SHREE SARSWATI KANYA KELAVANI MANDAL SANCHALIT

SHREE R.G.PATEL COLLEGE OF NURSING, KADI

SUBJECT:- Obstetric & Gynecological Nursing

TOPIC:- Visit Report (OT)

SUBMITTED TO:-

SUBMITTED BY:-

Ms. Bhavika G. Sonagara

Roll No.- 12
F.Y. M.Sc. Nursing
Shree R.G. Patel College of Nursing
Nanikadi, Kadi.

Date of Submission:-

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Introduction:

I am the students of F.Y. M.Sc Nursing was placed in sola Civil Hospital . I posted in OT.

It was very interesting experience to me despite of short duration. I saw two surgeries for
the First time such as,. I learned many things like the roles and responsibilities of scrub
nurse and circulating nurse, nurse in recovery room, and roles of anesthetist. For the first
time I knew how the anesthetist is important. The team was very cooperative with me, I
hope to practice more in the future as a circulatory and scrub nurse. And I am satisfied
about this training.

Operating Theater :
An operating theater, also called surgery center, is the unit of a hospital where surgical
procedures are performed, an operating room may be designed and equipped to provide
care to patients with a range of conditions, or it may be designed and equipped to provide
specialized care to patients with specific conditions.

Nurses in this field provide care and support to patients before, during, and after surgery.
These nurses are responsible for maintaining a sterile environment in the operating room,
monitoring the patient during surgery, and coordinating care throughout the process.
They are also responsible for making sure the OR team provides the patient with the best
possible care.

As patient advocates, intra-operative nurses monitor factors that can cause injury, such as
patient position, equipment malfunction, and environmental hazards, and they protect the
patient’s dignity and interests while the patient is anesthetized. Additional responsibilities
include maintaining surgical standards of care and identifying and minimizing risks and
complications.

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Areas of OT:
The OT divided to three areas:
1. Unrestricted area: contains sitting room & kitchen and dressing rooms for men and
women and the dressing room have a bathroom and special cabinets for team use.
This area doesn't need safety precautions such as, special uniform, head cover, shoes
cover, mask and other precautions, but this precautions are inside this area because it
is the starting point for both other area.

2. Semi-restricted area: this area is the connecter area between unrestricted and
restricted areas. It contains recovery room. Another part of this area are the reception
area and reporting area (areas for enter and exit the patients). The reception area is
equipped with steel doors, one of them open to receive the patient from outer wards.
The other door is for entering the patient to the restricted area and it's open by
touching the sensor from both sides. Printer for printing copies of surgeries forms for
the patients, central control for gases used in OR, and it's also supplied with UBS
electrical outputs. And the corridor between the operating rooms is also included as a
semi-restricted area. This semi-restricted area need for take some of safety
precautions such as, special uniform, head cover and shoes cover; there is no
importance for mask in this area. There are special markers that divide this area from
restricted area which is a red line at the end of this area.

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3. Restricted area: It contains five operating rooms. In this area team should take all
safety precautions (special uniform or gown, head cover, shoes cover and mask). The
surgeons and other surgical team members wear additional sterile clothing and
protective devices during surgery, and they have to do surgical scrubbing before
surgery.

The Recovery Room:

Is a Post Anesthesia Care Unit and it is present in the semi restricted area. The Recovery
place is a very safe place to be directly postoperatively. The Anesthesiologist and Nurse
provide attention to needs of patient and assist the patient in wakening and recover his
consciousness safely and comfortably.
There is one place for recovery in the ward. So there is on recovery room with a qualified
nurse gives constant care and follow up to all patients immediately after surgery.
The recovery room or place nurse connects the patient to devices such as cardiac
monitoring equipment, and to intravenous therapy for fluids and pain medication.
The Recovery Room or place contains many things such as, cardiac monitors, suctions,
O2 access, emergency trolley, medical instrument, medications, and contains office and
computer system for documentation process and this room is supplied by electricity
outputs.

Stores:
In this OR there is 2 stores, one of them called supplies store which contain the medical
instrument that needed for surgeries. And the other one called drugs store which contain
medications and narcotics.

Operating Room:
It is the place where the surgery performed. In Sola Civil hospital there are 10 operating
rooms, all of them has the same characteristics. The operating room has a special
temperature (180-220c) to inhibit the growing of microorganisms. The operating room
should have positive pressure to push the air outward while the door is opened and
prevent the air entry to the operating room, and the humidity is 50%.

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Operating room equipment:
 All wall outputs (Gases, Air, electricity and UPS electricity and other outputs).
 The anesthesia machine is at the head of the operating table. This machine has tubes
that connect to the patient to assist him or her in breathing during surgery, and built-in
monitors that help control the mixture of gases in the breathing circuit, and it's also
use for anesthesia gases like, Sevoflurane, Isoflurane and Nitrous Oxide.
 The anesthesia cart is next to the anesthesia machine. It contains the medications,
equipment, and other supplies that the anesthesiologist may need.
 Sterile instruments to be used during surgery are arranged on a stainless steel table.
 The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It
measures the amount of oxygen contained in the blood.
 Automated blood pressure measuring machine that automatically inflates the blood
pressure cuff on patient's arm.
 The operating room lights are over the table to provide bright light, without shadows,
during surgery.
 An electronic monitor (which records the heart rate and respiratory rate by adhesive
patches) is placed on patient's chest.
 An electrocautery machine uses high frequency electrical signals to cauterize or seal
off blood vessels and may also be used to cut through tissue with a minimal amount
of bleeding.
 If surgery requires special equipment, may be brought into the room.
 The operating table in the center of the room can be raised, lowered, and tilted in any
direction.
 Trolleys that use for the instrument during surgery.
 Special cabinet that contains medical instruments.
 Linen and waste Hamper, chairs.
 There is a trolley which containing medications, needles, syringes, blades, tubes, and
other medical instrument.
 Also there is bypass machine in the operation room.
 There is a computer located in the corner of the operating room next to the door.

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Operating room team:
 There is qualified professional nursing team component of 16 nurse.
 one aid nurse, and are the same cleaner.
 Medical team (20 Surgeon)
 Anesthesia team 4 full time.

Ideal Operating Room:

(1) Protective zone: It includes

 Dressing rooms for all medical and paramedical staff with conveniences.
 Transfer bay for patient, material & equipment.
 Rooms for administrative staff.
 Stores & records.
 Pre & post-operative rooms.
 I.C.U. and P.A.C.U.
 Sterile stores.

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(2) Clean zone: Connects protective zone to aseptic zone and has other areas also like
 Stores & cleaner room.
 Equipment store room.
 Maintenance workshop.
 Kitchenette (pantry).
 Firefighting device room.
 Emergency exits.
 Service room for staff.
 Close circuit TV control area.

(3) Aseptic zone- Includes operation rooms (sterile).

(4) Disposal zone- Disposal areas from each OR & corridor lead to disposal zone.

Sub areas (excluding OT place):

(1) Pre-operative check in area (reception). This is important with respect to
maintaining privacy, for changing from street clothes to gown and to provide lockers and
lavatories for staff.
(2) Holding area. This area is planned for IV line insertion, preparation, catheter, Gastric
tube insertion, connection of monitors, & shall have O2 and suction lines.
 Facility for CPR should be available in this area.
(3) Induction room (anesthetic room). It should have all facilities as in OT, but there is
controversy as to its need.
(4) Post anesthetic care units (PACU). Preferably adjacent to recovery room.
(5) Staff room. Men and women change dress from street cloth to OT attire; lockers and
lavatory are essential; rest room TV, etc. are desirable.
(6) Sanitary facility for staff. One wash basin and one western closet (WC) should be
provided for 8-10 persons.
(7) The anesthesia gas / cylinder manifold room / storage area. A definite area to be
designated. It should be in a cool, clean room that is constructed of fire resistant
materials.

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(8) Offices. for staff nurse and anesthesia staff- The office should allow access to both
unrestricted and semi-restricted areas as frequent communication with public is needed.
(9) Rest rooms. Pleasant and quiet rest for staff should be arranged either as one large
room.
(10) Laboratory. Small lab. With refrigerator for pathologist to be arranged.
(11) Seminar room. Since staff cannot leave an OT complex easily, it is better to have a
seminar room.
(12) Store room. This is designed to store large but less frequently used equipment in the
OT.
(13) Theatre sterile supply unit (TSSU). Within this area, following are desirable:
 Temperature between 180-220C, humidity of 40%-50% is the aim.
 Air conditioned with 10-12 air exchanges per hour.
 Storage of sterile drapes, sponges, gloves, gowns and other items ready touse.
 Option to store in from one side and remove from other side.
 Proper inventory to prevent running out of stock.
(14) Scrub room. This is planned to be built within the restricted area. Elbow operated or
infrared sensor operated taps / water source is ideal. It is essential to have non slippery
flooring in this area.

C.S.S.D (Central Sterile Supply Department):

CSSD is a crucial function in any hospital that when integrated with a hospital ERP helps
in automating the workflow in sterilization of hospital equipments, surgical tools and
instruments, syringes, catheters/tubes/other rubber goods, lab equipments in various
departments and procedure sets.

It considered from semi-restricted area so some safety precautions have to be taken. It is

divided into three areas. Firstly sterile area which is a room that includes the machines
and shelves for sterile sets and instruments. Second, clean area which includes working
room, decontamination room, team office, dressing room, kitchen and WC. Third, dirty
area which includes dirty corridor that form the entry pathway for dirty instrument to

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C.S.S.D. it has a special window with each operating room that used for deliver dirty
instrument after surgery finish to C.S.S.D and this windows has a special character which
is the window can't open from both sides at the same time so it is a safety precaution that
decrease hazards of OR.

This C.S.S.D has one type of Autoclave which is steam sterilizer that works by pressure
and temperature. It uses 1430c and 312 PSI pressure for 45 minutes for the full cycle, and
the expired date for this type is about 3 months. The high speed steam sterilizer calibrated
at the same rates but takes less time (25 minutes).

The steam sterilizer is used for all instruments and material, clothes and liquid except
plastic instrument. The plastic instruments are being sterilized by Gas, so they deliver
these instruments outside of institution to Gas sterilizer, and this type has expiry date
within 3 years.

Role of circulatory and scrub nurse:

Circulatory Nurse
 Monitors the patient and documents specific activities throughout the operation to
ensure the patient’s safety and well-being.
 The circulating nurse manages the OR and protects the patient’s safety and health
by monitoring the activities of the surgical team, checking the OR conditions, and
continually assessing the patient for signs of injury and implementing appropriate
interventions.
 Verifying consent, coordinating the team, and ensuring cleanliness, proper
temperature, humidity, lighting, safe function of equipment, and the availability of
supplies and materials.
 Monitors aseptic practices to avoid breaks in technique.
 Works in collaboration with surgeons, anaesthesia providers, and other health care
providers to plan the best course of action for each patient.

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  While coordinating the movement of related personnel (medical, and laboratory),
as well as implementing fire safety precautions.
 Responsible for “time out” that takes place among the surgical team prior to
induction of anaesthesia. Every member of the surgical team verifies the patient’s
name, procedure, and surgical site using objective documentation and data before
beginning the surgery.
 As the surgical incision is closed, the scrub person and the circulator count all
needles, sponges, and instruments to be sure they are accounted for and not
retained as a foreign body in the patient.
 Receives and identifies pt. from receiving area.
 Checks for available Blood, consent form and other important thing in check list.
 Helps in transferring patient to OR table and safety of him.
 Estimating fluid and blood lose.
 Take care of drains.
 Application of dressing and plaster.
 Receives and labels all specimens.
 Helps in transferring pt to recover.

Scrub Nurse:
 Performing a surgical hand scrub.
 Setting up the sterile tables; preparing sutures, ligatures, and special equipment.
 Assisting the surgeon and the surgical assistants during the procedure by
anticipating the instruments and supplies that will be required, such as sponges,
drains, and other equipment.
 As the surgical incision is closed, the scrub person and the circulator count all
needles, sponges, and instruments to be sure they are accounted for and not
retained as a foreign body in the patient.
 Tissue specimens obtained during surgery are labelled by the person in the scrub
role and sent to the laboratory by the circulator.
 Help to transfer the patient from the operating table to the trolley.

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Safety precaution that were carried when the patient admitted to
surgery:
Precaution must be taken in operation room to minimize the potential hazards, and
nurses must take the following instruction seriously:
1. Hands must be washed before starting the work with pt's, and also after finish
the procedure.
2. Masks and head & shoes covers should be worn before coming in the
operation room
3. .Gloves must be worn before doing any procedure, and to wear sterile gloves
for procedures which need sterile technique, and gloves must be changed
before moving on another pt or another procedure.
4. Infection and sepsis is major complication of surgery, so that sterility must be
considered as a good point for preventing the infection.
5. Sharps and needles, syringes should be inserted in special box (sharp box),
and needles should not be recapped when are used. Follow appropriate
procedures in handling and disposing of sharp instruments or body needles.
6. Pt should be informed and instruct don’t eat or drink anything before the time
of operation of 12 hours, to prevent nausea, vomiting, and aspiration during
the surgery.
7. Restrict opening and closing the doors when the surgery begins, to reduce to
possibility of moving the microorganisms from pt to pt.
8. Doing suctioning carefully when exhumation the ETT to prevent aspiration.
9. Follow established appropriate infection assuming blood body fluids and
tissue are infectious.
10. Consent form was signed by pt as protection to team.
11. Check list to make sure that all the necessary pre-operative routine was done.
12. Check pt name to confirm that correct pt admitted to correct surgery.
13. Explain the surgery to the patient.
14. Surgical team should be free of any infection (upper respiratory infections,
dermatitis, and any unhealed wound, infection of the mouth or eyes).

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 15. Temperature should be within human body temp. To prevent
hypo/hyperthermia. Humidity should also be appropriate.
16. Operation room should be close ventilator system, no window to control
infections.
17. Side rails of the trolley and the breaks should be closed when transferring the
pt to OR table.
18. During the surgery, the team reduces their talking and movement to help the
surgeon to keep concentrated.
19. Place the electrical safety.

Potential hazards of the intra-operative experience for the patient, and

nursing care to prevent those hazards:

1. Hypo/ Hyperthermia
 Keep the patient covered with sheets during the operation, only the operating part
is kept exposed.
 Make sure that the temp of operation room is suitable (180-220c).
 Prevent hyper or hypothermia and always monitor the pts temperature for any
change.
 Hyperthermia could always be a side effect of anesthesia. This is the anesthetist's
responsibility with the assistance of the circulator nurse to take appropriate
measures.
2. Bleeding from the site and potential risk for internal bleeding
 Blood typing and cross matching should be done before surgery.
 Blood units should be readily available for use if needed.
 Anticoagulants, if taken, should be stopped few days before surgery.
 The amount of blood loss should be estimated, and observe the site of surgery
for excessive bleeding.
3. Forget the instruments inside the Pt
 Counting and checking should be done accurately at right intervals by both the
circulator and scrub nurse.

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  Notes should be written on a board.
 The wound should never be closed if there is suspicion of missing any
instruments or gauze.
 Look for the missing item inside the wound, outside at the bed side, and at the
floor.
 If not found, x-ray the patient to make sure that all is clear.
4. Respiratory problems from the use of anesthesia & aspiration
 Monitor and record vital signs.
 Administer Oxygen to the patient as needed.
 Deep breathing exercises before and after surgery.
 Suction as needed.
5. Infection
 Patients should take shower before going to OR.
 The team should be restricted from wearing the surgical suite outside OR.
 Sterile instruments should be opened and handled in a sterile technique.
 Sharps should be discarded in the sharp box only, and it should be closed.
 Contaminated instruments should be taken from a special window that opens
on the dirty corridor. The window should never be opened during surgery,
only after it.
 The operating rooms should be sterilized before and after each surgery with
antiseptics agents.
 Filter should be checked and tested. Air pressure should be positive inside OR
than the outside so as not to allow the outside air to come inside to the sterile
operating room.
 Reduce moving and unnecessary crowding in OR as much as possible.
 Keep doors closed as much as possible.
 Routine cultures should be taken from different areas inside and outside the
OR.

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6. Risk for burn from the cattery
 Diathermy should be used with caution by experts.
 Put diathermy plate under big muscles not under boney ones, or excessive
hair.
7. Hypotension
 Monitor vital signs and blood pressure.
 Encourage patient to drink prescribed fluid amounts, or administer I.V
solutions.
 Obtain and maintain a large-bore intravenous (IV) catheter. Parenteral fluid
replacement is indicated to prevent shock.
8. Hypoxia
 Maintain oxygen administration device as ordered, attempting to maintain
oxygen saturation at 90% or greater.
 Position patient to facilitate ventilation/perfusion matching.
 Suction as needed.
 For postoperative patients, assist with splinting the chest.
9. High risk for fluid and electrolyte imbalance related to NPO & blood loss or
shift of body fluids and electrolytes
 Monitor and record intake and output.
 Estimate blood loss on sponges in suction containers. Report estimated losses
to appropriate personnel.
 Assess availability of blood and blood products. Record type of blood and
blood products used.
 Record type and amount of irrigation used during surgery.
10. Allergy to some medication
 Check pt's chart before the operation.
 Close monitor for any sign of anaphylactic shock.

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Summary:
OT is one of the most important wards in hospitals and the most danger one, because in
this ward pt being sedated and waked up again. It was a useful experience in the OR
despite of its short duration. I learned many things in this department. For example, how
to check the facilities and devices, how to receive patients, what are the appropriate
standers for OR, what is the roles of (scrub nurse, circulatory nurse, anesthesia doctor and
anesthesia technician), and names of some devices and instruments and other many
things So it was benefit for me and it added a valuable thing to my experience. The team
was cooperative especially the nurses who explained everything to me and introduce the
OR ward also they show me the meaning of working as a team for the benefit and safety
of the patient.

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