Peri-operative nursing

Category: Education

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By: sneha.nancy (5 month(s) ago)

nice presentation mam , plz allow me for download

By: ravibharaj (13 month(s) ago)

Excellent. Really a nice presentation to have come across. Would be really helpful for the OT Nurses.

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Peri-operative nursing :

Peri-operative nursing Conducted by: Ms.Monika (Clinical instructor) Army college of Nursing

Introduction (Nursing is the harmony of head ,heart & hands) :

Introduction ( Nursing is the harmony of head ,heart & hands ) Operation theatre nursing is an integral part of nursing services in the hospital. Operation theatre nursing may be considered as a critical nursing services area. Operation theatre nursing services need to make genuine efforts to regards pt as individuals ,not to surgical cases.

Historical perspective (History retain the link b/w yesterday ,today & tomorrow):

Historical perspective (History retain the link b/w yesterday ,today & tomorrow) a) PRE-HISTORIC ERA: Modern surgical intervention have their roots in pre- historic period. the skull & skeleton of ancient era bear the evidence of surgical interventions. There is record of suturing of wounds in Egypt 4000years ago


Cont……..d Medicinal herbs & hallucinogenic substances were used to dull the senses during surgery. Surgery were performed with crude stones knives & stone instruments. The instruments which were used for caesarean section were knives made of stone or metal which were generally very heavy ( 1900-1600 BC )


b) PRE-CHRISTAIN ERA During Pre- Christian Era (1600-1000 BC) ,the father of Indian physician & surgeon , -’ SUSHRUTA.’ Sushruta is considered the father of Indian Surgery a .Master Ayurvedic Surgeon


cont……..d Susruta made grasping instruments like arrow heads to extract substances from within the body. He also designs plain forceps ,toothed forceps ,scalpels ,knives ,lancets ,trocars ,canulae . These were made from stone ,gold ,silver ,ivory or wood. later on he used copper ,bronze ,brass etc. The sushruta samhita also refers of washing hands & instruments & drying them in the sun b/w surgeries. He used cocoa leaf for local pain relief.


b) HIPPOCRATES Hippocrates ,the father of the western medicine was born around 450-300 BC. He wrote many books on medicine & surgery. He had written about pt’s ,instruments ,lights ,assistants & surgical methods.

c) Aristotle :

c) Aristotle He was born around 380-322 BC. He was the son of a physician. He wrote books on herbal medicine ( THE GOLDEN CABINET OF SECRETS) records the use of analgesic ,anti- spasmodics ,laxatives ,sedatives ,astringents & stimulants


c) POST CHRISTIAN ERA The surgical methods developed slowly & gradually in post Christian era. During the time of physician CLAUDIUS GALEN ,who was born around 125-200 AD ,surgery was formally included in medical discipline. In post Christian ANTON VAN LEEUWENHOCK , a Dutch scientist developed a compound microscope in 1630 which could magnify the image of an object 250 times. After about 200 years Microscope was used for the first time in clinical surgery .

Definition :

Definition It is the defined as the nursing care of surgical patient . BEFORE ,DURING & AFTER THE SURGERY. The perioperative nurse has to be able to implement nursing actions to ensure and maintain a safe environment for the patient.


Cont……..d Perioperative nursing is a nursing specialty that works with patients who are having operative or other invasive procedures. Perioperative nurses work closely with surgeons , anesthetists , surgical technologists , and practitioners . They perform preoperative, intraoperative, and postoperative care primarily in operating theatres , stress test evaluations, cardiac monitoring, and health assessments. Perioperative nurses typically have Basic Life Support and Advanced Cardiac Life Support certification


Cont………d He or she demonstrates the proper use of all equipment such as...electrosurgical equipment, placement of The nurse has to have knowledge of the working of and be able to troubleshoot problems with any and all equipment used in the operations .

Operation Theatre :

Operation Theatre It is special room in a hospital equipped for the performance of surgical operations; "great care is taken to keep the operating rooms aseptic“.

Classification of OT:

Classification of OT The major OT is a spacious and air-conditioned hall that has Four operating tables They are engaged with major surgeries conducted under the use of general anesthesia. The operation theatre is well equipped with all the necessary instruments & machinery. A central sterile supply department with two big horizontal sterilization machines are located close to the Operation Theatre where all instruments and linen are sterilized and kept ready to use Major OT

b) Minor OT:

b) Minor OT Equipped with a microscope, an anesthetic machine and all the other routine equipment is used to operate minor eye cases, foreign body removal etc. It deals with the minor surgeries operate under local anesthesia. Removal of suture can also be done in minor OT. Diagnostic procedures such as Biopsy can also take place.

Classification :

Classification I MMEDIATE – Immediate life, limb or organ-saving intervention: resuscitation simultaneous with intervention. Normally within minutes of decision to operate. A) Life-saving B) Other e.g. limb or organ saving URGENT – Intervention for acute onset or clinical deterioration of potentially life-threatening conditions, for those conditions that may threaten the survival of limb or organ, for fixation of many fractures and for relief of pain or other distressing symptoms. Normally within hours of decision to operate. EXPEDITED – Patient requiring early treatment where the condition is not an immediate threat to life, limb or organ survival. Normally within days of decision to operate . ELECTIVE – Intervention planned or booked in advance of routine admission to hospital. Timing to suit patient, hospital and staff.

Objectives of operation theatre nursing :

Objectives of operation theatre nursing To create & maintain an aseptic & safe environment for pt’s. To provide a safe & efficient working environment to all OT personnel. To provide safe ,supportive & quality nursing care to meet the surgical requirement of the pt’s. To function effectively as Ot team member. To adhere to the policies ,guidelines & procedures of Ot services of the hospital.

Location of operation department :

Location of operation department It should be away from general wards ,OPD ,entrance & exit of hospitals. It should be adjacent to emergency & trauma unit ,intensive care unit or critical care unit & surgical wards. Ot should have an easy access to X –ray department ,diagnostic department & central sterile supply department. Ot should be on the top most floor to minimize overhead noise.

Lay out of OT design :

Lay out of OT design


OT DESIGN OPERATION THEATRE ZONES OR AREAS: In Operation department there are three distinct zones or areas. they are as under: Restricted zone or sterile area Semi restricted zone or sub sterile area Unrestricted zone or clean area.

a) Restricted zone or sterile area :

a) Restricted zone or sterile area This is a place where: Staff & pt’s in street clothes & shoes are not allowed to enter. Scrubbed personnel wear sterile gowns & gloves & get ready for operation procedure. Sterile trolleys & equipments are set. This zone has operation theaters & operation room where operations are done.

b) Semi restricted zone or substerile area :

b) Semi restricted zone or substerile area After changing from street clothes ,OT team or personnel ,with clean gown ,cap & OT slipper. This zone consist of the following: - Pre-operative pt’s waiting room with attached toilet ,Nurses Station ,Scrub areas ,Store room ,Store rooms for housekeeping items ,Anesthesia room ,Conference room ,Lecture hall ,Xray Room ,Laboratory ,Post operative room or recovery room ,Pantry.

a) pre-operative pt waiting room :

a) pre-operative pt waiting room It is the room where pt’s are received by OT nursing personnel. Here pt’s records are checked. Pt receive premedication ,insertion of NG tube ,urinary catheter or I/V lines.

b) Nurses station or counter:

b) Nurses station or counter nurse's station is an area of a health care facility (such as a hospital or nursing home ) where nurses and other health care staff sit behind when not working directly with patients and can perform some of their duties. The station has a counter that can be approached by visitors and patients who wish to receive attention from the nurses . It should be spacious enough to allow two or more personel to work together.

c) Scrub Area :

c) Scrub Area This should be spacious. Some time s two or three operation theaters can share one scrub facility. Scrub area should have deep & wide shink to avoid splash of water on the surrounding area. There should be facilities for running water. The taps should be such that they could be opened or closed by foot pedals or they have long handles that can be operate by elbows.

d) Store rooms :

d) Store rooms Rooms where clean but unsterile equipments & articles are kept. e)Store room for house keeping articles: it is the room where linen’s ,towels ,trays ,basins , bowls ,infusion bottles ,emergency drugs etc are kept.

f) Anesthesia room :

f) Anesthesia room This room should have adequate equipments which is always ready for immediate use such as anesthetic trolley. g) Conference room : Room where discussions & conferences regarding the surgical cases or surgical procedures can be held.

h) Lecture hall :

h) Lecture hall Here lectures on surgical cases or surgical procedures can be delivered. It can also be combined with conference hall Both the conference & lecture rooms should be equipped with the blackboards & other AV teaching equipments.

i) X-ray room :

i ) X-ray room This should have a portable X-ray machine & should provide the facilities for getting x-ray done . j) Laboratory : operation department sub sterile zone have a small pathology laboratory where blood test ,tissue specimen test etc can be done.

k) Post –operative or recovery room :

k) Post –operative or recovery room Room where pt’s are kept & cared till they are out of anesthesia & till their vital signs become stable . L) Pantry : room where tea or coffee or soup ca be prepared & served to the pt’s ,their attendants or OT personnel .

c) Unrestricted zone or Clean area:

c) Unrestricted zone or Clean area This is the area where hospital personnel ,OT personnel ,pt’s & their attendants can move about in street clothes. This zone consist of following areas: Entrance & exit : sometimes they are same . They should be wide enough ( at least 5 to 6 feet wide) to allow stretcher ,wheel chairs ,trolleys ,CSSD supply ,laundry supply to move OT freely. The doors should be preferably be sliding & open towards the outside of operation department

2) Personnel changing or dressing room :

2) Personnel changing or dressing room There should be separate changing rooms for male & female OT staff members. The grade 4 th staff again should have separate changing rooms. The rooms should have adequate arrangements for changing with attached toilet In the changing room operation theatre personnel changes from street clothes & shoes to operation theatre attire such as gowns or pajamas ,shirt ,caps ,Ot slipper After changing from street dress to Ot dress they can move to the sub sterile area or semi restricted zone.

3)Waiting room :

3)Waiting room Pt ‘s attendants or family members waiting room with attached toilet & drinking water facility. 4) Visitor’s gallery : Gallery from where the visitors can see the operative procedures being performed. 5) Utility Room : this is also called clean up room where instruments ,articles ,gloves are received following surgical procedures. here all these are cleaned ,washed & wiped dry & then wrapped ,stored & sent for sterilization.

6) Disposal or sluice room :

6) Disposal or sluice room This room receives all soiled linen & dressing. Here all disposable items are separated acc to biochemical waste management code & then packed in leak proof containers. The soiled linens are sent to the laundry. The OT set up should be such that it should be possible to dispose off soiled items without taking them through substerile or sterile areas.

a) Operation theatre size ,shape & construction :

a) Operation theatre size ,shape & construction

ii) Side ,shape & construction of OT:

ii) Side ,shape & construction of OT The standard OT should be rectangular or square in shape & should be 20*20*10 feet in size so it provides a floor space of 400 Sq feet approx. It should be spacious enough to allow free movement of personnel ,trolleys ,stretchers ,wheel chairs ,monitoring devices ,portable x-ray machines etc. Cardiac or neurosurgery OT should be bigger in size of 20*30*10 feet with 600 SQ feet floor space.


Cont………d OT for endoscopy or minor surgery can be of small size of 18*18*10 feet with a floor space of 324 sq feet. The small operation theatre can be used for cardiac catheterization. The OT should be equipped with endoscopy equipments ,laser & electro surgery items with CPR equipments ,suction apparatus ,o2 cylinder.


Cont……..d The walls ,ceiling & floor surfaces should be made of hard fire resistant ,smooth ,non porous material. These surfaces should be easily washable , free as possible joints ,seams so that they do not permits adherence of bacteria or dust particles containing micro-organism. These surfaces should be able to withstand repeated washing with germicidal agents. The surfaces should be able to absorb sound. The color of the flooring should be such that if a needle is dropped on the floor it is visible.

b)Operation theatre ventilation :

b)Operation theatre ventilation There should be no open window in the OT. The sliding doors of the OT should be open from the OT towards the sub sterile zone. There should be no circulating fan or cross ventilation to prevent airborne contamination of the surgical wound. An effective ventilation system is necessary to exchange the air. This air is filtered with an efficient air filtering system.


Cont……….d Ventilation should follow the principles that the direction of airflow should take place from the sterile to the clean zone & form the clean zone to the less clean areas.

c) OT temperature & humidity :

c) OT temperature & humidity The temperature of the OT must be maintained b/w 18 degree to 22 degree C with an air conditioning system. The humidity must be maintained at the level of 50-55 %.

d) OT Lighting :

d) OT Lighting The general room illumination the OT is provided by fluorescent lamps. The artificial lighting should be evently distributed throughout the OT. The surgical or operation light should be an overhead ceiling mounted unit.. The light should be from a circular source & shadowless.


Cont……….d The light should be near daylight in color to reduce visual fatigue. The light should be adjustable & movable to any position to direct & focus light on the operation site from several angles. The radiant heat produced by the light should raise the tissue temperature not more than 2 degree C.

e) OT electric generator :

e) OT electric generator OT department should have electric generator to ensure uninterrupted electricity supply in case of electricity failure Other essential requirement : there should light alarm to call for assistance in emergency. There should also be a wall clock in the OT for monitoring time.

f) OT o2 supply & suction system :

f) OT o2 supply & suction system OT should have piped in O2 supply through central O2 supply system from a central source. There should also be central suctioning through piped in suction arrangement.

g) Music system:

g) Music system Operation theatre can also have a soft music system. Music creates a pleasant environment for pt’s & staff. Music also provide diversion of the pt’s mind. Music can provide relaxation to pts who undergo surgery under local ,regional or spinal anesthesia. It also [provide a soothing atmosphere & decreses tension & fatigue of the Ot staff.

h) Store Room :

h) Store Room These rooms should have steel cabinets & separate for specific items. These cabinets should be spacious enough to accommodate various items such as sterile linens ,sterile trays ,sterile drums with sponges ,dressings ,cotton swabs ,bandages ,sterile rubber sheets ,catheters ,sutures ,syringes ,infusion & transfusion sets. A separate store room is needed for unsterile ,clean articles such as linen ,OT dress items ,stainless steel equipments


Cont……….d The cabinets of store rooms should be made up of such materials which can be cleaned & washed without being damaged. There should be bigger store room for equipments such as monitoring devices ,suction apparatus ,o2 cylinder ,trolleys ,wheel chairs ,stretchers ,defibrillator ,pace makers ,bed urinals ,ot slippers etc.

i) Sterile preparation room:

i ) Sterile preparation room This should be adjacent to OT. This should be spacious enough to allow free movements & setting up of trolley with sterile items & instruments. J) computer terminal : the modern OT construction also provide a surface area for the computer terminal in each OT. These computers are being used to record & maintain pt information.

k) Attendants waiting lobby:

k) Attendants waiting lobby This is to provide facilities for family members & relatives to wait when the pt is undergoing surgery. This lobby should be spacious enough with adequate suiting arrangements & attached toilet facilities. This should be adjacent to OT & nearby post op unit.

L) Procedure room:

L) Procedure room Some hospital’s OT department have procedure rooms where special procedures such as artificial pacemaker implementation ,cardiac catheterization ,defibrillator etc are performed. M) Specific OT: Some hospital’s OT department have specific pt such as cardiac OT ,neurology OT ,orthopaedic ot ,ophthalmic ot ,ENT ot ,general ot.

Staff of OT:

Staff of OT

OT Staffing :

OT Staffing The management of intra-operative nursing care is the coordinated efforts of well organized nursing personnel. Whose function include safe ,efficient & effective nursing care to the surgical pt in OT. OT has the following personnel in the surgical team: Nursing personnel -X ray technician Medical personnel - OT technician Anesthesiologist -OT Attendants Lab technician - OT Sweepers or Cleaners

a) Nursing Personnel:

a) Nursing Personnel Nursing personnel or nursing section in OT is headed by the nursing director or chief nursing officer (CNO). The other members of the nursing team working under the nursing director are as the following: Deputy nursing director or deputy CNO Nursing supervisors Scrub nurses Circulatory nurses Nurse – in – charge store Nurse – in –charge reception ,admission ,transfer etc .

Hierarchy of nursing personnel in OT:

Hierarchy of nursing personnel in OT Nursing Director/Chief Nursing officer ( CNO) Deputy Nursing /Deputy CNO Nursing Supervisor Reception (for admission & transfer ) Nursing Supervisor OT Nursing Supervisor Store OT Nurse Assistant Circulatory nurse Scrubbed nurse

a) Deputy nursing director:

a) Deputy nursing director The unit of nursing services in OT is headed by the nursing director. Nursing director should have a qualification of post graduation in nursing with the specialty in OT nursing. She or he is the administrative or managing authority of nursing services in OT. She has three areas of responsibilities: Administration Management Education & research

b) Nursing supervisor :

b) Nursing supervisor Nursing supervisor needs to have a post graduate qualification in nursing with specialty in OT nursing. Responsibilities : Planning OT activities as per the surgical schedule. Delegating responsibilities to the scrub nurse & circulatory nurse for smooth conducting of the surgical schedule.


Cont………d Assessing the requirements f equipments & articles & other supplies & arranging for obtaining them. Communicating effectively to the nursing personnel under her to ensure that all information is received . Evaluating the effectiveness of the performance of the nursing personnel in OT. Conducting research n OT nursing participating in the team research.

c) Scrub nurse :

c) Scrub nurse The scrub nurse is onr works directly with the surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure. Surgical team members who work within the sterile field have scrubbed their hands and arms with special disinfecting soap and generally wear surgical gowns, caps, eyewear, and gloves.

Circulator Nurse:

Circulator Nurse The circulator is responsible for managing the nursing care of the patient within the OR and coordinating the needs of the surgical team with other care providers necessary for completion of surgery. The circulator nurse observes the surgery and the surgical team and assists the team to create and maintain a safe and comfortable environment for the patient.


Cont……….d The circulator nurse assesses the patient's condition before, during, and after the operation to ensure an optimal outcome for the patient.

2)Medical or surgeon personnel :

2)Medical or surgeon personnel A surgeon can be defined as a doctor, who operates a body either to cure or prevent a disease, fix an injury, or to solve a health problem. Thus, it is said that a surgeon is a medical practitioner, who is an expert at performing operations on the body. The surgeon job description depends upon the type of the surgeon he/she is. There are different types of surgeons and their set of duties:


Cont……….d A general surgeon usually operates on the abdominal parts and performs operations related to hernia and appendicitis. Neurosurgeon : operates on brain and spinal cord Orthopedic surgeon : An orthopedic surgeon is an expert at performing operations related to bones, joints, spine, etc. Plastic surgeon : They perform various types of cosmetic surgeries which include, liposuction, treating skin burns, etc Each of these specialized surgeon is an expert in operating the respective parts of the body.

Duties of surgeon :

Duties of surgeon Learn the medical history of the patient, make sure if the patient has certain allergies, expected outcome after the operation. Before starting with the surgery, a surgeon should make sure that the operation theater is well equipped with surgical instruments required for the surgery. The surgeon should provide all the information and risks associated with the surgery to the patient. The surgeon should manage, plan and schedule the surgery, after studying the physical condition of the patient. After completion of the surgery, the surgeon should prepare the case history and provide all the necessary after surgery care to the patient.

3)Anaestheologist :

3)Anaestheologist is a physician trained in anesthesia and peri-operative medicine. They administer anesthetics, which are medicines to prevent patients from feeling pain and sensations; closely monitor patients' vital signs during surgery and adjust anesthetics accordingly; monitor patients through the first recovery stages after an operation; anesthesiologists may also help treat patients with conditions causing chronic pain. More than ninety percent of the anesthetics used in health care are administered by or under the direct supervision of an anesthesiologist .

4)OT Technician :

4)OT Technician O.T. Technician is a qualified person, is the member of the surgical team. Operating room technicians are also called surgical technicians. They assist in preparing operating rooms for surgery.  They are responsible for having surgical instruments, sterile bandages and linens, needed fluids, and other equipment ready for the operation.


Cont….d They may also assist doctors by handing them needed instruments during surgery and for counting sponges and needles before and after the operation.  They deliver specimens to hospital laboratories for analysis, and after operations they take patients to the recovery room.

Duties of OT technician :

Duties of OT technician Operation Theatre Technician has to carry out the routine work pre-operatively such as - Carbolization - Fumigation - Sterilizaton - Autoclaving Ultra Violet (U.V.) lighting has been used for germicidal sterilization to prevent Mould / Bacteria Growth etc. So the environment is free from the disease causing microrganisms & the required instruments, linen, dressing materials etc. are free from the pathogenic microorganisms & ready for the use in operation / surgical procedure

5) OT Cleaners:

5) OT Cleaners OT cleaners are the personnel who are engaged themselves in cleaning the OT pre-operative & post operatively. Cleaners clean the OT with the antiseptic lotion with wearing of gloves ,mask & cap. They are responsible for maintaining the cleanliness of OT.

Duties & responsibilities of nurse in OT:

Duties & responsibilities of nurse in OT

Thanks for your attention :

Thanks for your attention