1 — Operating Room Orientation

Operating Theatre

This is another name for the operating room

Operating Room

This is a sterile, controlled environment within a hospital where surgical procedures are performed

Operating Room

This is a critical space designed to minimize infection and ensure safety of both surgical teams and patients

• Aseptic technique

• Zoning

• Proper lighting

• Ventilation system

• Temperature control

• Proper equipment

• Drugs and other consumables required for routine and emergency use

Important considerations for operating room set up

• Anesthesia Machine

• Anesthesia Monitor

• Anesthesia Cart

• Operating Table

• Operating Lights

• Defibrillator

• Suction Units

• Electrocautery Machine

• Back Table

• Mayo Table/Stand

• Prep Table

• IV Pole

• Kick Bucket

• Storage Cabinets

• Laparoscopic Tower

Key Components of Operating Room

Anesthesia Machine

A machine usually checked by the circulating nurse

Patient Monitor

Anesthesia Cart

Operating Room Table

Operating Room Lights

Electro Boperized Machine

Suction Machine

Back Table

Kidney Table

Mayo Table

Prep Table/Cart

IV Pole

Kick Bucket

Steel Cabinet

Laparotomy Tower

• Unrestricted

• Semi Restricted

• Restricted

Three Areas of the Operating Room

Unrestricted Area

• Traffic is not limited

• Street clothes are allowed

• Allows access for communication with the department and the hospital personnel

Semi Restricted

Traffic is not allowed to everyone

Restricted

• Traffic is limited

• Wearing of scrub attires, caps, and masks are compulsory

• Sterile Team

• Unsterile Team

Two Components of a Surgical Team

• Anesthesiologist

• Circulating Nurse

• IW/Cleaner/Lifter

Members of the Unsterile Team

• Surgeon

• Assist

• Scrub

Members of the Sterile Team

Only sterile item are used within the sterile field

Principle 1 of Aseptic Techniques in Operating Room

Sterile persons are gown and gloved

Principle 2 of Aseptic Techniques in Operating Room

Table are only sterile at table level

Principle 3 of Aseptic Techniques in Operating Room

Sterile persons touch only sterile items while unsterile OR personnel touch only unsterile items

Principle 4 of Aseptic Techniques in Operating Room

Unsterile persons avoid reaching over sterile field and sterile person avoid touching or leaning over an unsterile area

Principle 5 of Aseptic Techniques in Operating Room

Edges of anything that encloses sterile contents are considered unsterile

Principle 6 of Aseptic Techniques in Operating Room

Sterile field is set-up just before a surgical procedure

Principle 7 of Aseptic Techniques in Operating Room

Sterile areas are continuously kept in view

Principle 8 of Aseptic Techniques in Operating Room

Sterile persons keep well within sterile area

Principle 10 of Aseptic Techniques in Operating Room

Sterile persons keep in contact with sterile areas to minimum

Principle 10 of Aseptic Techniques in Operating Room

Unsterile persons avoid sterile areas

Principle 11 of Aseptic Techniques in Operating Room

Destruction of integrity of microbial barriers result in contamination

Principle 12 of Aseptic Techniques in Operating Room

Microorganisms must be kept to irreducible minimum

Principle 13 of Aseptic Techniques in Operating Room

• Hand hygiene

• Attire

• Prepare the work surface

• Open sterile packages

• Place sterile items

• Maintain sterility

• Consider contamination

• Timing

• Environment control

• Monitoring

Key Steps in Preparing a Sterile Field

• Cutting tools

• Grasping tools

• Haemostatic Instruments

• Retractors

Commonly Used Surgical Instruments by Category

Cutting Tools

Instruments that are used to make incisions and sever muscle, tendon, cartilage, bone, vessels, and other connecting tissue

Scalpel

• Used for making incisions, tissue dissections

• Include a blade and a blade holder or knife handle

Blade Holder #4

What blade holder number is used to hold blade sizes #20 and #22 in a scalpel?

Blade Holder #3

What blade holder number is used to hold blade sizes #15, #12, #11, and #10 in a scalpel?

Blade #10 and #20

What blade sizes (there are two mentioned) in a scalpel is used for major surgeries?

Blade #12

What blade size in a scalpel is used to puncture?

Blade #15

This is a smaller version of Blade #20

Scissors

These are used for cutting tissues, sutures, and for dissection

Mayo Scissors

Surgical scissors that primarily used for cutting heavy tissues, sutures, fascia, and dressings during surgery

Metzenbaum Scissors

These are lighter surgical scissors used for cutting delicate tissues and blunt dissection during surgical procedures. They are characterized by their long shank and relatively short blades compared to mayo scissors.

Grasping Tools

Used to hold items, both organic tissue (skin, bone, organ) and inorganic materials (surgical towels, sponges, needles), to manipulate, hold in place, or reveal and access the areas beneath

• Ratcheted

• Non-Ratcheted

Two categories of grasping tools

Clamps / Kelly Forceps

Right-Angle Forceps / Mixter

These are specialized forceps primarily used for clamping, dissecting, and grasping tissues in deep, confined, or hard-to-reach surgical areas to minimize the risk of injury to surrounding tissues.

Schnidt Forceps

This is a surgical instrument used primarily in ENT (ear, nose, and thorax) procedures, especially during tonsillectomy. Their main uses include clamping blood vessels to control bleeding, holding and stabilizing tonsil sponges, and placing surgical packing after the tonsils are removed.

Allis Forceps

This is a ratcheted forceps that is used to grasp and hold tissues during various procedures, and is characterized by its interlocking jaws with teeth.

Sponge / Ovum Forceps

This is surgical that could be used to either hold surgical sponges or gauze to absorb fluids and maintain a clear surgical field, or grasp, hold, manipulate and remove delicate tissues within the uterus — particularly during and after procedures like cesarean sections, hysterectomies, and uterine repair

Babcock / Bobcock (spelling from ppt)

This is a surgical forceps used for grasping and holding delicate tissues, particularly in procedures involving the intestines, uterus, or fallopian tubes.

Pennington Forceps

This is also known as a Duval clamp/forceps. Characterized with its triangular eyelet, this surgical forceps is used for grasping tissues, particularly during intestinal and rectal operations, including some OB/GYN cases like Cesarean sections.

Kocher Clamp/Forceps

Also known as hemostatic forceps, this surgical instrument is primarily used to clamp and manipulate small to large blood vessels to control excessive bleeding during surgery

Towel Clips / Clamps

This are surgical forceps that are used to secure surgical drapes to the patient and maintain sterile environment during operations

Needle Holder

These are used as drivers for procedures that require suturing.

Debakey Forceps

This is a non-ratcheted forceps that is used for handling delicate tissues, particularly in cardiovascular and general surgeries.

Tissue Forceps

This is a non-ratcheted forceps used to hold and manipulate delicate tissues during surgical procedures or laboratory work. They are designed with fine tips, often with teeth, to provide a secure grip without causing significant tissue damage.

Haemostatic Instruments

These are surgical instruments that are used to control or cease bleeding

Electrocautery / Bovie

This is a haemostatic device or procedure that uses heat from an electric current to either control bleeding (coagulation), remove diseased or unwanted tissue (cutting and desiccation), and seal blood vessels

Retractors

These surgical supplies are used to hold the incision open, hold back tissues or other objects to maintain a clear surgical field, or reach other structures

Army Navy Retractor

Senn Retractor

Retractor more commonly used in plastic surgery, small bone and joint surgeries, and thyroidectomies

Deaver Retractors

Retractors particularly useful in deep abdominal or thoracic surgeries, but can also be used in a variety of specialties

Bladder Retractor

A retractor particularly useful in gynecological, urological, and abdominal surgeries

Richardson Retractor

Balfour Retractor

A self-retaining retractror used during surgeries in which large abdominal incisions need to be held open to provide more visibility to the surgeon such as during a cesarean section