Surgical and Procedural Assistance
What the domain tests
This domain tests sterile technique, procedure setup, skin antisepsis, instrument handling, wound care, and the assistant's role during minor office surgery. Surgical conscience, the habit of reporting your own breaks in technique, is tested directly.
Core rules
- The sterile field is sterile only at table level and above; anything below waist level or outside your view is contaminated. Only sterile items touch sterile items.
- Establish the field immediately before use, check package integrity indicators, and keep the field in view at all times.
- Perform a surgical hand scrub for the required duration, keep hands above the elbows, and dry with a sterile towel from fingers to elbows.
- Gown and glove without contaminating the outside of the gown or gloves; in open gloving, touch only the inside of the glove with the bare hand.
- Skin antisepsis: chlorhexidine or povidone-iodine applied from the incision site outward in concentric circles; allow the agent to dry fully before draping.
- Position the patient for comfort and access, pad pressure points, and keep a running count of sponges and instruments when the procedure requires it.
- Verify informed consent and site marking, and confirm allergies, especially to latex and antiseptics.
- Specimens go into the correct fixative, usually 10% formalin, labeled with identifiers, site, and laterality; never allow a specimen to dry.
- Suture removal: cleanse, snip close to the skin on one side, and pull through from the opposite direction.
Worked example
During a mole excision you notice a tear at the index finger of the surgeon's glove. Reasoning: a torn glove breaks the sterile barrier. Announce it immediately, step back, remove the glove, perform hand hygiene, and reglove. Continuing the case, or covering the tear with a second glove, is not acceptable.
Traps that cost marks
- Turning away from the sterile field or reaching over an open sterile tray.
- Draping before the antiseptic has dried.
- Forgetting laterality on a specimen label.
- Touching the outside of sterile packaging with a bare hand.