Preparation for Surgery Sterile Field Maintenance

1. Preparation for SurgerySterile Field Maintenance Sterile preparation of Back Table, Mayo Stand, Ring Basin, and Prep Stand

2. Textbook Reading • Review Pages 341-346 thoroughly

3. Back Table

4. Back Table • Provides a large sterile area for preparation and storage of needed supplies and equipment • All instruments and supplies that are needed for a surgical procedure are kept on the Back Table • The Back Table is usually the first to be set up

5. Back table should be positioned so that the STSR can retrieve needed supplies and instruments without turning their back towards the back table Position yourself to conserve steps and unnecessary movements Try to stay centered on the back table and use your shoulders and arms to move needed items Work in sections on the back table Learn a logical and efficient pattern for back table setup Repeat the same setup pattern for every case Be aware of all movements near your sterile back table Back Table Setup

6. Place drapes in order of use. Items can be placed on a corner of a back table, draped mayo stand, or basin in the ring stand Other supplies may be place in their permanent locations such as sponges, medicine cups, needle board, saline container, and bowls Place basins and medicine cups near but not over the edge of the back table Place instrument tray (s) on your designated area on back table Remove loose instruments in tray (s) and place stringed instruments on a towel roll Replace loose instruments in a manner that enables quick handling and accurate counting All sharps should be place in needle board to prevent injury Back Table Setup Techniques

7. Back Table Setup Techniques • Back table should be orderly and consistent • Position of all sponges, needles, blades, and instruments should be accessible and easily counted • All liquids and medicines should be labeled and placed in a safe area until needed • Adequate work area should be maintained for tasks during surgery or additional instrumentation

8. Back Table Setup Organization is the key to efficiency Efficiency is the key to organization

9. Common Back Table Setup

10. Back Table Set up Example

11. Back Table Set up Example

12. Tray Set up Example

13. Mayo Stand

14. Mayo Stand • The mayo stand is a modified table • The mayo stand can be adjusted in height and moved to and from the sterile field • All necessary and immediate items are placed on the mayo stand for immediate use • When moved over the patient, the bottom side is considered contaminated due to that space being unobserved during surgery • Do not place hands or items under mayo stand • The mayo stand is used often and frequently • May not use mayo stand on hand cases

15. Use towels to help pad mayo stand and prevent instruments from going through mayo stand cover Place instruments that are most likely to be used on mayo stand Use a rolled towel to position stringed instruments on mayo stand Close ratcheted instruments that go on mayo stand Typically place all hemostats and then other ringed instruments in pairs You need something from every instrument classification Think patient anatomy and pathology Place scissors with tips pointing down Knives are placed with tips pointing away from you Place all pick ups to be used with tips pointing away from you Place any needed sponges on mayo to be used for start of surgery Place suction tubing, light handles, bovie with holster, and scratch pad on mayo stand Mayo Stand Setup

16. Mayo Stand Set up Example

17. Self-retaining retractor Appropriate for case V V V V knife Metz Scissors Mayo Scissors You and mayo’s legs are Here ↓ Hand held retractors appropriate for procedure Ringed instruments All hemostats and pairs of everything else pertinent to procedure Towel Roll Forceps for case Toothed and tissue in pairs Proper length Suction tubing With proper tip attached Light glove Light glove Laps or raytex x 2 Bovie Holster and Pencil Patient’s feet ↓

18. Light glove Light glove V V V V knife Suction tubing With proper tip attached Metz Scissors Mayo Scissors Laps or raytex x 2 Bovie Holster and Pencil Hand held retractor appropriate for procedure You and Mayo’s legs are Here ↓ Forceps for case Toothed and tissue in pairs Proper length Ringed instruments All hemostats and pairs of everything else pertinent to procedure Towel Roll Patient’s feet↓