General operating procedure in the operating unit

The operating room should be ready for operation at any time of the day: the instrument table is laid, the necessary equipment is prepared, all the necessary medicines and solutions should be stored in the cabinet.

The acceptable shelf life of sterile underwear and tools is three days, but one should strive to change the set on duty daily. The operation of the operating room is constructed as follows.

1. On the eve of cleaning the operating room.

2. Check the availability of tools picked up the day before and begin to sterilize them.

3. The nurse checks the presence of all necessary instruments in the operating room, arranges furniture, gives the operating table and lamps the right position.

4. Then the sister changes clothes, puts on operational clothes.

5. Hand processing for operation. Having preliminarily checked, carefully cleaned hair and trimmed nails, the sister twice washes her hands with soap, takes a sterile mask from the bix and puts it on, closing her nose and mouth. Handles one of the antiseptic hands.

Treatment of the hands of a surgeon and a nurse

For the treatment of hands, various antiseptics allowed by the pharmacological committee are used: gibitane( chlorhexidine bigluconate), degmine, deglycide, iodopyrone, cerigel, etc.

Gibitant is released as a 20% aqueous solution in 500 ml vials. Shelf life of the drug is 3 g. The working solution of chlorhexidine is prepared on the day of application in any container. For the treatment of hands, use 0.5% alcohol solution( in dilution 1:40) in 70% ethyl alcohol and 1%( diluted 1:20) aqueous solution prepared by dilution of the starting 20% ​​solutionin distilled water: 500 ml of a 20% solution in 10 liters of water. Hand treatment is made with a cotton swab dipped in this solution for three minutes, then wipe dry with a sterile towel. Chlorhexidine causes fast-passing stickiness of the hands. When using chlorhexidine, iodine and iodine-containing antiseptics should not be used due to the risk of dermatitis.

Cerigel is a clear, colorless, viscous liquid. It is produced in 400 ml vials. The composition of the drug introduced film-forming agent, due to which the processing of hands formed a film of cerigel. On dry skin, apply 3-4 grams of cerigel and for 8-10 seconds carefully rub to make the solution cover the palmar and dorsal surfaces of fingers and hands, interdigital spaces and lower third of the forearms. Hands are dried in air or under a fan, during drying, fingers should not touch each other and be slightly bent. The drying time of the film should not be shortened, as this may cause it to slip. Gloves do not use. After the operation, the film of cerigel is easily removed with alcohol.

Degmine is a solid waxy substance of a yellowish white color, readily soluble in water to form a thick, persistent foam. Produced in 500 ml vials. Degmicide is a liquid containing 30% degin. For the treatment of hands use 1% solution of degmine, for which the degymicide is diluted with ordinary unboiled water in the ratio 1:30.Hot water accelerates the dissolution of the drug. Bactericidal solution persists for 6 months. Hand treatment is carried out by successive wiping with two tampons, moistened with a solution of the drug for 3 minutes. When re-treatment, the hands are rubbed with one swab for 3 minutes.

After processing your hands, the operating sister goes to the operating room. The nurse opens the lid of the sterile bix with gowns. The operating nurse takes a folded robe from the bix, unfolds it, making sure that the outer surface of the sterile gown does not touch the neighboring objects. It is best to immediately put both hands in the sleeves of the robe and throw it on yourself in front. The nurse pulls the robe behind the edges and ties up the ribbons. The nurse takes out a belt from her pocket, keeps it at a distance of 30-40 cm from herself so that the free ends of the belt hang down. The nurse carefully takes the ends of the belt and, without touching the sterile dressing gown, winds back and ties up. The operating sister ties the ribbons on her sleeves herself or is assisted by another sister who was prepared for the operation.

The nurse takes out gloves from the bix. The edges of the gloves open outwardly in the form of a cuff, with the thumb and forefinger of the right hand grasps the turned edge of the left glove and pulls it on the left arm. Let's start with the left hand( dressed in a glove) brings under the lapel of the back surface of the right glove and pulls the last on the right hand. Without changing the position of the fingers, the turned edge of the glove is turned into place. The edges of the gloves should be placed over the sleeves of the sleeves of the dressing gown. Then the sister takes a large ball, heavily soaked in alcohol, carefully wipes his gloves. Hands in sterile gloves should be kept bent at the elbows and raised slightly above the waist. If for some reason the operating nurse is waiting for the surgeon and is not busy, the gloves on the hands to protect against air infection should be wrapped with sterile gauze, a napkin soaked in 96% alcohol.

After putting on a sterile dressing gown and gloves, the operating sister can proceed to cover the operating table.

The operating nurse must calculate the time so that the instruments are placed on a large table 20 minutes before the surgeon's dressing. From the bix with linen, the sister takes out the sheet and covers it in two layers with a large instrument table. The second sheet she puts in such a way that one of her half closes the table, and the second was rolled up on the far edge of the table. It is necessary to close the tools located on the table in the future.

The nurse dismantles the instruments and places them in the middle of the instrument table. Each type of tools is assigned its own place, and the tools used most often are placed closer to the edge of the table. The right edge of the table is not covered with a sheet on top, but is used to place wide-necked cans with antiseptics and a sterile tray with an antiseptic solution containing a scalpel and needles. In the tray, put sterile corncang or a long tweezers to grasp the desired object and transfer it to a small table.

Suture material should not be taken out of the cans in which it is stored without special need.

Sterile sets for blood transfusion and tracheotomy should be stored separately, wrapped in sterile sheets.

When all the tools are laid out, the sister covers them with a sheet folded in half, with the edges hanging from the edges of the table, clamps must be placed in the corners.

After all is prepared on the big table, the operating nurse places the instruments on the instrument table, which is previously covered with a sterile sheet in two layers;The edges of this sheet should hang far beyond the edge of the table. On this sheet put the second with such a calculation that one half of it could cover the instruments. The operating nurse shifts the necessary tools from the large instrument table to the small one and places them in a strict order. Do not put a lot of tools, as this interferes with the work of the sister and surgeon.

Depending on the position of the operating-nurse's table - to the right of the operating table( next to the surgeon) or to the left of the table( next to the assistant), - tools are placed in two ways( from right to left or from left to right).

If the sister is to the right of the surgeon, on the right edge of the table from the operating sister's place lie napkins in three packs - behind the large napkins, then medium and small. At the forefront have tools that are constantly needed by a surgeon. The instruments from the front edge of the table are taken by the surgeon and assistant himself, and the nurse only maintains the order on the table and restores the correct placement of the instruments. The posterior edge of the table is at the disposal of the operating sister and the surgeon does not concern him. There are spare tools ready to work, but not required at the moment, suture material and scissors of the operating sister, with the help of which she cuts the strings of the required length. The operating sister has no right to touch the tools used and stained with blood;in the extreme case it removes them by forceps.

Lastly, the suture material is transferred.

In the left corner, the suture material is laid, in the right - the instrumentation necessary for local anesthesia.

Usually the tools are laid out in three rows:

• in the front row, the most common tools( scalpels, scissors, hemostatic clamps, needle holders, tweezers);

• in the second row - those tools that are needed for this particular operation;

• in the 3rd row - more rare tools and duplicates.

After the sister is ready for surgery, she helps the surgeon. The surgeon treats his hands, and his sister helps him put on a robe.

Dressing the surgeon.

The nurse submits an unfolded robe to the surgeon so that he can slip both hands into his sleeves at once, then he throws the upper edge of the robe over his shoulders. The nurse at the back fastens the ribbons and belt. After putting on a robe, they change the mask to sterile: for this, the sister gives a mask, holding it with fingers over the ends of the ribbons, the nurse ties them to the back of the head.