The Role of the Scrub Nurse

Overview

A scrub nurse acts as a sterile assistant to the surgeon within the sterile field of the operating room. This role is critical in ensuring surgical efficiency, patient care, and the maintenance of sterile conditions. Scrub nurses wear the same attire as surgeons, which includes sterile gloves and gowns, essential for preventing infection.

What is a Scrub Nurse?

A scrub nurse is responsible for a variety of tasks that assist the surgeon during the surgical procedure. Key aspects of their role include:

• Attire includes:

  • Sterile gloves: Essential for maintaining a sterile environment and preventing contamination.

  • Sterile gown: Provides a barrier against infection.

• Responsibilities include:

  • Assisting the surgeon directly during the procedure.

  • Maintaining a sterile environment, which is essential for patient safety.

Surgical Responsibilities

The scrub nurse's responsibilities encompass several critical aspects of the surgery:

• Maintain aseptic technique throughout the procedure. This involves strict protocols to ensure no contamination occurs.

• Assist in surgery in various ways:

  • Immobilization of body parts: Stabilizing the area being operated on, providing the surgeon with a clear field to work.

  • Tissue retraction: Using tools to hold back tissues to expose the surgical site effectively.

  • Hemostasis control: Managing bleeding effectively during surgery to maintain visibility and reduce patient risk.

  • Anticipation of needed instruments: Having the required surgical instruments ready at the right time enhances surgical effectiveness and efficiency.

• It is essential for scrub nurses to have a working knowledge of surgical procedures to:

  • Decrease surgery time by being prepared and organized.

  • Enhance the flow of surgery with proactive assistance.

  • Improve the quality of patient care through effective support and preparedness.

Attire for Surgery

Scrub nurses wear attire similar to that of circulators:

• Sterile gloves and sterile gowns to prevent contamination.

• Restrictions on accessories:

  • No rings, nail polish, acrylic nails, long nails, band-aids, or heavy makeup are permitted as they can harbor bacteria.

• Footwear: Specific shoes for surgery or shoe covers must be used to maintain sterility in the operating room.

Sterile Areas on a Sterile Person

Understanding sterile areas is crucial:

• The front of the gown is sterile from the shoulders to the waist or table height.

• The back of the gown is not considered sterile.

• The face and head are never sterile.

• Gloves should remain clasped in a prayer position between the waist and shoulders to maintain sterility.

• The scrub nurse must avoid folding arms, dropping hands below the waist, or raising arms above the shoulders.

Maintaining Sterility

• Non-sterile personnel must only touch non-sterile items, never reach over or turn their back to sterile items, and should pass behind a sterile person.

• Scrubbed-in personnel must only touch sterile items and face the sterile field at all times. Maintaining aseptic technique is critical in all aspects of surgical procedures.

Opening Sterile Items

The process of opening sterile items includes significant procedural details:

• The outer wrap of the pack is opened by non-sterile personnel, who should only touch the outside of the pack.

• The inner wrap must be opened by sterile personnel who do not reach over a sterile field.

• Proper procedure includes creating a sterile surface on top of a mayo stand for opening packs to ensure nothing contaminates the instruments.

Pre-Surgical Duties of the Scrub Nurse

Scrub nurses share several duties with the circulator, such as:

• Cleaning the Operating Room (OR): Ensuring the environment is sterile and ready for surgery.

• Surgical table setup: Confirming that the surgical table is properly set up with all necessary instruments and supplies.

• Confirming supplies: Ensuring all supplies are available prior to surgery.

• Specific duties include:

  • Opening sterile gown and gloves: Preparing their own attire for scrubbing in.

  • Scrubbing hands: Following strict protocols to ensure cleanliness.

  • Donning gown and gloves: Properly gowns to maintain sterility.

Surgical Duties of the Scrub Nurse

Once scrubbing in and donning the gown/gloves:

• Gowning and gloving the surgeon: Assisting in preparing the surgeon for surgery.

• Assisting with patient draping: Properly covering the patient to maintain a sterile field.

• Organizing sterile instruments: Keeping instruments in order and ready for the surgeon's use.

• Passing instruments to the surgeon swiftly and correctly is essential for surgical flow.

Handling Tissue

Careful tissue handling is imperative during surgery to prevent trauma and infection:

• Using sharp scalpels: Minimizes tissue disruption and promotes better healing.

• Managing hollow organs carefully: Avoiding contamination and maintaining the integrity of the surgical procedure.

• A thorough knowledge of anatomy is necessary for effective support during surgeries.

Sponge Hemostasis

The aim of sponge hemostasis includes:

• Obtain optimal visibility: Essential for performing complex procedures.

• Limit volume of blood loss: Critical for patient safety.

• Decrease infection risk: Through effective management of bleeding.

• The application of sponges should be performed with a blotting motion to prevent irritation to the surrounding tissues.

• Importance of maintaining sponge counts: To avoid leaving sponges inside the patient's body, which can lead to severe complications.

Lavage

Incision irrigation and suction functions include:

• Physically diluting and removing bacteria to maintain a sterile field.

• Keeping tissues moist enhances visualization for the surgeon, facilitating better surgical outcomes.

• The solutions used for lavage should be isotonic and warmed to body temperature to prevent shock to the tissues.

Surgical Drains

The primary functions of surgical drains include:

• Allowing infected incisions to properly drain to prevent complications.

• Preventing seroma development, where soft tissues cannot be opposed, which can lead to further issues.

• Types of drains include passive drains (e.g., Penrose drains) and active drains, which differ in the mechanisms of fluid removal.

Post-Surgical Duties

Post-surgery, scrub nurses have essential responsibilities, including:

• Separating and disposing of used instruments and sharps safely to ensure no risk in the operating environment.

• Assisting in cleaning the OR and restocking supplies for the next procedure.

• Ensuring proper management of all tissue samples collected during the procedure.

Additional Procedures

Techniques such as folding cloth surgical gowns are vital in maintaining sterile conditions. Practicing and discussing all mentioned duties in labs will enhance proficiency, ensuring scrub nurses are well-prepared for real surgical environments.