Setup for a C-Section (South College, Knoxville, TN)

CHAPTER 1

Hi, guys. My name is Shannon Morris. I am a Clinical Coordinator here at South College, Knoxville campus for our surgical technology program. So today, I'm gonna show you guys how to do a basic setup for a C-section.

CHAPTER 2

So as you can see, I've already done my hand scrub for the day, surgical scrub. I have also done my sterile outfit and I checked my preference card to make sure I put all my doctor preference supplies. I also opened them as well, but before opening them, I checked the integrity of all the packages. I looked at my seal, my indicator, my expiration date, and I checked for any moisture on any of my surfaces or on any of my wraps. I also double-draped my back table as well for an extra layer of protection and I have also popped my tray and checked my indicator inside as well with my circulator. I'm ready just to lay all my supplies out. The first thing that you wanna make sure you keep in mind is that once I start pulling all this stuff out, I make sure that I only move it once because too much movement, you're at a higher risk of contamination.

CHAPTER 3

So, first I'm gonna pull everything out. I'm gonna get all my stuff out of here, out of my ring stand. This side will be my working end. This side will be my non-working end. So, I will put all my sharps and my soft goods over here on this side. My gowns, my drapes, and my towels will go on the other. Set everything out here. And lay this out. Okay. So, everything that I have over here, so I have my placenta basin. This will be for my specimen to send to pathology. I also have my saline basin here as well with my labels that I will label once my circulator pours my solution in. And I have an Asepto that will be labeled as well inside of my basin. I have a medicine cup here that I will use for my cord blood from the baby. And I also have a cord blood tube that I'll use. To get the blood inside, I will have the surgeon milk some of the blood out of the umbilical cord. The blood will go inside here and I will draw it up with the syringe. And then, I can use one of... These. And this will help me draw up the blood, and then I'll be able to insert it into my cord blood tube. So, I'll set all my sharps here on my working end. Marker and my ruler. My cord clamp. I'm gonna tuck my labels here under my kidney basin for the time being. I'm gonna set my baby bulb syringe here on my Mayo.

CHAPTER 4

I will set my gowns on my non-working end and I also have my surgeon's and my assistant's gloves as well, and I'll keep those together. I always like to put their gloves in order of how they'll put them on, so when they open 'em like a book, they'll be able to just slip them on. Put that there. So, my indicator glove will go on top, and then my Biogel will go on the bottom. I'll also place towels over here on this side, and then my drape as well will go over here.

CHAPTER 5

I'm gonna leave all of my things that I'll pass off once my patient's draped out. I'm gonna leave everything here in this ring stand, so that way I can just pull this up to the patient once we're draped, and I'll have it to throw off to the circulator.

CHAPTER 6

So, I've already looked for my indicator in here, and it's good. I'm going to now take my tray out and move it to my back table. So, I'll use... Making sure I'm maintaining my distance, I wait for my circulator to come check the inside of the tray to make sure it's good. Looks good. She says it's good. Now, for my instruments, I'm gonna make a roll towel to lay it out. Okay. I will not take my instruments off the stringer until after I have counted. Now, I'm gonna organize my forceps and my retractors. So, I have... My bladder blade, my Army-Navy. Richardson retractor, my ribbon. My knife handles. So, two Army-Navys. And then my towel clips. I will set those right here, so I'll not forget to count them. Now, for my forceps, I separate mine from atraumatic to traumatic. I'll put my atraumatic forceps on my working end and I'll put my traumatic forceps on my non-working end.

CHAPTER 7

Now, other instrumentation that I have, that I'll set out, I have a Kiwi vacuum here. This is just equipment that'll help assist with getting baby out. If baby's stuck underneath mom's pelvis, this'll help. They'll put this suction cup on top of baby's head, and then you'll hand this part to the surgeon to pump up. So, I will set this right here, so that way if I need it, usually we'll use these in emergency purposes. So if you need it, you need to put it somewhere where you will have easy access to. Also, I have an Alexis retractor. This can be used in place of your bladder blade and your Richardson. This is surgeon preference, and also it may be determined if your patient has a larger BMI, they may want this rather than the bladder blade or the Richardson. I have my Yankauer and my Bovie in here as well, and my light handle.

CHAPTER 8

All right, I think I'm ready to count with my circulator. So, to start for counting, I will always start with my softs, and then move to my sharps, and then instruments. So first, we have laps. You never break the band around your laps until you're ready to count. I always like to fan mine out and count on the one-folded end instead of the double-folded end. So, I give it a little fan and then I separate one by one. So, one, two, three, four, five. One, two, three, four, five, for 10. I'm gonna use my knife handle to point at my sharp objects to help me count. So first, I have one blade. I have one, two suture. I have one needle. I have one cord clamp. I have one Bovie tip. And one Yankauer suction tip, disposable. I also have a marking pen, one, two, three pieces. And one ruler. Now, for my instruments, I'll use my knife handle as well to help me guide for my instruments to help separate so my circulator can see them better. So... I have one, two mosquitoes. One, two, three, four, five, six hemostats. One, two, three, four Kellys. One, two, three, four Babcocks. One, two, three, four Allises. One, two, three, four Kochers. One, two, three, four sponge sticks. One Hegar needle driver. One, two Heaney needle driver. One Metzenbaum, one curved Mayo, one straight Mayo, and one bandage scissor. I also have one, two, three, four towel clips. And I'll set those there for my towels. Now, for retractors. I have one bladder blade, one, two Army-Navy, one Richardson, and one ribbon malleable, for a total of one, two, three, four, five retractors. I have one smooth pickup, one DeBakey, one Adson-Brown, one rat tooth, one, two Bonneys, for a total of one, two, three, four, five, six forceps. I have one, two knife handles. So, I've counted all of my supplies and I have verified with my circulator that my count sheet is correct, so I'm good with all my counts and my instruments.

CHAPTER 9

So now, I'm gonna move on to putting my instrumentation on my Mayo stand for what I will specifically need during surgery. So I know I'm gonna need some sort of retractor, so I'm gonna take my bladder blade and my Richardson. I've also made sure my Mayo stand was draped and covered well. When I drape my Mayo, I have the orientation of it facing me, so I always make sure that I switch it around to where the post of the Mayo is facing towards me, so when I pull up to my patient, I'm ready to go. I'm squared off with my back table. So now I'm good to take my stringer off. Once I've taken my stringer off, I like to place my instrument stringer under my tray here on the table, and I do that just because I don't want it to fall off, I don't wanna lose it, and I'll also have easier access for it during turnover and I know exactly where it's at. So, I got my two retractors over there. I'm also gonna need two Army-Navys for retraction of the fascia to pull back, so I'll put those up there as well. Now, I'm gonna put three hemostats. There, this will be for my cord clamp, I'll use these. So, I'm gonna place my cord clamp up there as well. Then, I'm also gonna place three Kellys. Now, depending on if you have more than one baby, you may need multiple cord clamps as well. I will also put two Allises. And two Kochers. And then I will place one sponge stick as well. This will help to retrieve the placenta. And I'll set that right there. Now, scissors. I need bandage scissors to cut the umbilical cord. I'll need my suture scissors to cut suture. And then I'll also need my curved Mayos for the cutdown of the fascia. And my Metz for any peritoneum, if that needs to be. So, I'll keep all my scissors together. I'm gonna put my scissors actually with my cord clamps and my Kellys. And then I'm gonna put all my scissors together here on my Mayo as well. Put that there. And I'll leave my baby bulb syringe up here also.

CHAPTER 10

I'm also gonna put up here what we call a no-pass zone. So, what I like to do is I cut a piece of my pink pad that I use here for my sharps, and I take it and I put it on my Mayo stand, and this is just here with my blade sitting on it. So that way, if the surgeon does grab my blade or he's using it and he or she is wanting to put it back on my =Mayo, this is a way that if I'm doing something maybe on my back table, maybe I'm cutting off a piece of the cord segment, I'm busy, he'll be able to say, "Hey, scalpel down, no-pass zone." and I'll know that it's there and then I can grab it and I can put it back on my back table once he's done.

CHAPTER 11

Also, one thing that I have left to do is I need to also make my towels to drape out my incision. So, I'll make four towels. I'll do three that are folded towards me. And then the last one I'll put away from me. I'm also gonna use these towel clips. The surgeon will ask for these to keep the towels all together so that incision will stay right there in that opening. So, I'm just gonna fold these towels over and I'm gonna set my towel clips right on top of it. I'm gonna give this to him before I give the drape out. So, I'll set that right there.

CHAPTER 12

Now, I'm just checking to make sure that I have everything. I'll make sure all my solutions are labeled once my nurse has came around to give it to me. I'll label my Asepto and my basin. I will also, if any other meds are given, I would label them on my med cup as well. But yes, so here you see I have a C-section set up. Thank you.