Intraoperative Nursing Care | NCLEX RN Review
The intraoperative nurse cares for the patient from the time the patient is moved onto the OR bed until the patient is transferred to the care of the recovery room nurse, or postanesthesia care unit.
You may have heard the term “perioperative nursing” – this encompasses the preoperative, intraoperative, and postoperative phases of the patient’s surgical experience. This article will focus on intraoperative nursing care.
Nursing responsibilities during the intraoperative phase include continuing the assessment of the patient’s physiologic and psychologic status, promoting safety and privacy, preventing wound infection, and promoting healing.
The surgical team must work together to deliver safe and effective care to the patient in the intraoperative phase.
The team is divided into categories based on responsibilities and consists of the primary surgeon and assistants, the scrub tech/nurse, circulating nurse, and anesthesiologist.
The surgeon, assistant, and scrub tech working the sterile field, while the circulating nurse, anesthesiologist, and other personnel functions outside the sterile field.
The circulating nurse is an RN with several responsibilities, including… Coordinating patient care before, during,and after the surgical procedure Providing emotional support to the patient and assisting the anesthesiologist during the initiation of anesthesia Ensuring patient safety, positioning and monitoring the patient, and enforcing policies and procedures throughout the surgery – including a “time out” Maintaining sterile technique while providing supplies and equipment for the sterile team Documenting all nursing care during the intraoperative period and making sure that surgical specimens are labeled correctly and placed in the appropriate media Recognizing and resolving environmental hazards that involve the patient or surgical team, including protecting the patient from electrical hazards Ensuring with the scrub tech that all sponge, instrument, and sharps counts are completed and documented And communicating relevant information to family members and other healthcare workers outside the ORThe surgical environment is designed to provide a safe therapeutic environment for the patient.
Traffic in and out of the operating suites kept to a minimum to decrease potential contamination from air turbulence and bacterial shedding. Floors, walls, and ceilings are made of materials that are easy to clean with antimicrobial agents. The temperature in the OR is kept between 68 and 75 degrees to reduce the risk of infection.
The relative humidity is kept between 40 to60%, which diminishes bacterial growth and restricts static electricity. The aseptic technique involves following practices that prevent contamination from pathogens and must be followed by all members of the team to reduce the risk of surgical site infections.
The Association of periOperative Registered Nurses (AORN) has “Perioperative Standards and Recommended Practices” for asepsis that include the following: Scrubbed persons should function within the sterile field.
Sterile drapes should be used to establish a sterile field. Items used within a sterile field should be sterile. All items introduced onto a sterile field should be opened, dispensed, and transferred by methods that maintain sterility and integrity.
A sterile field should be maintained and monitored constantly. All personnel moving within or around a sterile field should do so in a manner that maintains the sterile field.
(Sterile persons remain close to the sterile field and never turn their backs to it.) Policies and procedures for maintaining a sterile field should be developed, reviewed periodically, and readily available in the practice setting.
Individuals working in the OR area major source of microbial contamination to the environment due to the large quantities of bacteria in the respiratory tract and on the skin, hair, and clothes.
Surgical attire is required to reduce the patient’s risk of surgical site infection (SSI) from microorganisms and also to protect personnel from exposure to hazardous substances and infectious microorganisms.
Everyone in the OR will need to wear a surgical cap, mask, and shoe/boot covers. Dressing in OR attire progresses from head to toe – surgical hat first (to prevent the shedding of microbes from the head/hair to the scrubs), then surgical scrub suit, face mask, and safety eyewear, and shoe/boot covers.
Non-sterile team members should wear a long-sleeve scrub jacket. Those in the sterile field will also perform surgical scrub of hands and arms before entering the OR to put on a sterile gown and gloves.
Double gloving is recommended and has many benefits including preventing SSI and protecting the hands of healthcare providers. Patient skin preparation involves the patient showering thoroughly with an antiseptic wash prior to surgery.
The intraoperative circulating nurse will be involved in hair removal from the surgical site (when necessary) and cleaning the incision site with a skin antiseptic, using the manufacturer’s recommendation for contact and drying time.
Skin preparation begins with mechanical scrubbing at the incision site, moving out in a circular fashion, away from the site. The sponge is considered contaminated when it reaches the outer edge and is then discarded. A new sponge is used each time the area is scrubbed.
Once the patient is prepped and draped in the OR, the circulating nurse usually initiates the “time-out” that takes place between the entire surgical team.
The “time out” is a verbal agreement that includes, at a minimum, the following… correct patient identity, correct site, and correct procedures to be performed. If implants or radiologic exams are involved, these should be verified at this time also.
Document the completion of the time-out, indicating that everything has been verified and agreed upon. The circulating RN plays a role in assisting the anesthesiologist with anesthesia.
Anesthesia may be a limited loss of feeling of a total loss of feeling, with or without loss of consciousness. There are three main types of anesthesia – local, regional, and general.
General anesthesia produces unconsciousness, regional anesthesia creates a loss of sensation in a particular area, and local anesthetic agents may be used alone or in conjunction with other anesthesia.
The OR nurse needs to know the various types of anesthetics used in surgery, methods of administration, and the potential side effects and complications, in order to assist the anesthesia team. Let’s look at a brief overview of the types of anesthesia.