UNIT 2 Intraoperative Care
Intraoperative Care refers to the care provided to the patient during surgery – from the time the patient is transferred to the operating room (OR) until they are transferred to the post-anesthesia care unit (PACU).
| Complication | Signs/Symptoms | Nursing Intervention |
|---|---|---|
| Hemorrhage | Low BP, high HR, pallor | Inform surgeon, ensure IV access, prepare transfusion |
| Anaphylaxis | Rash, wheezing, hypotension | Administer epinephrine, support airway |
| Hypothermia | Shivering, low body temp | Warm blankets, warm IV fluids |
| Nerve Injury | Poor positioning | Reposition, use padding |
| Malignant Hyperthermia | High temp, muscle rigidity, tachycardia | Administer dantrolene, cool patient, alert anesthetist |
| Nursing Diagnosis | Goal | Nursing Interventions | Evaluation |
|---|---|---|---|
| Risk for infection | Maintain sterile field throughout | Monitor aseptic technique, limit exposure | No signs of infection post-op |
| Risk for injury due to positioning | Maintain safe positioning | Use padding, reposition limbs as needed | No redness, numbness post-op |
| Risk for aspiration | Prevent aspiration during anesthesia | NPO before surgery, suction ready | No aspiration events during OR |
An Operation Theatre (OT) is a specialized sterile facility in a hospital where surgical procedures are performed. It must be well-organized, sterile, and functionally efficient to ensure patient safety and support surgical teams.
The OT is designed using the Zoning System and includes a variety of structural, functional, and equipment-based requirements.
To maintain asepsis, the OT is divided into four zones:
| Zone | Description |
|---|---|
| Unrestricted Zone | Entrance area, change rooms, lounges (street clothes allowed) |
| Semi-restricted Zone | Access corridor, sterile store (only OT dress, hair covers allowed) |
| Restricted Zone | Actual operating room – maximum sterility (OT dress, mask, cap mandatory) |
| Dirty Zone | Area for disposal of waste, cleaning of instruments |
| Room | Function |
|---|---|
| Operating Room (OR) | Main sterile room for performing surgery |
| Scrub Area | For hand scrubbing and gowning before surgery |
| Anesthesia Room | Prepares patient for anesthesia |
| Pre-op Holding Room | Temporary area for patients before surgery |
| Post-op Recovery Room (PACU) | For monitoring after surgery |
| Sterile Store Room | Stores sterile linen, instruments |
| Soiled Utility Room | Collects contaminated linen/instruments |
| CSSD (Central Sterile Supply Dept.) | Prepares and supplies sterilized instruments and items |
| Equipment | Use |
|---|---|
| Operating Table | Adjustable, used to position patient |
| Operating Lights | Shadow-free, adjustable for visibility |
| Anesthesia Machine | For gas delivery and monitoring during anesthesia |
| Suction Apparatus | Removes secretions/blood during surgery |
| Electrocautery Unit | For cutting tissue and controlling bleeding |
| Monitors (ECG, SpO2, BP) | To monitor vital signs during surgery |
| Instrument Trolley | Holds surgical tools during procedures |
| Kick Bucket/Foot Stool | Assists in maintaining cleanliness/mobility |
| Defibrillator | For emergency cardiac resuscitation |
| Lead Apron | Used during X-ray guided procedures |
| Feature | Purpose |
|---|---|
| Seamless walls/flooring | Easy cleaning, prevents dust collection |
| Laminar Air Flow System | Reduces airborne contaminants |
| HEPA Filters | Filter bacteria/viruses from air |
| Positive Pressure Ventilation | Prevents entry of air from non-sterile areas |
| Temperature and Humidity Control | Maintains comfort and inhibits microbial growth |
| Personnel | Role |
|---|---|
| OT In-charge Nurse | Supervises entire OT setup |
| Circulating Nurse | Manages patient prep, assists sterile team |
| Scrub Nurse | Assists surgeon, maintains sterile field |
| Anesthesiologist | Provides anesthesia, monitors patient |
| Surgeon and Assistants | Perform the surgical procedure |
| Technicians | Operate machines, sterilize instruments |
| Housekeeping Staff | Maintains cleanliness and transport of waste |
An Operation Theatre (OT) is a sterile, specialized unit where surgical procedures are carried out under aseptic conditions with the help of trained personnel and equipment.
Operation theatres are classified based on different criteria, such as case type, sterility, usage, and design. Here’s a detailed classification:
| Type of OT | Description |
|---|---|
| General OT | Used for routine general surgeries (e.g., hernia, appendectomy) |
| Specialized OT | Designed for specific disciplines |
| – Cardiac OT (e.g., bypass, valve replacement) | |
| – Neuro OT (e.g., craniotomy) | |
| – Orthopedic OT (e.g., fracture, joint replacement) | |
| – ENT OT, Gynecology OT, Urology OT, etc. |
| Type | Description |
|---|---|
| Septic OT | For infected or contaminated surgeries (e.g., gangrene, abscess) |
| Aseptic OT | For clean surgeries (e.g., C-section, hernia, tumor removal) |
⚠️ Septic OT is usually scheduled after clean cases or done in a separate room to avoid contamination.
| Type | Description |
|---|---|
| Elective OT | Pre-planned, scheduled surgeries (e.g., cataract, cholecystectomy) |
| Emergency OT | For urgent/life-threatening cases (e.g., road traffic accident, C-section in fetal distress) |
Emergency OTs are usually available 24×7 and located near casualty/trauma centers.
| Type | Description |
|---|---|
| Conventional OT | Basic structure with standard lighting and minimal automation |
| Modular OT | Advanced design with laminar airflow, HEPA filters, anti-microbial surfaces, and smart panels for better asepsis and control |
Modular OTs are becoming the modern standard in tertiary care hospitals.
| Type | Description |
|---|---|
| Government OT | Found in public hospitals; funded and maintained by the state |
| Private OT | Run by private hospitals or nursing homes |
| Teaching OT | Located in medical colleges with student observation facilities |
| Type | Description |
|---|---|
| Central OT Complex | Cluster of all OTs in one area with shared support facilities (CSSD, PACU) |
| Decentralized OT | OTs scattered across hospital departments (e.g., in labor room, trauma unit) |
| Type | Description |
|---|---|
| Major OT | Equipped for major surgeries requiring general or spinal anesthesia |
| Minor OT | For minor procedures under local anesthesia (e.g., suturing, biopsy) |
| Basis | Types |
|---|---|
| Type of surgery | General, Specialized (Cardiac, Neuro, Ortho, ENT, Gynae, etc.) |
| Asepsis level | Septic OT, Aseptic OT |
| Usage | Elective OT, Emergency OT |
| Setup | Conventional OT, Modular OT |
| Ownership | Government, Private, Teaching |
| Location | Centralized, Decentralized |
| Functionality | Major OT, Minor OT |
To prevent infection and maintain asepsis, OTs are designed with four major zones:
| Zone | Description | Example Areas |
|---|---|---|
| Unrestricted Zone | Entry zone; street clothes allowed | Reception, waiting area, staff room |
| Semi-restricted Zone | Only OT attire and hair covering allowed | Corridors, sterile supply storage |
| Restricted Zone | Complete sterility maintained, masks mandatory | Actual Operating Room, Scrub area |
| Dirty Zone | Disposal of used materials and instruments | Dirty utility, disposal chute |
| Component | Specifications |
|---|---|
| Walls | Smooth, seamless, anti-microbial, easily washable (e.g., epoxy-coated) |
| Floors | Antistatic, slip-resistant, seamless flooring (e.g., vinyl or PU) |
| Ceiling | Non-porous, anti-bacterial, sealed around fixtures |
| Doors | Sliding/automatic to minimize airflow; ideally hermetically sealed |
| Windows | Minimal or none; if present, must be fixed and sealed |
| Lighting | Shadow-free, ceiling-mounted surgical lights, intensity adjustable |
| Component | Design Consideration |
|---|---|
| Laminar Air Flow System | Vertical or horizontal flow of filtered air to minimize airborne particles |
| HEPA Filters | Remove 99.97% of bacteria and viruses from air |
| Air Exchanges | Minimum 15–20 air changes/hour |
| Positive Pressure | Prevent entry of contaminated air from surrounding areas |
| Temperature Control | Maintained between 20–24°C |
| Humidity Control | 50–60% to prevent infection |
| Feature | Description |
|---|---|
| Operating Table | Centrally located, adjustable, radiolucent |
| Operating Light | Ceiling-mounted, movable, with variable intensity |
| Gas Outlets | For O2, N₂O, suction, compressed air |
| Electrical Outlets | Multiple outlets for monitors, cautery, etc. |
| Storage Cabinets | For sterile instruments and consumables (in-wall preferred) |
| Monitors & Control Panels | Touch-screen panels for equipment control, anesthesia monitoring |
mathematicaCopyEditPatient Entry → Pre-op Holding → Anesthesia Room → Operating Room → Recovery Room (PACU) → Exit
Sterile Corridor → Operating Room ← Scrub Area ← Sterile Store
↓
Dirty Utility → Waste Exit (Dirty Zone)
| Feature | Key Points |
|---|---|
| Layout | Centralized preferred; zoning essential |
| Surfaces | Smooth, washable, antimicrobial (epoxy/vinyl) |
| Ventilation | Laminar airflow + HEPA, 20 air exchanges/hour, positive pressure |
| Lighting | Ceiling-mounted, shadowless, variable intensity |
| Infection control | Zoning, UV light, sensor taps, limited personnel movement |
OT Staffing refers to the systematic allocation and deployment of trained medical, nursing, technical, and support personnel in the Operation Theatre, ensuring the smooth, safe, and sterile conduct of surgical procedures.
OT staffing includes a multi-disciplinary surgical team divided into sterile and non-sterile members.
| Personnel | Role |
|---|---|
| Surgeon | Performs surgery; team leader |
| Surgical Assistant | Assists surgeon; may hold instruments, suture, retract |
| Scrub Nurse | Works in sterile field, assists surgeon directly |
| Circulating Nurse | Manages patient, equipment, supplies outside sterile field |
| Anesthesiologist | Administers and monitors anesthesia |
| Anesthesia Technician | Assists anesthetist with machines, drugs, airway support |
| Personnel | Role |
|---|---|
| OT Technician | Prepares and maintains instruments, sterilization |
| CSSD Personnel | Sterilize and supply instruments from Central Sterile Supply Dept. |
| Housekeeping Staff | Maintains cleanliness, assists with waste management |
| Transport Attendant | Shifts patients from ward to OT and PACU |
| Reception/Clerical Staff | Manages scheduling, documentation, patient record entry |
| Nurse Role | Responsibility |
|---|---|
| OT In-Charge Nurse | Oversees the functioning of OT; manages staff, supplies, coordination |
| Staff Nurse (Scrub) | Assists surgeon, handles sterile instruments, counts materials |
| Staff Nurse (Circulating) | Provides patient care, fetches materials, maintains records |
| Recovery Room Nurse | Monitors and cares for patient post-op in PACU |
| Staffing Element | Ideal Ratio or Recommendation |
|---|---|
| Scrub Nurse | 1 per surgery per OT |
| Circulating Nurse | 1 per surgery per OT |
| Technician | 1 per OT (some setups 1 for 2 OTs) |
| Anesthetist | 1 per OT |
| Surgeons | 1 primary + 1 assistant (or more depending on case) |
| Housekeeping Staff | 1 for every 2 OTs (or per shift) |
| On-call backup staff | For night/emergency/ICU transfers |
| Role | Qualification / Training |
|---|---|
| Nurse (OT trained) | BSc/GNM + specialized OT training or diploma |
| OT Technician | Diploma in OT Technology / DMLT |
| Anesthetist | MBBS + MD/DNB/DA in Anesthesia |
| Housekeeping Staff | Basic infection control and OT protocol orientation |
🔁 Regular in-service training is vital:
| Time | Scrub Nurse | Circulating Nurse | OT Technician | Anesthetist | Housekeeping |
|---|---|---|---|---|---|
| 8 AM – 2 PM | Nurse A | Nurse B | Tech 1 | Dr. X | Staff 1 |
| 2 PM – 8 PM | Nurse C | Nurse D | Tech 2 | Dr. Y | Staff 2 |
| 8 PM – 8 AM | On-call | On-call | On-call | On-call | On-call |
The OT team is a multi-disciplinary group of healthcare professionals who work collaboratively to ensure safe and effective surgical procedures while maintaining sterility, patient safety, and team coordination.
They are classified into:
These team members scrub, gown, and glove in for surgery.
| Team Member | Roles & Functions |
|---|---|
| Surgeon | – Leader of the team – Performs the surgical procedure – Makes pre-op and post-op decisions – Ensures the correct procedure and site – Supervises scrubbed staff |
| Assistant Surgeon | – Supports the primary surgeon – Helps in retraction, suturing, suction, exposure – May take over in long/complex surgeries |
| Scrub Nurse (Instrument Nurse) | – Prepares sterile instruments and supplies – Sets up the sterile field – Hands instruments during surgery (sterile technique) – Counts instruments/sponges before and after surgery – Maintains strict asepsis |
These members provide support and coordination but do not directly touch the sterile field.
| Team Member | Roles & Functions |
|---|---|
| Circulating Nurse | – Prepares patient for surgery – Positions patient with padding – Assists in applying monitor leads, Foley catheter – Opens sterile packs maintaining asepsis – Maintains intraoperative records – Coordinates with other departments |
| Anesthesiologist | – Assesses patient preoperatively – Induces and maintains anesthesia – Monitors patient vitals and airway – Manages pain, fluid balance, and emergency situations – Reverses anesthesia and transfers patient to recovery |
| Anesthesia Assistant / Technician | – Prepares anesthesia machine and circuits – Assists with intubation, ventilation – Draws medications, sets IV fluids – Monitors equipment and alarms – Assists with shifting to recovery |
| OT Technician | – Checks, arranges, and sterilizes instruments – Prepares OT before and after surgery – Assists in suction, cautery machine setup – Maintains and operates equipment |
| Housekeeping Staff (Attendant/Sweeper) | – Cleans OT before and after procedure – Disposes of biomedical waste as per protocols – Helps in shifting patients or equipment |
| Receptionist / OT Clerk | – Maintains OT schedule – Ensures correct documentation – Coordinates with wards, labs, and blood bank |
| Member | Additional Roles |
|---|---|
| RN First Assistant (RNFA) | – Advanced practice nurse – Assists in tissue handling, suturing – Helps in wound closure, hemostasis |
| PACU Nurse (Recovery Room Nurse) | – Monitors patient post-anesthesia – Manages pain and vitals – Identifies complications like nausea, hypoxia |
| Infection Control Nurse (ICN) | – Audits OT asepsis, fumigation – Tracks infection rates, educates staff |
| Role | Minimum Qualification |
|---|---|
| Surgeon | MBBS + MS/MD/DNB in specialty |
| Anesthesiologist | MBBS + MD/DA/DNB in Anesthesia |
| OT Nurse (Scrub/Circulating) | GNM/BSc Nursing + OT training |
| OT Technician | Diploma in OT Technology / DMLT / BSc OT |
| Housekeeping | Basic infection control orientation |
| Anesthesia Assistant | DOTT or specialized OT technician course |
makefileCopyEditPRE-OP: Patient ID → Consent → Site Marking → Pre-medication
↓
INTRA-OP: Anesthesia → Scrubbing & Gowning → Surgery Begins
↓
Team Roles in Action (Scrub + Circulator + Anesthetist + Technician)
↓
Closure → Count → Dressing → Transfer to PACU → Documentation
| Member | Sterility | Main Functions |
|---|---|---|
| Surgeon | Sterile | Performs surgery |
| Assistant Surgeon | Sterile | Supports primary surgeon |
| Scrub Nurse | Sterile | Handles instruments and maintains asepsis |
| Circulating Nurse | Non-sterile | Coordinates environment and patient care |
| Anesthesiologist | Non-sterile | Manages anesthesia and airway |
| OT Technician | Non-sterile | Prepares and maintains equipment |
| Housekeeping Staff | Non-sterile | Cleaning and waste disposal |
| Receptionist | Non-sterile | Scheduling and documentation |
A scrub nurse is a sterile member of the surgical team responsible for maintaining the sterile field, preparing surgical instruments, and directly assisting the surgeon during the procedure.
| Task | Description |
|---|---|
| 1.1 Scrubbing and gowning | Performs surgical hand scrub, dons sterile gown and gloves |
| 1.2 Equipment check | Ensures surgical instruments, sutures, and drapes are sterilized and ready |
| 1.3 Sterile field setup | Arranges surgical trays and equipment in the sterile field |
| 1.4 Count of items | Performs initial count of sponges, instruments, and sharps with circulating nurse |
| 1.5 Verification | Confirms patient ID, surgical site, and consent (in coordination with the team) |
| Task | Description |
|---|---|
| 2.1 Instrument handling | Passes instruments and supplies to the surgeon efficiently |
| 2.2 Tissue handling | Assists in retraction, suction, sponging, or irrigation as needed |
| 2.3 Aseptic maintenance | Maintains strict sterility of self and field throughout the surgery |
| 2.4 Monitoring needs | Anticipates surgeon’s needs and prepares next instruments accordingly |
| 2.5 Count management | Performs sponge/instrument/sharp counts during surgery to prevent retention |
| 2.6 Specimen handling | Assists in proper collection, labeling, and handover of surgical specimens |
| 2.7 Emergency readiness | Prepares and passes emergency instruments or sutures promptly |
| Task | Description |
|---|---|
| 3.1 Final count | Completes final count with circulator before wound closure |
| 3.2 Instrument care | Separates and sends used instruments for cleaning/sterilization |
| 3.3 Sterile field breakdown | Disposes of waste in biohazard bins following infection control protocol |
| 3.4 Documentation | Assists in completing OT notes, sponge/instrument counts, incident reports if any |
| 3.5 Handover | Updates recovery/PACU nurse about drains, dressing, instruments used, complications |
| Skill | Importance |
|---|---|
| Knowledge of surgical procedures | Essential to anticipate needs |
| Manual dexterity & speed | To handle and pass instruments efficiently |
| Sterile technique | To prevent infection and maintain field |
| Teamwork and communication | To work smoothly with surgeon and team |
| Crisis management | To act quickly during surgical emergencies |
| Phase | Duties |
|---|---|
| Pre-operative | Scrubbing, sterile field setup, instrument check, count |
| Intra-operative | Instrument handling, aseptic maintenance, count, specimen handling |
| Post-operative | Final count, instrument care, documentation, sterile field breakdown |
A circulating nurse is a non-sterile member of the OT team responsible for overall coordination, patient care, safety, documentation, and maintaining the sterile environment without directly participating in the surgical field.
| Task | Description |
|---|---|
| 1.1 OT preparation | Ensures cleanliness, arranges equipment and supplies |
| 1.2 Patient verification | Confirms patient ID, consent form, surgical site, and allergies |
| 1.3 Equipment checks | Checks working condition of monitors, lights, suction, cautery, and anesthesia machine |
| 1.4 Aseptic setup support | Opens sterile packs and supplies for scrub nurse while maintaining sterility |
| 1.5 Patient transfer | Assists in safe shifting and positioning of the patient onto the OT table with support pads |
| 1.6 Skin prep | Assists in prepping the surgical site with antiseptic under sterile guidance |
| 1.7 Informed consent | Confirms and verifies that signed consent is present in file |
| Task | Description |
|---|---|
| 2.1 Assist sterile team | Passes extra supplies, medications, and solutions as needed |
| 2.2 Patient monitoring | Assists anesthesiologist in monitoring patient’s vitals and responses |
| 2.3 Count coordination | Assists in counting sponges, sharps, and instruments with scrub nurse |
| 2.4 Specimen care | Labels, documents, and sends surgical specimens to lab with proper identification |
| 2.5 Equipment adjustments | Controls OR lights, monitors, warming devices, suction settings, etc. |
| 2.6 Documentation | Maintains intraoperative records like surgery start/end time, medications given, any incidents |
| 2.7 Environmental safety | Ensures OT temperature, humidity, and lighting are optimal and safe |
| Task | Description |
|---|---|
| 3.1 Patient transfer | Assists in shifting patient to recovery/PACU along with anesthetist and staff |
| 3.2 Waste disposal | Disposes of used materials in proper biomedical waste bins |
| 3.3 OT reset | Helps in preparing OT for the next case – changes linen, disposes waste, restocks items |
| 3.4 Documentation completion | Final recording in OT register, count sheets, and surgical records |
| 3.5 Incident reporting | Reports any break in asepsis, count discrepancy, or patient-related event immediately |
| Responsibility | Description |
|---|---|
| Communication bridge | Coordinates between scrub team, anesthetist, lab, blood bank, ICU |
| Emotional support | Provides reassurance to the patient pre-op, especially in awake or spinal cases |
| Infection control | Ensures hand hygiene, restricts OT traffic, and monitors sterile practice compliance |
| Fire and safety checks | Verifies electrical safety, presence of fire extinguishers, and crash cart readiness |
| Skill | Importance |
|---|---|
| Knowledge of surgical procedures | To anticipate needs of the team |
| Good communication | Essential for coordination and reporting |
| Observation and alertness | To detect patient or equipment issues |
| Documentation accuracy | Legal and clinical importance |
| Empathy and calmness | To support patient and team under stress |
| Phase | Key Responsibilities |
|---|---|
| Pre-operative | OT setup, patient verification, equipment checks, assisting with sterile setup |
| Intra-operative | Supplies assistance, count coordination, documentation, environment monitoring |
| Post-operative | Waste disposal, patient transfer, OT cleaning, documentation |
Positioning is the technique of placing the patient on the OT table in a way that provides maximum access to the surgical site, while ensuring safety, comfort, and physiological stability.
Draping is the process of covering the patient and surrounding areas with sterile cloths (drapes) after positioning, to create a sterile field and expose only the operative site.
| Details | Description |
|---|---|
| Used for | Abdominal surgeries (e.g., hernia, appendectomy, laparotomy), thoracic surgery, cardiac, breast |
| Positioning | Lying flat on back, arms secured, legs extended |
| Sites Exposed | Abdomen, chest, pelvis |
| Risks | Pressure on heels, sacrum; possible back pain |
| Nursing Role | Pad bony prominences, secure arms, check ECG leads |
| Details | Description |
|---|---|
| Used for | Gynecological (D&C, hysterectomy), urological (cystoscopy), rectal surgeries |
| Positioning | Supine + legs flexed in stirrups above level of hips |
| Sites Exposed | Perineum, rectum, lower pelvis |
| Risks | Nerve injury (femoral/sciatic), hip dislocation, hypotension |
| Nursing Role | Raise legs simultaneously, pad stirrups, check circulation post-op |
| Details | Description |
|---|---|
| Used for | Spine surgeries, rectal surgeries, posterior head/neck |
| Positioning | Patient lies face-down, arms extended or tucked |
| Sites Exposed | Back, neck, spine, buttocks |
| Risks | Respiratory compromise, pressure on face/chest/genitals |
| Nursing Role | Protect airway, pad face and bony areas, avoid eye/nerve compression |
| Details | Description |
|---|---|
| Used for | Kidney, lung, hip surgeries |
| Positioning | Side-lying with lower arm flexed, upper leg flexed |
| Sites Exposed | Flank, thorax, lateral abdomen |
| Risks | Nerve damage, shoulder pressure, lung compression |
| Nursing Role | Place pillow between legs, secure patient, support chest and head |
| Details | Description |
|---|---|
| Used for | Pelvic/gynecologic surgeries, laparoscopic procedures |
| Positioning | Supine with table tilted head-down (15–30°) |
| Sites Exposed | Pelvis and lower abdomen |
| Risks | Respiratory distress, increased ICP, aspiration |
| Nursing Role | Secure patient with shoulder braces, monitor airway and circulation |
| Details | Description |
|---|---|
| Used for | Head and neck surgeries, laparoscopic upper abdominal |
| Positioning | Supine with table tilted head-up |
| Sites Exposed | Upper abdomen, head, neck |
| Risks | Hypotension, pooling of blood in lower limbs |
| Nursing Role | Secure patient, use anti-embolism stockings if needed |
| Details | Description |
|---|---|
| Used for | Craniotomy, thyroidectomy, shoulder or facial surgery |
| Positioning | Head of table elevated 45–90°, knees may be flexed |
| Sites Exposed | Head, neck, chest |
| Risks | Venous pooling in lower body, pressure ulcers |
| Nursing Role | Support head and neck, pad pressure areas, ensure secure straps |
| Drape Type | Use |
|---|---|
| Fenestrated Drape | Central opening for the operative site (e.g., hernia, cataract) |
| Non-Fenestrated Drapes | Used to cover large body areas |
| Laparotomy Sheet | Abdominal surgeries |
| Leggings | Used in lithotomy position |
| Head Drapes | Craniotomies, ENT procedures |
| Phase | Responsibilities |
|---|---|
| Before Surgery | Identify surgical site, explain procedure, inspect skin integrity |
| During Positioning | Use correct position, apply safety straps, pad bony prominences |
| During Draping | Maintain asepsis, assist surgeon, prevent exposure of non-surgical sites |
| Post-Positioning | Check for pressure areas, evaluate limb circulation and nerve compression |
| Position | Procedure Example | Site Exposed | Key Precautions |
|---|---|---|---|
| Supine | Hernia, C-section | Abdomen | Pad heels/sacrum |
| Lithotomy | Hysterectomy, D&C | Perineum | Pad legs, avoid nerve stretch |
| Prone | Spinal surgery | Back | Protect face, chest, genitals |
| Lateral | Nephrectomy | Flank | Support shoulders, hips |
| Trendelenburg | Laparoscopy (pelvis) | Pelvis | Risk of aspiration, eye pressure |
| Reverse Trend. | Thyroidectomy | Head/upper abdomen | Monitor BP, pad feet |
| Fowler’s | Craniotomy | Head, chest | Support head, prevent slumping |
Surgical instruments are commonly classified based on their function:
| Type of Surgery | Common Instruments Used | Purpose / Use |
|---|---|---|
| General Surgery | – Scalpel (No.10, 11) – Dissecting forceps – Mosquito forceps – Mayo scissors – Needle holder – Sponge holding forceps | – Incision and tissue dissection – Holding tissues – Clamping small vessels – Suturing wounds |
| Gynecological Surgery | – Vulsellum forceps – Sim’s speculum – Uterine sound – Hegar’s dilator – Curette | – Cervical grasping – Vaginal examination – Uterine cavity measurement and dilation |
| Orthopedic Surgery | – Bone cutter – Bone nibbler – Periosteal elevator – Gigli saw – Bone holding forceps | – Cutting bone – Lifting periosteum – Sawing bone – Holding fractured segments |
| Neurosurgery | – Hudson brace and burr – Dural scissors – Raney clips – Kerrison punch – Nerve hook | – Skull drilling – Dura cutting – Scalp bleeding control – Bone removal – Nerve lifting |
| ENT Surgery | – Tilley’s forceps – Nasal speculum – Laryngeal mirror – Tonsil snare – Mastoid gouge | – Foreign body removal – Examining nasal cavity – View vocal cords – Tonsil excision – Mastoidectomy |
| Urological Surgery | – Cystoscope – Lithotrite – Bladder sound – Stone forceps – Catheter introducer | – Bladder inspection – Crushing stones – Detecting bladder pathology – Removing calculi |
| Cardiac Surgery | – Rib retractor – Sternal saw – Vascular clamp – Coronary artery probe | – Rib spreading – Cutting sternum – Clamping vessels – Identifying coronary artery |
| Laparoscopic Surgery | – Veress needle – Trocars & cannulas – Laparoscope – Graspers – Endo-scissors | – Pneumoperitoneum – Port access – Internal visualization – Tissue handling |
| Plastic Surgery | – Iris scissors – Fine forceps – Skin hook – Dermatome | – Delicate cutting – Handling fine tissues – Skin grafting |
| Instrument Name | Category | Primary Use |
|---|---|---|
| Scalpel | Cutting | Making skin/tissue incisions |
| Mayo Scissors | Cutting | Cutting heavy tissues |
| Metzenbaum Scissors | Cutting | Dissecting delicate tissue |
| Mosquito Forceps | Clamping | Clamping small vessels |
| Allis Forceps | Grasping/Holding | Holding soft tissues |
| Kocher’s Forceps | Grasping/Holding | Firm tissue grasping |
| Needle Holder | Suturing | Holding needle during stitching |
| Retractors (Langenbeck, Deaver, Balfour) | Retracting | To retract body wall or organs |
| Sponge Holding Forceps | Miscellaneous | Holding sponges for cleaning or antisepsis |
| Suction Tip (Yankauer, Poole) | Suction | Removing fluids/blood from site |
| Instrument Type | Recommended Sterilization Method |
|---|---|
| Metal instruments | Autoclaving (steam under pressure) |
| Endoscopic tools | Gas sterilization (ETO) or plasma |
| Scopes (e.g., laparoscope) | Cold chemical sterilization or high-level disinfection |
Surgical equipment refers to non-handheld medical machines or devices used to support various surgical procedures by providing functions like lighting, suction, imaging, monitoring, or sterilization.
| Type of Surgery | Common Equipment Used | Purpose / Use |
|---|---|---|
| General Surgery | – Electrocautery machine – Suction machine – Surgical lights – Anesthesia machine | – Cuts or coagulates tissue – Removes blood or fluids – Illuminates surgical field – Administers anesthesia gases |
| Laparoscopic Surgery | – Insufflator – Laparoscope with camera & monitor – Trocars and cannulas – Light source and fiber optic cable | – Maintains CO₂ pneumoperitoneum – Internal visualization – Port access – Provides light for laparoscopy |
| Orthopedic Surgery | – C-arm (Image Intensifier) – Orthopedic drill – Bone saw or oscillating saw – Bone plating system | – Real-time imaging of bones – Drilling screws into bone – Cutting bone – Fracture fixation |
| Neurosurgery | – Operating microscope – CUSA (Ultrasonic aspirator) – Neuro navigation system | – Magnifies delicate structures – Removes brain tumors safely – Real-time brain mapping during surgery |
| ENT Surgery | – Endoscope (nasal/laryngeal) – Suction cautery unit – Microscope (for ear) | – Visualization of cavities – Removes bleeding tissue – Ear surgeries (e.g., tympanoplasty) |
| Cardiac Surgery | – Heart-lung bypass machine – Defibrillator – Thermal blanket (warming unit) | – Takes over heart/lung function – Manages cardiac arrest – Maintains body temperature |
| Gynecological Surgery | – Colposcope – Hysteroscope – Electrosurgical unit – Suction curettage unit | – Cervical/vaginal visualization – Uterine endoscopy – Cauterization/cutting tissue |
| Urological Surgery | – Cystoscope with monitor – Lithotripter (ESWL) – Uroflowmetry machine | – Bladder inspection – Break kidney/bladder stones – Measure urine flow |
| Plastic Surgery | – Dermatome – Skin graft mesher – Laser unit (CO₂ laser) | – Skin harvesting – Expands grafts – Precision cutting or resurfacing |
| Emergency/Trauma Surgery | – Portable suction – Crash cart with defibrillator – Portable X-ray machine | – Airway clearance – Life-saving resuscitation – Emergency imaging |
| Equipment Name | Use |
|---|---|
| Operating table | Adjustable table to position patient for surgery |
| Shadowless surgical lights | Provide high-intensity, shadow-free illumination |
| Anesthesia machine | Delivers inhalational agents and oxygen |
| Multiparameter monitor | Displays vital signs (BP, ECG, SpO₂, Temp) |
| Infusion pumps | Delivers fluids/medications at controlled rate |
| Suction apparatus | Removes fluids, blood from surgical site |
| Electrocautery/Diathermy unit | Cuts tissue or coagulates bleeding vessels |
| Sterilizer (Autoclave) | Sterilizes surgical instruments before use |
| Fumigator or UV Light | Maintains asepsis in OT environment |
| Bair Hugger (Warming device) | Prevents hypothermia during long surgeries |
| Phase | Responsibilities |
|---|---|
| Pre-operative | Check equipment functionality, ensure availability, calibrate machines |
| Intra-operative | Monitor settings, assist in operation, alert for alarms/malfunction |
| Post-operative | Turn off, clean, and send for sterilization or maintenance as required |
| Documentation | Record equipment usage, serial numbers (if applicable), malfunctions |
| Surgery Type | Key Equipment | Main Use |
|---|---|---|
| Laparoscopic | Laparoscope, insufflator | Internal view, CO₂ access |
| Orthopedic | C-arm, drill, saw | Bone cutting and fixation |
| Cardiac | Heart-lung machine, defib | Pumping and emergency response |
| ENT | Endoscope, microscope | Ear/nose/throat surgeries |
| Gynecology | Colposcope, hysteroscope | Visualize cervix and uterus |
| Plastic | Dermatome, laser unit | Skin grafting and shaping |
A suture is a thread-like medical device used to approximate (bring together) body tissues after injury or surgery to promote healing and prevent infection.
Sutures are used to ligate blood vessels or close surgical incisions, wounds, or lacerations.
Sutures are classified based on absorbability, origin, structure, and material.
| Type | Description | Examples |
|---|---|---|
| Absorbable Sutures | Get broken down and absorbed by body enzymes over time | – Catgut (plain, chromic) – Vicryl (polyglactin) – Monocryl – PDS |
| Non-absorbable Sutures | Not absorbed by the body; require manual removal or are left permanently | – Silk – Nylon – Prolene – Stainless steel wire |
| Type | Description | Features |
|---|---|---|
| Monofilament | Single, smooth strand | Less tissue drag, less infection risk |
| Multifilament (Braided) | Multiple strands twisted/braided together | Stronger, more knot security but more infection risk |
| Type | Description | Examples |
|---|---|---|
| Natural Sutures | Derived from organic sources | – Catgut (sheep intestine) – Silk |
| Synthetic Sutures | Man-made, polymer-based | – Vicryl – Nylon – Prolene – Monocryl |
| Suture Material | Type | Common Use |
|---|---|---|
| Plain Catgut | Absorbable, natural | Mucosal closure, ligating small vessels |
| Chromic Catgut | Absorbable, treated | Peritoneum, GI surgeries |
| Vicryl (Polyglactin 910) | Absorbable, synthetic | Skin, muscle, bowel anastomosis |
| Nylon | Non-absorbable, synthetic | Skin closure, plastic surgery |
| Silk | Non-absorbable, natural | Ligatures, general closure (not often used today) |
| Prolene (Polypropylene) | Non-absorbable, synthetic | Vascular surgery, fascia closure |
| Stainless Steel Wire | Non-absorbable, metal | Bone fixation, sternum, orthopedic use |
| Technique | Use Case |
|---|---|
| Simple interrupted | Most common; general skin closure |
| Continuous (running) | Fast closure; bowel, fascia |
| Subcuticular suture | Cosmetic skin closure; plastic surgery |
| Mattress suture (vertical/horizontal) | Provides tension relief; scalp, high tension areas |
| Purse-string suture | Circular wound closure; anus, stoma |
| Figure-of-eight suture | Hemostasis; muscle, tendon fixation |
Sutures may be avoided or used cautiously in the following cases:
| Situation | Reason / Alternative |
|---|---|
| Contaminated or infected wounds | May trap infection; consider delayed closure or staples |
| Allergy to suture material (e.g., catgut) | Use synthetic hypoallergenic sutures |
| Wounds under tension | May cause dehiscence; mattress sutures or tension sutures preferred |
| Oozing or bleeding site | Secure hemostasis before suturing |
| Poor vascular supply (e.g., diabetic foot) | Risk of necrosis; suture sparingly |
| Phase | Responsibilities |
|---|---|
| Before | Prepare sterile suture tray, ensure correct suture material and size |
| During | Assist surgeon, handle instruments, maintain asepsis |
| After | Document type/size of suture, observe site for bleeding/infection |
| Suture Removal | Remove non-absorbable sutures as per doctor’s order (usually 5–10 days) |
| Patient Education | Teach wound care, signs of infection, follow-up for suture removal |
| Size | Thickness | Common Use |
|---|---|---|
| 0, 1 | Thick | Fascia, tendon |
| 2-0, 3-0 | Medium | Muscle, skin |
| 4-0, 5-0 | Fine | Face, delicate skin |
| 6-0 to 10-0 | Ultra-fine | Microsurgery, eyes, vessels |
✳️ Higher the number, thinner the suture!
| Category | Types/Examples |
|---|---|
| Absorbable | Catgut, Vicryl, Monocryl, PDS |
| Non-absorbable | Nylon, Silk, Prolene, SS wire |
| Natural | Catgut, Silk |
| Synthetic | Nylon, Vicryl, Prolene |
| Monofilament | Nylon, Prolene |
| Braided | Silk, Vicryl |
Suturing is the surgical act of stitching body tissues (usually skin, muscles, or organs) together using sutures (threads) to close wounds/incisions and promote healing.
| Instrument/Item | Purpose |
|---|---|
| Needle Holder | Holds and drives the suture needle through tissue |
| Surgical Sutures (threads) | For stitching (absorbable or non-absorbable) |
| Suture Needles | Attached to thread; various shapes (e.g., curved, straight) |
| Tissue Forceps (Toothed) | Holds skin/tissue while suturing |
| Scissors (Suture/Dissecting) | Cuts thread or tissue |
| Gauze and Sponge | Cleans blood, maintains visibility |
| Antiseptic Solution | Cleansing and disinfection |
| Gloves and Sterile Drapes | For asepsis |
| Sterile Dressing Material | To cover the wound post-procedure |
| Technique | Use |
|---|---|
| Simple Interrupted | Skin closure (most common) |
| Continuous (Running) | Long incisions (e.g., bowel, fascia) |
| Subcuticular | Cosmetic closure, minimal scarring |
| Vertical Mattress | High-tension wounds |
| Horizontal Mattress | Fragile skin (e.g., elderly, scalp) |
| Purse-string | Circular openings (e.g., drain sites) |
| Figure-of-eight | Hemostasis in vessels/tendons |
(Aseptic technique must be followed throughout)
✅ “Wound sutured at 10:30 AM by Dr. X using 3-0 Nylon. 6 interrupted sutures applied. No bleeding noted. Dressing applied. Patient tolerated well. Informed for suture removal on 7th day. – Nurse’s Name”
| Step | Action |
|---|---|
| 1 | Prepare sterile tray & patient |
| 2 | Clean wound |
| 3 | Apply local anesthesia |
| 4 | Perform suturing as per technique |
| 5 | Apply dressing |
| 6 | Document and clean area |
Suture material refers to the thread or strand used to approximate tissues, ligate vessels, and support wound healing after a surgical incision or injury.
| Type | Description | Examples |
|---|---|---|
| Absorbable | Broken down and absorbed by body enzymes or hydrolysis | Catgut, Vicryl, Monocryl, PDS |
| Non-Absorbable | Remains in body indefinitely or needs removal | Nylon, Silk, Prolene, Stainless Steel |
| Type | Description | Examples |
|---|---|---|
| Natural | Derived from organic substances | Catgut (sheep intestine), Silk (silkworm) |
| Synthetic | Man-made polymers | Vicryl (polyglactin), Nylon, Prolene, Monocryl |
| Type | Description | Features |
|---|---|---|
| Monofilament | Single smooth strand | Less tissue drag, less infection risk |
| Multifilament (Braided) | Multiple fibers twisted or braided | Better knot security, but higher infection risk |
| Suture Material | Absorbability | Origin | Structure | Common Uses |
|---|---|---|---|---|
| Plain Catgut | Absorbable (7–10 days) | Natural | Monofilament | Mucosa, ligatures |
| Chromic Catgut | Absorbable (10–20 days) | Natural | Monofilament | Peritoneum, internal tissue |
| Vicryl (Polyglactin 910) | Absorbable (30–90 days) | Synthetic | Braided | Muscle, fascia, skin |
| Monocryl | Absorbable (20–30 days) | Synthetic | Monofilament | Subcuticular skin closure |
| PDS (Polydioxanone) | Absorbable (up to 180 days) | Synthetic | Monofilament | Deep abdominal wall, pediatric |
| Silk | Non-absorbable | Natural | Braided | Ligatures, GI tract, drains (not commonly used now) |
| Nylon (Ethilon) | Non-absorbable | Synthetic | Monofilament | Skin, plastic surgery |
| Prolene (Polypropylene) | Non-absorbable | Synthetic | Monofilament | Vascular surgery, hernia |
| Stainless Steel Wire | Non-absorbable | Metal | Monofilament or twisted | Orthopedic, sternal closure |
A good suture material should be:
| Size | Diameter | Use |
|---|---|---|
| 0, 1 | Thick | Fascia, tendon, ligatures |
| 2-0, 3-0 | Medium | Skin, muscle |
| 4-0, 5-0 | Fine | Face, cosmetic closure |
| 6-0 to 10-0 | Ultra-fine | Ophthalmic, vascular, microsurgery |
📌 Higher the number, thinner the suture (e.g., 6-0 is thinner than 3-0).
| Needle Type | Shape | Use |
|---|---|---|
| Cutting Needle | Triangular, sharp | Skin, tough tissues |
| Reverse Cutting | Strengthened cutting edge | Cosmetic, skin |
| Taper Point (Round) | Smooth, round body | Soft tissues (muscle, bowel) |
| Blunt Point | Rounded tip | Liver, friable tissues |
| Factor | Preferred Suture |
|---|---|
| Skin closure | Nylon, Prolene (non-absorbable) |
| Deep tissue | Vicryl, PDS (absorbable) |
| Vascular surgery | Prolene (non-absorbable) |
| Mucosa (oral, GI) | Plain catgut |
| Tendon repair | PDS, strong non-absorbables |
| Cosmetic surgery | Subcuticular Monocryl or fine Nylon (6-0, 5-0) |
| Pediatric surgery | Absorbable (Monocryl, Vicryl) preferred |
| Classification Basis | Types/Examples |
|---|---|
| Absorbable | Catgut, Vicryl, Monocryl, PDS |
| Non-absorbable | Nylon, Silk, Prolene, Steel |
| Natural | Catgut, Silk |
| Synthetic | Vicryl, Nylon, PDS |
| Monofilament | Nylon, Prolene, Monocryl |
| Braided | Silk, Vicryl |
Disinfection is the process of eliminating most pathogenic microorganisms (except spores) from inanimate objects such as instruments and equipment by using chemical agents or physical methods.
🔴 Disinfection ≠ Sterilization
Disinfection kills most microbes, not spores, while sterilization kills all forms of microbial life.
| Level of Disinfection | Microbial Effect | Use |
|---|---|---|
| High-Level | Kills all organisms except spores | Endoscopes, respiratory equipment |
| Intermediate-Level | Kills TB bacteria, most viruses, fungi | Laryngoscope blades, suction tips |
| Low-Level | Kills some bacteria and viruses | BP cuffs, bed rails, stethoscopes |
| Instrument Type | Disinfection Method |
|---|---|
| Critical items (enter sterile tissue) | Sterilization (not disinfection) |
| Semi-critical items (contact mucous membranes) | High-level disinfection |
| Non-critical items (contact intact skin) | Low/intermediate disinfection |
| Disinfectant | Type | Uses |
|---|---|---|
| Glutaraldehyde (2%) | High-level | Endoscopes, anesthesia tools (20 mins) |
| Hydrogen Peroxide (6-25%) | High-level | Cold sterilant for delicate equipment |
| Chlorine (Sodium Hypochlorite) | Intermediate | Linen, floors, spills, blood cleanup |
| Alcohol (70% Isopropyl/Ethanol) | Intermediate | Thermometers, stethoscopes, skin |
| Phenol compounds | Low to Intermediate | Bedpans, furniture |
| Quaternary ammonium compounds (QACs) | Low-level | Surfaces, walls, mop handles |
| Method | Description | Used For |
|---|---|---|
| Boiling (100°C for 10–20 mins) | Kills bacteria and viruses | Metal instruments, syringes |
| Pasteurization (70–80°C for 30 mins) | Low heat disinfection | Respiratory therapy items |
| UV Radiation | Damages DNA of microbes | Surface disinfection in OT |
| Hot Water Disinfection (65–75°C) | Often used in washer-disinfectors | Bedpans, utensils |
| Task | Responsibility |
|---|---|
| Selection | Choose appropriate disinfectant per instrument type |
| Preparation | Dilute chemical as per protocol |
| Monitoring | Ensure correct contact time & immersion |
| Safety | Use PPE and follow spill management protocols |
| Documentation | Maintain records of disinfection cycles, logs |
| Storage | Ensure proper drying and clean storage after disinfection |
| Item | Disinfectant / Method | Contact Time |
|---|---|---|
| Endoscopes | 2% Glutaraldehyde | 20–30 mins |
| Thermometers | 70% Alcohol | 2–5 mins |
| Floors, beds, spills | 1% Hypochlorite | 10–15 mins |
| Respiratory items | Hot water / Pasteurize | 30 mins |
| Bedpans, urinals | Phenolic / QAC | 10 mins |
Sterilization is the process of destroying all forms of microbial life, including bacteria, viruses, fungi, and spores, on instruments, equipment, or surfaces using physical or chemical methods.
✅ Sterilization is essential for “critical items” (that enter sterile tissues, blood, or body cavities).
| Instrument Type | Examples | Required Process |
|---|---|---|
| Critical Items | Surgical instruments, needles, implants | Sterilization |
| Semi-critical Items | Endoscopes, laryngoscopes | High-level disinfection |
| Non-critical Items | BP cuffs, thermometers | Cleaning or low-level disinfection |
| Method | Principle | Used For |
|---|---|---|
| Autoclaving (Steam under pressure) | 121°C at 15 psi for 15–20 mins or 134°C for 3–5 mins | Surgical instruments, linen, dressing trays |
| Dry Heat (Hot Air Oven) | 160°C–170°C for 1–2 hours | Glassware, metal, powders |
| Radiation (Gamma rays) | Ionizing radiation | Disposable syringes, catheters |
| Boiling (Not sterilization technically) | 100°C for 15–30 mins | Temporary disinfection only |
| Method | Common Chemicals | Used For |
|---|---|---|
| Gas Sterilization (ETO – Ethylene Oxide) | ETO gas | Heat-sensitive items, plastic, endoscopes |
| Chemical immersion | 2% Glutaraldehyde (Cidex), 6% Hydrogen Peroxide | Scopes, laryngoscope blades (with contact time: 6–10 hours for sterilization) |
⚠️ Chemical disinfection ≠ Sterilization, unless used with prolonged contact time (e.g., glutaraldehyde for >10 hrs).
| Parameter | Standard Setting |
|---|---|
| Temperature | 121°C or 134°C |
| Pressure | 15 lbs (psi) |
| Time | 15–30 minutes depending on load |
| Items Used For | Gauze, gloves, surgical instruments |
| Type | Purpose |
|---|---|
| Chemical Indicator | Tape that changes color (e.g., white to black) on exposure to correct conditions |
| Biological Indicator | Vials containing heat-resistant spores (e.g., Bacillus stearothermophilus) to confirm sterility |
| Mechanical Indicator | Checks temperature, pressure, and time inside sterilizer |
🟢 Biological indicators are gold standard.
sqlCopyEditCleaning → Drying → Packaging → Indicator placement → Sterilization → Cooling → Storage → Issue/Use
| Sterilization Method | Items Used For | Key Points |
|---|---|---|
| Autoclave (steam) | Surgical tools, dressing, gloves | Fast, effective, most used |
| Hot Air Oven | Glassware, metal instruments | Longer time, for dry items |
| ETO Gas | Plastics, endoscopes | Toxic gas, long cycle |
| Gamma Radiation | Disposable syringes, IV sets | Done industrially |
| Chemical (Glutaraldehyde) | Scopes, delicate equipment | Requires long immersion time |
| Phase | Responsibilities |
|---|---|
| Before Disinfection | |
| ✔ Sort instruments based on use (critical/semi/non-critical) | |
| ✔ Remove gross contamination (blood, secretions) | |
| ✔ Perform manual or mechanical pre-cleaning using detergent or enzymatic solution | |
| ✔ Use PPE (gloves, apron, mask) |
| During Disinfection |
✔ Prepare correct chemical disinfectant (right concentration and amount)
✔ Immerse instruments completely for required contact time
✔ Use closed container with label
✔ Ensure proper ventilation if using strong chemicals (e.g., glutaraldehyde)
| After Disinfection |
✔ Rinse instruments (especially if high-level disinfectant used)
✔ Dry with sterile cloth or air-dry
✔ Label and store in clean, dry, covered area
✔ Record disinfection date, chemical used, and next due date
| Phase | Responsibilities |
|---|---|
| Preparation | |
| ✔ Arrange cleaned instruments into sets/trays | |
| ✔ Wrap using autoclave sheets, indicator tape, or pouches | |
| ✔ Check sterilizer (autoclave) for temperature, pressure, water level |
| During Sterilization |
✔ Load instruments without overpacking
✔ Run the autoclave for appropriate cycle and time
✔ Monitor biological/chemical indicators for sterility assurance
✔ Maintain sterilization logbook
| Post-Sterilization |
✔ Unload only when dry and cool
✔ Check indicator color change for sterility confirmation
✔ Label with date of sterilization and expiry date
✔ Store in dust-free, dry cabinets
| Task | Nurse’s Role |
|---|---|
| Indicator Use | Apply chemical indicators (autoclave tape) on every pack |
| Sterility Tests | Ensure weekly biological indicator testing |
| Environmental Cleanliness | Supervise OT and CSSD hygiene |
| Storage | Ensure sterile items are stored correctly to avoid contamination |
| Area | Nurse’s Role |
|---|---|
| Pre-cleaning | Wash, rinse, sort instruments |
| Disinfection | Chemical preparation, contact time monitoring |
| Sterilization | Packing, autoclave handling, indicator check |
| Documentation | Maintain logs, labels, sterility records |
| Quality Control | Perform indicator tests, environmental cleaning |
| Safety & Storage | Use PPE, label packs, store correctly |
🟢 Used for suturing small wounds, abscess drainage, dressing changes.
| Instrument Name | Quantity |
|---|---|
| Artery forceps (mosquito) | 2 |
| Dissecting forceps (toothed & non-toothed) | 1 each |
| Scissors (straight, curved) | 1 each |
| Needle holder | 1 |
| Suture cutting scissors | 1 |
| Sponge holding forceps | 1 |
| Bowl (for antiseptic) | 1 |
| Towel clips | 2 |
| Kidney tray, gauze pieces, gloves, dressing pack | As required |
🟢 Used for general open surgeries like hernia repair, laparotomy, appendectomy.
| Instrument Name | Quantity |
|---|---|
| Scalpel handle with blades | 1 |
| Artery forceps (medium & long) | 6–8 |
| Needle holder | 2 |
| Mayo scissors | 1 |
| Metzenbaum scissors | 1 |
| Dissecting forceps (toothed & non-toothed) | 1 each |
| Retractors (Langenbeck, Deaver) | 2–4 |
| Towel clips | 4 |
| Sponge holding forceps | 2 |
| Bowl (antiseptic/saline) | 2 |
| Surgical drapes, gauze, dressing items | As required |
🟢 Used for dilation and curettage, uterine procedures.
| Instrument Name | Quantity |
|---|---|
| Sim’s speculum | 1 |
| Auvard weighted speculum | 1 |
| Vulsellum forceps | 1 |
| Uterine sound | 1 |
| Cervical dilators (Hegar’s or Hawkin-Ambler) | Full set |
| Curette (sharp and blunt) | 2 |
| Sponge holding forceps | 2 |
| Ovum forceps | 1 |
| Artery forceps | 4 |
| Bowl | 1 |
🟢 Used for lower segment C-section.
| Instrument Name | Quantity |
|---|---|
| Scalpel handle with blades | 1 |
| Artery forceps | 6–8 |
| Sponge holding forceps | 2 |
| Needle holder | 2 |
| Mayo scissors | 1 |
| Uterine forceps | 2 |
| Allis tissue forceps | 2 |
| Retractors (Doyen’s, Deaver) | 2 |
| Towel clips | 4 |
| Dressing materials, suction tip, catheter | As required |
🟢 Used in fracture reduction, ORIF (open reduction & internal fixation).
| Instrument Name | Quantity |
|---|---|
| Bone holding forceps | 2–4 |
| Periosteal elevator | 1 |
| Bone nibbler | 1 |
| Bone cutter/saw | 1 |
| Drill machine + bits | 1 |
| Screwdriver and plates/screws | As required |
| Artery forceps | 4–6 |
| Retractors | 2–4 |
🟢 Used in minimally invasive procedures like laparoscopic cholecystectomy, appendectomy.
| Instrument Name | Quantity |
|---|---|
| Veress needle | 1 |
| Trocar and cannula (5mm, 10mm) | 2–4 |
| Laparoscope with camera | 1 |
| Graspers, scissors, dissector | 2–4 |
| Clip applicator | 1 |
| Light source and fiber optic cable | 1 |
| Suction-irrigation cannula | 1 |
| Phase | Responsibilities |
|---|---|
| Before packing | Clean, inspect, and dry instruments thoroughly |
| During packing | Arrange instruments by category, use indicator strips, wrap securely |
| During sterilization | Load autoclave correctly, ensure correct temp/time |
| After sterilization | Check chemical indicators, label pack, store in sterile area |
| Before surgery | Verify expiry date, integrity of sterile pack, and count instruments |
A proper sterile pack should have:
sqlCopyEditTop Layer:
✔ Gauze swabs
✔ Sponge-holding forceps
✔ Bowl
Middle Layer:
✔ Scissors
✔ Dissecting forceps
✔ Artery forceps
Bottom Layer:
✔ Needle holder
✔ Towel clips
+ Add suture material, gloves, dressing set as per requirement.
Surgical hand scrub is a systematic procedure of cleaning the hands, forearms, and nails using antiseptic soap/solution to remove dirt, reduce transient and resident microorganisms before donning sterile gloves and entering the OT.
🎯 Goal: Achieve maximum asepsis and prevent surgical site infections (SSIs).
| Method | Description |
|---|---|
| Timed Scrub | Scrubbing done for a specific time (usually 5–10 minutes) |
| Stroke Count Method | A specific number of brush strokes per surface area (e.g., 20 strokes per surface) |
| Case Type | Scrub Time |
|---|---|
| First scrub of the day | 5–10 minutes |
| Subsequent scrubs (if same person and case) | 3–5 minutes |
| Item | Purpose |
|---|---|
| Scrub sink with elbow/foot operated tap | Prevents contamination |
| Antiseptic solution (e.g., Povidone-iodine, Chlorhexidine) | Antimicrobial cleansing |
| Sterile nail pick | Cleans under nails |
| Sterile scrub brush/sponge | Removes debris and bacteria |
| Sterile towel (for drying) | Maintains asepsis |
| Sterile gown and gloves | To wear after scrub |
⏱️ Start from fingertips → hand → forearm → elbow
| Step | Key Points |
|---|---|
| Preparation | Remove jewelry, wear OT dress, open sterile packs |
| Nail Cleaning | Use sterile nail pick under running water |
| Scrubbing (Timed or Stroke) | Start from fingers → elbow (15–20 strokes per part) |
| Rinsing | Hands above elbows, rinse from fingers downward |
| Drying | Sterile towel, pat dry, one arm at a time |
| Gowning & Gloving | Wear sterile gown and gloves aseptically |
Gowning is the aseptic technique of donning a sterile surgical gown after scrubbing, to maintain a sterile barrier between the surgical team and the patient’s sterile field.
🎯 Goal: Prevent transfer of microorganisms from the staff to the surgical wound.
| Item | Purpose |
|---|---|
| Sterile surgical gown | Worn after scrubbing to maintain asepsis |
| Sterile gloves | To be worn after gowning (closed gloving method) |
| Sterile drape or wrapper | Used to keep gown sterile inside the sterile pack |
| OT mask, cap, and dress | Worn before scrub to maintain cleanliness |
| Assistant (optional) | Helps in assisted gowning method |
| Type | Description |
|---|---|
| Self Gowning | Performed by individual after scrubbing using sterile technique |
| Assisted Gowning | Done with the help of a circulating nurse or another sterile team member |
| Step | Action |
|---|---|
| 1 | Pick the sterile gown by grasping the inner folded surface near the neck (inside part is considered clean, outside is sterile) |
| 2 | Hold gown away from body and allow it to unfold, touching only the inner part |
| 3 | Insert arms into sleeves (only till the wrist), keeping hands inside the gown to maintain sterility |
| 4 | Let the assistant pull the gown over shoulders and tie it at the back (back side is non-sterile) |
| 5 | Proceed to closed gloving while keeping hands inside the gown sleeves |
| 6 | Once gloved, secure the waist ties (either self-tie or ask circulating nurse to assist using sterile technique) |
| Step | Action |
|---|---|
| 1 | Scrub nurse presents the sterile gown to the surgeon by unfolding it at the shoulders (sterile side facing the surgeon) |
| 2 | Surgeon inserts arms, keeping hands inside sleeves |
| 3 | Assistant pulls the gown over shoulders and ties the neck and waist ties at the back |
| 4 | Surgeon performs closed gloving next, followed by final waist tie adjustment |
Immediately after gowning, perform closed gloving to complete the sterile barrier.
📌 Do not touch the outer gown surface with bare hands!
| Gown Type | Disposal |
|---|---|
| Disposable gown | Disposed in yellow biomedical waste bag |
| Reusable cloth gown | Sent to laundry and re-sterilized via autoclaving |
| Role | Responsibilities |
|---|---|
| Before gowning | Ensure sterile gown is available and opened aseptically |
| During gowning | Assist in back tying if needed, supervise sterile technique |
| After gowning | Help with closed gloving or final waist tie |
| Monitoring | Check for any breaks in asepsis, report contamination |
| Inventory | Ensure gowns are restocked and labeled correctly after sterilization |
| Step | Key Point |
|---|---|
| Open gown | Touch only inner folded part |
| Insert arms | Keep hands inside sleeves |
| Assistant help | Pull gown over shoulders |
| Closed gloving | Before exposing hands |
| Secure ties | Back and waist using sterile technique |
| Gown Part | Sterility |
|---|---|
| Front (chest to waist) | Sterile |
| Sleeves (above elbow to cuff) | Sterile |
| Back of gown | Non-sterile |
| Underarm area | Non-sterile |
Masking refers to the correct application and removal of a surgical face mask to prevent the spread of microorganisms from the healthcare provider’s mouth and nose to the patient or sterile field.
🎯 Purpose: To act as a barrier protecting both patient and staff from cross-contamination during surgical and sterile procedures.
| Part | Description |
|---|---|
| Outer layer | Water-repellent surface (colored side – usually worn outward) |
| Middle filter layer | Filters bacteria and viruses |
| Inner layer | Absorbs moisture from the wearer’s breath |
| Nose strip | Malleable metal strip for sealing over the bridge of the nose |
| Ear loops or tie strings | For securing the mask on the face |
| Type of Mask | Description | Use |
|---|---|---|
| Surgical Mask | 3-layer mask; filters large droplets | OT, general patient care |
| N95 Respirator Mask | Filters ≥95% of airborne particles | TB, COVID-19, airborne infections |
| Cloth Mask (not for OT) | Washable, reusable | Community or non-clinical use |
| Duckbill Mask | Folded shape for comfort and filtration | Used in certain sterile procedures |
📌 Surgical masks are used in sterile environments like OT, not cloth masks.
| Situation | Action |
|---|---|
| Moist or wet mask | Must be changed immediately |
| Soiled/damaged mask | Discard and replace |
| Patient with difficulty breathing | Use only if medically tolerated |
| Latex allergy (in some elastic straps) | Choose latex-free versions |
| Step | Action |
|---|---|
| 1 | Perform hand hygiene before touching the mask |
| 2 | Check mask for tears or damage |
| 3 | Identify top edge (with nose strip) and colored side (outer) |
| 4 | Hold mask by ear loops or tie strings |
| 5 | Place mask over nose, mouth, and chin completely |
| 6 | Press nose strip to mold it securely over nose bridge |
| 7 | Secure ear loops or tie top strings at crown, bottom strings at nape |
| 8 | Avoid touching the front of the mask once worn |
| Step | Action |
|---|---|
| 1 | Perform hand hygiene |
| 2 | Do not touch front of the mask |
| 3 | Remove mask using ear loops or tie strings (untie bottom, then top) |
| 4 | Discard in yellow biomedical waste bin if used in OT |
| 5 | Perform hand hygiene again |
| Task | Responsibility |
|---|---|
| Availability | Ensure sterile masks are available in sufficient quantity |
| Instruction | Teach staff and patients about proper use |
| Monitoring | Check compliance in OT, wards, ICU |
| Changing | Instruct staff to change masks after 6–8 hours or when moist |
| Disposal | Ensure masks are discarded safely in biomedical waste |
| Training | Demonstrate correct donning and doffing methods to new staff or students |
| Step | Key Points |
|---|---|
| Before Wearing | Hand hygiene, check mask, identify sides |
| Wearing | Cover nose-mouth-chin, mold nose strip, secure ties |
| After Wearing | Avoid touching, do not pull mask under chin |
| Removing | Remove by straps only, discard properly, wash hands |
Gloving is the process of wearing sterile gloves to prevent transmission of microorganisms and maintain asepsis during sterile procedures or surgery.
🎯 Gloves create a protective barrier between healthcare workers and patients during sterile or invasive procedures.
| Type | Description | Use |
|---|---|---|
| Sterile Gloves | Individually packed, free from microorganisms | Surgery, wound dressing, invasive procedures |
| Non-Sterile Gloves | Not guaranteed sterile, used for general care | Bed making, handling waste, cleaning |
| Latex Gloves | Made from natural rubber (may cause allergy) | Common but requires allergy screening |
| Nitrile Gloves | Latex-free, chemical-resistant | For latex-sensitive individuals |
| Vinyl Gloves | Loose-fitting, less durable | Short, low-risk procedures |
| Technique | Description | When Used |
|---|---|---|
| Open Gloving | Hands are exposed; gloves are worn individually | Catheterization, minor dressing |
| Closed Gloving | Hands remain inside sleeves of gown | During surgery (after gowning) |
| Assisted Gloving | Helped by a sterile team member | During major surgeries or assisted setup |
🔹 Indications: Minor sterile procedures (e.g., catheter insertion, dressing change)
| Step | Action |
|---|---|
| 1 | Perform hand hygiene and dry hands properly |
| 2 | Open sterile glove pack on a sterile surface |
| 3 | Pick up first glove by inside of the cuff (only touch the inner surface) |
| 4 | Insert one hand into the glove, fingers first |
| 5 | With gloved hand, slide fingers under cuff of second glove (touch only outside) |
| 6 | Pull second glove onto the opposite hand |
| 7 | Adjust both gloves without touching skin or non-sterile surfaces |
| 8 | Keep hands above waist level and do not touch anything unsterile |
🔹 Indications: Major surgeries where full sterile technique is required.
| Step | Action |
|---|---|
| 1 | After gowning, keep hands inside sleeves of the gown |
| 2 | Pick up sterile glove (palm down) using covered hand inside sleeve |
| 3 | Place glove palm against the palm of the corresponding hand and align |
| 4 | With opposite sleeve-covered hand, pull glove over gown sleeve and hand |
| 5 | Repeat for other hand – do not allow bare hands to touch outside of gloves |
| 6 | Adjust fingers inside gloves without touching skin or unsterile areas |
| Step | Action |
|---|---|
| 1 | Grasp outside of one glove at wrist and peel it off, turning inside out |
| 2 | Hold removed glove in the opposite hand |
| 3 | Slide fingers of ungloved hand under the wrist of remaining glove |
| 4 | Peel it off over the first glove (both gloves now inside out) |
| 5 | Discard gloves in yellow biomedical waste bin |
| 6 | Perform hand hygiene immediately |
| Responsibility | Action |
|---|---|
| Preparation | Ensure correct glove size and sterility |
| Teaching | Educate students or staff on correct technique |
| Monitoring | Observe compliance with aseptic technique |
| Assisting | Help in assisted gloving (if needed) |
| Changing gloves | Encourage changing gloves if torn, wet, or after contamination |
| Waste disposal | Discard in correct biomedical waste bin |
| Step | Key Action |
|---|---|
| Hand hygiene | Before and after gloving |
| Open gloving | Touch inside of 1st glove, outside of 2nd |
| Closed gloving | Hands inside gown sleeves |
| During use | Keep hands sterile and above waist |
| After use | Remove safely, discard, and wash hands |
Monitoring during surgical or invasive procedures refers to the continuous observation, assessment, and documentation of the patient’s physiological status to ensure safety, stability, and timely identification of complications.
🎯 Goal: To maintain homeostasis, detect changes early, and prevent complications during surgery or procedures.
| Parameter | Why It’s Monitored |
|---|---|
| Heart rate (Pulse) | Detects arrhythmias, stress, bleeding |
| Blood pressure (BP) | Monitors perfusion, fluid balance |
| Respiratory rate (RR) | Detects apnea, anesthesia effect |
| Oxygen saturation (SpO₂) | Prevents hypoxia |
| Temperature | Detects hypothermia or fever |
| Electrocardiogram (ECG) | Continuous cardiac monitoring |
| End-tidal CO₂ (ETCO₂) | Measures ventilation during anesthesia |
| Urine output | Indicates kidney function and fluid status |
| Neurological status | Especially in local/regional anesthesia |
| Level of consciousness | Sedation or anesthesia monitoring |
| Equipment Name | Function |
|---|---|
| Multiparameter monitor | Shows ECG, BP, SpO₂, temperature, RR |
| Pulse oximeter | Measures oxygen saturation |
| Non-invasive BP cuff (NIBP) | Tracks blood pressure trends |
| Capnograph | Monitors exhaled CO₂ |
| Thermometer/Temperature probe | Measures body temp |
| ECG electrodes and leads | Tracks cardiac rhythm |
| Foley catheter with urometer | Measures urine output |
| Infusion pump | Controls IV fluids/medications |
| Defibrillator (standby) | For emergency cardiac events |
| Type of Monitoring | Description |
|---|---|
| Non-invasive Monitoring | Pulse, BP, SpO₂, temp (external tools) |
| Invasive Monitoring | Arterial line, central venous pressure (CVP), intubation (critical cases) |
| Neuromuscular Monitoring | Measures level of muscle relaxation in anesthesia |
| Anesthesia Depth Monitoring | BIS monitor, verbal response (in conscious sedation) |
| Phase | Role of the Nurse |
|---|---|
| Pre-procedure | – Record baseline vitals |
🚨 These signs require immediate intervention and team notification.
| What to Document | Why |
|---|---|
| Time and type of monitoring started | To track the duration of procedure |
| Baseline and periodic vital signs | For trend observation |
| Fluids administered, blood loss | Maintain fluid balance record |
| Any unusual findings | Legal and clinical importance |
| Names of personnel involved | For accountability |
| Parameter | Normal Range | Monitored How? |
|---|---|---|
| Pulse | 60–100 bpm | ECG, palpation |
| BP | 90/60–140/90 mmHg | NIBP or arterial line |
| SpO₂ | ≥ 95% | Pulse oximeter |
| RR | 12–20/min | Observation, monitor |
| Temp | 36.5–37.5°C | Thermometer, probe |
| ETCO₂ | 35–45 mmHg | Capnograph |
| Urine Output | ≥ 30 ml/hr | Foley catheter |
A therapeutic environment in OT refers to a controlled, sterile, safe, and supportive surgical setting that promotes optimal patient outcomes, prevents infections, and ensures efficient teamwork during operative procedures.
🎯 Goal: To ensure a sterile, safe, and psychologically supportive environment for both patient and surgical team.
| Component | Description |
|---|---|
| Sterility & Asepsis | Sterile instruments, gowns, gloves, drapes, and strict aseptic practices |
| Cleanliness | Regular cleaning and disinfection of OT surfaces and floors |
| Temperature & Humidity | OT temp (20–22°C), humidity (50–60%) for infection control |
| Ventilation/Air Flow | Laminar airflow systems, HEPA filters to remove contaminants |
| Lighting & Visibility | Shadowless surgical lights, adjustable lighting for different procedures |
| Noise Control | Quiet environment to support concentration and safety |
| Safety Equipment | Fire extinguishers, emergency exits, backup power, suction, oxygen |
| Organization of Equipment | All instruments and machines properly placed and checked |
| Communication | Clear, respectful, and calm communication among team members |
| Task | Action |
|---|---|
| Pre-operative cleaning | OT walls, floors, lights, and trolleys cleaned before the first case |
| Between cases | Table, instruments, suction jar, and floor cleaned between surgeries |
| Post-operative terminal cleaning | Entire OT mopped with disinfectants (e.g., 1% hypochlorite) |
| Fumigation (weekly/monthly) | Formalin/automated fumigation to eliminate microbes |
| UV disinfection (optional) | UV lights used when OT is unoccupied to reduce microbial load |
| Method | Purpose |
|---|---|
| Laminar Airflow System | Delivers HEPA-filtered air in a unidirectional flow to maintain sterility |
| Positive Pressure Ventilation | Prevents outside air from entering the sterile OT |
| HEPA Filters | Trap airborne particles and microorganisms |
| Parameter | Ideal Range | Purpose |
|---|---|---|
| Temperature | 20–22°C | Comfort & microbial control |
| Humidity | 50–60% | Reduces risk of static and airborne contamination |
| Area | Safety Practice |
|---|---|
| Fire Safety | No open flames, check cautery machine, fire extinguisher availability |
| Electrical Safety | Check all cords, plugs, avoid wet surfaces |
| Sharps Disposal | Use puncture-proof yellow bins |
| Emergency Preparedness | Crash cart and defibrillator checked daily |
| Patient Identification & Site Marking | Prevent surgical errors |
| OT Zoning System | Follow sterile vs non-sterile zones strictly (e.g., sterile zone, clean zone, disposal zone) |
| Task | Done (✔) |
|---|---|
| OT cleaned and disinfected before case | |
| Sterile packs checked and arranged | |
| Equipment functioning properly | |
| OT temperature and airflow normal | |
| Bio-waste bins labeled and placed | |
| Hand hygiene stations filled and functional |
| Component | Maintained How? |
|---|---|
| Sterility | Aseptic technique, sterile supplies |
| Cleanliness | Routine cleaning, disinfection, waste disposal |
| Air quality | HEPA filters, laminar airflow |
| Temperature & humidity | Set via central system (20–22°C, 50–60%) |
| Lighting & equipment | Pre-use check, shadowless lighting |
| Communication | Clear, calm, respectful team interaction |
Assisting in a major operation refers to the active participation of nurses and OT technicians in preparing, supporting, and maintaining the surgical field, instruments, patient safety, and asepsis during major surgical procedures.
🎯 Goal: To ensure safe, smooth, sterile, and successful completion of a major surgery.
Major surgery involves:
🛠️ Examples:
| Responsibility | Description |
|---|---|
| Patient prep | Verifies consent, ID, allergies, site marking |
| Equipment setup | Ensures all monitors, suction, cautery, anesthesia machine working |
| Positioning | Assists in safe patient positioning with padding |
| Asepsis support | Opens sterile packs, adds instruments to sterile field |
| Documentation | Records procedure details, sponge/needle counts |
| Communication | Liaison between scrub team and outside personnel |
| Responsibility | Description |
|---|---|
| Sterile field prep | Arranges instruments, drapes, and solutions |
| Instrument handling | Passes correct instruments using proper technique |
| Sponge/needle count | Conducts counts with circulator at start, before closure, and end |
| Tissue handling | May assist surgeon with sponging, retracting, suction |
| Specimen care | Receives and labels biopsy or surgical specimens |
| Asepsis maintenance | Monitors sterility and reports any breaks immediately |
| Aseptic Practice | Description |
|---|---|
| Scrubbing | Surgical hand wash before gowning and gloving |
| Gowning & gloving | Sterile attire for scrub team |
| Draping | Sterile drapes over patient to isolate surgical site |
| Sterile field | Maintain sterility; do not cross or contaminate |
| Traffic control | Limit personnel and entry during surgery |
| Phase | Circulating Nurse Tasks | Scrub Nurse Tasks |
|---|---|---|
| Induction | Assist anesthesia, apply monitors | Standby with sterile field ready |
| Incision | Document time, help with lights | Pass scalpel and initial tools |
| Dissection & Exposure | Provide additional items | Suctioning, retraction |
| Hemostasis | Monitor cautery unit | Pass clamps, ligatures |
| Suturing/Closure | Prepare dressing, document count | Pass needle, scissors |
| Specimen Handling | Label and send to lab | Transfer from field safely |
| Wound Dressing | Provide sterile dressing pack | Apply or assist dressing |
| Post-op Transfer | Help shift patient to recovery | Clean instruments for CSSD |
| When to Count | Items Counted |
|---|---|
| Before incision | Sponges, needles, instruments |
| Before closure of a cavity | Same items |
| At final skin closure | Final count to confirm none retained |
❗ Discrepancy in count must be reported immediately and resolved before closure.
| What to Document |
|---|
| Time of incision and closure |
| Instruments and sutures used |
| Blood loss estimation (EBL) |
| Medications given intraoperatively |
| Specimens collected and sent |
| Name of surgeon and team members |
| Any intraoperative events or breaks in sterility |
| Role | Key Actions |
|---|---|
| Circulating Nurse | Patient prep, supply, documentation, safety |
| Scrub Nurse | Sterile field, instrument handling, asepsis |
| Nurse’s Focus | Aseptic technique, patient safety, smooth workflow |
| Equipment Used | Monitor, suction, cautery, anesthesia machine, crash cart |
Assisting in a minor operation means supporting the doctor/surgeon in performing a short, less invasive surgical procedure, usually under local anesthesia and involving minimal risk, time, and tissue penetration.
🎯 Goal: To provide safe, sterile, supportive care for minor surgical interventions and ensure patient comfort and quick recovery.
| Instrument | Quantity |
|---|---|
| Artery forceps (mosquito) | 2 |
| Dissecting forceps (toothed and non-toothed) | 1 each |
| Surgical scissors (straight/curved) | 1 each |
| Needle holder | 1 |
| Sterile surgical gloves | 1 pair (per person) |
| Sponge holding forceps | 1 |
| Surgical blades and handle | 1 |
| Bowl (for antiseptic/normal saline) | 1 |
| Sterile drapes and gauze | As required |
| Sutures | As per need |
| Local anesthetic (e.g., Lignocaine) with syringe & needle | 1 set |
| Task | Description |
|---|---|
| Patient Preparation | – Explain procedure |
| Task | Description |
|---|---|
| Assist the doctor | – Pass instruments |
| Task | Description |
|---|---|
| Wound Care | – Apply sterile dressing |
| Phase | Nurse’s Key Role |
|---|---|
| Pre-procedure | Prepare patient, equipment, sterile field |
| During procedure | Assist doctor, pass instruments, monitor patient |
| Post-procedure | Dressing, waste disposal, documentation |
| Asepsis | Maintain sterile environment at all times |
Specimen handling refers to the correct collection, labeling, preservation, transportation, and documentation of biological materials (e.g., tissue, blood, fluid) obtained during a surgical procedure or investigation for diagnostic purposes.
🎯 Goal: To maintain the integrity, sterility, and identity of the specimen and prevent contamination, errors, or loss.
| Specimen Type | Examples |
|---|---|
| Tissue Biopsy | Tumors, lymph nodes, organ parts (e.g., liver, uterus) |
| Fluid Specimens | Peritoneal fluid, pleural fluid, CSF |
| Swabs | Wound swabs, throat swabs, pus swabs |
| Body Parts (Whole) | Appendix, gall bladder, amputated limbs |
| Stones/Foreign bodies | Renal stones, bullets, orthopedic implants |
| Specimen Type | Container Type |
|---|---|
| Tissue biopsy | Sterile container with 10% formalin (unless for culture) |
| Body fluids | Sterile screw-cap container or syringe |
| Microbiology swabs | Sterile culture tube or swab kit |
| Blood or CSF | Sterile test tubes (plain, EDTA, or citrate tubes) |
| Frozen sections | Dry container without formalin, labeled for urgent histopathology |
Label immediately using a permanent marker or printed label:
⚠️ Unlabeled or mislabelled specimens can lead to legal and diagnostic errors.
| Type | Preservation Method |
|---|---|
| Histopathology | 10% formalin (volume should be 10x the size of specimen) |
| Microbiology (Culture) | No formalin – keep in sterile container only |
| Frozen section | Dry sterile container; sent immediately to lab |
Record details in:
| Phase | Responsibility |
|---|---|
| Before Collection | – Ensure sterile container is ready |
| Task | Action |
|---|---|
| Collect specimen | Using sterile technique |
| Label specimen | Name, ID, date, site, test type |
| Preserve specimen | Formalin (for histopath); sterile (for culture) |
| Document | In OT register, patient file |
| Transport | Leak-proof, sealed container with lab form |
Prevention of accidents and hazards in the OT refers to all the safety measures and protocols implemented to protect patients, staff, and equipment from injury, contamination, fire, electrical shock, or procedural errors during surgical care.
🎯 Goal: To maintain a safe, sterile, and secure surgical environment for all members of the surgical team and the patient.
| Type of Hazard | Examples |
|---|---|
| Fire and Explosion | Alcohol-based prep catching fire, electrical sparks |
| Infection/Biohazard | Surgical site infections (SSIs), needlestick injuries |
| Electrical Hazards | Faulty wires, improper use of cautery machines |
| Chemical Hazards | Exposure to formalin, glutaraldehyde, anesthetic gases |
| Mechanical Injuries | Falls, patient injury due to improper positioning |
| Sharps Injury | Needle prick, blade cuts |
| Radiation Exposure | C-arm/X-ray without protection |
| Latex Allergy | Reaction to latex gloves or materials |
| Safety Item | Check ✔ |
|---|---|
| Sterility of all equipment | |
| Cautery machine and suction tested | |
| Fire extinguisher ready | |
| OT temperature and ventilation OK | |
| Biomedical bins labeled and available | |
| Patient consent and ID verified | |
| Instrument and sponge count done | |
| Emergency drugs and defibrillator available |
| Hazard Type | Prevention Measures |
|---|---|
| Infection Control | Asepsis, PPE, sterilization |
| Fire & Explosion | Avoid alcohol + cautery, fire equipment |
| Electric Shock | Dry floors, check equipment |
| Sharp Injury | Use containers, no recapping |
| Radiation Exposure | Use lead protection |
| Chemical Exposure | Ventilation, correct storage |
| Physical Injury | Proper positioning and padding |
Anesthesia is the controlled, reversible loss of sensation (with or without consciousness) induced by drugs to allow surgical or diagnostic procedures to be performed without pain or distress.
🎯 Goal: To relieve pain, relax muscles, control physiological responses, and enable surgery safely.
🟢 Complete loss of consciousness and sensation.
| Feature | Details |
|---|---|
| Drugs Used | Propofol, Thiopentone, Sevoflurane, Nitrous oxide, Ketamine |
| Routes | IV, Inhalation |
| Airway Management | Endotracheal tube, Laryngeal mask |
| Uses | Major surgeries (abdominal, thoracic, neuro) |
🟢 Loss of sensation in a specific region of the body.
| Type | Description | Example Use |
|---|---|---|
| Spinal | Drug injected into subarachnoid space | Lower limb, cesarean |
| Epidural | Drug injected into epidural space | Labor analgesia |
| Nerve block | Injection near a nerve/plexus | Arm/leg surgery |
| Field block | Localized area blocked | Hernia repair |
🟢 Loss of sensation in a small area without affecting consciousness.
| Route | Topical or infiltration | | Examples | Lignocaine, Bupivacaine | | Use | Suturing, minor procedures |
🟢 Patient remains awake but relaxed and pain-free.
| Drugs | Midazolam, Fentanyl | | Use | Endoscopy, colonoscopy, minor ortho |
| Stage | Description |
|---|---|
| Stage I: Analgesia | Induction phase, drowsy but conscious |
| Stage II: Excitement | Loss of consciousness, involuntary movements, irregular breathing |
| Stage III: Surgical anesthesia | Ideal stage: unconscious, no reflexes |
| Stage IV: Medullary paralysis | Overdose – danger zone (requires resuscitation) |
| Equipment | Purpose |
|---|---|
| Anesthesia machine | Delivers gases (O₂, N₂O) and anesthetic agents |
| Laryngoscope | Helps visualize the airway for intubation |
| Endotracheal tube (ETT) | Maintains open airway |
| Face mask | Initial induction or maintenance |
| IV cannula and fluids | Drug administration |
| Pulse oximeter | Oxygen monitoring |
| ECG monitor, NIBP cuff | Monitor vitals |
| Suction apparatus | Removes secretions |
| Resuscitation equipment | In case of emergency |
| System Affected | Complications |
|---|---|
| Respiratory | Airway obstruction, aspiration, hypoventilation |
| Cardiovascular | Hypotension, arrhythmia, cardiac arrest |
| Neurological | Delirium, delayed recovery, nerve injury |
| Gastrointestinal | Nausea, vomiting |
| Allergic | Anaphylaxis, rashes |
| Other | Malignant hyperthermia (life-threatening reaction to GA), headache after spinal |
| Type | Consciousness | Area Affected | Use |
|---|---|---|---|
| General | Unconscious | Whole body | Major surgeries |
| Regional | Conscious | Large area | Lower limb, delivery |
| Local | Conscious | Small area | Minor procedures |
| Sedation | Conscious but drowsy | Targeted relaxation | Endoscopy, minor OT |
General Anaesthesia (GA) is a medically induced reversible loss of consciousness, along with loss of sensation and reflexes, to allow painless surgical procedures.
🎯 The patient is unconscious, unaware, pain-free, and immobile.
| Type | Description |
|---|---|
| Inhalational GA | Anaesthetic gases or vapors are inhaled into the lungs |
| Intravenous (IV) GA | Drugs injected into the vein to induce anaesthesia |
| Balanced Anaesthesia | Combination of inhalational + IV drugs for optimal effect |
| Total Intravenous Anaesthesia (TIVA) | Only IV drugs used throughout procedure (no inhalation) |
| Contraindication Type | Examples |
|---|---|
| Absolute | Allergy to anesthetic agents |
| Relative |
| Stage | Description |
|---|---|
| Stage I – Analgesia | Conscious but drowsy; reduced pain sensation |
| Stage II – Excitement | Loss of consciousness, involuntary movements, irregular breathing |
| Stage III – Surgical Anesthesia | Ideal stage: unconscious, muscle relaxation, regular breathing |
| Stage IV – Medullary Paralysis | Dangerous: vital centers depressed, may cause respiratory/cardiac arrest |
⚠️ Surgery should be conducted during Stage III.
| Equipment | Purpose |
|---|---|
| Anaesthesia Machine | Delivers oxygen, nitrous oxide, and volatile agents |
| Laryngoscope | Assists intubation (placing ET tube) |
| Endotracheal Tube (ETT) | Maintains airway and ventilation |
| Face Mask / LMA | For non-invasive airway management |
| Pulse Oximeter | Monitors SpO₂ (oxygen saturation) |
| ECG Monitor | Heart rate and rhythm monitoring |
| BP Monitor (NIBP) | Blood pressure monitoring |
| Capnograph (ETCO₂) | Measures exhaled CO₂ |
| Suction Machine | Clears airway secretions or vomitus |
| Crash Cart / Defibrillator | For emergency resuscitation |
| Drug | Use |
|---|---|
| Propofol | Fast, smooth induction |
| Thiopentone Sodium | Short-acting barbiturate |
| Ketamine | Increases HR and BP, used in trauma, children |
| Etomidate | Cardio-stable, used in heart disease |
| Drug | Use |
|---|---|
| Sevoflurane | Common for maintenance |
| Isoflurane | Potent, slower onset |
| Nitrous Oxide | Used with oxygen as carrier gas |
| Type | Drug | Use |
|---|---|---|
| Depolarizing | Succinylcholine | Rapid muscle relaxation (intubation) |
| Non-depolarizing | Vecuronium, Atracurium | Maintenance of muscle relaxation |
| Drug | Use |
|---|---|
| Fentanyl | Potent opioid analgesic |
| Midazolam | Anxiolytic, sedative |
| Morphine | Pain relief in longer surgeries |
| System | Possible Complication |
|---|---|
| Respiratory | Airway obstruction, aspiration, hypoxia |
| Cardiovascular | Hypotension, arrhythmia, arrest |
| CNS | Delirium, confusion, delayed recovery |
| Allergic | Anaphylaxis |
| Rare | Malignant hyperthermia (genetic reaction to GA drugs) |
| Component | Details |
|---|---|
| Types | Inhalational, IV, Balanced, TIVA |
| Indications | Major surgeries, unconscious procedures |
| Contraindications | Cardiac disease, respiratory failure, MH risk |
| Stages | Analgesia → Excitement → Surgical → Paralysis |
| Equipment | Anesthesia machine, monitors, ETT |
| Drugs | Propofol, Sevoflurane, Succinylcholine, Fentanyl |
| Nursing Role | Monitoring, airway support, emergency prep |
The nurse’s role in general anesthesia involves providing comprehensive care and support before, during, and after the administration of general anesthesia to ensure patient safety, maintain sterility, monitor vital signs, and assist the anesthesiologist.
🎯 Goal: Ensure smooth, safe anesthesia care and early detection of complications.
| Task | Nurse’s Responsibility |
|---|---|
| Assessment | – Check patient identity, consent, allergies, fasting status |
| Task | Nurse’s Responsibility |
|---|---|
| Airway support | – Assist in intubation (pass laryngoscope/ETT) |
| Task | Nurse’s Responsibility |
|---|---|
| Airway maintenance | – Place in lateral recovery position |
| What to Record |
|---|
| Phase | Nurse’s Role Highlights |
|---|---|
| Pre-anesthesia | Patient prep, psychological support, equipment & drug check |
| During GA | Monitor vitals, assist airway management, ensure safety |
| Post-GA | Recovery position, airway care, observe for complications |
| Emergency role | Prepare crash cart, assist in resuscitation |
| Documentation | Record all actions, drugs, vitals, and outcomes accurately |
Spinal anaesthesia is a type of regional anaesthesia where a local anesthetic drug is injected into the subarachnoid space (cerebrospinal fluid) of the lumbar spine to induce temporary loss of sensation and movement in the lower part of the body.
🎯 The patient remains conscious but experiences complete pain relief below the level of the block.
| Type | Description |
|---|---|
| Low spinal | Block level up to T12 (perineal procedures) |
| Mid spinal | Block level up to T6–T10 (C-section, hernia repair) |
| High spinal | Block level above T4 (rare; risk of respiratory depression) |
| Single-shot spinal | One-time injection (common method) |
| Continuous spinal | Using a catheter for prolonged anesthesia (less common) |
| Step | Action |
|---|---|
| 1 | Explain procedure, obtain consent |
| 2 | Ensure NPO status, IV line, and baseline vitals |
| 3 | Position patient in sitting or lateral position with spine flexed |
| 4 | Clean back with antiseptic, drape with sterile towel |
| 5 | Identify L3–L4 space, inject local anesthetic (e.g., lignocaine) to numb skin |
| 6 | Insert spinal needle (22G–25G) until CSF flows |
| 7 | Inject anesthetic drug slowly (usually 2–4 ml) |
| 8 | Remove needle, apply sterile dressing |
| 9 | Position patient supine and monitor vitals |
| Type | Example |
|---|---|
| Absolute |
| System Affected | Effect |
|---|---|
| Nervous system | Loss of sensation, reflexes, and motor activity below block level |
| Cardiovascular | Bradycardia, hypotension due to sympathetic block |
| Respiratory | Minimal effect unless block is too high |
| Urinary | Urinary retention (monitor output) |
| Stage | Description |
|---|---|
| 1. Sensory Block | Loss of pain and temperature below block |
| 2. Motor Block | Paralysis of lower limbs (depending on drug dose) |
| 3. Autonomic Block | Vasodilation, drop in BP, loss of bladder control |
| Duration | 1.5 to 3 hours (depends on drug used) |
| Equipment | Purpose |
|---|---|
| Sterile spinal needle (22–25G) | For injecting into subarachnoid space |
| Syringe (2–5 ml) | For anesthetic agent |
| Sterile gloves and drapes | Maintain asepsis |
| Antiseptic solution (Betadine/Chlorhexidine) | Skin prep |
| Tray with spinal set | Contains all needed items |
| IV fluids and cannula | To maintain BP |
| Monitoring devices | ECG, BP, pulse oximeter |
| Emergency drugs | Atropine, Ephedrine (for bradycardia or hypotension) |
| Oxygen supply | If patient becomes hypoxic |
| Drug Name | Type | Duration |
|---|---|---|
| Lignocaine (2%) | Short-acting local anesthetic | 1–1.5 hrs |
| Bupivacaine (0.5%) | Long-acting anesthetic | 2–3 hrs |
| Adrenaline (optional) | Vasoconstrictor (prolongs action) | Prolongs effect |
| Fentanyl (add-on) | Opioid for pain relief | Enhances effect |
| Complication | Description |
|---|---|
| Post-spinal headache | Due to CSF leakage |
| Hypotension | Due to vasodilation |
| Bradycardia | Due to sympathetic block |
| Urinary retention | Common; may require catheterization |
| Total spinal block | Dangerous; high block causing respiratory arrest |
| Infection or abscess | Rare but serious |
| Nerve damage | Very rare |
| Item | Details |
|---|---|
| Site | Subarachnoid space at L3–L4 or L4–L5 |
| Patient status | Conscious but pain-free |
| Indications | C-section, hernia, limb surgery |
| Contraindications | Infection, bleeding disorders, raised ICP |
| Drugs | Bupivacaine, Lignocaine, Adrenaline |
| Duration | 1.5–3 hours |
| Monitoring | Vitals every 5–10 minutes |
| Nurse’s Role | Assist, monitor, position, observe complications |
The nurse’s role in spinal anesthesia includes preparing the patient and environment, assisting the anesthetist, monitoring the patient throughout the procedure, and ensuring safe recovery—with a focus on asepsis, patient safety, and comfort.
🎯 Spinal anesthesia is administered into the subarachnoid space, and nurses play a vital role in ensuring the procedure is safe, sterile, and effective.
| Responsibility | Details |
|---|---|
| Assessment | – Check patient identity, consent, NPO status |
| Responsibility | Details |
|---|---|
| Assist the Anesthetist | – Pass sterile equipment (syringe, needle, local anesthetic) |
| Responsibility | Details |
|---|---|
| Positioning | – Keep patient in supine or slightly elevated head position for 6–8 hours to prevent spinal headache |
| Monitor Vitals | – Check BP, pulse, respiratory rate, SpO₂ regularly |
| Task | Action |
|---|---|
| Crash cart check | Ensure emergency equipment is nearby |
| Emergency drugs ready | Atropine, Ephedrine, Oxygen |
| Rapid response | Be prepared for hypotension, bradycardia, respiratory depression, or seizure |
| Complication | Nursing Observation |
|---|---|
| Hypotension | Sudden drop in BP, dizziness |
| Bradycardia | Pulse < 60 bpm |
| Post-Spinal Headache | Occurs when patient sits up too early |
| Urinary Retention | Bladder fullness, no voiding |
| Back Pain | Pain at injection site |
| High Spinal Block | Difficulty breathing, unconsciousness (emergency) |
| Phase | Nurse’s Key Role |
|---|---|
| Before | Consent, preparation, positioning, tray setup |
| During | Assist anesthetist, monitor vitals, reassure patient |
| After | Monitor vitals, assess recovery, prevent complications |
| Always | Maintain asepsis, ensure documentation, emergency readiness |
| Type | Description | Example Procedures |
|---|---|---|
| Spinal Anesthesia | Drug injected into subarachnoid space (L3–L4) | C-section, lower limb surgery |
| Epidural Anesthesia | Drug injected into epidural space | Labor, abdominal surgeries |
| Caudal Block | Anesthesia via sacral canal | Pediatric surgeries |
| Nerve Block | Local anesthetic injected near specific nerve/plexus | Brachial plexus block for arm surgery |
| Field Block | Anesthetic injected in a pattern to block nerves in an area | Hernia repair |
| IV Regional (Bier Block) | Anesthetic injected into a vein with tourniquet | Short limb surgeries |
| Type | Method | Example Use |
|---|---|---|
| Surface (Topical) | Applied to mucosa or skin | Throat spray before endoscopy |
| Infiltration | Injected into tissues directly | Wound suturing |
| Ring Block | Anesthetic injected around a digit | Finger/toe surgery |
| Tumescent | Large volume for liposuction | Cosmetic procedures |
| Route | Description |
|---|---|
| Injection | Infiltration, nerve block, epidural/spinal |
| Topical Application | Creams, gels, sprays on mucosa or skin |
| Catheter Technique | Continuous infusion (e.g., epidural catheter for labor) |
| Absolute | Relative |
|---|---|
| Patient refusal | Coagulopathy |
| Infection at site | Deformity/spinal surgery |
| Allergy to drugs | Hypovolemia |
| Raised ICP (for spinal) | Sepsis |
| Effect | Description |
|---|---|
| Sensory block | Loss of pain and temperature sensation |
| Motor block | Paralysis (depending on depth of block) |
| Sympathetic block | Vasodilation, hypotension (especially spinal/epidural) |
| Minimal systemic effect | Patient remains conscious and awake |
| Stage | Description |
|---|---|
| Onset | Within 5–15 mins post-injection |
| Full Effect | Complete loss of pain, possible motor block |
| Recovery | Gradual return of sensation/movement |
| Duration | Varies from 30 minutes to 4 hours depending on drug |
| Equipment | Use |
|---|---|
| Sterile gloves and drapes | Aseptic technique |
| Syringes (2–10 ml) | For drug injection |
| Needles (different lengths) | Spinal: long; Nerve block: short or guided |
| Spinal/Epidural needle | Tuohy needle (epidural), Quincke (spinal) |
| Local anesthetic drugs | Lignocaine, Bupivacaine |
| Antiseptic solution | Skin preparation |
| Monitoring devices | ECG, BP cuff, Pulse oximeter |
| Emergency drugs & oxygen | For management of complications |
| Drug | Concentration | Duration | Notes |
|---|---|---|---|
| Lignocaine (Xylocaine) | 1–2% | Short-acting (1–1.5 hr) | Quick onset |
| Bupivacaine | 0.25–0.5% | Long-acting (2–4 hr) | Common for spinal/epidural |
| Ropivacaine | 0.2–0.75% | Long duration | Less cardiotoxic |
| Adrenaline | Mixed with local | Prolongs action | Vasoconstriction |
| Fentanyl, Morphine | Epidural/spinal add-on | Enhances pain relief |
| Regional Anesthesia | Local Anesthesia |
|---|---|
| Hypotension, bradycardia | Localized swelling, pain |
| Spinal headache | Allergic reaction |
| Urinary retention | Numbness/tingling |
| Nerve injury (rare) | Accidental vascular injection |
| Total spinal (emergency) | Toxicity (seizure, CNS depression) |
| Feature | Regional Anesthesia | Local Anesthesia |
|---|---|---|
| Consciousness | Awake | Awake |
| Area affected | Larger region | Small localized area |
| Drugs used | Bupivacaine, Lignocaine | Lignocaine, Prilocaine |
| Duration | 1–4 hours | 15 min to 1.5 hours |
| Indications | C-section, limb surgery | Suturing, dental, minor skin surgery |
| Nurse’s Role | Prep, assist, monitor, document | Same |
Regional Anesthesia is a technique that involves injecting an anesthetic near a cluster of nerves to numb a specific region of the body (e.g., spinal, epidural, nerve blocks), while the patient remains conscious.
The nurse’s role is to prepare the patient and environment, assist the anesthetist, monitor the patient, and provide post-anesthesia care and safety.
| Responsibility | Description |
|---|---|
| Assessment | – Verify identity, check consent, allergies, NPO status |
| Responsibility | Description |
|---|---|
| Patient Positioning | – Assist into sitting or lateral curled position (especially for spinal/epidural) |
| Responsibility | Description |
|---|---|
| Positioning | – Keep patient flat or slightly elevated (especially after spinal) |
| Complication | Nurse’s Response |
|---|---|
| Hypotension | Lower head, give IV fluids, inform doctor |
| Bradycardia | Monitor closely, prepare atropine |
| Spinal headache | Keep patient flat, provide fluids, inform doctor |
| Urinary retention | Monitor output, catheterize if needed |
| Respiratory distress (rare) | Oxygen support, call anesthetist |
| Total spinal (emergency) | Assist resuscitation immediately |
| Phase | Nurse’s Key Role |
|---|---|
| Before | Consent, prep, position, asepsis, vitals |
| During | Assist, monitor, support, document |
| After | Monitor recovery, check motor/sensory return, observe complications |
| Always | Maintain aseptic technique, ensure safety, be ready for emergencies |
| Advantage | Explanation |
|---|---|
| Complete Unconsciousness | Patient is unaware, feels no pain, and does not recall the procedure |
| Full Muscle Relaxation | Useful for surgeries requiring deep muscle dissection (e.g., abdominal, thoracic) |
| Airway Control (Intubation) | Secure airway allows control of ventilation and oxygenation |
| Suitable for Long Surgeries | Ideal for procedures lasting >2 hours |
| Controlled Environment | Depth of anesthesia, vitals, and response can be precisely monitored and adjusted |
| Patient Cooperation Not Needed | Useful in children, mentally ill, anxious, or uncooperative patients |
| Can Be Used in Any Surgical Area | Head, neck, thorax, abdomen, limbs – no regional limitation |
| Disadvantage | Explanation |
|---|---|
| Loss of Protective Reflexes | Risk of aspiration due to loss of cough and gag reflex |
| Airway Management Required | Requires intubation, suctioning, and close respiratory monitoring |
| Post-Operative Nausea/Vomiting (PONV) | Common side effect after waking up |
| Cardio-Respiratory Depression | Risk of hypotension, bradycardia, arrhythmias, or respiratory arrest |
| Delayed Recovery | Especially in elderly or liver/kidney-compromised patients |
| Higher Cost and Equipment Needs | Requires anesthesia machine, gas supplies, trained personnel |
| More Monitoring Required | ECG, SpO₂, BP, ETCO₂, etc. needed throughout procedure |
| Rare but Serious Risks | Malignant hyperthermia, allergic reactions, aspiration pneumonia |
| Feature | General Anesthesia |
|---|---|
| Patient Conscious? | No (completely unconscious) |
| Pain-Free? | Yes |
| Airway Support Needed? | Yes (ET tube, mask) |
| Used For? | Major, long, complex surgeries |
| Recovery Time | Longer |
| Risks | More systemic effects |
| Advantage | Explanation |
|---|---|
| Rapid Onset | Provides immediate pain relief (within 2–5 minutes) |
| Effective Analgesia and Anesthesia | Produces profound sensory and motor block below the level of injection |
| Avoids Airway Manipulation | No need for intubation or ventilator support (patient breathes spontaneously) |
| Patient Remains Conscious | Suitable for patients who wish to avoid general anesthesia |
| Reduced Risk of Nausea/Vomiting | Less post-operative nausea compared to general anesthesia |
| Minimal Drug Requirement | Requires a small dose of anesthetic for effective action |
| Lower Blood Loss | Sympathetic block leads to vasodilation and reduced bleeding |
| Faster Post-Operative Recovery | Earlier return to eating, mobility, and discharge in some cases |
| Useful for High-Risk Patients | Safer in elderly or those with cardiac/respiratory compromise (if stable) |
| Disadvantage | Explanation |
|---|---|
| Limited to Lower Body Surgeries | Not suitable for upper abdominal, thoracic, or head/neck surgeries |
| Risk of Hypotension | Due to vasodilation from sympathetic block |
| Post-Spinal Headache | Common complication if patient sits up too early or CSF leak occurs |
| Urinary Retention | May delay voiding and require catheterization |
| Back Pain or Soreness | Possible at injection site |
| Shorter Duration | Not suitable for long surgeries unless additives or repeat doses used |
| Patient Cooperation Required | Patient must remain still during the procedure |
| Contraindicated in Some Cases | Not safe in patients with bleeding disorders, infection at site, or raised ICP |
| Rare Neurological Complications | Nerve damage, abscess, meningitis (very rare but possible) |
| Feature | Spinal Anesthesia |
|---|---|
| Consciousness | Patient remains awake |
| Onset | Fast (2–5 minutes) |
| Duration | 1.5 to 3 hours |
| Suitable for | Lower limb, pelvic, C-section |
| Airway Control Needed? | No |
| Monitoring Required | Moderate |
| Common Side Effects | Hypotension, headache, urinary retention |
| Advantage | Explanation |
|---|---|
| Patient Remains Conscious | Suitable for patients who want or need to avoid general anesthesia |
| Effective Pain Control | Offers good post-operative analgesia, especially with continuous epidural |
| No Airway Manipulation | No intubation needed; lower risk of airway complications |
| Fewer Systemic Side Effects | Less nausea, vomiting, sedation compared to general anesthesia |
| Less Blood Loss | Vasodilation due to sympathetic block reduces bleeding during surgery |
| Early Mobilization | Patients can often ambulate earlier, especially after epidurals |
| Useful in High-Risk Patients | Better option for elderly, respiratory-compromised, or cardiac patients (if vitals stable) |
| Cost-Effective | Uses fewer drugs and less recovery time compared to general anesthesia |
| Postoperative Pain Relief | Can continue analgesia post-op through catheter (epidural/nerve block) |
| Disadvantage | Explanation |
|---|---|
| Limited to Certain Surgeries | Suitable only for specific regions (e.g., limbs, pelvis, lower abdomen) |
| Requires Patient Cooperation | Patient must remain still during the block |
| Risk of Hypotension | Due to sympathetic nerve blockade, especially in spinal/epidural |
| Inadequate Block | May need to convert to general anesthesia if block fails |
| Complications at Injection Site | Bleeding, infection, nerve injury (rare) |
| Technical Expertise Required | Needs skilled anesthesiologist for accurate administration |
| Urinary Retention | Due to autonomic block, especially with spinal or epidural |
| Contraindicated in Certain Patients | E.g., bleeding disorders, infection at site, severe hypovolemia |
| Post-Anesthesia Headache or Backache | Common after spinal anesthesia |
| Feature | Regional Anesthesia |
|---|---|
| Consciousness | Awake |
| Airway Management Needed? | No |
| Best For | Lower abdomen, limb surgeries |
| Common Complications | Hypotension, failed block, headache |
| Advantages | Less systemic risk, better post-op pain control |
| Disadvantages | Limited use, requires skill and patient cooperation |
Anesthesia is a medical technique that causes reversible loss of sensation, with or without loss of consciousness, to allow surgical or diagnostic procedures to be carried out without pain.
🎯 Purpose: To relieve pain, suppress reflexes, ensure patient immobility and comfort during procedures.
| Type | Description |
|---|---|
| General Anesthesia (GA) | Total loss of consciousness and sensation; patient is completely asleep |
| Regional Anesthesia | Loss of sensation in a large area by blocking nerve supply; patient remains awake |
| Local Anesthesia | Numbs a small area of the body; patient is fully conscious |
| Conscious Sedation (Moderate Sedation) | Patient remains relaxed and drowsy, but responsive and able to breathe independently |
| Type of Anaesthesia | Route of Administration |
|---|---|
| General | Inhalation (mask, ET tube), IV injection |
| Regional | Injection near nerves (e.g., spinal, epidural, nerve block) |
| Local | Infiltration, topical application, spray |
| Sedation | IV injection (e.g., midazolam, fentanyl) |
| Type | Indicated for |
|---|---|
| General | Major surgeries: abdominal, thoracic, neuro, cardiac |
| Regional | C-section, limb surgery, hernia repair, urology procedures |
| Local | Minor surgery: wound suturing, dental, skin biopsy |
| Sedation | Diagnostic procedures: endoscopy, colonoscopy, minor OT procedures |
| Type | Contraindications |
|---|---|
| General | Severe cardiopulmonary disease, allergy to anesthetic, raised ICP |
| Regional | Infection at injection site, coagulopathy, patient refusal, spine deformity |
| Local | Allergy to local anesthetics, infection at application site |
| Sedation | Severe respiratory depression, uncooperative patient without airway support |
| System | Effect |
|---|---|
| Nervous system | Loss of consciousness or sensation |
| Muscular system | Muscle relaxation (GA, regional) |
| Cardiovascular | May cause hypotension, bradycardia (especially in spinal) |
| Respiratory | May depress breathing (GA, sedation) |
| Gastrointestinal | Nausea, vomiting (mostly with GA) |
| Urinary system | Retention or suppression (spinal/epidural) |
| Stage | Description |
|---|---|
| Stage I – Analgesia | Consciousness with decreased pain awareness |
| Stage II – Excitement | Loss of consciousness with uncontrolled movements |
| Stage III – Surgical Anesthesia | Ideal stage for surgery; no movement, no pain, regular breathing |
| Stage IV – Medullary Paralysis | Overdose stage; depression of vital centers – emergency condition |
✔️ Surgical procedures should occur in Stage III.
| Equipment | Use |
|---|---|
| Anesthesia machine | Delivers anesthetic gases and oxygen |
| Pulse oximeter | Monitors oxygen saturation |
| ECG monitor | Tracks heart rate and rhythm |
| BP monitor (NIBP) | Measures blood pressure |
| Capnograph | Measures exhaled CO₂ |
| Laryngoscope | Used for intubation |
| Endotracheal tube (ETT) | Maintains airway in GA |
| Suction machine | Removes secretions |
| Oxygen mask/nasal cannula | Delivers oxygen |
| Crash cart | Emergency medications and equipment |
| Type | Drug Examples | Purpose |
|---|---|---|
| Induction agents | Propofol, Thiopentone, Ketamine | To induce unconsciousness |
| Inhalational agents | Sevoflurane, Isoflurane, Nitrous Oxide | To maintain anesthesia |
| Muscle relaxants | Succinylcholine, Vecuronium | For intubation and relaxation |
| Opioids | Fentanyl, Morphine | Pain relief |
| Anticholinergics | Atropine, Glycopyrrolate | Reduce secretions, prevent bradycardia |
| Drug | Type | Use |
|---|---|---|
| Lignocaine (2%) | Local anesthetic | Infiltration, nerve block |
| Bupivacaine (0.5%) | Long-acting local anesthetic | Spinal, epidural anesthesia |
| Ropivacaine | Newer long-acting anesthetic | Safer alternative |
| Adrenaline (optional) | Vasoconstrictor | Prolongs duration of action |
| Phase | Role |
|---|---|
| Pre-operative | Check consent, allergies, fasting status, prepare equipment |
| During anesthesia | Monitor vitals, assist anesthetist, manage airway |
| Post-operative | Monitor recovery, position patient, manage pain, watch for complications |
| Type | Examples |
|---|---|
| General | Hypotension, bradycardia, aspiration, airway obstruction, malignant hyperthermia |
| Regional | Post-spinal headache, hypotension, nerve damage, urinary retention |
| Local | Allergic reaction, tissue necrosis, toxicity (if injected into a vessel) |
| Sedation | Hypoventilation, drowsiness, airway obstruction |
| Feature | General | Regional | Local | Sedation |
|---|---|---|---|---|
| Consciousness | Unconscious | Conscious | Fully conscious | Drowsy but responsive |
| Airway control | Required | Not needed | Not needed | May be needed |
| Area affected | Whole body | Large region | Small area | None – for pain relief |
| Used for | Major surgeries | Limb/lower body surgeries | Minor surgeries | Endoscopy, dental |
| Onset | Rapid | Moderate | Quick | Quick |
Legal aspects in intraoperative care refer to the laws, ethical standards, and professional responsibilities that nurses and surgical staff must follow to ensure patient safety, protect patient rights, and avoid legal liability during surgery.
🎯 Goal: To ensure that all intraoperative activities are performed safely, ethically, and within the law.
| Point | Details |
|---|---|
| What is it? | A written and signed document that confirms the patient agrees to undergo surgery after full explanation |
| Who obtains it? | The surgeon is responsible for obtaining it; the nurse witnesses it |
| Nurse’s duty | – Ensure consent is taken before shifting to OT |
| Legal Safeguard | Description |
|---|---|
| Patient ID check | Use at least 2 identifiers (name, ID band, DOB) before surgery |
| Surgical site marking | Must be done by the surgeon on the correct side or limb |
| Nurse’s responsibility | – Verify patient identity |
| Legal Concern | Description |
|---|---|
| Infections due to negligence | Hospital-acquired infections (e.g., surgical site infection) due to break in asepsis may lead to legal action |
| Nurse’s role | – Follow infection control protocols strictly |
| Why Important? | Legal proof of what happened in OT | | Nurse must document | – Start and end time of surgery
| Legal Principle | Description |
|---|---|
| Duty of care | Nurse is legally responsible for following standards of practice |
| Acting beyond scope | Performing tasks meant for doctors (e.g., injecting drugs without order) can lead to legal action or license cancellation |
| OT nurse’s scope | – Prepare sterile field |
| Legal Obligation | Nurse’s Role |
|---|---|
| Prevent burns, falls, pressure sores | – Use safety straps |
| Legal Right | Patient has right to privacy | | Nurse’s Responsibility | – Do not discuss patient details in public areas
| Legal Rule | Biomedical Waste Management Rules, 2016 | | Nurse’s Role | – Label and send specimens correctly
| Legal Doctrine | Doctrine of Implied Consent | | When Applicable | If patient is unconscious and needs life-saving surgery, doctor may proceed | | Nurse’s Duty | Document clearly that procedure was done as an emergency and consent could not be obtained in time |
| Term | Meaning |
|---|---|
| Negligence | Failure to provide expected standard of care |
| Malpractice | Professional misconduct or lack of skill |
| Battery | Performing a procedure without consent |
| Assault | Threatening to perform a procedure without consent |
| Autonomy | Patient’s right to make decisions |
| Documentation | Legal record of nursing care and activities |
| Legal Aspect | Nurse’s Responsibility |
|---|---|
| Informed consent | Ensure obtained & witnessed |
| Patient identification | Verify ID, surgery site |
| Asepsis & safety | Maintain sterile field, avoid injury |
| Documentation | Accurate, timely, detailed records |
| Confidentiality | Respect privacy and secure information |
| Scope of practice | Do not act beyond training |
| Waste/specimen handling | Follow correct procedures |
| Emergency action | Document and report when consent not possible |