Organizing the Sterile Field, Draping the Mayo Stand, & Counting Concorde Career College

Objectives Describe the technique utilized when dressing the Mayo stand and explain the related sterile concepts. Outline an efficient pattern utilized to organize the sterile field. Describe the technique utilized when removing an instrument set from a container system.

Objectives Describe the technique utilized when filling a bulb syringe and explain the related concepts.

Organizing the Sterile Field and Dressing the Mayo Stand Define the term don. Define the term dress. What is the difference?

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand Troubleshooting If the cover will not move forward – STOP PUSHING it! Slowly unfold Do NOT let the cover drop below the level of the sterile field. Use your foot to stabilize the Mayo stand

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand

Organizing the Sterile Field and Dressing the Mayo Stand Place one sterile towel (or two depending on procedure or preference) over the top of the Mayo stand. Place one rolled towel in the desired position (Use the A POSitive CARE approach to determine the location of the towel.) A POSitive CARE approach to surgical problem solving that concentrates on the ability of the surgical technologist to predict the patient’s and surgeon’s needs through the intraoperative period. The goal is for the surgical technologist to apply this model in daily practice for maximum efficiency and effectiveness during the surgical procedure.

Organizing the Sterile Field and Dressing the Mayo Stand Organization of the Sterile Field Conserve time and motion Keep your hands over the back table Place each item in its final destination the FIRST time you touch it and DON’T touch it again!

Organizing the Sterile Field and Dressing the Mayo Stand Work in one small area at a time Step away only to retrieve additional items and then return to small working area Place items in the same arrangement for every case Place items for easy counting

Organizing the Sterile Field and Dressing the Mayo Stand View of sterile field with all supplies open

Organizing the Sterile Field and Dressing the Mayo Stand Close up view of Mayo stand with towel, gown, and gloves for the STSR

Organizing the Sterile Field and Dressing the Mayo Stand Close up view of back table – note that supplies have been added to the back table near the intended area of use

Organizing the Sterile Field and Dressing the Mayo Stand Close up view of basin set

Organizing the Sterile Field and Dressing the Mayo Stand Close up view of instrument set (minor tray)

Organizing the Sterile Field and Dressing the Mayo Stand Dress the Mayo stand Mayo cover in position Towels in position Several variations are available – learn from your preceptors

Organizing the Sterile Field and Dressing the Mayo Stand Even though the Mayo stand has been draped, note that the back table organization has not changed Compare to slide #16 Mayo stand cover and towels were removed from back table without disturbing (moving) other items

Organizing the Sterile Field and Dressing the Mayo Stand Items from the basin set that are to be positioned on the back table are in place but the original items on the back table have not been disturbed (moved)

Organizing the Sterile Field and Dressing the Mayo Stand Basin set with items that are to remain in the basin set Light handle covers (separated) Suction tubing and tip (packaging material removed and properly connected) ESU pencil (packaging material removed)

Organizing the Sterile Field and Dressing the Mayo Stand Basin set with draping supplies added Laparotomy sheet and four drape towels

Organizing the Sterile Field and Dressing the Mayo Stand Back table with draping supplies removed

Organizing the Sterile Field and Dressing the Mayo Stand Basin set with gloves, gowns, and towels for additional sterile team members added Items are placed in the basin set in the reverse order of use! This is the reverse order of use! WRITE IT DOWN Suction (connected and properly curved), ESU pencil (packing material removed), and light handle covers (packing material removed and separated) Laparotomy sheet Four drape towels (prepared – 3 toward, one away, and fan folded) Towel clips, if desires Gloves for the surgeon and assistant Gowns for the surgeon and assistant Towels for the surgeon and assistant

Organizing the Sterile Field and Dressing the Mayo Stand Back table following dressing the Mayo stand and basin set organization Other minor adjustments to the back table have been made

Organizing the Sterile Field and Dressing the Mayo Stand Close up of right side of back table Note position of sponges (strings in) Suture organized in order of use (according to preference card) Suture (trash) bag (refer to AST recommendation) http://www.ast.org/pdf/Standards_of_Practice/Guideline_Suture_Bag.pdf

Organizing the Sterile Field and Dressing the Mayo Stand Work with circulator to ensure that the inside of the tray is dry and the filter is intact

Organizing the Sterile Field and Dressing the Mayo Stand Instruments organized on back table Note: Like items together Ready to count (count prior to organizing Mayo stand) **Make sure students are placing at least one towel under instruments when setting up (though not depicted in this image). Students must also practice making roll towels.

Organizing the Sterile Field and Dressing the Mayo Stand Perform the initial count before moving items to Mayo stand!

Organizing the Sterile Field and Dressing the Mayo Stand Mayo stand organized for use (front view) Have the students list (or draw) the items

Organizing the Sterile Field and Dressing the Mayo Stand Mayo stand organized for use (side view)

Organizing the Sterile Field and Dressing the Mayo Stand View of instrument set following organization of the Mayo stand Compare to slide #28

Organizing the Sterile Field and Dressing the Mayo Stand Attend to as many details in advance as possible Note suture loaded on needle holders

Organizing the Sterile Field and Dressing the Mayo Stand Detail – towel clips place near draping material for possible use

Organizing the Sterile Field and Dressing the Mayo Stand Expel air Maintain pressure on bulb Place in liquid Release pressure on bulb to draw liquid into syringe Repeat as needed Use caution not to expel liquid contained in syringe

Organizing the Sterile Field and Dressing the Mayo Stand Filling the Bulb Syringe Remember – This is NOT a squirt gun!

Organizing the Sterile Field and Dressing the Mayo Stand Counting Preop on pg. 342 see table 12-1, 12-2 12-3, pg. 346 Intraop pg. 386 see table 12-21 Review technique box on pg. 347 Have items to demo count. AST RSOP http://www.ast.org/pdf/Standards_of_Practice/RSOP_Counts.pdf

Organizing the Sterile Field and Dressing the Mayo Stand What is the importance of counting instruments, sponges, sharps, and incidental items?

Organizing the Sterile Field and Dressing the Mayo Stand What is meant by the term incidental items? Stuff other than instruments, sponges, and sharps. Bovie scratch pad, FRED, etc.

Organizing the Sterile Field and Dressing the Mayo Stand How many counts are needed for each procedure? When are the counts performed? Are there any exceptions? Initial count before case, Additionally as needed, Team changes, Closing count 1 of all stuff (peritoneum), Closing count 2 (fascia) Final Count (skin)

Organizing the Sterile Field and Dressing the Mayo Stand Who is responsible for counting? How?

Organizing the Sterile Field and Dressing the Mayo Stand What is the counting procedure?

Organizing the Sterile Field and Dressing the Mayo Stand What happens if additional items are added to the field during the procedure (after the initial count)? Pg 386

Organizing the Sterile Field and Dressing the Mayo Stand What if… The count is incorrect? Pg. 387 Table 12-21