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Basic General Surgery Set Up
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So the next skill we're going to demonstrate today is setting up a basic general surgery case. So the first thing I want to do is I want to is I want to consolidate all of my instrumentation and drapes so that people who are coming in and out of the OR aren't going to contaminate anything that I'm going to use for my setup.
So, first I'm going to come over to my… uh, kit pan of instruments. The outside container of the kit pan is not sterile, however, the inside of the container is, as are my instruments. So, making sure that I'm far enough away from the table that the kit pan is on, I'm going to reach in and I'm going to lift straight up. Before I set this down onto my table, I'm going to check an indicator to make sure that it has passed, uh, letting me know that the instruments have been through the sterilization process. This indicator, um, has passed and our instruments are okay.
Next I'm going to set up a prep table, so I'm going to remove this. Take this pack, and I'm going to open it on this table. The same principles.
Inside this pack, I have some drapes and gowns for my surgeons. I'm going to drape out a ring stand using an impervious table cover.
Open the drape. Going to go towards me, and away from me. And then I will get my basin, and I will place my basin into my ring stand. So now I've created a sterile ring stand and basin, and I have a table here for my prep.
I will then take my basin and empty all the supplies out of it. Return the basin to the ring stand. Take my laparotomy sheet, place it down. Take my surgeons' gowns, place that on top of my drape.
Take four towels, for prepping and draping purposes. And place them here as well. And this is going to be in the order in which I use them. So the surgeons are going to go gown and glove- I'm going to gown and glove the surgeons first, then we will use the towels to drape about the surgical, um, the surgical area, and then our final drape is the lap sheet.
This is an Ioban… drape, it goes over the lap sheet. And I just tuck that into my drape. So now I am prepared to gown and glove the surgeons, as well as drape.
I now am going to set up my prep table. On my prep table, I will have a bowl for some Betadine, as well as a towel. Jayne, may I have another pack of towels please? Next I'm going to set up a sharps area or a sharp zone. I do this by using a towel. There many different ways you can do this. This is my method of choice. Set up some basins. I have my pitcher for saline. Light handles. My sharp box is going to go there is well. Inside my sharp box I have a Bovie scratch pad.
Next we have some dressings. I can just place them somewhere on my table where they're not going to be dirty or get dirty and use them for later. I have my Asepto for irrigation. May I have a mayo tray cover, please?
The next step, I'm going to drape out my mayo stand. Um, so this is a mayo stand cover. You open it like a book. On the mayo tray cover itself, it says right hand under cuff, left hand under cuff. So I'm going to my place my hands under that. I'm going to lift it up. It's going to form a little mouth. I'm going to then approach my mayo stand. Step on the stand with one of my feet. And then I'm going to shimmy the mayo stand cover over to cover the mayo stand.
Now the top of my mayo stand, as well as the bottom of my mayo stand, is now considered sterile. I'm going to fold the cover to make it nice and neat. Tuck it into my field, and then take a towel and place it over the stand. I then am going to take my suction and my Bovie, and place it on the mayo stand. Those are the first two things that I'm going to do um, when I get to the field, I'm going to throw off my Bovie and throw off my suction. I'm also going to pass up light handles to the surgeons. So all that stuff can go on the mayo.
Next I'm going to set up my instrumentation. First, I'm going to make a towel roll for my instruments to sit on. I'm going to lift my instruments out of my pan. I like to set up my instruments so my scissors are closest to my sharps zone. Remove the stringer. And then the next step is just to make the rest of the instruments in the kit pan neat and orderly so it makes it easier for counting. I find it best to empty the kit pan and then organize.
So we have suction. Suctions go there. The knife handles that go in the kit, are going to go into my sharp zone. It's very important to know where your sharps are for safety reasons. Line up my retractors, so they're easily counted. And then set up my forceps. I set up my forceps, I like to have all my tooth forceps in one area and then all of my smooth forceps in another area. The longer ones I put on the other side just to make more room. These Senns are sharp, so I like to place them in my sharps area.
Now all that's left are what I like to call arts and crafts. My sutures. I'm going to make a- take a towel and make a fan fold, so my sutures can fit into it and I can easily see what sutures I have on my field. And those will sit nicely like that. My lap pads, and… my lap pads go here.
My knife blades will go into my sharps container, and ultimately onto my knife handles. Labels, I'll place in my suture bin. It's very important to label any medications that are on the field. This is an instrument pouch. You can place your Bovie in it after you're done draping. This is part of my dressings, these will go away. And now I am ready to count with my circulator.