DUTIES OF A SCRUB NURSE

A. Before the surgeon arrives 

     1. Do a complete scrub according to accepted practice 
     2. Gown and glove 
     3. Drape tables as necessary 
     4. Drape mayo stand 
     5. Count and arrange the instruments on instrument table. Count sponges and count instruments,

   needles and sharps. 

     6. Arrange the instruments on the mayo stand making and opening initial incisions

     Instruments are classified as: 

               a. Cutting or dissecting – knives and scissors 
               b. Grasping and holding – tissue and thumb forceps 
               c. Clamping and occluding – hemostatic forceps and clamps 
               d. Exposing – retractors 
               e. Suturing – needle holders

     7. Put blades on knife handles (Scalpel) 
               Blade holder # 3 – blade # 10,11,12,15 
               Blade holder # 4 – blade # 20 and above

     8. Prepare sutures in the sequence in which the surgeon will use them
               Free Ties – use to ligate blood vessels if not they can also use the cautery machine.

     LAYERS OF ABDOMEN 

               1. Peritoneum 
               2. Muscle 
               3. Anterior fascia 
               4. Subcutaneous 
               5. Skin



     9. Count surgical needles with circulating nurse 
     10. Count all sponges with circulating nurse. Circulating nurse immediately records it

• counts before the start of the operation 
• counts before the surgeon starts closure of a body cavity or deep or large incision

          a. Table count – scrub nurse and CN count all items in the instrument table and mayo  stand 
          b. Floor count – CN counts sponges and other items that are recovered from the floor 
          c. Field count – CN totals floor and table count. Then inform surgeon if sponge count is correct

• counts all over again before subcuticular closure. If sponges are intentionally retained for packing or instrument remains with the patient, this should be documented in the patient chart

      INCORRECT COUNT 
          1. Entire count is repeated immediately 

          2. CN looks at trash receptacles, under furniture, linen hamper or throughout the room 

          3. SN looks over drapes and under items on table and mayo stand
          4. Surgeon rechecks field and wound

          5. CN should call HN to check the count

          6. X-ray must be taken before the patient leaves OR whenever a sponge or instrument

              count is incorrect

          7. CN makes an incident report.

B. After Surgeon and Assistants Scrub

     1. Gown and glove the surgeons and assistants as soon as they enter the room 
     2. Assist in draping the patient accdg. to the routine procedure 
     3. Bring mayo table into position after draping is completed. Position the table at right angle to
         operating table

C. During the Operation 

      1. Hand skin knife to surgeon and hemostat to assistant. When handling knife, hold the handle
          blade down and pointed toward your wrist NEVER toward the surgeon 
      2. Watch field and anticipated the needs of the surgeon. Keep one step ahead of him in offering
          instruments, sutures, or sponges. Notify CN quietly for supplies not in the table 
      3. Pass instruments in a positive manner. When surgeon extends the hand, instruments should be

    slapped firmly into the palm in proper position for use.

          Hemostat – bleeding
          Scissors – need to cut tissues
          Mayo scissors – cut sutures

• keep instruments clean as  possible wipe blood with moist sponge 
• return instruments to mayo stand promptly after use

     4. Save all tissue specimen 

• Never use a large clamp for all small specimens. It may crash. 
• Put in a specimen bottle, basin wrapper or towel NEVER in a sponge. Tell CN what specimen it is if not sure asks MD.

     5. Maintain sterile technique. Watch for any breaks

D. During Closure

     1. Count sponges, needles, instruments with CN  when surgeon begins closure of the wound 
     2. Clear off mayo stand as time permits leaving a knife handle with blade, tissue forcep, scissors,
         4 hemostat and 2 allis forceps 
     3. Have a damp sponge ready to wash blood from the area surrounding the incision as soon as
         skin closure is completed. 
     4. Have betadine, dressings and plaster ready