Setup for an Open Incisional Hernia Repair (Ivy Tech Community College, Indianapolis, IN)

CHAPTER 1

Hi there, my name is Heather Seib, I am a CST and I'm a full-time instructor with the surgical technology program here at Ivy Tech Community College in Indianapolis. And today, I'm gonna show you the back table setup for an open, recurrent incisional hernia repair.

CHAPTER 2

So first thing I am going to do is I'm gonna lay out my towel here before I put my fluid bowls down. And that's just to protect from any fluid getting through and compromising the integrity of our back table. Put my towels over here, and then I am going to take suction tubing here and I'm going to go lay it right on top of my Mayo so that it's ready to go when we pull up. Same thing with my light handle covers. They're gonna hang out there on my Mayo. Our Bovie pencil, I am going to put up here with my suction. With that Bovie pencil, I'm gonna put up a Bovie scratch pad. With the hernia repairs, especially with the recurrent, there's gonna be scar tissue, that Bovie can get gunked up pretty quickly. So we'll stick this to our drapes and that way the surgeon will be able to scratch the Bovie tip clean. Put our sharps container there. Blades out. I'm gonna get this bowl empty here so we can get some normal saline put in. That is going to be for irrigation on the skin. For irrigation within the abdomen, we would have a fluid warmer available and have that fluid warmed up. You always wanna make sure when you take your fluids from your circulator that you are checking your fluid expiration date and then you immediately label your container. Here I have a pair of sterile gloves that came in our pack. They're gonna be for the surgeon. I'm gonna lay those down there along with a gown and then a towel so that when she comes in we can have her dry her hands if they are wet.

CHAPTER 3

And then I am going to make myself a roll towel for my instruments. We'll get our instruments out and then get them arranged, do a count, and then I will start setting those up for the procedure. I always tuck my stringer under my pan so that it's out of the way. Get these untangled here. And then I am just gonna organize my pan here. I like to separate my forceps, our toothed forceps from our smooth forceps. That way during the procedure it makes it easier for us to grab when the surgeon is asking for them. So I have my smooth forceps on this side. On this side, and then these are my forceps with teeth. I have a smooth Adson there.

CHAPTER 4

All right, so now I will start my count with my circulator. We're gonna start with our softs. I have laps. With our laps when we count, I'm going to tug on the blue string here. That's just to make sure that they stay attached. So I'm gonna check the integrity of each lap as I count them. One, two, three, four and five. Five laps. Ray-Tecs. One, two, three, four, five, six, seven, eight, nine, ten. Bovie tip, one. Some facilities count the scratch pad, so one Bovie scratch pad. Blades, I have one, two. And that's all for our softs.

CHAPTER 5

What I am going to do now is get out my knife handles. I actually always load my blade as soon as possible. And that is so that if the patient comes into the room and they crash or there's any sort of an emergency, we have a blade loaded and ready to go. I keep it loaded until the patient has left the room as well.

CHAPTER 6

All right, so now for instruments. When I'm counting my instruments, I like to use an empty knife handle. It makes it easier to point out to your circulator what it is you're counting. So mosquitoes, I have one, two, three, four. Criles, one, two, three, four. Kellys, one, two, three, four, Peons, one, two. Tonsils, one, two. Allis, one, two, three, four. Babcocks, one, two. Kocher's, I have one, two. Right angles, one, two. Foerster ring, one, two. Needle Drivers, one, two, three. Scissors, one, two, and three. Knife handles, one, two. Retractors, I have Gelpi, one, Army-Navy, one, two, Weitlaner, one, two, three, four. Rake Retractor, one, two. Deaver, one. Rich, one. Penetrating towel clamps, one, two, three, and four. Forceps, I have one, two, three, four, five, six, seven. I have one Yankauer and that's all of our instruments.

CHAPTER 7

So now I will put my Yank on my suction tubing. On my Mayo I am also going to go ahead and put my two Army-Navys. They will usually use these after they've made an incision as they're dissecting down. I am also going to put my Adson with teeth. Two Adson with teeth. I'm going to put one Weitlaner up there. And then I'm also going to put one of my rake retractors up there.

CHAPTER 8

Over here on our drapes, we will go in with four blocking towels first. Clamp those together with our penetrating towel clamps. Then our down sheet, and then our laparotomy drape. So we stack those in the order that they will be used. And then we are good to start our procedure.