Surgical Technologist Prepares the OR for a Case

CHAPTER 1

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

CHAPTER 2

In the morning, typically, we will come in and 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 supplies that you're gonna open are gonna be an envelope fold, so you'll break the seal and always opening every sterile item away from you first and then towards yourself. In our packs, our gown is separate. We'll use to set up the table and 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 contact with each other to keep no gaps between 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 from falling back up for you. Also keep in mind that you want the edge to be covered with the wrap so that there's no way you can contaminate yourself when you go to gown and glove.

Opening up gloves. By placing them on top. Again, making sure that nothing lands within the outer one inch because 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 clips to make sure that both indicators are changed and 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 you by then reaching towards the middle, pulling up away from yourself.

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

CHAPTER 4

So depending upon your instruments, some have to 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 in and grab your gown, making sure not to touch the bottom. And then at the top, there's two pockets that will become your sleeves. So let it, stepping back, drop down. You always wanna make sure that your hands are inside the cuff of your gown because the end of it is not sterile. Open. Fold it over. Once you've placed both of them, you're then able to put your second pair on more freely because 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 ready to 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 hand and your right hand to go. Sliding it up and over. It's always nice to have another layer on top of it to protect it. All right. In organizing your back table, it is helpful to always do the same thing, as I was taught years ago, the saying of, "Touching everything once will help make your process faster." You obviously will get faster as time goes along, but additionally, the more familiar you are with the packs that you're using - everything has a home. So my towels will go into my basin. Set these up. The pitcher will go inside another basin so 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 go to 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 tables with 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 less pretrash in it because it can get heavy depending 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 them that 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 roll for your instrument set. Depending upon the size of instruments, and what you're gonna be using, will vary the length of 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 changed and that you don't see anything that 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 nothing is at the bottom that's not supposed to be there. Come over to place your pan on your back table to 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 this Poole 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 has a few different instruments, but you have your wide malleable and 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 sure that you completely separate one from the rest of the bunch so that you can - you and both yourself and your circulator can see the separation so that 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 remove whatever system you guys have holding all your instruments together 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 - scissors for one, two, three, four, five, six, seven. As you can see the separation between in each instrument so that you can, again, both yourself and 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 gloves that would be dirty from your case. Then break your tie on the side, grab by your hips to 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.