Perioperative nursing involves crucial roles in patient safety and surgical team collaboration. Nurses ensure proper identification, monitor vital signs, maintain sterility, and document care. They also assist with positioning, instrument handling, and aseptic technique to prevent infections.

Surgical positioning requires careful consideration of patient risks and safety strategies. Nurses must be aware of potential complications like pressure ulcers and nerve compression in various positions. They use specialized devices and techniques to protect patients during procedures.

Perioperative Nursing Roles and Responsibilities

Roles of perioperative nurses

• Ensure patient safety and well-being by conducting patient identification and verification of surgical procedure, assessing patient's condition and monitoring vital signs (heart rate, blood pressure, oxygen saturation), and maintaining patient privacy and dignity (using drapes, respecting patient's cultural and religious beliefs)
• Collaborate with surgical team by communicating patient information and concerns (allergies, comorbidities), assisting with patient positioning and draping (ensuring proper body alignment, protecting pressure points), and providing necessary instruments and supplies (scalpels, sutures, sponges)
• Maintain aseptic technique by performing surgical hand scrub and gowning (using antimicrobial soap, sterile gown and gloves), monitoring sterile field and ensuring sterility of instruments and supplies (using sterile indicators, inspecting package integrity), and anticipating and responding to potential breaks in sterile technique (replacing contaminated items, re-gowning if necessary)
• Document intraoperative care by recording medications administered, including time, dose, and route (intravenous, intramuscular), documenting surgical counts (sponges, needles, instruments), specimens (labeling, handling, and transport), and any intraoperative events or complications (bleeding, hypotension, arrhythmias)

Surgical Positioning and Patient Safety

Surgical positions and risks

• Supine position
  • Risks include pressure ulcers (sacrum, heels), nerve compression (brachial plexus, ulnar nerve), and venous stasis (lower extremities)
  • Safety strategies involve using pressure-relieving devices (foam mattresses, gel pads), padding bony prominences (elbows, ankles), and ensuring proper body alignment (neutral head and neck position)
• Trendelenburg position
  • Risks encompass increased intracranial pressure, respiratory compromise (diaphragm compression), and venous pooling (lower extremities)
  • Safety strategies include gradually adjusting position (15-30 degrees), monitoring vital signs (airway pressure, end-tidal CO2), and using safety straps and supports (shoulder braces, footboards)
• Prone position
  • Risks involve pressure ulcers (face, chest, iliac crests), facial edema, eye injuries (corneal abrasions), and nerve compression (brachial plexus, lateral femoral cutaneous nerve)
  • Safety strategies include using specialized positioning devices (prone pillows, chest rolls), protecting eyes and face (lubricating ointment, foam headrest), and ensuring adequate padding (arms, knees, feet)
• Lithotomy position
  • Risks include nerve compression (common peroneal, sciatic), compartment syndrome (lower legs), and venous stasis (lower extremities)
  • Safety strategies involve using stirrups with adequate padding, avoiding excessive flexion or extension (hips, knees), and monitoring lower extremities (color, temperature, sensation)

Aseptic Technique and Infection Prevention

Principles of aseptic technique

• All objects within the sterile field must be sterile, meaning they have been subjected to a sterilization process (autoclaving, ethylene oxide) to eliminate all microorganisms, including spores
• Sterile objects should only contact other sterile objects to maintain the integrity of the sterile field and prevent contamination from non-sterile items or surfaces
• Movement around and over the sterile field should be minimized to reduce the risk of contamination from air currents, dust particles, or accidental contact with non-sterile items
• Edges of sterile drapes and packages are considered non-sterile due to the potential for contamination during handling and opening, so they should not come into contact with sterile objects or surfaces
• Importance in preventing surgical site infections lies in reducing the risk of introducing microorganisms (bacteria, viruses, fungi) into the surgical wound, which can lead to local or systemic infections
• Minimizes patient morbidity and mortality associated with surgical site infections, such as prolonged recovery, additional surgical procedures, sepsis, or organ dysfunction
• Decreases healthcare costs related to prolonged hospitalization, antibiotics, and additional treatments required to manage surgical site infections, which can be a significant financial burden for patients and healthcare systems

Surgical Environment Management

Management of surgical environment

• Temperature regulation
  1. Maintain normothermia $36°C$ to $38°C$ to prevent hypothermia-related complications (impaired wound healing, coagulopathy, increased infection risk)
  2. Use forced-air warming devices (Bair Hugger), warmed intravenous fluids, and warm irrigation solutions to maintain patient's core temperature
  3. Monitor patient's temperature throughout the procedure using esophageal or bladder temperature probes to ensure adequate warming measures are in place
• Humidity control
  • Maintain relative humidity between 30% and 60% to reduce static electricity (which can interfere with electronic equipment) and microbial growth (which thrives in moist environments)
  • Use humidifiers or dehumidifiers as needed to maintain appropriate humidity levels, depending on the season and ambient humidity
  • Monitor humidity levels in the operating room regularly using a hygrometer to ensure they remain within the recommended range
• Ventilation and air filtration
  • Ensure adequate air exchanges per hour (minimum 15 exchanges) to remove airborne contaminants (dust, lint, skin squames) and maintain a clean environment
  • Use high-efficiency particulate air (HEPA) filters to capture and remove 99.97% of microorganisms and particles $\geq0.3\mu m$ in size
  • Maintain positive pressure (0.05-0.1 inches water column) in the operating room to prevent the influx of contaminated air from adjacent areas (corridors, substerile rooms)