Surgical Observation 1

Surgical Observation
Inflatable Penile Prosthesis Removable/Replacement
Yolanda James

Wayne county Community College

Nursing 112
November 22, 2010
 Surgical Observation 2

Surgical Observation
Inflatable Penile Prosthesis Replacement

My experience at St John Macomb Hospital in the OR has given me a clear

understanding of the roles of the perioperative nurses during surgery. My observation of
the OR team, aseptic technique, maintaining sterility etc, will be addressed in the
following discussion:
1. The role of OR team members.
2. Surgical procedure observed and challenges for nurses.
3. Key responsibilities specific to each role within the OR team
4. Principles of aseptic technique. What was seen?
5. Describe any breaks in technique.
6. Activities occurred to create the sterile field
7. Aseptic technique principles applied to nursing activities outside peri-op.
8. Discuss importance of maintaining aseptic technique in OR.

The role of OR team members.

Pre-op nurses interact and communicate more with patients. Their main
focuses are on safety, advocacy, completing medical history of patients, performing
an assessment, patient education and discharge planning. The circulating nurse is
responsible for coordinating procedures and ensuring the patient’s safety and comfort.
They manage the overall nursing care in the OR The scrub nurse must maintain a
sterile environment for the surgeon as well as the patient on the operating table in
order to decrease the chances of spreading infections during surgeries. These nurses
must be able to identify, understand and operate every instrument used in the
operating room in order to pass to surgeons in a timely manner. The anesthesiologist
along with the certified or training nurse anesthetist gives anesthetic drugs to induce
and maintain anesthesia, also gives other drugs as needed to support the patient
during surgery. Lastly, post-op nurses in the postanesthesia care unit provide ongoing
evaluation and stabilization of patients to anticipate, prevent and treat issues after
surgery.
Surgical procedure observed and challenges for nurses

The surgical procedure observed was the removable and replacement of an inflatable
penile prostheses. This is a treatment for erectile dysfunction. The primary challenges
for the scrub nurse were to keep track and count along with the circulating nurse every
item counted for while assisting the surgeon with instruments needed and the procedure.
There were some instruments that were not readily available for the surgeon and had to
be ordered. Therefore, there were few minutes delay in the surgery. The circulating
nurse had to call to order supplies, while documenting new supplies ordered and keep
track of supplies used, all within time frame allotted.
 Key responsibilities specific to each role within the OR team

The key responsibilities of the scrub nurse is to work with the rest of the OR team
to make sure that everything needed for the surgical procedure is in the room and that a
sterile environment has been established. The circulating nurse’s duties were performed
outside the sterile field, such as giving supplies to scrub nurse, monitoring the I & O,
documentation and answering surgeon’s phone. The patient was under general anesthesia
and unable to make decisions during the surgery, the circulating nurse was pts advocate
until he was able to care for himself. The key responsibilities specific to the nurse
anesthetist during surgery were to monitor pts vital signs-and adjust anesthetics as
needed. Once surgery was finished, patient was given medications to reverse the effects
of the anesthetic returning him to consciousness. Once in PACU, the pt was closely
monitored by the post-op nurse and the nurse anesthetist. The nurse anesthesiologist
determined when the pt has recovered sufficiently to leave the recovery room.

Principles of aseptic technique. What was seen?

Breaks in technique and activities to create & keep sterile field.

The aseptic techniques observed were that everyone’s hands within the sterile field
were always kept above waist level. Hands were vigorously washed before and after
procedure. Hair was tucked in under caps, No badges were allowed in room. The
surgeon did not allow outside traffic inside the OR, he instructed the circulating nurse to
post a “No outside traffic” sign on door. Everyone in the OR were required to don caps,
masks, sterile shoe coverings, sterile gowns and gloves. The scrub nurse donned all
sterile garbs for the surgeon and his assistant. Surgical drapes were in place as an aseptic
barrier with minimum amount of movement around the drapes, which prevented
mocroogranisms from floating. The nurse cleaned the pt’s skin area to be operated, with
betadine for 4-minutes, this procedure was done to avoid microogrannisms from pt’s skin
affecting the wound. The circulating nurse opened packages using the 1” border and
dropping instruments/items above the sterile field on the sterile table. She also poured
liquids without contaminating by using a long sprout. The OR team never turned their
backs on the sterile field, this would lead to automatically contamination. . The
anesthesiologist team and I were not allowed around the sterile field. Therefore; there
were no breaks in aseptic technique and sterility was maintained by the circulating nurse,
scrub nurse and surgeons. .

Aseptic technique outside the perioperative environment

Medical asepsis was applied outside the peri-op environment, such as the wound
care after incision has been closed up. Removal of biohazards, wet and soiled dressing
were prompt. The area was immediately cleaned of soiled and moist areas.
 Importance of maintaining aseptic technique in the OR

The importance of maintaining aseptic technique in the OR is to protect the patient

from nosocomial infections especially those who are immunocompromised, such as the
very young and the very old, and to prevent the spread of pathogens from patient to
patient. This will also help prevent longer stay in the hospital and perhaps cut hospital
cost.
 REFERENCE PAGE

Mangram, Alicia, Teresa Horan, Michele Pearson, Leah Christine Silver, and William
Jarvis. “ Guideline For Prevention of Surgical Site Infection, 1999” Infection Control
and Hospital Epidemiology 20 (April 1999): 247-78

Barbara Kozier, Glenora Lea Erb, “Fundamentals of Nursing 8th Edition. 2008”
669-706