NEW YORK CITY COLLEGE OF TECHNOLOGY

Campus Information

  • Institution: New York City College of Technology, City Tech

  • Course Name: Intraoperative Nursing

  • Course Code: Med-Surgical Nursing Nur-1130

  • Instructors: Dr. Gibson, Prof. Lewis

Objectives

  • Understand the roles of RN and surgical team members.

  • Learn principles of surgical asepsis.

  • Identify the adverse effects of surgery.

  • Familiarize with types of anesthesia.

The Surgical Team

Anesthesiologist

  • Role: Delivers anesthesia and monitors the patient’s condition during surgery.

Registered Nurse (RN)

  • Role: RN trained to deliver anesthesia and monitor the patient during surgery.

Surgeon

  • Role: Performs the surgery and heads the surgical team.

1st Assistant

  • Responsibilities:

    • Handles tissue and sutures.

    • Maintains hemostasis.

Circulating RN

  • Role:

    • Coordinates and documents patient’s O.R. care.

    • Manages OR with a focus on patient safety and health.

    • Monitors surgical team activity.

    • Assesses patient for signs and symptoms of injury and implements interventions.

    • Verifies consent before surgery.

    • Coordinates the surgical team.

    • Ensures cleanliness of the OR including temperature, humidity, lighting, and equipment functionality.

    • Monitors aseptic practices.

    • Coordinates with collaborators such as X-ray, respiratory therapists, and lab personnel.

    • Verifies and documents the “Time Out.”

Scrub Role

  • Personnel: RN, LPN, or Surgical Tech

  • Responsibilities:

    • Scrubs and dons surgical attire.

    • Prepares instruments and supplies, including a sterile table with sutures and ligatures.

    • Anticipates needed instruments and hands them to the surgeon during procedures.

    • Counts all needles, sponges, and equipment after the incision is closed to ensure that no foreign body is left in the patient.

Patient Safety

Surgical Safety Checklist

Before induction of anesthesia (with nurse and anesthetist):

  • Has the patient confirmed their identity, site, procedure, and consent?

  • Is the site marked?

  • Is the anesthesia machine and medication check complete?

  • Is the pulse oximeter on the patient and functioning?

  • Does the patient have known allergies?

  • Does the patient have a difficult airway or aspiration risk?

  • Is there a risk of >500ml blood loss in adults or >7ml/kg in children?

Before skin incision (with nurse, anesthetist, and surgeon):

  • Confirm all team members have introduced themselves by name and role.

  • Confirm the patient's name, procedure, and incision site.

  • Has antibiotic prophylaxis been given within the last 60 minutes?

Anticipated Critical Events

  • To Surgeon: What are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss?

  • To Anesthetist: Are there any patient-specific concerns?

  • To Nursing Team: Has sterility been confirmed? Are there any equipment issues? Is essential imaging displayed?

Before the patient leaves the operating room (with nurse, anesthetist, and surgeon):

  • Nurse verbally confirms the name of the procedure.

  • Completion of instrument, sponge, and needle counts.

  • Specimen labeling, including reading specimen labels aloud.

  • Address any equipment problems.

  • Discuss key concerns for the recovery and management of the patient.

Important Note

  • This checklist is not comprehensive; additions and modifications should fit local practice.

Time Out Protocol

  • Purpose: Verifies critical information prior to surgery.

    • Verifies patient identity.

    • Verifies surgical procedure.

    • Verifies the surgical site prior to the operation.

    • The surgical site must be marked by the physician and confirmed by the patient in the consent process.

    • The marking should be visible after sterile drapes are applied and verified by the surgical team during the time-out.

Assessment

  • Assess patient fire risk and utilize fire prevention tools.

  • Assess hazards to patient and OR staff.

Surgical Asepsis

  1. All surgical supplies (instruments, needles, sutures, dressings, gloves, covers, solutions) that contact the surgical wound or exposed tissue must be sterilized before use.

  2. All OR team members must scrub hands and arms with antiseptic soap and water or use alcohol-based solutions.

  3. The surgical team wears sterile gowns, gloves, masks covering the nose and mouth, and caps.

  4. The patient’s exposed skin must be cleansed with antiseptic solution.

  5. The patient’s hair should be clipped, not shaved, to prevent infection.

Guidelines Reference

  • Consult Page 422 for maintaining surgical asepsis.

Hazards of the Surgical Environment

  • Risks include:

    • Faulty or improper use of equipment.

    • Laser risks.

    • Exposure to blood and body fluids.

    • Surgical smoke.

Anesthesia and Sedation

Types of Anesthesia
General Anesthesia

  • Methods: Inhalation or intravenous administration.

  • Characteristics: Patient is not arousable to verbal, tactile, or painful stimuli and loses ventilatory function requiring assistance.

  • Cardiovascular function may be impaired.

Other Types of Anesthesia

  • Regional Anesthesia: Includes epidural, spinal, and local conduction block. Anesthetic agent is injected around nerves, rendering the region supplied by those nerves anesthetized.

  • Moderate Sedation (Conscious Sedation): Involves intravenous administration of sedative and analgesic medications to reduce anxiety and pain during procedures.

  • Local Anesthesia: Injection of anesthetic into tissues at the planned incision site.

    • Benefits: Simple, economical, minimal equipment needed, brief recovery, minimal adverse effects; suitable for short and minor procedures.

    • Note: A state of narcosis refers to CNS depression produced by pharmacological agents.

Inhalation Anesthetic Agents

  • Examples Include:

    • Nitrous Oxide

    • Oxygen

    • Volatile Liquids such as:

    • Halothane

    • Enflurane

    • Isoflurane

    • Sevoflurane

    • Desflurane

Opioid Analgesics

  • Examples Include:

    • Alfentanil

    • Succinylcholine

    • Diazepam

    • Fentanyl

    • Atracurium

    • Etomidate

    • Morphine Sulfate

    • Cisatracurium

    • Ketamine

    • Remifentanil

    • Rocuronium

    • Midazolam

    • Sufentanil

    • Vecuronium

    • Propofol

    • Tubocurarine

    • Methohexital

    • Metocurine

    • Thiopental

    • Pancuronium

Local Anesthetic Agents

  • Examples Include:

    • Lidocaine

    • Bupivacaine

    • Tetracaine

    • Procaine

Potential Intraoperative Complications

  • Common Complications:

    • Nausea and Vomiting

    • Anaphylaxis

    • Hypoxia

    • Hypothermia

    • Malignant Hyperthermia

Conclusion

  • This lesson on intraoperative nursing has been completed.