Surgical Nursing and Instrumentation
Surgical Nursing and Instrumentation
This domain tests asepsis, instrument identification, suture selection, sterilization, patient preparation, and the nurse's role in the operating room and recovery.
Core rules
- Asepsis: surgical hand scrub, sterile gown and gloves, and a sterile field that is never turned away from or left unattended. Contaminated items are replaced, not wiped.
- Patient prep: clip hair, then scrub with chlorhexidine or povidone-iodine alternating with alcohol; alcohol alone is not a disinfectant for skin prep.
- Instruments: Kelly and Crile hemostats, needle holders, Mayo and Metzenbaum scissors, Brown-Adson tissue forceps, Balfour and Gelpi retractors, Backhaus towel clamps.
- Suture: absorbable (polyglactin, poliglecaprone, polydioxanone) for internal tissue; nonabsorbable (nylon, silk, polypropylene) for skin or tension.
- Sterilization: steam autoclave at 121°C for 15 minutes or 132°C for 4 minutes, monitored with chemical and biological indicators.
Worked example
A surgeon asks for an instrument to clamp a bleeding vessel with minimal tissue crush. A Kelly hemostat is appropriate: its half-length serrations crush less than a fully serrated instrument and it is used to grasp the vessel before ligation.
Traps
- Reaching over the sterile field or turning your back to it.
- Using Mayo scissors for fine dissection; Metzenbaum scissors are for delicate tissue.
- Skipping biological indicator monitoring.
- Releasing a patient from recovery before it can maintain sternal recumbency and temperature.