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Assisting as a scrubbed nurse (Passing instruments (The nurse's role…
Assisting as a scrubbed nurse
The role involves
Holding or retracting tissues
Cutting suture material
Preparing instruments e.g. loafing scalpel blades or threading needles
Keeping track of instruments or swabs
It is vital to keep track of the swabs used during surgery. Leaving a swab inside a patient is a mistake that is surprisingly easy to make.
Some swabs come with a radio-opaque line stitched into the swab meaning they can be viewed on x-rays
Passing instruments to the surgeon as required
Counting swabs
Before the surgery starts, the number of swabs present in surgical kits should be counted and a record must be made
Every time new swabs are added to the kit, count them and ask a non-scrubbed nurse to record it
At the end of the surgery, BEFORE closing any incisions, count the number of used swabs present in the kit and add the total to the unused swabs. Ask that a note is made on the patient's records to say the task has been completed, and the swab tally is correct
Counting instruments
The nurse must record the instruments used, particularly when new instruments are added to the surgical kit
The nurse should also record any consumables used such as suture materials, drains and staples
An effective and efficient scrub nurse is one step ahead of the surgeon, constantly anticipating the next instrument which might be required
Passing instruments
The nurse's role is to support the surgeon, the aim is to create a working environment that facilitates the surgeon's concentration when operating and to ensure that sterile instruments remain sterile
When passing an instrument to the surgeon the scrubbed nurse should gently but firmly slap the instrument into the waiting palm of the surgeon. This method is recognised and enables the surgeon to receive the instrument without taking attention away from the surgical site
Close instrument ratchets before handing them as they can catch on gloves and other equipment
Other procedures that accompany instrument handling include:
Instruments with finger rings are always passed to the surgeon with the rings forward
Scalpels are passed so that the nurse and surgeon are protected from the blade. The thumb and forefinger hold the blade handle with the blade pointing downwards
Curved instruments are passed and applied with the concave side up
Before returning the instrument to the trolley, wipe blood or tissue from the instrument using a sterile swab. These should not be used to swab the surgical site
Always return instruments to the same position on the trolley so that you can locate them quickly
If any instruments are contaminated e.g. by touching a non sterile area should be discarded and not returned to the trolley
Swabbing the surgical site
During surgery one of the roles of the scrub nurse is to watch for and mop blood accumulations around the surgical site. Swabbing is accomplished by blotting rather than wiping. Avoid rubbing the swab across the site as this promotes bleeding and disrupts any clot formation
Handling and retracting the tissues
Tissue must be handled firmly but carefully and held in the exact position that the vet instructs. The nurse needs to check that the tension applied to the tissues is correct
Tissue slippage can also have unwelcome consequences; if slippage is anticipated or suspected, use both hands and support your elbows on a firm surface
Cutting sutures
When suture material requires cutting during surgery, the scissors are brought to the surgical site with the blades closed. The jaws are then opened slightly and only the tips of the scissors are used to cute the suture