Perfusionist Orientation

Perfusionists

Clinical Orientation

Perioperative Education

Late Start Days and Quarterly MM&I

During the MM&I meeting, you will text the conference code they give you to (855) 776-6263

• First cases start at 7:30 a.m. on Monday, Tuesday, and Thursday.

• On Wednesday and Friday, the first cases start at 8:00 a.m.
• There is a built-in in-service time from 6:50-7:20 a.m. on Wednesday and Friday. The in-service is a rotating monthly schedule (i.e., Breezeway Bonanza, Unit Board, Executive Unit Board, etc.)
• Quarterly, on designated Fridays, there are scheduled MM&I Conferences usually held in Langford Auditorium from 6:30 a.m. - 8:00 a.m.
• On MM&I Fridays, surgeries are scheduled to start at 9:00 a.m.
• To get continuing education credit, sign up at this website:
• https://vumc.cloud-cme.com/default.aspx

Scan this QR code to load an OR map onto your phone.

Crash Cart Locations and Map of ORs

Trauma Cart Locations

Perioperative Areas

HOW DO WE GET OUR CASE CARTS?

Vanderbilt Case Cart Operations Center (VCCOC) and VUAH Basement

Instruments

Fingernails

• Must be short, clean, and healthy
• Nail polish must not be chipped
• Long natural fingernails and artificial nails (acrylics, overlays, bonding, tips, extensions, tapes, inlays, and wraps) are prohibited

• Practice the proper technique to reduce cross-contamination by hands onto other surfaces
• If hands are not visibly soiled, a hospital approved waterless hand sanitizer may be used

Hand Hygiene

• Jewelry (including earrings, necklaces, bracelets, and rings) that cannot be confined or contained should not be worn in the semi-restricted and restricted areas
• Microorganisms thrive under jewelry

• ID badges must be worn in clear sight above the waist with name, title, and picture clearly visible

Identification Badges & Jewelry

• Obtain and return these scrubs from the machines in your work area
• Short-sleeved shirts may be worn under scrub tops
• Wear personal attire into work, change into a freshly hospital-laundered set of scrubs
• The department gets charged if scrubs are not returned within three days

• VUMC launders and issues scrub sets and scrub jackets
• These are the only attire approved to be worn in the OR
• Healthcare laundry facilities must launder to standards not met with home laundering equipment

How to Wear Team Jackets in the OR Area

PPE

When you leave the OR, dispose of PPE

Head coverings

• Must confine all hair (including the nape, scalp skin, beards, and sideburns) due to risk of SSI
• Cloth hats may be worn, but need to be laundered daily

Masks

• Must completely cover the mouth, nose, and chin snugly
• Must not dangle from around the neck

Eye Protection

• Direct patient care or when patient is in the OR suite
• Approved eyewear with side protection
• Regulatory requirement

Shoe Covers/Boots

• Worn in instances when gross contamination is anticipated (optional)
• Replace when soiled or leaving the room

Exam Gloves

• Worn when performing contaminated tasks

Personal Items

Site Marking

Patient Identification

Before Transport to the OR

• Anesthesia providers use a barcode scanner to verify the correct patient chart is accessed.
• The electronic record (eStar) is connected to the flightboard, populating patient information and the Time-Out checklist

• Once in the OR, before transfer to the OR table, the anesthesia provider and licensed circulator must verify patient identity and MRN again using the:
• OR flightboard*
• Patient’s ID band, and
• Patient stickers
• Chart
• If awake, involve the patient in the identification process
• The case number is not an acceptable patient identifier
• If the original armband is removed in the OR, it must be replaced by printing another, and two staff members will confirm identification with the OR Flightboard and/or ID band.

Intra-op Patient ID

Expiration Symbol

• Before opening a package to the sterile field, check the integrity of the package and look for an expiration date.
• Some supplies have expiration dates. Others are "event related" meaning they are sterile as long as there are no holes or leakage of fluids.
• Items should be placed on the field in a sterile manner (not with uncovered hands hanging over the sterile field).
• Hard to open items should be presented to the scrub person to retrieve.

Verifying Instrument Sterility

Verifying Instrument Sterility

Criteria to look for inside of a rigid instrument pan before the basket is removed

• Check the filters for holes and proper placement
• Place all integrators from the pans in the “popcorn bag” that the count sheet comes in – one bag needed per case
• Write the patient’s initials on the bag and then hand it off to the circulator

Verifying Instrument Sterility

Instrument Handling After Case

Surgical Hand Scrubs

Water-based

• Three (3) minute scrub time
• Pick nails under running water
• Use brush side of scrub sponge only on nails/cuticles or visible soil
• After that, the three-minute timespan begins

Avagard (Waterless)

• Wash hands and pick nails before first application
• Wash and dry hands if soiled before any subsequent applications
• Apply product following manufacturer’s recommendations

Gowning & Gloving

• Gowning and gloving should be performed on a separate surface from the back table
• Closed gloving is used for self gloving
• Performed when donning gloves for the first time after donning the gown (before hands are passed through the white cuff)

• Double glove for all invasive procedures
• Gowns are sterile from chest to waist/level of the sterile field and from gloves to 2 inches above the elbows

Draping

• If the sterility of a drape is in question, consider it CONTAMINATED
• Handle sterile drapes as little as possible and in a controlled manner
• After initial positioning, do not move the portion of the sterile drape that establishes the sterile field
• Consider items that fall below the level of the sterile field to be contaminated
• Consider only the top surface of the sterile drape to be sterile (not the underside)
• Be sure all instruments have been removed from the drapes before they are put in the garbage container

Before Scrubbing, Check Yourself

• Hair and beard are completely covered
• Mask - covers nose and mouth (not dangling)
• Protective eyewear
• Shoe covers
• Shirt tucked in and sleeves rolled up
• Fingernails need to be short - no false nails or chipped nail polish
• No jewelry
• Do not scrub if you have a cut that requires a bandage
• OPEN GOWN AND GLOVE ON A SEPARATE SURFACE FROM THE BACKTABLE - SUCH AS THE MAYO OR PREP STAND

Sterile Areas Square at chest area

• From 2 inches below neck-line to waist or level of the sterile field (as pictured in yellow)
• Fingertips to 2 inches above the elbows

We will demonstrate and practice the following:

• After Scrubbing, dry your hands- Bending so the towel does not touch scrubs
• Gown and glove yourself using the closed glove method
• Assist gowning and gloving of others
• Assist re-gowning & regloving to correct contaminations
• Removing gown and gloves being careful not to soil scrubs

Draping Considerations

• Be sure all instruments have been removed from the drapes before disposal
• Surgical drapes provide a barrier to maintain the sterility of the operative site
• The sterile field must be maintained throughout the entire surgical procedure

When setting up the back table, work logically with as little movement of supplies as possible. Most people will put towels down first to pad the drape(reduce the risk of holes if instruments are dropped). Every service line does it differently because they have different equipment, instruments, and needs. The ST Leads will show service line-specific set-ups.

Setting up a Backtable

Once draped, the Mayo Stand holds the most frequently used instruments. For easy access, instruments are returned to the same place when returned. At the beginning of the case, the items that will be handed off are placed on the mayo stand for quick access (light handles, suction tubing, bovie, etc.). It may be pulled directly over the patient. The scrub nurse must make sure it is not touching tp or laying on the patient's body.

Mayo Stand

• Clean, unused sharps (knives and needles) can be passed hand-to-hand from scrub nurse to surgeon.
• Once sharps have been used on a patient, they must be returned to the NEUTRAL ZONE for the scrub nurse to be picked up.
• They are not to be passed hand-to-hand because they have been in contact with patient body fluids.
• A neutral zone should be established at the beginning of a case by the scrub nurse.
• The neutral zone could be a towel, emesis basin, magnetic instrument drape, or even a corner of the mayo stand.

Neutral Zone

Instruments are placed in the hands of the surgeon in such a way as to be ready to use.

• Be careful when passing sharps, even when clean and unused. Pass in such a way as to not cause a sharp injury(blades pointing away from hand and blades protected if using safety blades).
• Box-locked instruments should be passed tips up(hemostats, Vanderbilts, Allis clamps, etc.)
• We will demonstrate and practice the passing of basic instruments in the mock ORs.

Passing Instruments

https://www.vumc.org/periop-services/welcome

Perioperative Services Website: "VUMC Periop"