Perioperative Nursing

Marie Pia Iscel M. Villa, RN, MAN

 Topics to discuss
• Perioperative Checklist
• Perioperative Health teaching
• Surgical Scrub and attire
• Preparing operating room table
• Identification of Surgical Instruments
• Providing early postoperative and convalescent
phase recovery
Perioperative checklist
• It is a checklist that is required to be asked and assessed
as part of your safe care before going for surgery.
• What will I expect?
– Your nurse in the Preoperative Holding or Prep
area on the day of surgery will make sure that all
your requirements are done before surgery.
• NPO
• Consent (surgery and anesthesia)
• Allergies
• Pre-op antibiotics
• Special endorsement (clearances, blood products,
post op labs/diagnostics)
Perioperative checklist
Perioperative Health Teaching
• Preoperative teaching is beneficial to surgical patients
in alleviating their anxiety and promoting their
postoperative recovery.
• Upon admission of the patient to the operating room the
circulator verifies verbally with the patient and by the
inspection of the patient armband and the chart the
patients name, date of birth, patients surgeon and what
surgery to be performed.
• As a nurse, explaining the environment to the patient what
they expect inside the theater, encourage them to ask
questions for them to feel at ease and give appropriate
information regarding the surgery
Surgical Scrub and Attire
• The surgical scrub is an important procedure required to
reduce the risk of contamination by microorganisms
during operative procedures.
• The main objective of surgical hand washing is to reduce
as much as possible of the germ load (especially
bacteria) that may be found on the skin of the hands and
arms of the surgical team.
• Some people question the importance of hand washing
since surgeons use gloves. However, these latex gloves
are fragile and can sometimes have microscopic pores
that, while not allowing the passage of blood and other
fluids, are a great outlet for germs that live on the skin of
the surgeon.
You must open your gown and gloves before you scrub,
so as not to contaminate your hands:
• First, open the gown. Carefully use the edges of the
paper to open the packet and expose the surgical
gown.
• Next, choose your gloves. Peel the plastic glove
packet open over the gown and drop the gloves onto
the sterile gown without touching them.
• This will ensure your gloves and gown are untouched,
and therefore sterile.
• Finally, put on
a surgical mask and eyewear protection. Make sure
you are comfortable, as you cannot adjust these once
you are scrubbed.
instruments
https://www.youtube.com/watch?v=LrkJUKLnqaw
 instruments

Mosquito
instruments

Allis
 instruments

Ochsner straight or
Kocher straight
instruments

Needle
holder
instruments

Thumb
forcep
 instruments

Adson
forcep with
teeth
Towel clamp metzenbaum scissors
Schnidt Forceps Laryngeal Mirror
instruments

digman retractor castroviejo needle holder

instruments

Iris scissors Septum elevator

1. Ovum straight / sponge stick
2. Richardson
3. Army navy
4. Needle holder 14. Allis
5. Yankauer 15. Pennington
6. Bandage scissors 16. Kelly clamp straight
7. Metz scissors curve 17. Kelly clamp curve
8. Mayo scissors 18. Mosquito clamp curve
9. Bladder retractor 19. Thumb forcep
10. Self retractor 20. Tissue forcep
11. Blade holder number 4 21. Adson forcep with teeth
12. Blade holder number 3 22. Adson forcep without teeth
13. Towel clip / towel clamp
Left side to top then bottom
1. Army navy
2. Thumb forcep
3. Tissue forcep
4. Adson forcep with teeth
5. Blade holder
6. Cautery tip
7. Iris scissors
8. Mosquito curve
9. Kelly curve
10. Allis
11. Needle holder
Opening of supplies
Scrubbing + close gloving
set up
Open gloving
doffing
Passing of instruments
https://www.youtube.com/watch?v=PXOJfvye7O0
Patient Prepping
Purpose:

– Will serve as a guideline on how to do proper and

effective ways of doing skin prep of the surgical site
immediately prior to making the surgical incision -- to
minimize rebound microbial growth during intra-op and
post-op phase and reduce the risk of post surgical site
infection.
FDA Approved Preoperative Agents:
The healthcare facility must use FDA approved perioperative agents to be
used for skin prep.
§ The three widely used preoperative skin preparation agents --
Chlorhexidine Gluconate, Povidone Iodine, and Isopropyl alcohol, but
WHO recommended skin preparation agents are products with combination
of alcohol with iodophors or chlorhexidine containing products.
§ Alcohol has broad spectrum antimicrobial properties – 60% to 90% alcohol
is the most effective.
§ Surgeons may include alcohol wipe as an acceptable practice if alcohol-
based skin preparation agents are nor available and can be used as a part
of overall skin prep regimen; however, this should not be used as a single
agent. Alcohol must not be used on mucous membranes.
FDA Approved Preoperative Agents:

• In evaluating and choosing the antiseptic agents, must follow

the standard protocol of the institution.
• The surgical team and the infection control officer must be
involved in the process of testing and evaluating the agents.
• The manufacturer’s instruction must be followed strictly to
confirm its efficacy, storage, and warning of antiseptic agents.
• The WHO and US CDC recommend the use of alcohol-based
antiseptic solutions for surgical skin preparations. Alcohol,
however, is NOT recommended when the surgical site
involves mucous membranes.
Preoperative Hair Removal
• Preoperative hair removal should be avoided unless the hair at or
around the incision site will interfere with the operation.
» Increased SSI risk associated shaving has been
attributed to microscopic cuts in the skin that later
serve as a foci for bacterial multiplication.
» The use of depilatory creams has been associated
with a lower SSI risk as compared to shaving.
However, these chemicals may trigger skin
reactions and allergies in some individuals.
• If hair removal is necessary, an electric or battery-powered clipper
with disposable and reusable head which can be disinfected
between patients should be used.
Preoperative Hair Removal

• Hair removal should be done immediately before skin preparation.

• Clipping hair immediately before an operation is associated
with a lower risk of SSI than shaving or clipping the night
before an operation. Shaving immediately before the operation
compared to shaving within 24 hours preoperatively also
correlates with decreased SSI rates.
• Hair removal should take place away from the sterile field,
preferably in an area outside of the room where the procedure
will be performed, to avoid contaminating the surgical site and
sterile field.
Recommended Practices for Skin
Preparation
• Thoroughly wash and clean at and around the incision site to remove
gross contaminants like dirt, soil, or any other debris.
• Don sterile surgical gloves after surgical hand preparation
• In cases where there is a stoma present, isolate the area and cover it with
an antiseptic soaked sponge. Prepare the stoma site last.
• Do not allow antiseptic agent to pool beneath patients, pneumatic
tourniquet cuffs, electrodes, or electrosurgical unit pad to reduce the risk of
chemical burn, or hyperthermia in the case of pediatric patients.
• The contaminated area generally should be prepared last.
• For skin grafting, abdominal-perineal and abdominal vaginal skin prep;
require two separate skin preps and tables using double gloving to be
removed after one set.
Recommended Practices for Skin
Preparation
• For eye and facial prep, require the use of an alternative
prep solution or dilute regular solution to avoid injury
• Scrub the skin starting at the site of the incision with a
circular motion widening the circle to the outer portion
• Apply pressure and friction to remove dirt and
microorganism
• Never bring soiled sponge back toward the center.
Discard the sponge into the kick bucket after it has
reached the outer area
Patient Prepping
Before skin preparation;

– If you need to shave/clip hair of the patient in the operative site,

please do so.
– Prepare the supplies that you will need in prepping the patient:
• Bowls
• Sterile gloves
• Gauze
• Povidone iodine 7.5% and 10%
Patient Prepping
Prepping the patient:
– Handwashing
– Put on your sterile gloves (Double)
– Get the bowl with the Povidone Iodine 7.5% (soap)
– Start prepping: starting on the incision site (cleanest to
dirtiest)
– Get towel from scrub nurse, place on the prep site and
wipe the soap in one movement
– Remove first sterile gloves
– Get the bowl with Povidone Iodine 10% (paint)
– Start prepping again
– Done J
Recovery
• After surgery, the patient is transferred to the Post
Anesthesia Care Unit (recovery room)
• The patient is monitored every 15 minutes for 2 hours
(for general anesthesia) and around 3-4 hours or until
both legs can be raised straight (for spinal anesthesia).
• Nurses assess patient on the level of pain they are
experiencing; pain medications are given as ordered
with precautions.
• Post operative labs and other orders should be done
and carried out by the nurse. Critical eye is important in
recovery room, because every patient is unique and all
underwent anesthesia and they have different effects.
IV CANNULA COLORS
• Plain Lactated Ringers (PLR) – Blue
• Plain Normal Saline Solution (PNSS) – Green
• D5 Normal Saline Solution (D5NSS) – Yellow
• D5 0.3 Sodium Chloride (D5 0.3 NaCl) - Light
Blue
• D5 Lactated Ringers (D5LR) – Pink
• Balanced Multiple Maintenance Solution with 5%
dextrose (D5IMB) – Purple
• Dextrose 5% Water (D5W)- Red
• D5 Normosol-R (D5NR) - Yellow Green
• D5 Normosol-M (D5NM) - Orange
PHACOEMULSIFICATION
• is a modern-day cataract surgery that employs ultrasound energy to
emulsify the nucleus, vacuum to catch the nuclear material, and irrigation
and aspiration for cortex and viscoelastic removal. A typical phaco
machine consists of a handpiece, foot pedal, irrigation, and aspiration
system.

What Is an Intraocular Lens (IOL)?

• are the artificial lenses that are used to replace the natural lens during cataract
surgery.

• TYPES OF LENS

– Traditional lens: monofocal lens

– Crystalens: multifocal lens

– Accommodating IOL

– Toric IOL
PHACOEMULSIFICATION
PRE OP DROP

§ Tropicamide + Phenylephrine Hydrochloride OR (Sanmyd-P)

LOCAL ANESTHETIC

§ Proparacaine Hydrochloride Ophthalmic Solution OR

(Alcaine) : eye drop

§ Lidocaine : intraocular injection

POST OP EYE DROPS

§ Vigamox (Moxifloxacin)

§ Pred Forte (Prednisolone Acetate)

FLUID USED:

§ BSS (balance salt solution) or PLR

 Thankyou for listening,
Hope I inspired you to become
A theater nurse J