoring the activities of the surgical team,
Checking OR conditions and assess patient for signs of injury
Implementing appropriate interventions
Verifying consent,
Coordinating the team
Responsibilities of the circulator Nurse…
• Monitors aseptic practices to avoid breaks in technique
• “Surgical or pre-procedure pause” or timeout”
• Assists with preparing the room,
• Identifies and assesses the patient.
• Plans and coordinates the intra op cares.
• Admits the patient to the OR
• Providing comfort and the safety of the patient
• Serves as the patient’s advocate throughout the intra op experience.
• Performing ongoing patient assessment
Responsibilities of the circulator Nurse…
Administering drugs
Implementing and enforcing policies and procedures that
contribute to pt safety, such as:-
► Surgical checklists, “time-out” protocols,
► Surgical counts and Checking equipment
Documents and preserves any specimens received during surgery
► Prepare specimen for laboratory.
► Preparing, labels and disposing patient of specimens
► Submits to the laboratory for analysis.
Responsibilities of the circulator Nurse…
Opening a sterile package
► Opening outermost top flap away from the body
► Opening left side flap away from the center
► Opening right side flap
► Opening bottom flap toward the nurse’s body and
► Folding it backward, to prevent it from reentering the sterile field
► Dropping sterile contents on the sterile field,
► Keeping at least 2 inches from the edge of the sterile drape.
► Pour sterile solution into sterile cup without touching and splash it.
Responsibilities of the circulator Nurse…
During positioning procedure, it is the Circulator responsibility to:
► Restrict access to the OR
► Close all doors and Minimize exposure
► Limit traffic within the OR
► Provide auditory privacy
► Prohibit prejudicial behavior
Coordinated Roles of the Scrub and the Circulator
The coordinated role is essential
► To move the schedule of surgical procedures efficiently
► To serve the best interests of the patient.
Complete preparation of the environment.
Consists:- Sponge, Sharp, and Instrument Count
General Responsibilities of Nurses in the OR
Nurses have diverse role involving some or all of the following:
► Preparation role
► Prevention role
► Assistance role
► Monitoring role
► Organizing role
► Supervision role
General Responsibilities of Nurses in the OR…
► Training role
► Safety ensuring role
► Controlling role
► Stock mgt role etc.
► Managerial role
► Record keeping role
► Statistical reports
General Responsibilities of Nurses in the OR…
Nurses may be assigned to
► Scrub, circulator, recovery room, instrument room,
► Anesthesia section, or any other area within the surgical suite.
Function in various roles, including those of
► Manager/director,
► Clinical practitioner e.g.,
Scrub, Circulator, Clinical nurse specialist,
Registered nurse first assistant [RNFA],
► Educator, and Researcher.
THANKS YOU !!!
GALATOOMA!!!
FOR YOUR ATTENSION
