THE PERIOPERATIVE PATIENT
CARE TEAM & ROLES
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The Perioperative Team
Is subdivided according to the functions of its members:
1. The nonsterile team
a.Anaesthesia provider
b.Circulating nurse
c.Perianaesthesia nurse
d.Others (e.g., students, sales representatives, laboratory
or radiography personnel)
2. The sterile team
a.Surgeon
b.First assistant
c.Scrub person
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Nonsterile Team Members
Perianaesthesia Team
- Consists of RNs and specially trained patient
care assistants
- Preoperatively, the RN assesses the patient
and documents the findings.
- Any information that contributes to the care of
the patient in the intraoperative area is
communicated to the intraoperative team
members.
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Nonsterile Team Members
cont…
Anaesthesia Provider
– Is the person responsible for inducing and
maintaining anaesthesia at the required levels
and managing untoward physiologic reactions
throughout the surgical procedure.
– is an indispensable member of the
perioperative team.
– Functioning as a guardian of the patient
throughout the entire care period.
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Nonsterile Team Members
cont…
Circulating Nurse
– There are 3 major concerns:
1.Care of patient safety and the staff
2.The maintenance of asepsis
3.Allegiance to the scrub nurse
– The role involves working very closely with the
scrub nurse and being constantly alert to his or
her needs in particular.
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The Functions of Circulating Nurse
1. Orientation
Familiarize self with the geography of the suite and the department,
the equipment. Knowing things are and how they work saves time.
Outside the suite e.g.:
- nearest defibrillator, telephone, fire appliances and the exits.
- All the stockrooms: extra instrument, blades, sutures,
dressing, disposal bags and stationery.
Inside the theatre suite e.g.:
- locate all the sterile equipment needed for operations, lotions,
the warming cabinet etc.
- the major pieces of furniture: the diathermy machine, the lights,
the suction and the operating table.
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2. Preparing for an operation
Test all electrical equipment for safe functioning.
Switch on the lights, both the main and operating lights,
see all bulbs are working.
Switch on diathermy machine, and check that the
patient alarm is working.
Test to see the suction is working.
Report malfunctions immediately to the nurse in charge.
Check any additional equipment or furniture is needed
for the list e.g. an extra sucker or trolley.
See that clean linen, swab and rubbish bags have been
put out.
Scrub up area check for enough gowns and gloves
available, soap, sterile brush dispenser etc.
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3. Helping the Scrub Nurse
Help the scrub nurse to prepare the sterile
equipment for the operation.
Open a gown pack and the correct size gloves for
the scrub nurse.
When the scrub nurse has scrubbed up help
him/her into the gown and secure the tapes.
4. Opening extras
Open packs of sutures, ties, swab, blades and
other extras needed.
Check items for sterility.
Maintain sterility during opening
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5. Checking lotions
Prepare lotion for skin preparation
- show label on the bottle to the scrub nurse to
verify the correct solution and check the expiry
date.
Pour the lotion into the offered container from a
height of at least 15cm.
6. Drugs
Prepare the required drugs on the scrub nurse’s
trolley, such as an ampoule of local anaesthetic.
Check the drug and the expiry date with the
surgeon as well as the scrub nurse before it is
drawn up for use.
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7. Performing the first count
Count and record the number of instruments,
swabs and needles on the trolley before the
operation commences.
Check the instruments, use the check sheet
from the prepacked tray, and call out the
contents.
Record any added instruments to the basic
tray on the count sheet.
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8. Patient safety
Positioning the patient. Make sure all limbs
are securely positioned.
Check that all pressure points are
adequately padded.
Make sure the diathermy plate is in
position, and with good contact with an
area of dry skin ensure no contact with
metal as burns could occur.
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9. Arranging Furniture
Help the scrub nurse to arrange the trolleys
comfortably.
If a mayo table is to be used, move it in over the
patient’s feet.
Diathermy machine best placed at the foot of the
table. Connect the sterile diathermy lead and
switch it on.
Arrange foot pedal for the surgeon.
Connect the suction tubing and switch the
suction on.
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10. Weighing and Hanging Swabs
Hang the soaked swabs up on the swab
rack for counting e.g. group of five
according to type
11. Hunting for lost swabs
Recount discarded swabs.
If the swab still missing continue to search in the
disposal bins – in the linen and rubbish bins.
Final resort – the patient must be x-rayed.
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12. Handling Specimens
Handle the specimen with great care.
Put in the appropriate sized container and
label it clearly.
Most of the specimens are for histology
and can be put into the preservative formol
saline.
Specimens for microbiology may be left
dry or else put into a culture medium.
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13. Taking and Giving Messages
One of the major function of Circulating Nurse is
to act as a link between the scrubbed team and
the outside world.
Write down all the details of the message
accurately.
Any messages given regarding the details of
patients on the operating list or any changes to
the list itself, it is vital to tell the nurse in charge
immediately.
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14. Closing and Final Counts
Two counts are done:
1. When the first cavity is closed.
2. Once the surgeon begins to close the wound,
the scrub nurse and circulating nurse need to
count all the instruments, swabs and needles
again. This is to ensure that nothing has been left
at the site of operation.
Sign for any counts that have done.
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Sterile Team Members
Surgeon
– the surgeon must have the knowledge, skill
and judgment required to successfully
perform the intended surgical procedure and
any deviations necessitated by unforeseen
difficulties.
– The surgeon’s responsibilities include
preoperative diagnosis and care, selection
and performance of the surgical procedure ,
and postoperative management of care.
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Sterile Team Members
cont…
First Assistant
– Under the direction of the surgeon, a qualified
first assistant helps maintain visibility of the
surgical site, control bleeding, close wounds
and apply dressings.
– Handles and manipulates tissues and uses
instruments to provide haemostasis.
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Sterile Team Members cont…
Scrub Person/Nurse
The Role:
– The scrub nurse is a professional nurse
concerned with the safety of patients and staff.
– The maintenance of asepsis.
– Facilitating and coordinating the work of the
surgical team.
– Being the centre of the action, controlling the
team and the course of the operation.
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The Role cont….
– Some control over the theatre atmosphere,
particularly over the noise level and the number of
personnel present.
– Preparing in advance – read up ahead on the
relevant anatomy & physiology, the operative
procedure and ready the tray of instruments.
– Scrubbing up – dressed correctly and comfortably,
good hand-wash, put on gown and gloves.
– Legal responsibility – is to check the right patient to
be operated on and patient has consented.
– Introducing yourself to the surgeon.
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The Role cont….
– Skin preparation – hand the surgeon the receiver of
skin cleaning lotion and the mounted spongeholders.
– Draping – aim is to create a large sterile field around
the operation site on which to work. Also reduces
the danger of introducing infection to the wound
from the atmosphere, and also protects the wound
from contamination arising from other areas of the
patient’s own body. Only the area of skin to be
operated on is to be uncovered.
– Put the trolley in place and everything needed is
within easy reach, prepare the equipment and
instrument prior to surgery.
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The Role cont ….
– Passing of instruments.
– On completion of the procedure: two counts
are normally done;
i) when the first cavity is being
closed,
ii) when skin is sutured.
– Sort out trolley; check the set of instruments,
and complete the theatre documentation.
The End
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