Part Three
- General patient coverage
Purpose:
To create an area that will serve as a barrier against the invasion of bacteria to the wound.
Required requirements:
Roll the required pads.
Additional rolls.
Put a towel on the tray of the machines.
Open wound cover when needed.
Steps:
1. Refer to the schedule of operations shown to use the correct roll of pads for this operation.
2. Nursing handler opens the sterile nursing roll to take it as described in the steps of opening the towel rolls.
3. The sterile covers in the linen roll are arranged according to their use.
4. The sterile nurse and the surgeon or the surgeon's assistant brush the covers after processing the patient's skin
- This operation (brushes) is best done by two sterile people.
5. Sterile nursing should take the sterile cover for the surgeon to brush from his side and put the cover from his side on the operating table.
- Ensure that the patient is not inclined to cover.
6. When unscrewing the covers, wipe with a large area and stand back away from the operating table.
7. Hold the covers at arm's length and in a raised position to avoid touching non-sterile objects. It is not very high in the operational Searchlight range.
8. Avoid shaking the lids to open them.
9. Small lids should be grabbed from the two corners to allow them to open.
10. It should be opened and opened for medium, large caps or for laparotomy by sterile nursing.
A- the surgeon grasps one of the limbs.
B- the surgeon and the sterile nurse hold together the covers, straighten them completely and place them on the patient.
C- ensure that the lids are not dropped on a non-sterile surface before they are fully unrolled.
11. Make a sleeve from the tip of the cap or wrap the tip of the cap on the glove of the hand when laying on the patient the open part of the foot cap should be bent so that it is in the form of a sleeve for placing the gloved hand in it.
12. The pads used to cover the perineum should be laid by dried gauze.
13. When opening the lids, it must be ensured that there is no dampness, holes or tears in them.
- If the lid is wet or torn, put it aside.
- If the cap was placed on the patient before the rupture was detected, before the rupture was detected, or wetness, another cap is placed on it.
14. The covers should be placed on a dry area and should be kept dry during operations .
- If the lid gets wet, cover the wet area with a dry lid.
15. The operation trapezoid should be covered with two layers of covers, as well as additional pieces, special arms for anesthesia and an anesthetic screen.
- Additional layers of covers are placed around the place of operation and places prone to getting wet (to moisture).
16. When the cover is put in place, it should not be put back.
- If the space is not well covered, use additional covers.
17. If there is any doubt about the sterilization of the lids, they should be changed or covered immediately.
18. If a cut-off cap is used, it can be placed on the skin either before the Caps are put in place or after they are placed on the patient.
19. Use the towel clip to hold the covers from the wound site.
A- if a cut cover is used on fabric covers, the towel clip may not be used.
B- it must be ensured that the cloth is only tied and not the patient's skin with it.
C- make sure not to move the clip of the pads from one place to another as long as it is entangled in the covers.
20. The covers should be droopedat least 20 cm from the side of the process trellis.
- If no extra covers are used.
- It should be ensured that the operating table foot, armrest, anesthetic barrier are all well covered with covers.
21. If the anesthetic barrier is not available, solution carriers can be used .
- Fasten the towel (barrier) to the rolls with the towel clip.
22. The trolley used to clean the machines comes out of the operating room with the internal nursing staff and passes the trolley wheel on the sheet moistened with disinfectant and cleans before taking it to the room for storing unclean tools.
- The sheet is also lifted for the unclean tool compartment.
23. The operating room is ready for use as soon as the ground dries.
24. If it is not possible to have a handler nurse (outside the operating room), the handler nurse inside the room after cleaning the operating room can lift the mask, apron and change gloves.
25. She goes outside the room to work on suction bottles and samples...Etc
26. As long as the nurse in charge has left the operating room, do not enter it again.
27. If you find that the case is contaminated after the start of surgery, you should inform the chief of operations, who will arrange for additional equipment and disinfectants.
Optimal methods of patient coverage for certain operations
Cover for abdominal operations, chest operation, kidney, back chondectomy.
Required covers :
4 towels
1 A large cap for the lower part of the operation.
1 medium cap over the place of operation.
2 medium cover for the sides.
1 abdominal incision sheet.
Steps:
1. Place 4 pads one after the other around the place of the operation leaving enough space for the operation without overexposing the area.
2. Open the large cap and place it on the patient and under the place of operation.
3. Open a sterile medium cap and put it on the patient above the place of operation.
4. Place the two medium caps on the sides of the patient to form a square around the place of the operation.
5. Secure the covers with a towel clip . Place one clip on each corner of the box forming the covers.
6. Open the tummy tuck sheet in the direction of the foot or the head of the table.
7. Place the abdominal incision sheet on the other covers so that the puncture site at the operation site is marked with the covers.
8. Cover the foot first and then turn towards the head.
9. Cover the remaining exposed areas of the patient's body with towels.
Face coverings
Required covers :
1 medium cap (sterile) head cap
2 towels
3 towels
1 Open sheet for the abdomen
2 towels are bent to take the form of a roll.
1 large lid.
Steps:
1. When the anesthesiologist finishes placing the patient on the ping machine, a non-sterile person lifts the patient's head off the operating table.
2. Place a medium cap and 2 towels all together under the patient's head and under the shoulders.
3. Tuck the front of the towel on each side of the face and on the forehead to cover the hair and as much skin as possible.
4. Secure the pads with a pad catcher.
5. Place 2 towels bent in the form of a roll, on one side of the neck and carefully push into the space between the neck and shoulders.
This is to fill the void where bacteria can invade to suck up any blood or secretions.
6. Place 3 towels around the place of the operation to form a triangle, leaving enough space for the operation, but do not expose the area.
7. Secure the pads with towel clips.
8. Open the large cap, put it on the patient under the place of operation and fold the medium cap under the head.
Cover for dental operations
Necessary covers :
1 medium-sized lid
2 towels
1 large size cover
Steps:
1. Place the medium-sized cap and two pads under the head like facial operations.
2. Fixed with towel clips.
3. Spread a large cap from the first chin of the patient and under the head over the cap and the middle.
4. Fix the two rings with towel clips.
Shoulder coverage
Necessary covers :
2 towels
3 medium-sized lids
1 medium-sized lid
1 large lid
1 PCN slit sheet
Sterile ligature
Steps:
1. The nursing handler lifts the arm from the affected side.
2. Put a medium-sized cap on the arm and under it, straighten it under the shoulder and chest.
3. Spread a towel so that the nursing handler puts the arm without touching the towel. Wrap the arm and secure the towel with a sterile tie.
4. A sterile person may help with the placement of the sterile ligament.
5. Spread a medium-sized cap and place it over the chest and the anesthesia screen over the surgical site .
6. Roll out a large cap and place it on the abdomen and legs under the place of operation.
7. Place a towel on the chest to make a square around the place of the operation while leaving the operating place with enough space left for surgery.
8. Secure the pads with a towel catcher at each of the four corners of the lid.
9. Spread the sheet, make a belly incision and take the arm out of the hole.
10. Cover the exposed parts with a towel.
Hand coverage
Necessary covers :
1 Towel
2 medium-sized lids
1 large lid
Steps:
1. Nursing handling raises the arm up with a support from the elbow.
2. Put a folded medium cap over the arm and under it.
3. Spread out a towel so that the nursing handler puts the arm on it without touching the towel.
4. Wrap the arm from the lower part to the wrist, leaving enough space for surgery.
5. Secure the towel with a towel catcher.
6. Place the arm on a support, spread out a medium-sized cap and place the arm on it over the surgical site.
7. Fix a medium-sized cap with a towel catcher on the hand on both sides.
8. Spread the large operation cap and describe it over the chest and abdomen.
9. Cover the exposed places with a towel.
Thigh coverage
Necessary covers :
3 towels
3 medium size lids
1 large lid
1 belly slit cap
1 folded towel for making a buck
Sterile ligature
Steps:
1. The nursing handler grabs the injured man for a click.
2. Place two medium-sized caps over the operating table under the affected leg and over the healthy leg.
3. Spread out a medium-sized cap and fold it so that the handling nurse puts the man on it without touching the sterile cap.
4. Sterile nursing raises the man.
5. Put a towel around the thigh.
6. Lock the pads with a towel catcher.
7. Spread a large cap and place it over the patient on the operation site.
8. Place a towel under the thigh and a towel over the thigh to make a square around the place of the operation, leaving enough space for surgery.
9. Lock with a towel rail.
10. Straighten the tummy tuck cap and pull the leg out of the hole.
11. Cover the exposed places with a towel.
12. In case the leg is not amputated, it is covered like a laparotomy.
Foot and ankle wraps
Necessary covers :
2 towels
2 medium-sized towels
1 large lid
1st abdominal incision cap
Sterile tassels or lace
Steps:
1. The nursing handler lifts the man up.
2. Place two medium-sized covers over the affected leg and over the healthy one.
3. Wrap the man with a towel and secure with a sterile tie or tassels.
4. The towel is held carefully so that the nursing handler puts the patient's foot on it without touching the towel .
5. Wrap the man with the towel over the surgical site.
6. Secure the towel with a towel fixer (clops).
7. Spread a medium-sized cap and put it on the man over the surgical site.
8. Secure the cover with a clip (towel fastener).
9. Straighten the lid of the abdominal incision, put the first end on the table top and pull the leg out of the hole.
10. Cover the exposed places of the patient's body with a towel.
Leg coverage
Required covers :
2 medium size cap
1 large size cover
2 towels
1 folded towel to make a buck
Sterile dressing or a bag in the form of syrup
Steps:
1. Manipulator nursing raises the leg from the foot upwards .
2. Put two medium-sized caps on the operating table and wrap them around the buttock .
3. If one leg is injured, place the cover under the injured leg and over the healthy leg.
4. Spread a towel so that the nursing handler puts the foot on it without touching the towel, wrap the towel around the foot and lock it with a sterile tie .
5. In the case of a second leg surgery, repeat the same steps .
6. In case of injury to the legs, the folded cover is placed between the legs on the perineum .
7. Spread the large cap and place it over the patient .
8. Secure the large cap to the medium cap with clips .
9. Cover all exposed places with a towel .
Ear and eye covers
Covering the ear or eye follows the steps of covering the face, except that the eye and ear are exposed.
- Tigress Step 5 can be deleted.
Cap for calcaneal fissure surgery
Necessary covers :
2 man bags
2 medium-sized bags
1 Towel
1 lid with holes
1 folded lid
Steps:
1. A non-sterile person lifts the buttocks up.
2. Put a folded medium-sized cap under the buttocks.
3. Open the man's bag, separate his limbs, put the foot inside,and then pull.
4. Place a towel over the pubis, lower abdomen, making a square around the place of the operation.
5. Secure the covers with a towel catcher and place the towel catcher at each of the four corners of the box.
6. Spread the cover with an incision sheet and place it on the patient with the openings above the place of the operation.
Neck covers
Additional covers :
4 towels
1 medium cap
1 large sheet cover
1 tummy tuck sheet
2 towels folded like a garment.
Steps:
1. Place 2 callips each on one side of the neck.
These are to fill the space between the neck and shoulders where bacteria can invade or to suck up any blood or drainage.
2. Place 4 pads each one around the place of the operation to form a square, leaving enough space for the operation, but exaggerated.
3. Open a medium cap and place it on the face above the place of operation.
4. Open a large cap and place it on the chest under the place of operation.
5. Secure the covers with clips (each clip is on one of the corners of the box forming the covers ).
6. Open the tummy tuck sheet so that the bottom of the cover is towards the table top and place it
7. On all the covers so that the hole is on the place of operation.
8. Cover all uncovered areas with extra towels.
Knee coverage
Necessary covers :
2 medium caps
1 large garter
Sterile lace or tassels
Steps:
1. Nursing handler lifts the man by the foot
2. The longest medium-sized cap is placed under the injured leg and over the healthy one and then to the center of the hip.
3. The longest is a medium-sized cover for the nursing handler to put the leg and foot on it without touching the cover. Wrap the leg and foot with the cap under the place of surgery.
4. A sterile person lifts the man to wrap the lid with a sterile ligature.
5. Secure the cover on both sides with clips.
Coverage of breast and thoracic surgery
Required covers :
3 towels
3 medium lids
1 large lid
1 abdominal incision
1 towel folded in the form of a bag
Steps:
1. The nursing handler grabs the injured arm and supports it by the elbow.
2. Put a two-bent medium cap (sheet) on the armrest under the extended arm up to the bottom of the shoulders and chest.
3. Place the arm on the armrest and secure it with a wrist strap.
4. Place the folded towel in the form of a bag under the armpit and push it until it takes its place.
- This is to fill the empty space under the armpit where bacteria can attack the wound and to suck up all the blood and sweat.
5. Open a medium cap and place it on the patient above the place of operation.
6. Open a large cap and place it on the patient under the place of operation.
7. Secure the covers with a towel catcher place a towel catcher on each corner of the box made up of covers.
8. Open the laparotomy sheet and place it on the covers so that the hole is on the place of the operation.
9. Cover all uncovered areas with extra towels, the armrest may need extra towels to be fully covered.
Elbow coverage
Necessary covers :
1 Towel
3 medium-sized lids
1 large lid
1 abdominal incision sheet
Sterile ligature
Procedure:
1. Nursing handling lifts the arm from the hand.
2. Straighten the middle cap and place it on the patient's chest, under the arm and armpit.
3. Place a towel around the upper arm and secure it with a towel holder.
4. Fold a medium cover so that the nursing handler puts the lower arm, the hand on it without touching the cover.
5. Wrap the arm and hand under the place of operation, leaving enough space for surgery.
6. Install a sterile ligature.
7. Another sterile person can hold the arm when applying the sterile ligature.
8. Spread a medium-sized cap on the chest and arm.
9. Secure the covers around the arm with a towel catcher.
10. Straighten the large process cover and pull the hand out of the hole.
11. Cover the exposed places with many towels.
Preparing the skin for surgery
Required equipment :
Skin preparation tools .
Sterile water .
Sterile gloves .
Antiseptic solution for the skin .
Steps:
1. Open the preparation equipment on a trolley or a small table next to the operating table
2. Put sterile water on the preparation Basin, which contains soap, gauze and sponges .
3. Apply a disinfectant solution to the sink that contains only sponges .
4. Ask the anesthesiologist if you can start the preparation process and start after approval
5. The patient can be displaced or undressed to reveal the surgical site .
- Ensure the correct location of the surgery or arm .
6. Place a sterile towel or spare parts above and below the place to be prepared
7. Put on two sterile gloves .
8. Prepare 2 sterile gauze .
9. Place a sponge on top of the place of the procedure circular massage .
- This hand leaves the wound site throughout the processing period .
10. At the same time, with the other hand, massage the sides of the operation hole with a sponge and soap in a circular motion in case the skin gets dirty .
A - move your hand up and slowly while massaging the skin .
B - this process lasts for 3 minutes .
C - the largest part of the place of operation should be equipped .
11. After the cleaning is finished .
A - get rid of the sponge .
B - place the towel over the cleaning place .
C - if one towel is not enough, ask for a second towel from the cleaning nurse.
12. The use of sterile blood stand or peat contained within the processing tools
A - take the sponge dipped in antiseptic .
B - start from the incision site to the top and then the area around the operation site .
C - do not return to massage the painted area with a used sponge.
D - get rid of the sponge and take a sterile second sponge from the processing Basin
13. If the place where the surgery will be performed is contaminated or in the anus, cleaning should not start from it .
A - put a sponge over the anus.
B - start cleaning next to the wound or hole with a sponge placed over the wound or anus .
14. Start cleaning the contaminated part in the case of colostomy, sterilization should be done with a stool removal eyelid .
15. When using antiseptic :
A- put a sponge on the contaminated place or anus and then start sterilization as usual .
B- sterility of the contaminated place or anus.
16. Remove and discard the used towel or cover during the cleaning process .
17. I lift the processing equipment and leave the operating room clean .
Face and nose processing
Steps:
1. Put a cap over the eyes or ask the patient to close his eyes if he is not sleeping .
2. Prepare the place surrounding the surgical site (at least to the hair ) .
3. Use special cotton to clean the nose if the surgery is going to be performed in the nose .
Ear processing
Steps:
1. Clothes and a blanket should be under the shoulder .
2. Place a towel or blanket over the blanket and fold it over the non-sterile end of the cover .
3. Place a towel or cap under the head at the affected area .
4. If the wound is from behind the hair should be lifted upwards and backwards away from the wound site .
5. Make a lather with soapy water and clean with gauze the place to be shaved .
6. Make sure there is foam on the skin and hair .
7. Shave the wound site from all sides and make sure that there is foam on the skin and hair
8. Dry the place and lift the hair using a piece of blaster .
9. Replace the towel or cap under the head with a clean one .
10. Prepare the ear starting from the canal, then the conch and then the wedge to the edge of the ear .
11. Slide to the edge of the ear, then the tuber and lobule .
12. The casings are collected by curves and gaps and therefore must be cleaned thoroughly .
13. Do not push the sponge inside the channel .
14. Do not put ear cleaning cotton inside.
15. Prepare the place behind the ear to include :
· The whole place is shaved .
* Hair edge .
· Next to the ear .
Neck processing
Steps:
1. She undresses the patient and lifts the blanket to the nipple line of the breast .
2. Put a towel or a cover on the blanket and then fold it over the non-sterile cover .
Prepare the neck :
A - from the side to the line of operation of the trapezoid .
B - upward to the lower jaw .
C - to the top of the shoulders .
D - chest to nipple line .
For the neck and head operation is added :
A - the face is directed to the eyes .
B - the place of the shaved head .
C - permission .
D - behind the neck .
E - above the shoulders .
Shoulder processing
Steps:
1. The anesthesiologist turns the head away from the place to be equipped .
2. Take off the clothes and remove the blanket from the place to be prepared .
3. Place a sterile towel over the clothes and blanket and fold it over the letter of the non-sterile cover
4. Raise the hand up and then slightly lift the shoulder off the table .
5. Place a towel or cap under the shoulder and armpit .
Prepare the area :-
A - the circumference of the upper arm to below the elbow .
B - from the base of the neck to above the shoulder .
C - scapula.
D - chest to the middle.
E - equip the upper arm
Processing of the upper arm
Steps:
1. Take off the patient's clothes and lift the blanket to the bottom of the place to be equipped .
2. Lift the arm and shoulder up from the table .
3. Put a towel or a cap under the shoulder and armpit .
4. Prepare the place and include :
* The circumference of the whole arm to the wrist .
* Armpit.
* Above the scapula.
Elbow and front arm preparation
1. Take off the patient's clothes and lift the blanket to below the place to be prepared .
2. Position and lift the arm and shoulder up above the table .
3. Place a towel or cap under the arm and armpit .
4. Prepare the area to include the whole place from the armpit and shoulder to the hand .
Hand processing
Steps:
1. Raise the arm and support it above the elbow .
2. Place a sterile towel over the arm under the hand .
3. Prepare the place to include :
* The hand is from the front, back and between the fingers .
* Arm forward above the elbow .
Processing of the chest area and breasts
Steps:
1. The anesthesiologist turns the patient's head away from the area to be cleaned .
2. The patient is undressed and the blanket is removed to below the place to be equipped .
3. Place a towel or cap on the edge of the non-sterile cap and fold it inwards .
4. Place a towel or cap on the crossbar under the shoulder blade of the affected side .
Prepare the place to include :
* The shoulder .
* Armpits ·
· The chest .
· From the sternum to the reverse shoulder .
Processing of the lateral intervertebral zone
Steps:
1. The patient is undressed and the blanket is removed to below the place to be equipped.
2. Put a towel or cap on the letter of the blanket and fold it inward .
3. Raise the arm up during the processing process .
4. Prepare the place to include :
* Armpits ·
· The chest .
* Abdomen from the neck to the pleural ilium .
5. For kidney operations the equipped place should include :
· From above to armpit .
* Down to the pubis .
* Down the center line, front and back .
Preparation of the vagina
Steps:
1. The patient is undressed and the blanket is lifted below the navel .
2. Place a towel or cap over the letter of the blanket and fold it inward .
3. Put a towel or cap under the buttocks .
4. Prepare the place and include :
* The pubic .
* The vulva .
* Recovery .
* Kneading .
* The anus .
5. Get rid of the sponge after anal .
6. Use a new sponge to prepare the thighs from the lips outward (use a sponge for each thigh ).
7. The vagina is then cleaned with a sponge .
8. Use antiseptic solution abundantly in the vagina .
9. Dry the vagina thoroughly with a sponge .
Preparation of the pubic area
Steps:
1. She undresses the patient and lifts the blanket over the pubis .
2. Put a towel or a cap on top of the blanket and fold it inwards .
3. Put a towel or cap under the buttocks .
4. Prepare the place starting from the pubis to the genitals and around the navel .
5. Get rid of the monitor after anal wiping .
6. Clean the thighs with a clean sponge – use a sponge for each thigh .
7. For Abdominal Perineal operations, two trays are used to prepare
- The Recto Perineal is first prepared using a tray and the other is used for abdominal processing .
Preparation of the groin area
Steps:
1. The patient is undressed and the blanket is shifted above the navel .
2. Place a towel or cap on the edge of the unsterilized blanket and fold it .
3. Lift the man on the injured side with a support from the knee .
4. Place a towel or cap on the operating table under the raised leg .
5. Prepare the place to include :
thigh to knee .
buttocks to the level of trapezius operations .
the abdomen from the affected side .
inguinal region .
Oh, the pubic .
Knee preparation
Steps:
1. Undress the patient and lift the blanket to below the pubis .
2. Place a towel or cap over the edge of the blanket and fold it .
3. Lift the leg with its support at the foot .
4. Place a towel or cap on the operating table under the knee .
5. Prepare the place to include the circumference of the thigh and leg to the heel .
Wrist and foot processing
Steps:
1. Lift the leg up with its support at the knee .
2. Place a towel or cap on the operating table under the raised leg .
3. Prepare the place to include :
each foot and between the fingers .
all the circumference of the wrist and leg to the knee .
Processing of wound injuries
Steps:
1. She undresses the patient and lifts the blanket away from the place of processing .
2. Put a towel or a cap on top of the blanket and fold it inwards .
3. Place a screen over the wound and then clean well around it .
4. Get rid of the screen .
5. Change gloves to clean and wash the wound .
6. To wash the wound, use a warm salt solution and pour it over the wound with a syringe by directing the solution into the wound .
7. The material that flows out of the wound during cleaning is collected in a renal pelvis .
- In case of using a large amount of liquid, prepare a bucket to empty the renal pelvis into it when it is full .
8. Clean the wound with an antiseptic solution without color .
9. Get rid of any wet pads .
Preparation for skin grafts
Steps:
1. Undress the patient and lift the blanket to below the place to be equipped .
2. Put a towel or a cap on the edge of the blanket and fold it .
3. Prepare the surgical place for scissors, expanding the place of processing as much as possible .
4. To grease the area use a colorless antiseptic such as stearamide or saffron .
5. Discard the gauze .
6. Use a new sponge to clean the surgical site for the future while expanding the place as much as possible .
7. The sponge that was used for the given should not be used