History of ST
Galen - First great anatomist; controlled thought, unchallenged, for 1500 years; biology made to serve theology. (A. D. 162)
• Pare - Greatest surgeon of the 16th century; began to ligate arteries after amputation; stopped cauterizing wounds with hot irons and oil. (1500)
Vesalius - is considered the father of modern anatomy and changed the traditional approach to anatomical studies. (1500)
• Jenner - Inventor of the vaccination for smallpox. (1800)
• Lister - First developed techniques or antiseptic surgery. (1850s)
Pasteur - Father of microbiology, virology, and immunology. (1850)
• Roentgen – Developed the X-ray machine. (1850)
• Halstead - developed meticulous closure of wounds. (1850)
Cushing - Father of neurosurgery; reduced mortality rate for meningiomas from 96% to 5%. (1900)
• Cooley - Perfected the heart-lung machine; performed first U.S. heart transplant and first total artificial heart implant. (1950)
• Debakey - Developed the first ventricular assist pump. (1950)
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The Association of periOperative Registered Nurses (AORN) is the professional organization that establishes standards in perioperative nursing education and standards.
• In 1967, prompted by the need for guidelines and standards in the training of surgical personnel, AORN published a book, Teaching the Operating Room Technician.
In 1969, AORN played a vital role in OR education and in structuring the Association of Operating Room Technicians (AORT).
• In 1973, the AORT became independent from AORN.
In 1978 AORT was changed to Association of Surgical Technologists (AST).
THE SURGICAL TECHNOLOGIST
Professional Organizations
Association of Surgical Technologists (AST)
• Professional Organization for Surgical Technologists.
AST Mission Statement:
o “Enhancing the profession to ensure quality patient care”.
o Guiding principle, Aeger Primo (The patient first).
AST publishes the Core Curriculum for Surgical Technology as well as the professional guidelines for practicing surgical technologists.
• This organization also offers continuing education opportunities to advance the knowledge and skills base of the surgical technology professional to assist with maintaining the CST credential. The CST must support and participate in continuing education.
Related Professional Organizations
• ACS – American College of Surgeons – professional organization for surgeons.
AORN – Association of perioperative Registered Nurses (An organization that represents the interests of perioperative nurses by establishing standards in nursing education and clinical practice. RN circulators would join this organization.)
FDA – Food and Drug Administration When equipment fails with or without patient injury the device is removed from service and is reported to this organization.
OSHA – Occupational Safety and Health Administration This is a federal agency that is dedicated to enforcing standards of workplace safety and preventing work-related injuries.
The Joint Commission (TJC) - Independent nonprofit organization that develops standards and accredits healthcare organizations. Defines a surgical technologist.
Surgical Technology Education and Accreditation
CSTs are graduates of accredited programs. Upon graduation, they are eligible to take the national certification exam through the NBSTSA.
Education
• Surgical Technology programs are accredited by: Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES).
• The NEIT ST program is accredited by CAAHEP.
ARC/STSA does not grant accreditation but recommends it to CAAHEP. This is accomplished by reviewing educational programs using established CAAHEP standards.
• ARC/STSA provides educational standards and recommendations required for accreditation of programs in surgical technology and surgical first assisting.
Only graduates of a CAAHEP accredited program can take the certification exam.
• All graduates from a CAAHEP-accredited program are required to take the CST examination before graduation.
• Accreditation is voluntary.
Surgical Technology Certification
• National Board of Surgical Technology and Surgical Assisting (NBSTSA) awards the CST® and CSFA® credential after successfully passing the national certifying exam.
• They develop the national certification exam.
Employment and Career Development
• Professionalism refers to maintaining competence in a specialized body of knowledge and skills. It begins with competency and commitment in the workplace. It is a lifelong commitment.
• It contains several important traits, such as honesty, cooperation, and ability to problem-solve and prioritize. It does include the obligation to support and develop the profession. As well as educate others about the profession.
Professionalism is a lifelong commitment for a surgical technologist who has specific duties and responsibilities for providing the highest quality surgical patient care.
• Personal integrity is to be trustworthy, reliable, and responsible, not only on the job, but always, in all areas of one’s life. Must have good ethical behavior.
Job Descriptions and Expectations
The JD will have a title, requirements for employment, nature of position, duties, accountability for actions.
Building Future Opportunities
A private surgical technologist is usually employed by a physician, physician group or agency.
They can be an ST educator or a preceptor who teaches others
Clinical Ladder Programs
• Clinical ladder programs may allow a CST to move upward within an organization to positions with more responsibility.
• Clinical ladders have three levels:
o Entry –level
o Proficient
o Expert
Level I: Entry Level Practitioner
• Entry-level surgical technologist (ST) is the first level after graduation from an accredited surgical technology program and includes the first year of practice.
• A CST in an entry-level position, the job involves many disciplines, including basic patient care.
He or she will be able to demonstrate practical use of anatomy and physiology, pharmacology, and medical terminology and will be able to assist in the care of the patient at a basic level.
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Three phases of surgical case management include:
• Preoperative - Occurs prior to initiation of surgical procedure
• Intraoperative - Occurs while procedure is being performed
• Postoperative - Begins when procedure is terminated
All surgical team members participate in patient care in the three phases of surgical case management.
• Preoperative Case Management
o Gather the necessary case cart, equipment, and supplies (nonsterile).
o Damp dust equipment
o Review the patient’s information (nonsterile).
o Arrange the OR furniture (nonsterile).
o Perform the surgical scrub.
o Don the sterile gown and gloves.
o Create and maintain the sterile field.
o Prepares, labels, and handles medications at the sterile field. (Figure 1-4).
o Perform initial counts with the RN circulator.
o Gown and glove other sterile team members.
o Assist with draping the patient (Figure 1-5)
Intraoperative Case Management
o Maintain the sterile field, including establishing the neutral zone.
o Participate in the surgical time-out.
o Anticipate the needs of the surgeon and provide the necessary items in the order needed.
o Pass instruments and supplies to the surgeon (Figure 1-6).
Postoperative Case Management
Separate instruments and supplies to disassemble the sterile field.
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Surgical First Assistant
A nonphysician SFA is an individual who has acquired additional knowledge and experience and obtained an appropriate surgical assistant credential.
As defined by the American College of Surgeons (ACS), the nonphysician SFA provides aid in exposure, hemostasis, and other technical functions that will help the surgeon carry out a safe operation with optimal results for the patient. They can assist with closing of body planes.
The SFA provides aid in exposure (retraction), hemostasis (controlling bleeding in the surgical wound), suturing, suctioning fluids from the wound, and other tasks as directed by the surgeon. They carry out a safe operation with optimal results for the patient.
Surgeon
The surgeon is the patient’s primary physician in the operating room and is responsible for guiding the surgical procedure.
Nonsterile Surgical Team Members
Anesthesia Care Provider
The anesthesia care provider may be a physician (MD), Doctor of Osteopathy (DO), or Certified Registered Nurse Anesthetist (CRNA). They may be assisted by an Anesthesia Technologist. Who is a member of the team as well.
Manage all phases of anesthesia.
• Monitor the patient’s vital signs during the surgical procedure.
• Provide supportive measures such as administering fluid, blood and blood products and airway management.
• Monitors pain levels
Circulator
The circulator is an RN
• Assist the CST with preparation of the OR.
Assist with positioning the patient.
• Perform the patient skin preparation
Perform surgical counts with the first scrub CST. Provide additional items to the sterile field during the procedure, as requested by the sterile team members.
• Maintain the operative record (charting).
• Assist with the appropriate care of specimens.
• Secure dressings.
Assist the anesthesia care provider with transporting the patient to the postanesthesia care unit (PACU).
The circulator may have an advanced certification in perioperative nursing
(certified nurse–operating room [CNOR]). The circulator moves around the periphery of the room.