Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 109:
RLE MODULE 3F

Operating Room Technique

Procedure Guide
Group F-1:
Amante, Vanessa
Amores, Kate
Arandia, Aiza
Badiang, Steven Karl
Basalo, Danica Kate
Besin, Chast
Borces, Nicole Mykaela
Dandasan, Dave Antoni
Degracia, Dominic
Eslit, Denzelle Kate
Garnada, Giolie Ann Celesty
Gonzales, Juddey Gold

Facilitator:​ Ms.Nikki Rae R. Cayanan, RN

Date Submitted​: February 18, 2021
Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Related Learning Experience, Skills Laboratory

Operating Room Technique II

Learning Outcomes: ​After 4.5 hours of various classroom and laboratory activities, the Level II

students will be able to:

1. enumerate and identify the following:

1.1 basic instruments in the Basic Set as to:

1.1.1 clamping and occluding

1.1.2 viewing
1.1.3 cutting and dissecting
1.1.4 suctioning and aspirating
1.1.5 grasping and holding
1.1.6 dilating and probing
1.1.7 exposing and retracting
1.1.8 measuring
1.1.9 suturing and stapling

1.2 contents of the major pack and minor pack

2. demonstrate the beginning skills in performing:

1.1 medical handwashing

1.2 surgical hand scrubbing

1.3 opening and arranging drapes of the major pack 1.4 opening and arranging instruments of
the basic set 1.5 circulating experience

Criteria for Mastery:

1. Submission of Procedure Guide with rationales.

2. Individual Return Demonstration
Enrichment Activity

Read from following references enumerated below and prepare your notes before the
scheduled class.
Silbert-Flagg, J.S., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family (8​th ​ed.). Philadelphia: Wolters Kluwer
Berman, A., Snyder, S., & Frandsen, G. (2018). Kozier and Erb's Fundamentals of Nursing .
Philippines : Pearson Education South Asia PTE. LTD.
Hockenberry, M., Wilson, D., & Rodgers, C. (2017). Essentials of Pediatric Nursing. Canada:
Elsevier .
Potter, P., Perry, A., Stockert, P., & Hall, A. (2017). Fundamentals of nursing (9th ed.).
Singapore: Elsevier.
Wolters Kluwer Health. (2009). Lippincott's Nursing Procedures (5th ed.). Philadelphia:
Lippincott Williams & Wilkins.
VanPutte, C., Regan, J., & Russo, A. (2017). Seeley’s Essentials of Anatomy and Physiology (10​th
ed.). New York: McGraw-Hill
Lippincott Williams & Wilkins. (2008). Straight A’s in Maternal-Neonatal Nursing (2​nd ​ed.).
Philadelphia: Lippincott Williams & Wilkins.
Tighe, S. (2009). Instrumentation for the operating room. A photographic manual (7​th ​ed.).
Singapore: Elsevier.
Goldman, M. (2008). Pocket Guide to the operating room (3​rd ​ed.). Philadelphia: F.A. Davis
Company.

Materials needed:

Pick up forceps
1 Major Pack (complete)
1 Basic Set (complete)
Back table
Mayo stand
Cautery Cord
Suction Connecting Tube
4 x 4 and 4 x 8 operative sponges packed by 10 Suction tip (preferably Yankauer)
2 pairs of sterile surgical gloves
Procedure Guide: Operating Room Technique Responsibilities of the Scrub
Nurse

Sharps:
- Surgical / Suture scissors
- Metzenbaum scissors - Mayo scissors
- Bandage scissors
- Blade #10 & 20

Procedure Rationale

The forceps needs to be sterile in

PRE-OPERATIVE PHASE order to avoid contaminating the
inner layer of the Major Pack
1. Open the pick – up forceps using the sterile because it is used when opening it,
technique. which holds the sterile contents
(gowns, sterile gloves,and drapes).

The outermost layer of the Major

2. Open the outermost layer of the Major Pack with bare pack is unsterile, that’s why you’re
hands. going to use your bare hands when
opening it to reveal the inner layer
of the Major Pack.

This is to apply the principle of

3. Arrange the contents (gowns and drapes) of the pack. saving time and energy in the
Dispense the sterile gloves. Place the folded side of the procedure. Dispense the sterile
gown facing the OR door gloves in order to be properly worn.
When folding, it is done that way
also to save time and energy.

These materials are set in that

4. Arrange each set in this order: (from bottom to top) specific order because it is the most
efficient and cleanest way to use the
• Gloves objects in that it is arranged by when
it is to be used. That way, there is no
• Gowns
unnecessary moving of the materials
that can potentially cause delay or
• hand towels
unwanted contamination.
Dividing the table into portions will
5. Divide the back table into two portions (sterile and keep it organized and it will save
clean). The area adjacent to the gowns is considered the time and energy.
clean side.

This is done to prevent the spread of

6. Line the clean side of the back table with a towel microorganisms.
drape.

The outermost wrapper is unsterile

7. Open the outermost wrapper of the Basic set using that’s why you’re going to use your
your bare hand away from the sterile area. Open the bare hand and use forceps when
next layers using the pick – up forceps. opening the inner wrapper because
it’s sterile and holds the basic set.

When transferring the Mayo tray use

8. Lift the Mayo tray. Take note of the tips of the the dominant hand to avoid
wrapper with the non- dominant hand, grab the ends of accidents because it is stronger.
the wrapper making it sure it doesn’t come in contact Grab the ends of the wrapper to not
with the sterile field. contaminate the sterile field.

To avoid contact from the wrapper

9. Gently slide the Basic set in to the lined area of the to the sterile field slide the basic set
back table. Carefully remove the wrapper from the into the lined area. It also avoids
Mayo tray. disarrangement of the contents of
the Mayo tray.

Dropping the sterile instruments one

10. One by one, drop other sterile instruments (sharps & by one into the sterile field of the
other additional supplies) cautery and suction back of the table in order to avoid
connecting tube, sponges and etc.) into the sterile field sharp accidental injuries. Holding the
of the back table. Hold the packed instruments with the packed instruments with the label
label facing you. Take note that the instruments facing you to be make sure it doesn't
(individuals) are packed with 2 wrappers. come in contact with the non sterile
field.
There might be infectious particles
11. Cover the entire set – up with a hand towel using the on the air that might contaminate
pick – up forceps. the sterile set up. Using a pick-up
forceps will keep the area sterile.

Performing multiple sets of medical

12. Perform 3 sets of medical handwashing followed by handwashing will significantly
surgical hand scrubbing. decrease the amount of
microorganisms on extremities and
decreased potential risk for
transmission. Surgical hand
scrubbing will enhance the extreme
cleanliness as well.

Dry from fingers to elbows to

13. Pick the hand towel using your thumb and the observe technique of cleaning from
pointer finger to fully open the hand towel. Keeping most clean side to the least clean
your dominant hand steady, dry from fingers to elbows. side. Utilizing one side of the towel
With the non-dominant hand, grasp the other side of per arm will decrease the risk of the
the hand towel, and do the same procedure on the side of the used towel contaminating
other hand. the clean arm.

Putting on the gown is a very picky

14. Lift the gown with the thumb and grab it with the technique as any false moves or
remaining four (4) fingers. Look for the armholes. Flip dropping of the gown will initiate a
the gown to expose the sleeves. With the opposite repeat in scrubbing and new
hand, insert the fingers into the sleeves. Release the equipment in order to stay sterile.
folds of the gown, making sure that the gown does not
touch the floor.

This allows efficiency in doing the

15. Insert one arm into the sleeve, halfway. Do the same procedure and also maintains the
with the other arm. area sterile.

This will ensure that the gown still

16. Don the gown. Grab the OR gown belt by the waist maintains its sterility and that there
and slide it towards the side. Serve the belt to the won’t be any unnecessary
circulating nurse. movements done.
Closed gloving will allow a more
17. On the back table as the working area, perform sterile technique as opposed to open
closed gloving. Remember to keep your hands inside the gloving. The hands must be kept
gown cuffs. inside the gown cuffs as well to
ensure sterility of the gown and
gloves.

Draping the mayo stand with a

18. Drape the mayo stand. Make sure not to touch the sterile cloth keeps the mayo tray
mayo stand with the sterile hand. Move the draped from being unsterile. The back of the
Mayo Stand next to the back table. table is considered the working area

This is to promote mobility and

19. Transfer the Mayo tray to the Mayo stand. convenience to the surgeon and
Increased Operating Room
Efficiency.

This would be easier to put the waste

20. Assemble the surgical bowl, kidney basins and and instruments from the operation.
medicine cups by making a “Smiley Face”.

The towel roll is placed under the

21. Make a towel roll using one of the towel drapes. instruments because it serves to
Take the instruments and hold them firmly at the elevate the instruments. Make sure
handle of the sponge holder and its tip. Position the the sharp ends of the instruments are
tips of the instruments facing the clean area of the back facing against the patient.
table. For any additional instruments, place them after
the sponge holder.

It is important to secure the suction

22. Insert both ends of the suction connecting tube into connecting tube and tip because it is
both handles of the towel clip. Attach the suction tip used to clear operative sites during
(Yankauer Suction Tip) into the blue port of the suction surgical procedures and its suctioned
connecting tube. Set aside. volume counted as blood loss during
surgery.

Gently place and load blades to their

23. Load blades to their handles. handle since blades are sharp and
dangerous.
Identifying the magic corners to have
24. Set four towel drapes. Identify the magic corners to a draping material that is easy to
fold all together (tri-folded) handle and flexible in order to
conform as much as possible to the
contour of the patient and OR table.

Setting the mayo tray with the mayo

25. Set the mayo tray with the mayo cover. Using the cover so that there is no sterile drape
glove wrapper, line the mayo tray. hanging down beneath the stand.

Lining these instruments in this

26. Elevate the following on to the mayo tray specific order is to save time and
(according to use) – proximal to distal: energy. Having an organized
workspace allows everyone to work
Instruments & other supplies: efficiently and allows the procedure
to run smoothly.
● Pick-up forceps with & without teeth
● Sharps (Mayo & Metzembaum Scissors)
● Kelly curved and straight forceps
● Army-Navy Retractors
● Cautery
● Suction Connecting tube with suction tip

Drapes: (arranged from bottom to top)

● Laparotomy Sheet
● Towel Drapes (4 pieces folded together)

Counting all the equipment will

27. Count the instruments, needles, & operative ensure that everything is prepared
sponges together with the circulating nurse. and surgery will run more efficiently
rather than disrupting the flow of the
surgery.

Ensures that the hand towels, gowns,

28. Prepare the hand towels, gowns, and gloves to be and gloves are readily and
served to the surgeon and assistants to the surgeon. immediately ready for use by the
surgeons and its assistant.
29. Serving to the surgeon/assistant as follows:

Towels
1. Observe the principle of
1. Hold the “dog ear” of the hand towel.
microbiology at all times and it is
2. Serve the hand towel carefully without important to hold only the unsterile
touching the hand of the surgeon/assistant with portion to maintain the cleanliness.
your gloved hand. 2. The surgeon/assistant has to
maintain sterility throughout the
Gowns procedure, serving the towel must be
done carefully to avoid cross
1. Locate and hold the neckline of the sterile gown contamination.
using your dominant hand.
2. Drop the folds of the gown. Position the 1. To facilitate an easier way of
armholes facing the surgeon. wearing the gown.
3. Release the gown as it reaches the forearm of 2. Drop it properly, be careful not to
the surgeon. touch the gown into the floor to
maintain the sterility.
Gloves 3. This is to avoid the touching the
sterile body part of the surgeon
1. Unfold the cuff of the right glove.
2. Make sure the thumb side of the glove is 1.To make it easier to wear the
facing the surgeon. gloves.
3. Insert your four fingers, of both hands, into 2. This will help the surgeon to don
the unfolded cuff gloves easily.
4. Maintain stability by standing across the 3. To properly hold the gloves
without being in contact with the
surgeon with your right foot forward. Lock
sterile part.
your elbows.
4. To have a wide base support and
5. Serve right glove with the thumbs facing out.
put distance between you and the
6. Repeat steps 1-5 in serving the left glove. sterile area.
5. To provide guidance and easy
Serve the laparotomy sheet, draping towels, and other
access to the surgeon.
supplies to the surgeons and assistants.
6. To completely don gloves.

This will ensure the smooth and

INTRA-OPERATIVE PHASE efficient progress of the procedure.
Save time and energy. Also, provide
1. Assist the surgeon all throughout the procedure. quality care.
It is important to be attentive and
2. Listen carefully as to the surgeon’s requests. Serve focused to comprehend the
the instruments accordingly. surgeon’s requests and serve the
correct instruments. Saving even
seconds will save the patient’s life.

Speed and precision is vital to the

3. Anticipate the needs of the surgeon and the success of an operation. Anticipating
assistants. the needs of the surgeon will bring
about efficacy and speed.

Arranging the instruments will save

4. Continuously arrange the instruments according to time and energy. An organized
their use. workplace will also make it easier for
you to provide the instruments
needed.

To save time and energy, preparation

5. Prepare the needed sutures and other supplies. of the supplies will be easier for the
These should be made available during the operation. nurse during the procedure.

The operative field should be kept in

6. Check the operative field. This must be kept in order. order so as to not bother the people
who are crucial in the procedure.
Less distractions is equal to more
focus.

To maintain sterility and cleanliness.

7. Separate the used instruments from the unused ones. To avoid the spread of
microorganisms from the used
instruments to the unused ones.

To maintain sterility and cleanliness.

8. Serve new sponges.

To have all the instruments

9. Do partial count with the circulating nurse before the accounted for and ensure that none
start of suturing. of them are left inside the patient.
Maintaining sterility promotes
10. Keepall Instruments Sterile At The Completion of the proper conduct.
surgery.

Again, this is to ensure that all

11. Dofinal Counting With The Circulating Nurse. instruments are accounted for and
that none are possibly left inside the
patient.

Arranging the instruments makes it

POST-OPERATIVE PHASE easier to take note of which
instruments are present and if there
Note: ​It is the responsibility of the scrubbed nurse are any instruments missing.

to do after care of the instruments.

1. Arrange all the instruments.

Proper disposal is for the safety and

2. Discard the needles and blades appropriately in a security of the patient and the other
container. health care workers. Needles and
blades must be discarded in the red
bin.

The yellow trash bin contains

3. Check soiled and unused operative sponges. Discard infectious and pathological waste.
those in the yellow plastic bag. Proper disposal of such wastes
protects patients and hospital staff
alike from possible infections.

This will ensure that the no

4. Recheck all linens/drapes, including the gowns. Make equipment is lost and can then be
sure that there are no forceps included. sterilized for the utilization in the
next surgery.

This is done to ensure cleanliness on

5. Discard soiled gowns and other drapes, such as, plain the work area and avoid cross
sheets and mayo cover. contamination for the next
operation.
Ensures that the table is immediately
6. Prepare the back table for the next surgery. ready for use during the next
surgery.

Autoclaves are used to sterilize and

7. Pack the Basic Set and other additional instruments decontaminate surgical instruments
for request for autoclave. and labware to prevent cross
contamination of microorganisms
from one patient to another.

The charge nurse is assigned to

8. Report to the charge nurse for the next assignment. supervise and delegate tasks to
other nurses and it is important to
report to them to avoid a conflict of
tasks and schedules.

Revised June 2018

Responsibilities of the Circulating Nurse

Procedure Rationale

Medical handwashing is needed, to

PRE-OPERATIVE PHASE prevent cross contamination of
microorganisms. Preparing the
1. Perform medical handwashing. Prepare the operative needed equipments this is to follow
theatre and its equipment needed for the operation. the scientific principle time and
energy

Receiving endorsement from the

2. Receive endorsement from the floor nurse. Review floor nurses, helps the continuation
the OR checklist and the preparation of the patient of care. Reviewing OR checklist can
from the floor nurse. prevent mistakes and misconduction
of services such as in preparing the
patients.
Checking consent forms can be use in
3. Check the consent to operation, signed by the the future purposes, this also helps in
patient. agreement for such operations being
taken and documentation.

Reviewing together helps teamwork

4. Review with the floor nurse the pre-operative orders, and to avoid mistakes, especially in
medications, and other special endorsements. conducting the operations, check
everything for the patients safety.

Transporting the patient carefully

5. Transport the patient from the receiving area to the from the receiving area to the
operating theatre. operating theatre, helps in
completing the preparations needed.

Orienting the patients helps them

6. Orient the patient as to the set-up, especially the know what do’s and dont’s they need
Recovery Room for post-operative management. to do.

Monitoring devices serve to

7. Position the patient comfortably on the operating continuously keep track of the
table. Attach various monitoring devices, like the patient’s vital signs and immediately
cardiac monitor. alert the health care team of any
changes.

Verifies the instruments/ supplies

8. Check the preparation of the instruments/supplies prepared whether there is excess or
made by the scrubbed nurse. lack thereof.

This is to save time and energy.

9. Prepare the materials/equipment to be used by the Allows the anesthesiologist to work
anesthesiologist on the anesthesia table. Cover the efficiently.
table with a sterile drape.

The final position of the patient is of

10. Position Patient According The type/method of the utmost importance, but achieving
anesthesia to be inducted these positions requires careful
planning and coordination by the
operating room team. The overall
plan for each patient transfer should
be discussed prior to any movement.
Like pertinent patient comorbidities
should be reviewed first they might
have unstable spine fractures will
require additional staff for transfer
and positioning.

​The scrub will count the sponges

11. Do initial sponge and instrument count with the scrub with the circulating RN at the first
nurse. opportunity. An RN must witness the
count. A sponge count is necessary
for surgical procedures when the
depth or the location of the wound
may allow a sponge to be left
undetected in the wound.

Organizing supplies and actions for

INTRA-OPERATIVE PHASE the anesthesiologist is to ensure the
best possible outcome throughout
1. Assist the anesthesiologist in the induction of any surgery
anesthesia. Serve the sterile supplies needed.

This is to ensure safety and deliver a

2. Assist in FBC insertion. stage of care during the course of
surgery.

This is accomplished by removing

3. Do skin preparation based on the site involved. dirt and oil without causing damage
to the skin’s natural protective
function

The time-out represents the final

4. Initiate Time-Out following the guide questions recapitulation and reassurance of
written in the WHO Surgical Safety Checklist. accurate patient identity and surgical
site.

Time is one of the details needed to

5. Take note of the time of the first incision made by the be documented and by being detail
surgeon. oriented means is the ability to assist
with the procedure while listening to
the surgeon and monitoring the
patient to indicate that the
procedure will go smoothly

To avoid wasting time and energy

6. Anticipate the needs of the sterile team.

To save time and energy by

7. Assist the anesthesiologist as to what medications are providing what is needed and at the
needed. same time, make the medication
readily available for the benefit of
the patient.

To detect any deterioration in the

8. Continuously monitor the patient’s vital signs & early phase, which can allow
cardiac status. Note for any unusualities. preventive measures to be done
before any complications might
happen.

To ensure patient safety and

9. Do partial and final counting at proper intervals. accountability for all items used
during a surgical procedure.

To document legally all the

10. Finalize the operative record. procedures done to the patient.

To ensure that the client is safe and

11. Assist the anesthesiologist in transferring the client comfortable.
to the Recovery Room.

To provide direct and continuous

POST-OPERATIVE PHASE patient observation during recovery

1. Endorse the patient to the Recovery Room Nurse.

To maintain the continuity of care of

2. Report to the charge nurse for the next assignment. the patient.

Revised June 2019