Boven Birth Center Cesarean Section Orientation Beth Kalkman, BSN, RNC-OB
Overview of Cesarean Section and Perioperative Considerations for the Pregnant Woman
System Involvement • Skeletal • Gastrointestinal • Reproductive • Respiratory • Circulatory • Nervous • Genitourinary
Surgical Considerations in Pregnancy • Thromboembolism • Anemia • Aspiration • Hypoxia • Hemorrhage • TwoPatients
The Cesarean Section Cesarean Section Education Video
Skin incision is made, then the subcutaneous (sub-q) tissue down to the fascia is incised.
Cutting through rectus fascia (in this case, with cautery) SeparatingAbdominalmuscles with fingers
Opening the peritoneum Stretching the Abdominal Wall
Uterine incision is made Amniotic membranes are ruptured Uterine incision is stretched laterally
Surgeon reaches in to identify and lift the presenting part out of uterus through the abdominal incision
Head is delivered by hand or, by vacuum assistance
The trunk and lower extremities follow. After the cord is clamped, the baby is suctioned and handed to the newborn team. Collection of the cord blood sample follows.
Removal of placenta and amniotic membranes Exploration of uterus to insure complete Removal of tissue Uterine incision is closed in one or two layers
Fascia is closed Skin is closed with suture, staples, or glue
Wound Classification System • Class I: Clean wound: Gastrointestinal (GI), genitourinary(GU), or respiratory track is not entered. • Class II: Clean contaminated: The GI, GU, or respiratory track is entered under planned, controlled means. • Class III: Contaminated Wound: Gross contamination is present but obvious infection is not present. • Class IV: Dirty or infected: old traumatic wound with dead tissue or an infection process is present
Readings: • Nunny, R. (2008) Providing perioperative care for pregnant women. Nursing Standard, 22(47), 40-44.
To provide a safe, clean environment for obstetric surgical patients and hospital personnel The Boven Birth Center Operating Room
Origin of Governing Documents • Holland Hospital Policies • Association of periOperative Registered • Nurses (AORN) • Association of Women’s Health, Obstetric, • and Neonatal Nursing (AWHONN) • Association of Surgical Technologists (AST) Culture of Safety
Operating Room Suite Divided into three designated areas. Determined by the activities that take place in each area • Unrestricted • Semi-restricted • Restricted
Unrestricted • All areas where street clothes may be worn. • Area where surgical and non-surgical personnel interface
Semi-restricted: • Scrub attire and caps are required. • Storage of clean and sterile supplies and instruments • Corridors leading to restricted area
Surgical procedures are performed • and sterile items are stored. • All areas where scrub attire, caps, and masks are required and traffic is limited. Restricted
Semi-restricted Restricted Unrestricted Semi-restricted Semi-restricted
Readings: • Preparation and Maintenance of BBC Operating Room 188.8.131.52 • Preparation and Maintenance of the Operating room Environment 184.108.40.206 • Recommended Practices for Traffic Patterns in the Perioperative Practice Setting. Holland Hospital Policies and Procedures AORN Perioperative Standards and Recommended Practices
Sterile Team Members(Scrubbed) • Primary Surgeon • Assistant Surgeon • Scrub Technician • Non-Sterile Team Members • Circulator • Anesthesiologist • Infant Nurse • Infant Provider
Scrub Technician: • Preparing the Sterile Field • Selecting appropriate instruments and supplies • Scrubbing, donning gown and gloves • Maintaining integrity and sterility of the sterile • field • Knowledge of the procedure and anticipation • of the surgeon’s needs
Providing instruments, sutures, and supplies to the surgeon • Preparing sterile dressings • Implementing procedures that contribute to patient safety • Cleaning and preparing instruments for sterilization • (Spry, 2009, p.7)
Circulating Nurse • Managing and implementing activities outside • the sterile field • Emotional support to patient prior to and during • induction of anesthesia • Performing ongoing patient assessment • Documenting patient care • Obtaining appropriate surgical supplies and • equipment
Creating and maintaining a safe environment • Administering medications • Implementing and enforcing policies and procedures that contribute to patient safety • Preparing and disposing of specimens • Communicating relevant information • (Spry, 2009, p. 7)
Culture of Safety: What is it? • Reporting • Flexible • Learning • Wary • Just It’s about Caring, It’s about the Patient.
Surgical Conscience: “An inner commitment to adhere strictly to aseptic practice, and to correct any violation, whether or not anyone else is present or observes the violation“ (Spry, 2009, p.101)
Readings: • Responsibilities of the Circulating Nurse 220.127.116.11 • Surgical Assistants in the Operative Room/ Boven Birth Center 18.104.22.168 • Guidance Statement: Creating a Patient Safety Culture Holland Hospital Policies AORN Perioperative Standards and Recommended Practices
Pathogenic Microorganisms: Microorganismsthat cause disease Can you name a few? • MRSA • E-Coli • Pseudomonas • Strep
Sources of Infection • Endogenous: From the patient’s own body • Exogenous: Outside the body • Nosocomial Infections: Hospital Acquired Infections (HAI) • 1 in 20 patients • Surgical Site Infections (SSI) • 1-3 in 100 patients
The Patient-Internal Factors • Lifestyle Choices • Nutritional Status • Age • Existing Disease • Acute Illness
External Factors-presence of others • Movement • Talking • Attendance • Security
Surgical attire • Laundered by facility-approved laundry service • Replaced daily or when soiled • Loose fitting tops are tucked in • Non-scrubbed personnel – long jackets buttoned • or closed. • **Personal clothing that extends beyond the neck or • sleeves of the scrub attire are not worn.**
What Else? • Doors kept closed • Personnel kept to a minimum • Room is Cleanedbefore, during, and after cases
Readings: • Traffic Patterns in the Operating Room 22.214.171.124 • Cesarean section, Personnel in Attendance 126.96.36.199 • Recommended Practices (RP) for Traffic Patterns in the Perioperative Practice Setting • RP for prevention of Transmissible Infections in the Perioperative Practice Setting Holland Hospital Policies AORN Perioperative Standards and Recommended Practices
Hand Hygiene The single most important step in the prevention of infection
The Targets: Microorganisms Transient : Accumulate during activities of the day. Found on the surface of hands Resident : More permanent dwellers. Found in the deeper layers.
Methods: • Hand Washing • Antiseptic Hand Wash • Antiseptic Hand Rub • Surgical Hand Antisepsis Washing with soap and water for at least 15 seconds Hand wash performed with a product Intended to decrease the resident and transient flora An alcohol containing agent which is applied to the hands to decrease the resident and transient flora Wash or rub performed before surgery to eliminate transient microorganisms and significantly reduce resident organisms.
Condition and cleanliness: • Natural fingernails: < ¼ inch long • No rings, watches, or other jewelry up to elbows. • Free of damage