Perioperative Care; Fluid and Electrolyte

Room Preparation

Before transferring the patient into the OR, prepare the room to ensure privacy, prevention of infection, and safety. Individualization of this preparation is essential to achieve the expected patient outcomes. For example, when an obese patient is admitted to the OR, there are several special considerations Ask such questions as, What equipment is needed to safely transfer the patient to and from the OR table? Will extra staff be required for safe transfer and positioning? Is special equipment needed (e.g., extra-long instrumentation)? What special precautions, if any, must be taken to ensure maintenance of the patient’s airway? The unique needs of each patient must be addressed for a safe surgical experience.

Surgical attire (pants and shirts, masks, protective eyewear, and caps or hoods) is worn by all people entering the OR All electrical and mechanical equipment is checked for proper functioning. Aseptic technique is practiced as each surgical item is opened and placed on the instrument table. Sponges, needles, instruments, and small medical devices (e.g., surgical clip cartridges, universal adapters) are counted according to strict processes to ensure accurate retrieval at the end of the procedure. Any retained surgical supplies, devices, or instruments are sentinel events that can result in negative outcomes for the patient.

During room preparation and the surgical procedure, the scrub person performs surgical hand antisepsis, dons’ sterile gown and gloves, and touches only those items in the sterile field. The circulating nurse remains in the unsterile field and performs those activities that permit touching all unsterile items and the patient. This coordinated effort allows for smooth functioning throughout the procedure.

Transferring Patient

Once the patient’s identity has been verified and the OR has been prepared, the patient is transported into the room for the surgery. Each time a patient is transferred from one bed to another, the wheels of the stretcher must be locked, and a sufficient number of personnel should be available to lift, guide, and prevent accidental falling or injury to self, other staff, or the patient. Once the patient is on the OR bed, place safety straps snugly across the patient’s thighs. At this time the monitor leads (e.g., electrocardiogram [ECG] leads), BP cuff, and pulse oximeter are usually applied and an IV catheter is inserted if it was not done in the holding area.

Scrubbing, Gowning, and Gloving

Surgical hand antisepsis is required of all sterile members of the surgical team (scrub nurse, surgeon, and assistant). When the procedure of scrubbing is the chosen method for surgical hand antisepsis (often for the first case of the day), your fingers and hands should be scrubbed first with progression to the forearms and elbows. The hands should be held away from surgical attire and higher than the elbows at all times to prevent contamination from clothing or detergent suds and water from draining from the unclean area above the elbows to the clean and previously scrubbed areas of the hands and fingers.

Waterless, alcohol-based agents are replacing traditional soap and water in many facilities. When using an alcohol-based surgical hand-scrub product, prewash hands and forearms with soap and dry completely before applying the alcohol-based product. After application of the alcohol-based product, allow hands and forearms to dry thoroughly before donning sterile gloves.

Once surgical hand antisepsis is completed, the team members enter the OR to put on surgical gowns and two pairs of gloves to protect patients and themselves from the transmission of microorganisms. Because the gowns and gloves are sterile, those who have scrubbed can manipulate and organize all sterile items for use during the procedure.

Intraoperative nursing

Intraoperative nursing involves caring for patients from the time the patient enters the operating/procedure room, through the procedure, and until the patient is transferred to the post anesthesia care unit (PACU).