Surgical Technologist Prepares the OR for a Case

CHAPTER 1

Hi, I am Lauren Beausoleil.I work at Massachusetts General Hospitalas a certified surgical technologist.Today we're gonna be going through how to open a basic packto set up for any case.

CHAPTER 2

In the morning, typically, we will come inand check the outer integrity of our packs,make sure there's no holes, and then start by opening.

And in our packs here, our basin is wrapped separately,so we'll add it to the ring stand.Each pack and suppliesthat you're gonna open are gonna be an envelope fold,so you'll break the seal and always opening every sterileitem away from you first and then towards yourself.In our packs, our gown is separate.We'll use to set up the tableand as you can see the different color of blue.There's a fold to keep your hands on the unsterile side,pulling it towards yourself.And then from the other side of the table.Like that.

We'll do the same thing with the ring stand and the basin.Once you have both open, they can then come in contactwith each other to keep no gapsbetween your sterile fields.

Our gown - again, an envelope fold away from yourself.And a lot of these have memory to them.A slight tug on either side will keep it fromfalling back up for you.Also keep in mind that you want the edge to be coveredwith the wrap so that there's no way you can contaminateyourself when you go to gown and glove.

Opening up gloves.By placing them on top. Again, making sure that nothinglands within the outer one inchbecause that's considered not sterile in this setting.And then we go and set up.

CHAPTER 3

So this would be opening up a sterile kit.Our count sheets are located on the outside of our caskets,so we would take this off for future use.

Then, again, checking the integrity of the clipsto make sure that both indicators are changedand intact still, breaking both of them off.

Then depending upon your casket system,pop off both sides.And then when removing the cover,you would always keep the sterile field away from yourself.So keeping the non-sterile side closest to youby then reaching towards the middle,pulling up away from yourself.

Inside these particular ones, you would checkand make sure that none of the paper has holes.Also, you can see that the indicator haschanged on both of them.

CHAPTER 4

So depending upon your instruments, some haveto be processed differently.This one has to go in a Sterrad system,so it is peel-packed.Breaking the seals - also an envelope fold.So you would go away from yourself, to your right,to the left, and then towards yourself.

CHAPTER 5

After you scrubbed, come inand grab your gown, making sure not to touch the bottom.And then at the top, there's two pocketsthat will become your sleeves.So let it, stepping back, drop down.You always wanna make sure that your hands areinside the cuff of your gownbecause the end of it is not sterile.Open.Fold it over.Once you've placed both of them, you're then ableto put your second pair on more freelybecause you're now completely sterile.And then on your gown, you have a sterile side of it.In order to close it, you separate.Give the card to somebody else.And you can tie it.At which point then you're readyto start setting up your table.

CHAPTER 6

This will be organizing and setting up your back table.So each pack is slightly different,but you'll have gowns, towels,and other sterile supplies that you would need for the case.It's much easier if you find your Mayo cover first.If you lay it flat out on your table,it nicely will tell you that your left handand your right hand to go.Sliding it up and over.It's always nice to have another layer on top of itto protect it.All right.In organizing your back table, it is helpfulto always do the same thing, as I was taught years ago,the saying of, "Touching everything oncewill help make your process faster."You obviously will get faster as time goes along,but additionally, the more familiar you are with the packsthat you're using - everything has a home.So my towels will go into my basin.Set these up.The pitcher will go inside another basinso that there's no spillage from it.And strike through on your back table.This pack comes with sponges for us.Your suction. And your suction tip can goto the Mayo stand.Depending upon your facility,the back table setup will have some slight variations,but our sharps go about in the middle of our tableswith our needle counter.Trash bag.For all trash during your case.I try not to put trash from my table setup into it.It just makes it easier as your day goes on to have lesspretrash in it because it can get heavydepending upon the length of your case.This will go in here.Our packs have labels in them for us already.We have 0, 2-0, and 3-0 silk ties,and then also two blades.The first one, every pack will have a 10 blade.Obviously being mindful when opening themthat it is a sharp.And then your light handle covers.This is all trash.And then once all of your small things have been organized,you then need to create a towel rollfor your instrument set.Depending upon the size of instruments,and what you're gonna be using, will vary the lengthof the roll needed.Once that's all set,grab all your instruments to set up on your table.We would reach in to find the indicator,make sure the indicator has changedand that you don't see anythingthat does not belong inside your kit.Reach inside of your pan to grab your handles.Lifting straight up to not hit your sides.And then also looking in to make sure that nothingis at the bottom that's not supposed to be there.Come over to place your pan on your back tableto start organizing what's inside of it.Once your instruments are on your back table, reach inside.Most of our forceps, knife handles,and suctions are in a nice wrap fold for us.And any instruments that can be separated like thisPoole suction - when it's processed,it cannot be put together the way that I just did.Otherwise it will not be sterile.Your knife handles.And then inside here...Arrange your instruments in the order of the count sheet.Our clip appliers.And then our basic general hasa few different instruments,but you have your wide malleableand a thin malleable,a large abdominal retractor,two Weitlaners,and then two Riches.Your forceps.

Once your back table is organized,you're then ready to count.Here we start with our soft goods first.So you would break the wrap on it.And as you go to count, you wanna make surethat you completely separate one from the rest of the bunchso that you can - you and both yourselfand your circulator can see the separation sothat you know there's nothing else hiding.So we would go one, two, three, four, five,six, seven, eight, nine, ten sponges, or Ray-Tecs.After your sponges,we have blades for one, two. No sutures.Scratch pad for one.That is countable items open for right now.Next would be our instrumentation.You want to make sure to not removewhatever system you guys have holding all your instrumentstogether until you're ready to count with your circulator.We would start off with knife handles, for ours,we have one, two, three.Moving to your stringer - scissorsfor one, two, three, four, five, six, seven.As you can see the separation between in each instrument sothat you can, again, both yourselfand your circulator, who's not sterile,can see the definition between the two.Needle drivers for one, two, three, four, five,six, seven, eight, nine, ten.Snaps for one, two, three, four, five, six.Kellys for one, two, three, four, five, six.Schnidts for one, two, three, four, five,six, seven, eight, nine, ten, eleven, and twelve.Babcocks for one, two.Allises - one, two, three, four, five, six, seven, eight.Kochers for one, two, three, four.Moynihan's for one, two.Right angles - one, two, three, four.Sponge sticks for one and two.Towel clips - one, two, three, four, five, and six.Forceps - we have one, two, three, four, five,six, seven, eight, nine, ten, eleven.Retractors - we have one, two, three, four, five,six, seven, eight.Clip appliers for one, two, three, four.And then we have one, two blue clips.And suction tips - there's one, two, and three.For this table setup,that would conclude your counting process.So when taking sterile supplies from someone else,they will fold it out, providing it to you,and then you can take it to your fields.Same with the suture.Thank you.So counting as sterile supplies,both of these are countable items.So you would have sutures or needles for one, two.And lap pads - one, two, three, four, and five.That concludes setting up your back table.

CHAPTER 7

So in order to doff off your sterile stuff,take off your outer glovesthat would be dirty from your case.Then break your tie on the side, grab by your hipsto roll the rest of it off.Roll down and away from yourself.And then if your gloves are still on,you would take the sterile side to the inside,and then skin side to skin.