Intraoperative Nursing Care and Asepsis
Core concepts
Intraoperative nursing integrates asepsis, positioning, and surgical counts. Candidates must know sterile technique principles: the sterile field is only sterile at and above the table level, items below are contaminated, and any break in technique requires correction. Surgical hand antisepsis, gowning and gloving, and maintaining the sterile field are foundational. The circulating nurse manages the environment, documentation, and equipment; the scrub nurse maintains the sterile field and anticipates needs. Surgical counts (sponges, sharps, instruments) follow standardized protocols, are performed at defined intervals, and are reconciled before closure; a discrepancy must be reported to the surgeon and resolved. Positioning must protect pressure points, prevent nerve injury, and maintain alignment, especially in children with proportionally larger heads and less padding. Aseptic technique also includes minimizing traffic, proper surgical attire, and environmental controls. Time-outs and surgical safety checklists confirm patient identity, procedure, site, and consent before incision.
Traps in questions
A common trap is believing an item below the sterile field level remains sterile. Another trap skips the count reconciliation or assumes the surgeon decides alone. Do not assume a small child needs less padding.
Rule of thumb
If a count is incorrect, stop and search systematically: inspect the field, the floor, and the drapes, notify the surgeon, and document; never close with an unresolved count.