SECOND EDITION - Pearson

UNIT II: Surgery Fundamentals 175CHAPTER 19Identify, Prepare, and PassInstruments 176Prepare and pass knife handles—scalpelsWork with the no-touch zone and communicate identify andpass instrumentsScissors—identify and passForceps—identify and passDressingTissueHemostatRight angleRetractors—identify and passHand held retractorsSelf-retaining retractors—identify and passNeedle holders—identify and passPoole suctionSkin staplerDemonstrate point of use cleaningDiscuss repair protocolDiscuss second scrub ST roleIdentify instruments in a major setIdentify frequently used instruments in the clinical setting,60 instrumentsIdentify, prepare, and pass frequently used instruments ingeneral surgery, 128 instrumentsIdentify, prepare, and pass frequently used instruments insurgical specialties, 5–12 per specialtyD and C/GYNENTOral/MaxillofacialPlastics and cicUrologyDiscussion Questions (available on student resourceswebsite)Competency Assessment 221CHAPTER 20Prepare, Load, and Pass Suture for Rightand Left-Handed Surgeons 223Identify frequently used absorbable and nonabsorbablesutureOpen peel packs—nonsterile rolePlace suture on the sterile fieldPrepare free hand tie or free tiePrepare and passSuture—right-handed surgeonSuture—left-handed surgeonHand-to-hand transferHands-free transferAnticipate and pass Mayo scissorsCut suture strandsPass forceps for skin closureDiscuss back-handed stitching techniqueIdentify and prepare Keith needleDiscuss rationale for clear communicationDiscuss accidental puncture protocolDemonstrate handling of used suture, needle matDiscussion Questions (available on student resources website)Competency Assessment 233CHAPTER 21Maintain Sterile Technique235Interpret sterile technique principlesAnticipate and prepare for intraoperative change in sterileattire and instrumentsIsolation techniqueClean-contaminatedSeparate isolation tableTwo back table set-upsRecognize and correct contamination errorsTear or hole in glovesTear in back table coverContaminated sleeveItem falling below table levelIdentify wound classification systemDiscussion Questions (available on student resources website)Competency Assessment 245CHAPTER 22Facilitate Specimen Care, Dressings,Drains, and Postanesthesia Care 247Participate in specimen carePrepare dressings and drains for selected proceduresWound dressingsThree-layer dressingPetroleum gauze stripsPliable gauze and rollsClear film dressingLiquid adhesivesColostomy bag or pouch (available on student resourceswebsite)Closed wound drains (available on student resourceswebsite)Active systems—Jackson-Pratt and Hemovac (availableon student resources website)Trocar safety (available on student resources website)Passive drain—Penrose (available on student resourceswebsite)CONTENTSA01 DANK4030 02 SE FM.indd 7vii27/02/19 10:50 AM

Participate in postanesthesia careTransfer with a roller-board and use safe body mechanicsDiscuss components in a hand-off reportIdentify components of PACUDiscuss recovery and discharge criteriaDiscussion Questions (available on student resources website)Competency Assessment 259UNIT III: Essentials after Surgery 261CHAPTER 23Dismantle the Sterile Field andDisrobe 262Maintain sharps safetyDemonstrate point of use cleaningDisassemble sterile fieldDispose of solutionsDoff gown, gloves, and maskDemonstrate disposal and decontaminationIdentify locations for and use of an eyewash stationDiscussion Questions (available on student resources website)Competency Assessment 270CHAPTER 24Facilitate Room Turnover andConfidentiality 272Wear appropriate PPEPerform end-of-case disinfectionIdentify Spaulding’s criteriaManage surgical supplies—replenishParticipate in OR preparationAssist with terminal cleaningMaintain confidentialityDiscussion Questions (available on student resources website)Competency Assessment 279UNIT IV: Minimally Invasive Surgery 281CHAPTER 25Facilitate Minimally Invasive Surgery:Laparoscopic and Robot-Assisted 282Perform in laparoscopic surgeryLaparoscopic surgery equipmentNonsterile and sterile rolesComponent assessment and preparationCameraLight cordInsufflation tubingElectrocauterySuction IrrigatorAntifog and padTrocar-cannula unit preparationviiiVeress needle preparationHasson techniqueKit suppliesBack table and Mayo stand set-upPre-incision prep and white balanceCord and tube managementFirst scrub roleSecond scrub roleSpecimen careSterile field dismantlement special considerationsParticipate in robot-assisted surgeryTechnology componentsPreoperative preparationPatient considerationsOR team rolesPostoperative proceduresDiscussion Questions (available on student resources website)Competency Assessment 308UNIT V: Student Surgical Technologist inthe Operating Room 311CHAPTER 26Transition to the Clinical Setting312Proof of preclinical documentationHealth screeningFingerprinting, drug screeningCPR certificateOSHA and HIPAA trainingReliable transportation and day care for dependentsDefine the ST role according to the Association of SurgicalTechnologist’s core curriculumFirst scrubSecond scrubObservationDefine the number and type of surgical procedures forparticipationDocument participation with increasing complexityDocument hours at the clinical siteEmergencies, tardy, or absent policiesAssist with program review and improvementSit for the CST examinationPrepare a resumePrepare for an interviewDiscussion Questions (available on student resources website)Clinical Competency Assessment 317Glossary of TermsIndex 327321Online ResourcesChapter SkillsST Skills Videos and ScenariosGeneral Surgery Instruments #1–128 PowerPointCONTENTSA01 DANK4030 02 SE FM.indd 827/02/19 10:50 AM

PrefaceThis second edition of Operating Room Skills: Fundamentals for the Surgical Technologistcontinues its focus on developing essential skills needed to perform safely and competently in the operating room environment and as an integral team member. The uniqueformat follows the role of the surgical technologist in conjunction with the movement ofthe patient through the surgical experience. Beginning with the very first chapter, studentsare immersed in active learning strategies and integrate best practices, core curriculumrequirements, and recommendations from program graduates and instructors. With repetition, learners develop accurate skill performance and an awareness of the organizationto the work of the surgical technologist. In the risk-free laboratory setting, role-playing,face-to-face communication, small group scenarios, simulations, teamwork, and problemsolving are encouraged as precise performance and critical thinking are developed.Skill competence is evaluated and verified by using the competency assessmentsfound in each chapter. The Competency Assessment forms in this second edition have beenupdated and allow students and educators multiple opportunities for skill enrichment andtesting. When learning a new career, the enormity of information can be overwhelming. Inthis second edition, new strategies present a manageable amount of information. Emphasis is placed on learning the most frequently used general and specialty surgical instruments in Chapters 7 and 19, and the most frequently managed medications on the backtable are highlighted in Chapter 9. Keeping the patient and other team members safe continues to be paramount in this edition and a new Chapter 8 focuses on preventing retainedsurgical items. Intraoperative sterile technique in Chapter 21 prompts the learner to prepare for planned events, such as isolation technique, and to correct unplanned breachesin sterile technique. A short progress report, new for each chapter, provides a “to do” listbefore skills are tested. Students enter the clinical site with fundamental concepts, and anew Chapter 26 provides direction for preclinical requirements, clinical case participation,and log documentation for accredited programs.I am proud to offer a new edition of this lab manual where immersion, integration,repetition, and dedication to excellence continue to be the cornerstones for success. Enjoylearning and prepare to enter the fascinating operating room environment.STUDENT SUPPLEMENTSTo access the material on student resources that accompany this book, urces. Click on view all resources andselect Surgical Technology from the choice of disciplines. Find this book and you will findthe complimentary study materials. Website showcases surgical technology skill videos,operating room concepts and skills from selected chapters.ixA01 DANK4030 02 SE FM.indd 927/02/19 10:50 AM

INSTRUCTOR SUPPLEMENTSTo access supplementary materials online from Pearson’s Instructor Resource Center (IRC),instructors will need to use their IRC login credentials. If they don’t have IRC login credentialsthey will need to request an instructor access code. Go to www.pearsonhighered.com/ircto register for an instructor access code. Within 48 hours of registering, you willreceive aconfirming e-mail including an instructor access code. Once you have received your code,locate your book in the online catalog and click on the Instructor Resources button on theleft side of the catalog product page. Select a supplement, and a login page will appear.Once you have logged in, you can access instructor material for all Pearson textbooks. Ifyou have any difficulties accessing the site or downloading a supplement, please contactCustomer Service at http://support.pearson.com/getsupport. This book has the followinginstructor’s resources. PowerPoint lecture slides. The instructor should have access to the skills videos, too.xPREFACEA01 DANK4030 02 SE FM.indd 1027/02/19 10:50 AM

New to This Edition1. An Introduction to the chapter skills and roles provides a quickreference for instructors and students.2. List of Supplies, Directions for preparation and performance, andLearning Objectives to be used in each chapter prompt a quickstart to each lab session.SUPPLIES Soap, water, and paper towels Surgical face mask and eye protection Scrub brush soap packets with nail pick Surgical hand rub, wall-mountedDIRECTIONS Prepare by viewing the instructional video (availableon the Pearson Student Resource Website) andreading the skill sequence and instructions in thischapter. Refer to the team member role chart. Bring to lab the supplies needed for the skillsequence. Your instructor will discuss the objectives and theimportance of following the skill sequence andinstructions and will offer strategies for success. Practice performing surgical hand antisepsis withyour lab partner. Encourage and critique each other. Practice the surgical scrub or soap and brushprotocol. Your instructor will inform you to use eitherthe timed brush method or the counted brush strokemethod. Practice the waterless surgical rub protocol. Use a timer as a guide to gauge improvement inefficiency. At a designated time, demonstration of these skillswill be evaluated and graded by your instructorusing the competency assessment tool.xiA01 DANK4030 02 SE FM.indd 1127/02/19 10:50 AM

LEARNING OBJECTIVESThe learner will demonstrate the following skills with 100percent accuracy each time performing the surgical handscrub:1. Present intact skin on hands, forearms, and cuticles.Fingernails will be natural, short, and polish-free.2. Present hands and arms, free of rings, watches,and bracelets.3. Perform a basic hand wash, or prewash.4. Perform surgical hand antisepsis usingthe hand scrub—counted brush-strokemethod or timed method.5. Perform surgical hand antisepsis using awaterless, surgical hand rub.6. State the appropriate corrective actiondue to a contamination error.3. Jump into the ST role by learning a few of the most frequentlyused surgical instruments, suture, and dressing supplies inChapters 7, 19, 20, and 22. Learn how to name, prepare, andhandle these.Images and tables enhance the essential concepts andequipment.xiiNEW TO THIS EDITIONA01 DANK4030 02 SE FM.indd 1227/02/19 10:50 AM

4. Updated Competency Assessments in all chapters are designedfor role immersion, integration, repetition, and a dedication toexcellence.COMPETENCY ASSESSMENTSTUDENT’S NAME:CHAPTER 1 DON SCRUB ATTIREPERFORMANCE RATING:54321Independent: Safe. Confident, anticipates, and uses critical thinking.Above Average: Safe. Recognizes breaks in technique and self-corrects (0–1 errors).Competent: Safe. Recognizes breaks in sterile technique and self-corrects (2–3 errors). A rating of “3”or higher in each skill is required to pass.Remedial: Unsafe. Makes critical errors and is unable to implement cues consistently.Dependent: Unsafe. Makes critical errors. Requires multiple evaluator interventions.Perform independent, redundant scoring with two instructors.Critical errors: communication, sterile technique, sharps, medications, counts, and instruments.Date:PERFORMANCE CRITERIADate:Score1. Demonstrate professionalism. Communicates accurately, completely,and understandably, and shows initiative, self-direction, responsibility,accountability, and teamwork.1 22. Demonstrate home preparation: personal care, natural nails, and nojewelry, aftershave, or perfume. Dermal implants not allowed.Score34 512 34 512 34 5123 454 553. Enter locker room; wash hands; gather attire12312 3 44. Secure personal effects. Leave cell phone and valuables in a locker.123 4512 35. Don OR cap so that ears, scalp/hair, and any facial hair are covered. Assessfor stray hair and correct. Wear hood to cover a hijab, and per hospital/clinical site policies.123 45123 4 53 46. Don hospital-laundered scrub attire. Tuck in the top and draw strings.1 2 34 5127. Don dedicated OR shoes and use shoe covers per policy.1 24 512 334 554 58. Don and snap jacket for nonsterile role per policy.12 34 5123 459. Wear and secure ID badge to the front of the scrub top.12 34 512 3 45124 512 3 4510. State two conditions for donning fresh OR attire.3Optional: Total points can inform grading by percentages or letters.ADDITIONAL COMMENTSDATE: PERFORMANCE EVALUATION AND RECOMMENDATIONS PASS: Satisfactory Performance. Scores 3–5 on all performance criteria. Demonstrates professionalism: Shows professional communication, initiative, self-direction, and accountability. Exhibits critical thinking: Consistently displays comprehension and command of essential concepts. Skill performance: Exhibits no critical errors, self-corrects, performs all criteria safely and accurately in a reasonabletime frame, and applies sterile technique, as required. FAIL: Unsatisfactory Performance. Scores 1–2 on any performance criterion. Critical criteria not met. These may include sterile technique, safety, PPE, timing, or communication. Professionalism not demonstrated. Critical thinking skills not demonstrated. Skill performance unsafe or not demonstrated. REMEDIATION: Schedule lab practice. Date: DISMISS from lab or clinicals today. Visit www.pearsonhighered.com/healthprofessionsresources to access thecontent available on the student resources website. Click on view all resourcesand select Surgical Technology from the choice of disciplines. Find this bookand you can access the online content.NEW TO THIS EDITIONA01 DANK4030 02 SE FM.indd 13xiii27/02/19 10:50 AM

5. Before testing, students receive an editable progress report,and a “To Do” list.6. Chapter 9 prepares students to manage medications andsolutions, and features a student-inspired guide compiled fromtheir clinical site experiences in surgery centers, and in universityand community hospitals.Diagram 9.1 Medications Frequently Managed by the Surgical onRouteST ConsiderationsSide EffectsLidocaine0.5–1%Maximum dose 300 mg/hourAnestheticPainSQ by Surgeon*Swelling, tingling,confusion, seizures, respiratoryor cardiac arrestLipid Emulsion 20%(ILE)AnestheticLonger actingpain controlSQ by Surgeon*VasoconstrictionWarm compresses,nitroglycerinecreamFollow medication protocol1% 10 mg/mL*Treatment forOverdose/ReactionsLidocaine 1%with epinephrine 1:100,000or 1:200,000Maximum dose 500 mg/hourHeparin flush10–100 units/mLAnticoagulantFollow preference cardAntithromboticLidocainestrength mayvary.Epinephrine is anadrenergicHemostaticPrevents clotting by inhibiting activationof factors andprothrombinRead Red label forepinephrineContraindicated in use fornose, toes, penis, and fingersIV flush bysurgeon*Validate labels for number ofunits carefully. Seek maximumdosage allowed from surgeonor ACP, or preference cardNerve damage,limb ischemiaBleedingHemorrhageGiven by ACPProtamine sulfate1%Given by slow IVpush by ACPEvaluate bloodcoagulation studiesFollow the medication protocol for all medications, all of the time. Validate there are no patient allergies to the medication. Validate maximum dosage allowed. Know the indications, contraindications, and side effects. Validate the name, strength, dosage, and expiration date with the circulator. For high alert medications—those at risk for misidentification, misuse, and patient injury—perform independent, redundant verification per hospital/clinical site policy. Receive the medication.xiv Label the medication basin/syringe. Handle sharps safely and use one-handed scoop if recapping. State the name, strength, and dose as you pass the medication to the surgeon with each pass. Account for the dosage used.NEW TO THIS EDITIONA01 DANK4030 02 SE FM.indd 1427/02/19 10:50 AM

7. Chapter 26, “Transition to the Clinical Setting,” uses interactivestrategies to prepare students for their student role in the clinicalsite, and for documentation options of their participation. Facultyand students use this opportunity to be alerted to the challengesand opportunities imbedded in the operating room experiencefor student surgical technologists.TABLE 26.1 Analyze Surgical Procedures and Document Student ST RolesST Student RoleSurgical ctomyEndoscopic removal Generalof gall bladderVerify and set up sterile sup- plies, prepare local, count,pass instruments, maintainsterile techniqueBreast

Liquid adhesives Colostomy bag or pouch (available on student resources website) Closed wound drains (available on student resources website) Active systems—Jackson-Pratt and Hemovac (available on student resources website) Trocar safety (available on student resources website) Passi