Surgical First Assist

The role of the surgical assistant is vital to the operating room and any surgical case within the operating suite. The surgical assistant provides immediate support to the surgeon, direct patient care and should act as a vital resource to the staff of the operating room suite. The surgical assistant should be knowledgeable, well rounded, helpful, and supportive of a team-like attitude. The surgical assistant is a necessary source of knowledge and skills. This role is further defined as follows:

Surgical assistants provide aid in exposure, hemostasis, closure, and other intraoperative technical functions that help the surgeon carry out a safe operation with optimal results for the patient. In addition to intraoperative duties, the surgical assistant also performs preoperative and postoperative duties to better facilitate proper patient care. The surgical assistant performs these
functions during the operation under the direction and supervision of the surgeon and in
accordance with hospital policy and appropriate laws and regulations.

Positioning the P atient
The surgeon shall convey the exact position that will give the best exposure for the surgical procedure. The surgical assistant will carry out this order. Consideration will be given to the patient’s comfort and safety.
Points of pressure shall be padded: elbows, heels, knees, eyes, face, and axillary region.
Circulation shall not be impaired. (A tourniquet may be required for some
procedures.)
Nerve damage shall be guarded against.
The temperature of the patient should be discussed with the anesthesia personnel and methods employed to maintain the desired temperature range.
The surgical assistant shall be familiar with common positions related to the surgical procedure and will be able to use the equipment necessary to provide the position. Competencies will include the following:

• Fracture tables

• Head stabilizers

• Body stabilizers

• C-arm extensions

• Any other equipment needed

Upon completion of the procedure, the patient shall be evaluated for any possible damage from positioning which will include assessment of the skin. The abnormal condition shall be reported to the surgeon and treatment and documentation shall be carried out.

Providing visualization of the operative site by the following:

• Appropriate placement and securing of retractors with or without padding

• Packing with sponges

• Digital manipulation of tissu e

• Suctioning, irrigating, or sponging

• Manipulation of suture materials (e.g., loops, tags, running sutures)

• Proper use of body mechanics to prevent obstruction of the surgeon’s view

Utilizing appropriate techniques to assist with hemostasis

• Permanent
  - Clamping and/or cauterizing vessels or tissue
  - Tying and/or ligating clamped vessels or tissue
  - Applying hemostatic clips
  - Placing local hemostatic agents
  
  

Application
Applying tourn iquets and de monstrating awareness of the indications/contraindications for use with knowledge of side effects of extended use

Applying vessel loops

Applying non crushing clamps

Applying direct digital pressure

Participating in volume replacement or autotransfusion techniques as appropriate

Utilizing appropriate tec hnique s to assist with closure of body planes
Utilizing running or interrupted sutures with absorbable or nonabsorbable material of wound layers, including muscle and f ascia.
Utilizing subcuticular closure technique with or without adhesive skin closure strips
Closing skin with method per surgeon’s directive (suture, staples, etc
Postoperative subcutaneous injection of local anesthetic per surgeon’s directive
Selecting an d applying approp riate wound dressings, including the following:

• Liquid or spray occlusive materials

• Absorbent material affixed with tape or circumferential wrapping.

• Immobilizing dressing (soft or rigid)

Providing assistance in securing drainage systems to tissue

Assists Surgical Team

Scrubs, and dons gowns and gloves in accordance with performance standards. Sets up table, instruments and supplies using sterile technique according to the physician preference cards. Assists in the preparation and draping of patient and operative area according to need. Assists and anticipates surgeon's need in instruments, sponges and supplies according to techniques and procedures. M aintains and corrects any break in aseptic technique at all times according to established written procedures. Demonstrates an awareness of legal responsibility in maintaining a correct count of sponges, needles and instruments with circulating nurse, and reports correctness and discrepancies according . Always remains alert during procedures and demonstrates an ability to handle unexpected situations. Always consults other staff members when in question or when unfamiliar with equipment.

P rocedures

Always follows direction of staff nurse for maximum patient care and minimal adverse s ituations. Assists in dressing of wounds and application of casts. Actively participates in verification of surgical site and participates in time out. Regularly assists other team members, upon completion of surgery, in safely moving patients.

Manages Supplies, Equipment, and Instrumentation

Selects instruments and packs needed for each individual surgical procedures according to

established policies and procedures, and physician preference cards. Regularly assists in setting up the OR according to case schedule. Demonstrates responsibility of sterile instruments and supplies through proper packaging and Sterilization. Safely and accurately handles and discards all sharps, disposables and linens. Ensures that necessary supplies are available and that rooms are stocked appropriately. Cleans and prepares rooms between procedures, according to policy. Ensures that all supplies, e quipment and instrumentation are available and properly functioning prior to procedure. Reports malfunctioning instruments and equipment in a timely manner to appropriate staff . Demonstrates knowledge of OR safety (sharps, electro-surgical, laser, fire, scopes, etc.).

Preparation of Medication, Implants and Grafts and Specimen Handling

Verifies medication and expiration date with RN draws up medication, communicates name of medication to surgical team. Properly labels containers on sterile field. Communicates to the circulator the name of the medication, amount used, and administration of medication. Prepares implants, grafts for procedures, as directed by Surgeon. Confirms specimen identification with surgeon. Correctly identifies and prepares specimen. Confirms specimen identification with circulating nurse.

Performs Other Duties as Required

Attends mandatory in-services, staff meetings, actively participates in self-education and completes all required competency assessments on time. Willingly performs other duties as required . Identifies appropriate cases of abuse and neglect and demonstrates knowledge of mandatory reporting requirements.

Previous Surgical Scrubbing Experience .

• Certified Surgical First Asstpreferred
• Certified Surgical Tech (Required)