Intraoperative Nursing Care

Summary

This video tutorial delves into the critical role of intraoperative nursing, detailing the responsibilities from patient reception to recovery room transfer. It covers the collaborative efforts of the surgical team, including the surgeon, scrub tech, circulating nurse, and anesthesiologist, to ensure patient safety, privacy, and effective care. The tutorial also highlights the importance of aseptic techniques, patient preparation, anesthesia administration, and the nurse's role in managing the patient's physiological and psychological needs during surgery.

Takeaways

• 🏥 The intraoperative nurse is responsible for the patient's care from the time they are moved onto the OR bed until they are transferred to the recovery room or PACU.
• 🔍 Perioperative nursing includes preoperative, intraoperative, and postoperative phases of a patient's surgical journey, with this tutorial focusing on the intraoperative phase.
• 👨‍⚕️ The surgical team consists of the primary surgeon, assistants, scrub tech/nurse, circulating nurse, and anesthesiologist, each with specific roles to ensure patient safety and effective care.
• 📋 The circulating nurse has multiple responsibilities including coordinating patient care, providing emotional support, ensuring patient safety, and maintaining sterile technique.
• 🏢 The OR environment is designed to minimize contamination and infection risk, with controlled temperature, humidity, and materials that are easy to clean.
• 🧼 Aseptic technique is crucial in the OR to prevent surgical site infections, with guidelines provided by AORN for maintaining sterility.
• 👔 Surgical attire is mandatory to reduce the risk of surgical site infections and protect personnel from hazardous substances and infectious microorganisms.
• 🚿 Patient skin preparation is a critical step in preventing infection, involving thorough showering with antiseptic wash and careful cleaning of the incision site.
• ⏱️ The 'time-out' is a crucial procedure verification step involving the entire surgical team to confirm patient identity, site, and procedure before starting the surgery.
• 💊 The intraoperative nurse must understand the types of anesthesia, their administration methods, side effects, and complications to effectively assist the anesthesia team.
• 🌡️ The nurse plays a vital role in managing the patient's body temperature during surgery, using measures to prevent hypothermia or hyperthermia.

Q & A

What is the role of an intraoperative nurse?

An intraoperative nurse is responsible for the care of the patient from the time they are moved onto the OR bed until they are transferred to the recovery room nurse or postanesthesia care unit.

What is the difference between 'intraoperative nursing' and 'perioperative nursing'?

'Intraoperative nursing' refers specifically to the care of the patient during surgery, while 'perioperative nursing' encompasses the preoperative, intraoperative, and postoperative phases of the patient’s surgical experience.

What are the main responsibilities of the circulating nurse in the OR?

The circulating nurse is responsible for coordinating patient care, providing emotional support, ensuring patient safety, positioning and monitoring the patient, enforcing policies and procedures, maintaining sterile technique, documenting nursing care, and communicating relevant information outside the OR.

What is the purpose of the 'time out' in the OR?

The 'time out' is a verbal agreement among the surgical team to verify the correct patient identity, correct site, and correct procedure to be performed, ensuring patient safety and accuracy in the surgical process.

How does the OR environment contribute to patient safety?

The OR environment is designed to minimize contamination and infection by using materials that are easy to clean, maintaining a controlled temperature and humidity, and limiting traffic to reduce air turbulence and bacterial shedding.

What are the key components of aseptic technique in the OR?

Aseptic technique involves maintaining a sterile field, using sterile drapes and items, transferring items in a way that maintains sterility, and ensuring all personnel adhere to practices that prevent contamination from pathogens.

Why is surgical attire important in the OR?

Surgical attire is crucial to reduce the patient’s risk of surgical site infection from microorganisms and to protect personnel from exposure to hazardous substances and infectious microorganisms.

What is the significance of patient skin preparation in the OR?

Patient skin preparation is important to reduce the risk of infection by involving thorough showering with antiseptic wash, hair removal from the surgical site when necessary, and cleaning the incision site with skin antiseptic.

What are the three main types of anesthesia used in surgery?

The three main types of anesthesia are local, regional, and general anesthesia, each providing different levels of sensation and consciousness control during surgery.

What are the potential risks associated with spinal anesthesia?

Risks of spinal anesthesia include hypotension, inadvertent high level of anesthesia causing respiratory arrest and complete paralysis, neurologic complications, spinal headache, and infection.

How does an intraoperative nurse assist with anesthesia?

The intraoperative nurse assists the anesthesiologist by providing support during anesthesia induction and emergence, being aware of anesthetic types and potential side effects, and ensuring patient safety and comfort during these processes.

Outlines

00:00

👩‍⚕️ Intraoperative Nursing Overview

This paragraph introduces the role of the intraoperative nurse, who is responsible for the patient's care from the moment they are placed on the OR bed until they are handed over to the recovery room nurse or postanesthesia care unit. It explains the concept of 'perioperative nursing,' which includes preoperative, intraoperative, and postoperative phases. The video's focus is on the intraoperative phase, detailing nursing responsibilities such as patient assessment, safety, privacy, infection prevention, and promoting healing. The surgical team's composition and roles are also outlined, including the primary surgeon, assistants, scrub tech/nurse, circulating nurse, and anesthesiologist. The paragraph emphasizes the importance of teamwork and the circulating nurse's specific duties, such as coordinating patient care, providing emotional support, ensuring patient safety, maintaining sterile technique, and documenting nursing care.

05:01

🧼 Aseptic Techniques and Patient Preparation

This section delves into the importance of aseptic techniques to prevent surgical site infections, including the guidelines set by the Association of periOperative Registered Nurses (AORN). It discusses the setup of the sterile field, the use of sterile drapes and items, and the practices required to maintain sterility. The paragraph also covers the role of surgical attire in reducing microbial contamination and protecting personnel, detailing the dressing process from head to toe. Special attention is given to double gloving, patient skin preparation with antiseptic wash, and the procedure for hair removal and incision site cleaning. Additionally, it explains the 'time-out' protocol involving the surgical team to verify patient identity, site, and procedure, and touches on the types of anesthesia, their administration methods, and potential side effects.

10:03

💊 Anesthesia Types and Patient Care

The paragraph provides an in-depth look at the types of anesthesia, including local, regional, and general, with a focus on their administration and effects. It discusses the roles of the OR nurse in assisting with anesthesia, being aware of signs of toxicity, and understanding the risks associated with each type, such as hypotension and neurologic complications. The paragraph also covers the levels of sedation, from minimal to deep, and the importance of the nurse's role during the induction, maintenance, and emergence phases of general anesthesia. The nurse's responsibilities during these phases include providing support during intubation, applying cricoid pressure, and ensuring patient comfort during emergence. The discussion on thermoregulation during surgery highlights the risk of hypothermia and hyperthermia, their causes, symptoms, and treatments, emphasizing the nurse's role in monitoring and managing the patient's body temperature.

Keywords

💡Intraoperative Nursing

Intraoperative Nursing refers to the specialized care provided by nurses to patients during surgery. It is a critical component of perioperative nursing, which also includes preoperative and postoperative care. In the video, intraoperative nursing is the central theme, focusing on the nurse's responsibilities from the time the patient is moved onto the OR bed until they are handed over to recovery room staff.

💡Perioperative Nursing

Perioperative Nursing encompasses the entire surgical experience of a patient, including preoperative, intraoperative, and postoperative phases. The term is used in the script to describe the broader scope of nursing care that surrounds the surgical procedure, of which intraoperative nursing is a part.

💡Surgical Team

The Surgical Team in the context of the video consists of various professionals such as the primary surgeon, assistants, scrub tech/nurse, circulating nurse, and anesthesiologist. They all have distinct roles and responsibilities to ensure the safety and well-being of the patient during surgery.

💡Circulating Nurse

The Circulating Nurse is a registered nurse (RN) who has several responsibilities in the OR, including coordinating patient care, providing emotional support, ensuring patient safety, and documenting nursing care. The script highlights the importance of this role in maintaining the overall safety and efficiency of the surgical procedure.

💡Sterile Field

A Sterile Field is a designated area in the OR where the surgery takes place, and it must be kept free from all microorganisms to prevent infection. The script explains the importance of maintaining this sterile environment, with the surgeon, assistant, and scrub tech working within it.

💡Aseptic Technique

Aseptic Technique refers to the practices followed to prevent contamination from pathogens in a surgical setting. The script mentions that all members of the OR team must adhere to these techniques to reduce the risk of surgical site infections.

💡Anesthesiologist

An Anesthesiologist is a medical professional who specializes in anesthesia, ensuring the patient is adequately sedated or anesthetized for surgery. The script discusses the circulating nurse's role in assisting the anesthesiologist and understanding the types of anesthesia.

💡Anesthesia

Anesthesia is the administration of drugs to induce a state of insensibility to pain, used during surgery. The video script provides an overview of the different types of anesthesia, including local, regional, and general, and the nurse's role in monitoring and supporting the patient under anesthesia.

💡Surgical Site Infection (SSI)

Surgical Site Infection (SSI) is an infection that occurs at the site of a surgical incision. The script emphasizes the importance of surgical attire, aseptic technique, and sterile fields in reducing the patient's risk of SSI.

💡Time-Out

A 'Time-Out' is a standardized pause in the surgical procedure to verify the correct patient, site, and procedure. The script describes how the circulating nurse initiates this process, which is crucial for patient safety and preventing surgical errors.

💡Thermoregulation

Thermoregulation in the context of the video refers to the maintenance of the patient's body temperature during surgery. The script discusses how factors like anesthetics, the OR environment, and surgical exposure can affect body temperature, and the nurse's role in preventing hypothermia or hyperthermia.

Highlights

The intraoperative nurse's role extends from the patient's transfer to the OR bed until the patient is handed over to the recovery room nurse or postanesthesia care unit.

The term 'perioperative nursing' includes preoperative, intraoperative, and postoperative phases of a patient's surgical experience.

Nursing responsibilities during surgery involve assessment, promoting safety and privacy, preventing wound infection, and promoting healing.

The surgical team consists of the primary surgeon, assistants, scrub tech/nurse, circulating nurse, and anesthesiologist, each with specific roles.

The circulating nurse coordinates patient care, provides emotional support, ensures patient safety, and enforces policies throughout the surgery.

Aseptic technique is crucial for preventing contamination and reducing the risk of surgical site infections.

The Association of periOperative Registered Nurses (AORN) provides standards and recommended practices for maintaining a sterile field.

Surgical attire is mandatory to reduce the risk of surgical site infection and protect personnel from exposure to hazardous substances.

Double gloving is recommended for healthcare providers to prevent surgical site infections and protect their hands.

Patient skin preparation includes showering with antiseptic wash and hair removal from the surgical site when necessary.

The 'time-out' is a crucial step for verifying patient identity, site, and procedure before surgery begins.

Anesthesia types include local, regional, and general, each with different methods of administration and potential side effects.

Signs of local anesthetic toxicity include tachypnea, tachycardia or bradycardia, and seizures among others.

Regional anesthesia techniques such as spinal, epidural, and nerve block have specific uses and risks.

Sedation levels range from minimal to deep, with general anesthesia causing unconsciousness and potential impairment of respiratory and cardiovascular functions.

The intraoperative nurse assists with the induction and emergence from general anesthesia, providing support and ensuring patient safety.

Thermoregulatory responses during surgery include measures to prevent hypothermia and monitor for rare occurrences of hyperthermia.

Malignant hyperthermia is a potentially fatal complication of general anesthesia requiring immediate treatment with dantrolene.

The intraoperative nurse plays a significant role in meeting the patient's psychosocial needs and promoting a sense of security during surgery.

Transcripts

Welcome to this video tutorial on intraoperative nursing.

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 video 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 work in the sterile field, while the circulating nurse,

anesthesiologist, and other personnel function 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

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 OR.

The surgical environment is designed to provide a safe therapeutic environment for the patient.

Traffic in and out of the operating suite is 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 to 60%,

which diminishes bacterial growth and restricts static electricity.

Aseptic technique involves following practices that prevent contamination from pathogens

and must be followed by all members of the OR 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 a 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 are a 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 a 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 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 procedure 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 limited loss of feeling or 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.

Local anesthetics block the conduction of pain impulses, affecting motor and sensory nerves.

The nurse should be aware of signs of toxicity, including tachypnea, tachycardia or bradycardia,

tinnitus, drowsiness, metallic taste, numbness around the mouth, paresthesias, tremors, seizures, and coma.

Regional anesthesia uses local anesthetics to cause a temporary loss of sensation

in a particular portion of the body.

Types of regional anesthesia include a spinal, epidural, nerve block, and Bier block.

Spinal anesthesia is usually used for surgery on the lower abdomen,

groin area, perineum, or lower extremities.

The anesthetic agent is injected into the cerebrospinal fluid (CSF) in the subarachnoid space.

Risks include hypotension,

inadvertent high level of anesthesia that causes respiratory arrest and complete paralysis,

neurologic complications, spinal headache, and infection.

Epidural anesthesia can be used for abdominal, genitourinary, and lower extremity procedures.

It involves injecting the anesthetic agent into the epidural space, which is outside the CSF.

Compared to a spinal, an epidural requires higher doses of anesthetic, has a slower onset,

and is not dependent on the patient’s position for the level of anesthesia.

The provider is able to titrate the dose throughout the procedure.

Risks include hypotension, headache, respiratory depression, and neurologic complications,

but are not as common as with spinal anesthesia.

Other risks include infection and a higher potential for failure than with a spinal.

Another regional anesthesia is the nerve block, in which the local anesthetic is injected

around a peripheral nerve.

A Bier block is an intravenous regional anesthetic, injected into the veins of an arm or leg while

using a tourniquet to prevent the anesthetic from entering the systemic circulation.

This technique must be limited to two hours or less, or tissue damage can occur from the use of the tourniquet.

Let’s look at the levels of sedation…

Minimal sedation uses sedatives and anxiolytics that allow the patient to remain responsive

and breathe independently.

Moderate sedation and analgesia (also known as ‘conscious sedation’), is a drug-induced

depression of consciousness in which the patient is able to respond purposefully to verbal

commands and touch, maintain adequate spontaneous

ventilation, and won’t remember anything from the procedure.

Deep sedation and analgesia is a drug-induced depression of consciousness during which patients

cannot be easily aroused, but respond purposefully following repeated or painful stimulation.

Independent breathing may be impaired.

General anesthesia is the depression of the central nervous system by administration of

drugs or inhalation agents.

Patients are not arousable, even by painful stimuli,

and respiratory and cardiovascular functions are often impaired.

There are three phases of general anesthesia, including induction, maintenance, and emergence.

The intraoperative nurse is involved in the induction of and emergence from general anesthesia of the patient.

Induction begins with the administration of the anesthetic agents.

Endotracheal intubation is performed during this phase, while the nurse is at the patient’s

bedside to provide support and to assist the anesthesiologist.

The nurse may be asked to provide cricoid pressure before intubation,

which prevents aspiration and regurgitation of stomach contents by obstructing the esophagus.

Once the patient is ready for positioning, skin prep, or incision, the patient is now

in the maintenance phase of anesthesia during which the anesthesiologist maintains the appropriate

levels of anesthesia for the length of the procedure.

When the anesthesiologist begins to waken the patient, the emergence period has begun.

The patient is extubated and the nurse needs to be available to assist the provider as

needed with patient safety and comfort,

since the patient may experience vomiting, shivering, or restlessness.

The intraoperative nurse also needs to be aware of the thermoregulatory response of

the patient during surgery.

General anesthetics, muscle relaxants, and opioids can all cause a decrease in body temperature.

In the OR, the patient also loses core body heat due to the cool environment; infusion of IV fluids;

cool skin prep solutions;

cold, dry anesthetic gases;

and escape through the surgical incision.

The intraoperative nurse needs to take measures to keep the patient warm -

covering exposed areas as much as possible with warmed blankets

and using warmed IV solutions will help prevent hypothermia.

Occurring less often than hypothermia, is intraoperative hyperthermia, or an increase

in body temperature of 3.6 degrees F per hour.

It may be caused by sepsis, infection, or less commonly, malignant hyperthermia,

in which the patient’s temperature may rise 1.8 to 3.6 degrees F every 5 minutes

and may exceed 109.4 degrees F.

It is a potentially fatal complication of general anesthesia,

when there is a genetic defect in the muscle cell membrane, making the patient more susceptible.

Along with the rising temperature, symptoms include muscle rigidity, respiratory and metabolic

acidosis, and a fast heart rate.

Treatment includes immediately ceasing the causative agent, hyperventilating with 100% oxygen,

cooling with ice packs or cooling blankets, restoring acid-base balance,

treating hyperkalemia, and giving IV dantrolene (the antidote).

Cooling measures should be stopped when the patient’s temperature reaches 100.4 degrees F.

Caring for the patient in the intraoperative environment involves many technical activities;

however, the nurse is also responsible for meeting the patient’s psychosocial needs.

The operative phase is often short, and the patient may be sedated or unconscious most of the time.

However, the intraoperative nurse has a significant impact on the patient’s

response to the surgical experience.

Surgery is a stressful experience for anyone, and providing explanations of procedures and

events helps promote a sense of security and effective coping for the patient.

Thank you for watching this video tutorial about intraoperative nursing.

Be sure to check out our other videos!