What is a sterile field comprised of?
How may this be compromised?
- Incorporates the aseptically prepared skin covered by sterile drapes and extends to the sterile gloves and gown and the sterile instruments used by the surgeon.
- Linen drapes becoming wet or the surgeon touching a non-sterile object are examples of how asepsis can break down and increase the risk of contamination.
To facilitate the setting up and maintenance of a sterile field, all of the following need to be carried out faultlessly:
- cleaning surgical facilities.
- Specifically allocated cleaning utensils (used in theatre only)
- Blood and other debris must be removed asap at completion of surgery and before next procedure.
- theatre should contain only the essential furniture
- sterile preparation of equipment
- aseptic preparation of the surgical site
- wearing of sterile gloves and gown by the surgeon
- Cap, mask gown, glove and thoroughly scrub his or her hands with an antiseptic scrub
- all theatre staff recognising the boundaries of the sterile field.
To provide sterile assistance, a nurse must first:
- put on a surgical cap and mask
- carry out a surgical hand scrub
- put on a surgical gown
- put on surgical gloves
The scrubbed assistant may be required to assist with:
- preparation of sterile instruments
- passing instruments
- retraction
- haemostasis
- lavage and suction
- passing suture materials
- cutting ends of ligatures
Providing sterile assistance:
Preparation of the instruments
surgical assistant can open the inner wrap of the instrument pack and arrange the instruments in order on the instrument trolley, as required.
Providing sterile assistance:
draping
- placement of surgical drapes around the incision site forms a vital part of the sterile field.
- Ideally, the whole animal is draped leaving only the surgical site exposed.
- For some procedures, additional drapes such as skin towels or plastic adhesive drapes are used so that the draping extends up to the edge of the incision
Providing sterile assistance:
passing instruments
- Always pass instruments with the handles towards the surgeon and the ratchets open.
- Scalpel blades will need to be attached to the handle
Providing sterile assistance:
retraction
To improve visualisation of the surgical area, you may be required to assist with:
- packing off organs with moistened laparotomy sponges
- holding tissues with hand-held retractors or tissue forceps
- holding tissues with stay sutures to retract them (e.g. the stomach wall so that the surgeon can make an incision)
- holding tissues with moistened swabs
- counting swabs
- applying traction to a limb during an orthopaedic procedure (e.g. to better visualise a joint)
Providing sterile assistance:
Cutting ends of ligatures and sutures
- Ligatures and internal sutures usually have the ends cut to approximately 2mm in length.
- Skin sutures are left with ends of approximately 1cm.
- Suture scissors should be used as the suture material can blunt the blades of tissue scissors. The tips of the scissors are used.
Non-sterile assistance:
List some things you may be required to do as a non-scrubbed (non-setrile) assistant nurse
- set up theatre
- select the appropriate surgical packs an place them in the theatre
- transport and position the patient in the theatre
- complete surgical skin prep (on patient
- assist with tying the surgeon’s gown
- select and open surgical gloves
- select the appropriate suture material and scalpel blades and any other sterilised equipment which is not included in the general surgical pack
- open the outer linen wrap of the surgical pack
What is an ‘atraumatic’ needle?
Pre-packed needle and suture materials
(atrumatic means without trauma)
Describe the properties of an atraumatic needle
- they have no eye (suture material is inserted into shaft)
- no need for double strand of suture material
- less trauma caused to tissues
- some have ribbed shaft to prevent rotation in the needle holders.
What is a suture?
a strand, cord, thread or band of pliable material used to appose living tissue mechanically.
What is a ligature?
a thread or strand used to tie a vessel or strangulate a portion of tissue.
What are the two basic types of sutures?
- absorbable
- usually buried w/in the body
- non-absorbable
- usually on body surface
- Non-absorbable sutures eg, silk, mono-filament nylon, are also sometimes used in buried sites. Whenever a suture is used in a buried site, it must be absolutely sterile.
List the properties of an ideal suture material:
- easily sterilised
- easy to handle (less “memory”)
- adequate tensile strength
- lack of foreign body reaction
- good tying properties
- non-capillary
How long does it take for an absorbable suture material loses its tensile strength?
How does it lose its strength?
- 60 days
- is broken down by hydrolysis or the body’s natural inflammatory processes
Suture materials maybe ….filament or ….filament (braided)
mono or multi filament
-multi causes more tissue trauma
Name some common absorbable suture materials
- Maxon
- PDS
- Dexon
- Vicryl
- Chromic catgut
Name some common non-absorbable suture materials
- Vetafil
- Supramid
- Silk
- Prolene
- Nylon
Suture materials come packaged as:
(3 types)
- commercially pre-sterilised single-use materials with an inner foil and outer peel down wrapping. Many of these come with a suture needle already attached (swaged on)
- multi-use cassettes which usually contain propyl alcohol
- autoclavable reels. These are non-absorbable material (e.g. vetafil, stainless steel)
How many of each type of needle should you include in a surgical pack?
2 of each
Name the two kinds of needle shafts and what they are used for
- smooth (round-bodied)
- placing suture material in soft tissues
- cutting tip (e.g. triangular)
- generally used for the skin only.
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T1: Admissions and Scheduling18
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T2: Premeds30
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T3: Setting Up the Theatre and Anaesthetic Machine24
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T3: Other Equipment13
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T4: Scrubbing In22
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T5: Getting the Patient Ready for Theatre31
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T5: Induction24
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T6: Assisting During Surgery23
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T6: Teaching and Research Facilities0
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T7: Instrumentation and Care23
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T7: Cleaning and Sterilising22
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T8: Common Surgeries7
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T9: Post Operative Care30
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T10: Emergencies6
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T11: Veterinary Dental Nursing46
