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2. Surgical Technology for the Surgical Technologist: A
Positive Care Approach Association of Surgical Technologists, Inc.
Executive Editors Bob L. Caruthers, CST, PhD Deputy Director,
Association of Surgical Technologists Paul Price, CST/CFA, MBA
Education Director, Association of Surgical Technologists Executive
Director, Accreditation Review Committee on Education in Surgical
Technology Editors Teri L. Junge, CST/CFA Education Coordinator,
Association of Surgical Technologists Ben D. Price, CST Education
Coordinator, Association of Surgical Technologists Government and
Public Affairs Coordinator, Association of Surgical Technologists A
u s t r a l i a C a n a d a M e x i c o S i n g a p o r e S p a i n
U n i t e d K i n g d o m U n i t e d S t a t e s
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Cataloging-in-Publication Data Surgical technology for the surgical
technologist : a positive care approach / Association of Surgical
Technologists, Inc. ; executive editors, Bob L. Caruthers, Paul
Price; editors, Teri Junge, Ben D. Price. p. ; cm. Includes
bibliographical references and index. ISBN 0-7668-0662-6 1.
Surgical technology. 2. Operating room technicians. I. Caruthers,
Bob. II. Association of Surgical Technologists. [DNLM: 1. Surgical
Procedures, Operative. 2. Operating Room Technicians. WO 500 S96187
2000] RD32.3 .S866 2000 617.917dc21 00-020107 NOTICE TO THE READER
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14. Bob L. Caruthers, CST, PhD Association of Surgical
Technologists Englewood, CO Chapter 1: Orientation to Surgical
Technology Chapter 2: The Surgical Patient Chapter 9: The Surgical
Technologist in the Scrub Role (Case Management) Chapter 11:
General Surgery Chapter 12: Obstetric and Gynecologic Surgery Paul
Price, CST/CFA, MBA Association of Surgical Technologists
Englewood, CO Chapter 7: Instrumentation, Equipment, and Supplies
Chapter 8: Wound Healing, Sutures, Needles, and Stapling Devices
Chapter 10: Diagnostic Procedures Chapter 19: Cardiothoracic
Surgery Chapter 20: Peripheral Vascular Surgery Chapter 21:
Neurosurgery Ben D. Price, CST Association of Surgical
Technologists Englewood, CO Chapter 3: Physical Environment and
Safety Standards Chapter 4: Asepsis Chapter 5: General Patient Care
and Safety Chapter 9: The Surgical Technologist in the Scrub Role
(Case Management) Chapter 13: Ophthalmic Surgery Chapter 21:
Neurosurgery Teri Junge CST/CFA Association of Surgical
Technologists Englewood, CO Chapter 6: Surgical Pharmacology and
Anesthesia Chapter 14: Otorhinolaryngologic Surgery Chapter 16:
Plastic and Reconstructive Surgery Chapter 17: Genitourinary
Surgery Kevin Frey, CST, MA Pueblo Community College Pueblo, CO
Chapter 3: Physical Environment and Safety Standards Chapter 4:
Asepsis Chapter 18: Orthopedic Surgery Gary Allen, CST Ludlow, MA
Chapter 11: General Surgery Chapter 12: Obstetric and Gynecologic
Surgery Amy Croft, CST, BS South Plains Community College Lubbock,
TX Chapter 15: Oral and Maxillofacial Surgery Ann Marie McGuiness,
CST, RN, CNOR Charles H. McCann Technical School Adams, MA Chapter
6: Surgical Pharmacology and Anesthesia Jim Swalley, CST Redmond,
WA Chapter 13: Ophthalmic Surgery xiii CONTRIBUTORS
15. Betty F. Arnett, RMA, CST Director/Instructor, Surgical
Technology Program Orlando Technical Educational Centers Orlando,
Florida Dorothy Donesky, RN, MPH, CNOR Assistant Professor of
Surgical Technology Program Coordinator and Clinical Director
Cardiopulmonary Sciences Loma Linda University Loma Linda,
California Shelly Hayden, CST, CFA Surgical Technology Instructor
Northwest Technical Institute Springdale, Arkansas Linda W.
Higgins, RN, BSN, MPA, CNOR Commander (Ret.), U.S. Navy Nurse Corps
Adjunct Faculty Instructor Coastal Carolina Community College
Jacksonville, North Carolina Jeannie Hurd, RN, BS, CNOR Program
Director, Surgical Technology Spokane Community College Spokane,
Washington Marie Jacobs, CST Program Head, Surgical Technology
Larry G. Selland College of Applied Technology Boise State
University Boise, Idaho Ruth Jones, RN, BSN, MSC Divisional Chair,
Surgical Technology Northwest Technical Institute Springdale,
Arkansas Dean A. Kendall, CST Lander Valley Medical Center Surgical
Technology Instructor Central Wyoming College Lander, Wyoming
Arthur A. Makin, CST, BS Instructor, Surgical Technology Guilford
Technical Community College Jamestown, North Carolina Vicky D.
Tesar, CST Surgical Technology Instructor Northwest Technical
Institute Springdale, Arkansas Kimberly A. Whitson, RN Surgical
Technology Instructor Moore Norman Technology Center Norman,
Oklahoma Katherine J. Wolfer, RN, BSN, CNOR Instructor, Surgical
Technology Cincinnati State Technical and Community College
Cincinnati, Ohio xiv REVIEWERS
16. Surgical Technology for the Surgical Technologist: A
Positive Care Approach represents a significant change in the field
of surgical technology. Surgical technology faculty and students
have long de- pended upon textbooks prepared by and for the nursing
student or nursing graduate to serve as the foundation text for
surgical technology education. These textbooks, while excellent for
their primary audience, contained a significant amount of in-
formation not related to the role of the surgical technologist.
More significantly, these texts lacked the subtle observations and
nuances that come from years of experience in the role of surgical
technologist. This book approaches the surgical technology student
and instructor in a fresh and innovative manner. Primarily, this
textbook is focused on the knowledge and cognitive skills required
of the sur- gical technologist. Many specific practices and tech-
niques are described, but all are placed in the con- text of the A
Positive Care Approach. It is a systematic approach to surgical
problem solving fo- cused on the ability of the surgical
technologist to predict the patients and surgeons needs. Preface
xv
17. The A Positive Care Approach focuses on the cogni- tive
process used by the surgical technologist who is serving in the
traditional role called first scrub. The A Positive Care Approach
for the surgical technologist finds its foundations in the
following assumptions: The surgical technologist serves the
patients interest primarily by providing assistance to the surgeon.
The surgical technologists primary task during an op- erative
procedure is to predict the intraoperative needs of the surgeon and
surgical patient. In order to accomplish the primary task
efficiently and effectively, the surgical technologist must learn
to think like the surgeon intraoperatively. The surgical
technologist must be well grounded in the basic sciences,
especially anatomy, microbiology, and pathophysiology. The surgical
technologist contributes to global patient care by serving as one
of several team members who monitors the surgical environment. The
intraoperative team commonly makes these same assumptions and uses
them to judge the competency of the surgical technologist.
Educators struggle to get stu- dents to predict the surgeons next
move or the effects of a given surgical action. Surgical technology
graduates suddenly feel at home in the operating room when they
begin to plan many steps ahead during an operative pro- cedure.
More importantly, the surgical technologist can be observed
repeatedly following a specific sequence of cognitive steps. The
cognitive steps require an adequate preparatory education. The
surgical technologist must be well grounded in anatomy and
microbiology, as these studies are the foundation of all practices
in the OR. Normal physiology and a basic understanding of pathol-
ogy come next. All of this information is the springboard to the
cogni- tive activity of the surgical technologist. The basic steps
of the cognitive process are easy to define. The surgical
technologist: has a mental image of normal anatomy. makes a mental
comparison between the idealized anatomy and the actual anatomy of
a specific patient. knows an idealized operative procedure used to
cor- rect the pathological condition. makes a mental comparison
between the idealized procedure with the actual procedure being
per- formed. allows for a particular surgeons variations to the
ide- alized procedure. allows for variances in anatomy, pathology,
and sur- geons responses to the variances. predicts and prepares to
meet the needs of the surgi- cal patient and the surgeon prior to
the need being verbalized. The cognitive sequence described is a
predictive model. Its basis is the scientific method, and it
differs only in type and depth of information from other predic-
tive models. The more information surgical technologists have, the
better they will be able to predict needs in the surgical setting,
and contribute to better patient care. Several presumptions were
made in the writing of this book: Students will have had at least
one basic anatomy and physiology course that focused on systemic
anatomy. Surgical anatomy must be taught within the context of
surgical procedures without regard to the number of systemic
anatomy courses that have been taken. Due to the variance in
surgical technology programs, some basic microbiology is included
in the chapter on asepsis (the authors do not suggest that it is
inclu- sive). Due to the variance in surgical technology programs,
some basic pharmacology is included in the chapter on anesthesia
and pharmacology (the authors do not suggest that it is inclusive).
ORGANIZATION OF THE TEXT Surgical Technology for the Surgical
Technologist: A Pos- itive Care Approach is divided into two major
divisions. These divisions correspond to the A POSitive CARE Ap-
proach. The first nine chapters are related to the CARE acronym.
The CARE division itself is divided into two sections: Introduction
to Surgical Technology, and Prin- ciples and Practice of Surgical
Technology. The last twelve chapters relate to the A POSitive
acronym. These chapters focus on operative procedures by surgical
spe- cialty. A brief introduction to diagnostics precedes the
specialty sections. This is intended to provide a standard
background for all specialties. The CARE division will establish a
broad context in which the instructor will help the student place
the more specific technical information that dominates surgical
technology. Introductory and foundational information is taught
using the CARE approach which is intended to serve as a reminder to
the surgical technologist that all activities affect the care given
to the patient. The reader should be aware that the highly variable
topics of the first nine chapters do not allow for a simple
one-to-one correlation of the CARE memory tool, but that it is a
con- ceptual tool intended to help organize the information: Care
(directed toward the patient and/or surgical team) Aseptic
principles (and practice of sterile technique) Role of the surgical
technologist Environmental Awareness (and concern) The A POSitive
division relates directly to the final twelve chapters with the
desire to CARE as the underly- xvi PREFACE C A R E
18. ing theme. The surgical procedures are presented by
surgical specialty using the illustrative procedure format. The A
POSitive approach does allow for the one-to-one correlation of the
procedural chapter objectives, and should be used to reinforce
every surgical procedure presented to the student: Anatomy
Pathology Operative Procedure Specific Variations SPECIAL FEATURES
OF THE TEXT Several features are incorporated into each chapter to
help you master the content. Review the How to Use This Book
section for a detailed description and benefit of each feature.
Illustrative Procedures The illustrative procedure format is based
on the con- cept that allows one procedure to highlight several im-
portant steps that are repeated in related procedures. Rather than
presenting many procedures with brief out- lines of the steps,
fewer procedures are presented in de- tail allowing the surgical
technologist to predict the nec- essary preparation and action to
be taken. Space constraints dictate certain questions, one being,
how does one best present procedures to an entry-level student?
Upon review of current textbooks and discus- sion with educators,
two ideas seemed especially impor- tant: Current books did not
provide adequate insight into the intraoperative thinking or tasks
of the surgical technologist in the scrub role. Some procedures
have more instructive value than others. In the first instance,
listing procedural steps focuses on the tasks of the surgeon only.
These are important to know, but the surgical technology student
should be di- rected to a line of thinking and sequence of tasks
that are related to each step of the procedure. In the second
instance, a procedure such as a total abdominal hyster- ectomy with
bilateral salpingo-oophorectomy requires the knowledge of skills
used in many gynecologic pro- cedures. A procedure such as a tubal
ligation, on the other hand, may not require the same expanse of
knowl- edge and skills. This book uses the illustrative procedure
format. In each specialty section, a select number of procedures
will be presented in detail in a specified format. This for- mat
will be used repeatedly to help the student habitu- ate a pattern
for learning procedures. Illustrations Color inserts provide a
general overview of select ana- tomic systems, and photographs are
included to depict practical aspects of surgical technology. The
students will most likely refer to each color insert several times
throughout their educational experience and their career as a
surgical technologist. Illustrations in the chapters related to
CARE have been selected to help the student identify general equip-
ment and supplies or demonstrate the steps necessary to perform a
specific skill. Illustrations in each of the procedural chapters
are de- signed to demonstrate instruments and supplies specific to
the surgical specialty, and regional anatomy in con- text for the
illustrative surgical procedure. These illustra- tions should help
the student learn to predict the intra- operative needs of the
patient and the surgeon. Pearl of Wisdom These tips, based on years
of the authors experience, are intended to help the student keep a
practical focus on the procedure. Case Studies The case studies are
intended to stimulate critical think- ing through application of
the information presented in each chapter to a specific situation
or patient variation presented in the case. Questions for Further
Study These questions stimulate the student to seek and apply
additional related information. PREFACE xvii A P O S
19. LEARNING SUPPLEMENT Study Guide The study guide is designed
to enhance the material in the text. It includes various critical
thinking exercises and case studies that correspond to each chapter
in the text, as well as skill assessments and anatomical labeling
exer- cises. ISBN 0-7668-0664-2 Text and Study Guide Value Package
The study guide enhances material in the text through various
critical thinking exercises, case studies, skill as- sessments, and
art labeling exercises. ISBN 0-7668-7929-1 GUIDELINES FOR THE
STUDENT: LEARNING SURGICAL PROCEDURES Surgical procedures are
important to the surgical tech- nologist for several reasons:
Surgical procedures are the medical intervention taken to restore
health to the surgical patient. Surgical procedures are the event
around which most of the knowledge and skills of a surgical
technologist are focused. Surgical procedures provide the best
educational ex- perience for learning to think like the surgeon.
Learning to think like a surgeon is the best way to or- ganize the
knowledge and skills required. So how does one learn to think like
the surgeon? The pattern of presentation is one that encapsulates a
mind- set. The information included follows a rather pre- dictable
pattern: Patient identification Preoperative diagnosis Surgical
procedure performed Postoperative diagnosis Report of surgical
procedure (step-by-step, including notations of anatomical
conditions or variances) Report concerning drains, dressings, or
other relevant information Initial status of patient following
completion of the surgical procedure Surgical technologists should
organize their mental approach following this pattern with
variations that re- flect the needs of the first scrub role. The
student in par- ticular, should mimic this organizational style
until it be- comes habitual. Keeping these basic assumptions and
guidelines in mind, the surgical technology student should find
this text easy to use. TO THE INSTRUCTOR Teaching Support Materials
Resource materials are available to accompany this text.
Instructors Manual The text was written to support the Core
Curriculum for Surgical Technology as set forth in the Standards
and Guidelines of the ARC-ST. A correlation chart is in- cluded in
the Instructors Man- ual to indicate the location of the core
components in the text. The manual is designed to enhance the
instructors own teaching style by providing suggestions for
exercises and activities beyond those offered in the study guide.
Answers to text questions, study guide ex- ercises, and
competencies for all skill assessments found in the study guide are
also included. ISBN 0-7668-0663-4 Electronic Testbank By offering
1,000 multiple choice questions organized by chapter, this CD-ROM
testbank assists you in creating chapter, midterm, and final
examinations. An interview mode or wizard guides you through the
steps to create a test in less than five minutes. You also have the
capability to edit questions or to add an unlim- ited number of
your own questions. xviii PREFACE
20. The Association of Surgical Technologists would like to
thank the staff at Evans U.S. Army Hospital, Fort Carson, Colorado
for making their facility and personnel avail- able for the
photographs included in this text. The Association of Surgical
Technologists would like to thank Joshua G. Weitzman-Merritt,
LPN/BSW, for his contribution to Chapter 16Plastic and
Reconstructive Surgery. Access was granted to the following
historical doc- uments of the Association of Surgical
Technologists, Englewood, CO: Minutes of the Board of Directors
Minutes of the House of Delegates Policy and Procedures Manual The
Surgical Technologist (every edition) AORT Newsletter (select
editions) Recommended Standards of Practice Code of Ethics Surgical
Technologist Performance Appraisal Pamphlets xix
ACKNOWLEDGMENTS
21. The case studies are intended to stimulate critical think-
ing through application of the information presented in each
chapter to a specific situation or patient variation presented in
the case. The textbook employs a systematic approach to problem-
solving using the CARE and A POSitive acronyms. The CARE division
of the textbook deals with an introduction of surgical technology
and its principles and practices. It is designed to remind you that
the care of the patient in the operating room is the surgical
technologists highest priority, and to establish a broad context
for the place- ment of the specific technical information that
dominates this field. CARE represents: Care (directed toward the
patient and/or surgical team) Aseptic Principles (and practice of
sterile technique) Role (of the surgical technologist)
Environmental Awareness (and concern) A POSitive, which relates to
the textbooks section on operative procedures by surgical
specialty, represents: Anatomy Pathology Operative Procedure
Specific Variations xx How to Use This Book 1 Case Study 2
Objectives 1111 CHAPTER O B J E C T I V E S Af