CHAPTER 13 Perioperative Care^481
assistantmay be another surgeon, a surgical resident, an RN first assist, or a physi-
cian’s assistant. The person providing anesthesia and monitoring the vital signs of
the patient is either an anesthesiologist(a physician) or a certified registered nurse
anesthetist(CRNA). The circulating nurseis a registered nurse who acts as the
patientadvocate, obtains the necessary supplies for the procedure, makes sure diag-
nostic studies and blood products are available if necessary, prepares the operative
table, positions the patient (padding bony prominences if necessary), and cleanses
the skin in the operative area before positioning surgical drapes. The scrub nurseor
surgical techsets up the sterile field, assists with draping the patient, and hands ster-
ile supplies into the operative field and takes used instruments from the surgeon. The
circulating nurse and scrub nurse (or surgical tech) together count all instruments,
sponges, and sharps used in the surgical field. The count is performed before, dur-
ing, and after the procedure. The holding area nursecares for the patients who have
been brought into the operating room suite but who are not yet ready to go into the
operating room. The holding area nurse may be managing several patients at one
time and can also help to transport and transfer the patient.
Before entering the operating room, the members of the surgical team scrub at
the sink just outside the room in which the surgery will be performed. Prior to start-
ing the scrub, the team member applies a mask with face shield or goggles. The
surgical scrub is usually timed and covers the area from the fingertips to 2 inches
above the elbows. The surgical scrub renders the skin clean, not sterile. After the
scrub, the skin is dried with a sterile towel. A sterile gown, then sterile gloves are
applied. The front of the gown is considered sterile in the front from two inches
below the neck to the waist and from the elbow to the wrist. The circulating nurse
applies the gown and gloves unassisted, and then assists the other members of the
team into their gown and gloves as they enter the room.
RISK FOR INJURY
During the surgery, the patient is anesthetized and cannot tell you if there is pres-
sure anywhere. The patient is positioned to allow for maximal access to the opera-
tive site. This sometimes causes unnatural positioning of the patient or the patient’s
extremities. The operative table is padded to decrease pressure on the patient. There
may be additional padding added to areas of flexion or bony prominences to reduce
the risk of pressure ulcer formation or nerve damage due to positioning.
Heat loss can occur during surgery. The patient is sent to the operating room in
a hospital gown, which may be pulled up or removed depending on the body loca-
tion of the surgery. The body is draped for privacy so that only the surgical area is
exposed. The temperature within the operating room is kept rather cool because
the air exchange rate is higher within the operating room than in other rooms