LAKELAND COMMUNITY COLLEGE SURGICAL TECHNOLOGY PROGRAM
A CASE IN THE LIFE OF A SURGICAL TECHNOLOGIST (GENERIC)
Compare each act to Chapter 25 and the “Eight Ps” of OR and sterile field management pp448 B&K 10/eThis
is a basic, generic, open case format. Some variations will be seen in the clinical site.
OPEN UP THE ROOM AND THE SET UP
1. Don appropriate attire in locker room (non restricted) (review your notes to see what constitutes
“appropriate attire” and add PPE). No hand or arm jewelry. Earrings are contained within the cap.
2. Check assignment at the Control Desk (semi restricted)
3. Enter operating room (OR) in appropriate OR attire and PPE (restricted)
4. Check suction, lights, and ESU machine in the room. Are they working? (RN circulator may check this)
5. Wipe OR furniture surfaces as necessary. Remove unnecessary equipment.: remember the principle of
perfect picture (RN circulator may help with this)
6. Bring in Case Cart and check contents against Case Cart Sheet and Surgeon’s preference card (RN
circulator may check this with you to expedite the case start). Some things need to be gathered by you
and the RN circulator specific to the case, the surgeon, and patient.
7. Inspect each package before opening. When in doubt of sterility, throw it out. (send for reprocessing or if
disposable, save for classroom) Dates or expiration are event related unless an unstable element (drug or
chemical) is inside
8. Place sterile wrapped basin set in ring stand (if used) (sometimes the reusable prep is in here); custom
pack on back table; instrument set on prep-stand or other appropriate surface. (all of this part depends on
the facility and the types of packs and instrument sets they use)
9. Open up sterile field items: check integrity of packages. Touch only the edges of the packaging and
wrappers.
a. Open basin set (if used. This may be contained within the custom pack)
b. Open back table cover
c. Open peel pack items on your back table in one spot remember position of function. The basin is
good place to open things into. Do not open things into the closed container instrument pan
d. Open blades for scalpel in a visible spot on the corner of the drapes. Be consistent and always open
blades to same spot for safety. (If a custom pack is used, the blades will be opened by you after you
are sterile) Never open blades into a metal basin. It ruins the edge and they are too hard to pick up
safely
e. Open your gown and gloves (1 or 2 pr) on a designated separate surface (Mayo stand is a good
place) Never gown and glove from your back table. High risk of contamination.
SET UP
10. Go to the sink to scrub or perform hand antisepsis as appropriate: remember-mechanical and chemical
principles. If antiseptic gel is used. Follow manufacturer’s recommendations.
If a scrubbing method is used: prefer counted anatomic brush stroke over timed method
a. Peel open scrub brush (position of function)
b. Roll up sleeves and turn on water (adjust water temperature if needed)
c. Wet hands and arms (forearms and 2” above elbows)
d. Wash your hands and arms with antiseptic hand soap and rinse as a preliminary wash
e. Clean your nails of both hands with the nail cleaner under running water. Nail pick is discarded into
trash, not into the sink
Hands must remain higher than elbows at all times before and after the scrub procedure. If you
bump the faucet, rescrub the area with 10 strokes. Some facilities will make you completely scrub
all over again. Each hand and arm is done individually
f. Pick up scrub brush, discard the wrapper in trash, and start scrubbing your nails (30 strokes)
g. Scrub each plane of your fingers (10 strokes per plane)
h. Scrub palm and back of hand in circular motions (10 strokes each)
i. Scrub all planes of arm (10 strokes per plane)
j. Repeat steps with the other hand/arm
k. Soiled brush is discarded into trash, not the sink
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11. Enter the operating room with back first to open door (position of function)
12. Dry hands and arms with towel one end at a time and drop towel in trash can (or linen hamper if reusable
towel). Do not ball it up! You will be contaminated then!
13. Gown and glove using the closed glove method – don’t forget to get tied in by a sterile person or RN
circulator after donning gloves. Can double glove at this time or later as you begin your set up. RN
circulator will remove gown wrapper from Mayo stand.
PATIENT WILL ENTER THE ROOM The RN circulator will be tending the patient and you. Keep noise to a
minimum. Once the patient is settled, the RN circulator can continue to give you items or count with you. RN
circulator documents the time the patient enters the room and is tended by anesthesia personnel
14. Set up the case: Remember the “P” principles of proper function, place it once, position of function, point
of use, protected parts, perfect picture…etc.
a. Back table – Place instrument tray, drapes in order of use, gowns and gloves for the team, largest
items. Label the basins for saline and/or water. Label all solutions and medicines on the field
(medicine cups, basins, syringes). Double check the label with the RN circulator as the medicine is
dispensed to the field.
b. Drape the Mayo stand
c. You may need to set up the 2-step prep if a nondisposable is used. (varies by the type of prep and
facility. If a disposable 1-step or 2-step prep is used, the RN circulator or person doing the prep will
set it up.) 1-step prep does not have to be sterile, 2-step is treated as sterile
d. Make towel rolls x1 or x2 as needed for positioning the instruments
e. Start your baseline sponge, sharp, and instrument count with the circulating registered nurse
f. Put items on the Mayo stand; (2 scalpels, 4 hemostats, 3 scissors, 2 pick ups, small retractors, 2-3
Raytec 4x4 sponges), light handles, suction, electrosurgical cable (ESU) and other items particular to
the case you are doing. Mostly things needed to start the case (point of use). Close all the
instruments on the Mayo stand. The instruments on the back table can remain open, but are closed it
they are brought up to the Mayo stand. Scissors are always closed in both areas for safety.
g. Suture packets are organized per facility method. Ties are opened and positioned per facility method
h. Place basin set in ring stand (many places do not use this anymore, but some do) (may need to drape
the ring stand first if the basin is not singly wrapped)
START THE CASE
i. Gown and glove the surgeon and the rest of the team from your back table using the open assisted
method. No one is to take anything from your back table to gown and glove themselves.
j. The patient is draped – surgeon will start with incision site (square off with towels), then the larger
drapes (place it once) (the drapes used vary by surgeon and procedure)
k. Bring the Mayo stand up over the field, the RN circulator can help with back table (do not pull up to
field by grabbing the edge remember what we said about edges…), and ring stand (if used) Nothing
should be placed directly behind you. The back table will be placed at your side at the foot end of the
operating bed.
l. Throw off the ends of the suction tubing and ESU cords to the RN circulator for attachment to the
machines. Other machine may be used at this time too. The working ends of the tubes and cords are
attached to the drapes with non piercing instruments or passed through structured loops on the
drapes.
m. RN circulator will pour solutions to the table into small labeled basins
n. Sterile light handles are placed in spot lights by someone on the sterile team
o. Place 2 sponges on the field near the proposed incision site
15. Surgeon will make the skin incision. RN circulator will document the time
a. Start with skin scalpel (knife) using safe passing practices. Do not point scalpel at the field, keep
blade down. Pass handle first. Place used knife on back table until ready to disarm the blade and
place in sharps container. It is not used again. (a no-touch method will require a “safe zone” on the
field where all sharps are placed for passing to the surgeon)
b. Second scalpel is used if surgeon desires or may want ESU to continue into deep tissues. – A 2nd
scalpel is kept on the Mayo stand until certain it will not be used. It can be used more than once.
c. The surgeon may use ESU and suction or maybe hemostats to control the bleeding. Soiled sponges
are opened all the way and dropped into the rolling sponge bucket for counting by the RN circulator.
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d. Once the deep tissues are open, switch Mayo sponges from Raytec to lap tapes (larger sponges)
Clean Raytec are placed on back table for other uses during the later part of the case.
e. Anything nonstandard that is used inside of the patient such as a blue towel, is reported immediately
to the RN circulator for inclusion on the count sheet.*Anticipate the surgeon’s needs at all times
THE CASE IN PROCESS
16. Keep field neat and clean at all times. Wipe instruments as they handed back to you. Keep your fingers
out of the ring handles. Place in a position of function in the proper place. Don’t hand up a sticky, bloody
clamp. Wipe it and close it first
a. Never turn your back to the field. Take extra care with specimens. Ask how they should be labeled
b. Do not let anyone take things off your Mayo stand. Keep it far enough from other’s reach, yet
functional for you to hand things up to the main field
c. Do not just dump used stuff on your Mayo or back table. Position of function is critical to speed
d. Practice “one for one technique” with sponges and sharps. Give clean one, take one soiled one and
discard. Always have clean sponge available. Trim suture ends
17. You will be removing and adding items to the Mayo stand as you go along.
18. Any contaminated glove will be removed by the RN circulator, who is wearing exam gloves. Re-gloving
with sterile gloves is by the open or open assisted method ONLY.
19. A person entering the field in process? Do not hand a drying towel with your bloody gloves. The new
person should dry and gown self from a separate surface. You may gloves them or they can glove self
with closed glove method.
20. Be absolutely perfect with your sharps handling. Used needles and sharps go into needle box. Prepare
sutures slightly before they are needed and line up on back table. Minimal sharps should be on the Mayo
stand. Do not let tails spring up into face of surgeon, do not let tails hang over the edge of your field
21. At the end of the case, you will need to already have the closing suture or staplers prepared. (RN
circulator will give you the stapler(s). Handle with care…do not just open and drop onto the table ..it can
break or jam. Dressing is opened to the field by the RN circulator near the end of the case so it does not
get mixed in with the sponges.)
22. Don’t just pile up your instruments on the back table. Keep them in the position of function as you did
when setting up. Your table should look like you have never moved anything at the end of the case. The
only difference is that there may be some visible blood.
THE CASE ENDS
23. Procedure is finished and the surgeon starts the closing process: Place the dressing, 1 wet and 2 dry lap
tapes on the Mayo for the end
a. closing count #1 is done when closing begins. Always start count at the patient- field and work to
Mayo then to back table, then to rolling sponge bucket. Your count is added to RN circulator’s count.
b. closing count #2 for verification is done while skin is being closed. Same line of direction for order of
count
c. Counts are documented by the RN circulator
24. Surgeon or 1st assistant cleans the incision with a sterile moist Lap sponge. The incision is covered and
the drapes are removed. RN circulator documents the time of the case end.
25. Once the dressing is placed, a moist sponge is used to clean the surrounding skin and a dry towel or
sponge is used to dry. One step preps (Duraprep) is not meant to be removed. It remains as a barrier.
26. Remain sterile until the patient is moved from room as appropriate.
BREAK DOWN TABLE
27. Do not remove your (personal protective equipment) PPE
28. Break down table: biohazardous materials in Red Box/Bag, clean trash in white/regular trash can, and
linen in hamper. Remember to remove light handles. Instruments are all opened and prepared per facility
procedure and taken to proper place for decontamination. When instruments/cart are ready to leave room,
remove your gown via peel-off method. Your gloves are 2nd using glove to glove, skin to skin. Put on exam
gloves as a barrier to take instrument table/cart to decontam area. Never use your bare hands or soiled
gloves.
29. Housekeepers will clean room after you remove your instruments from the room
30. Remove exam gloves glove to glove and skin to skin, WASH YOUR HANDS WITH REAL SOAP AND
WATER, NOT JUST ANTISEPTIC GEL.
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