Chapter 19: Intraoperative Care
The surgical suite is divided into three distinct areas: unrestricted, semirestricted, and
o The unrestricted area is where personnel in street clothes can interact with those
in scrub clothing.
o In the semirestricted area, personnel must wear surgical attire and cover all head
and facial hair.
o In the restricted area—which includes the operating room (OR), the sink area,
and clean core—masks are required to supplement surgical attire.
In the holding area, the perioperative nurse makes the final identification and assessment
before the patient is transferred into the OR for surgery. Procedures such as inserting
intravenous (IV) catheters and arterial lines, removing casts, and drug administration may
The OR is a unique acute care setting removed from other hospital clinical units. It is
controlled geographically, environmentally, and bacteriologically, and it is restricted in
terms of the inflow and outflow of personnel.
The perioperative nurse is a registered nurse who implements patient care during the
perioperative period. This includes the following:
o Preparing the OR for the patient
o Serving as the patient’s advocate during surgery
o Assessing the patient for additional needs or tasks before surgery
o Educating the patient and family members
The function of circulating is implemented by the perioperative nurse who is not
scrubbed, gowned, and gloved and remains in the unsterile field.
The function of scrubbing is implemented by the nurse who follows the designated
scrub procedure, is gowned and gloved in sterile attire, and remains in the sterile field.
The registered nurse first assistant (RNFA) works in collaboration with the surgeon to
produce an optimal surgical outcome for the patient.
Assessment data important to intraoperative nursing care include the patient’s vital signs,
height, weight, and age; allergic reactions to food, drugs, and latex; condition and
cleanliness of skin; skeletal and muscle impairments; perceptual difficulties; level of
consciousness; nothing-by-mouth (NPO) status; and any sources of pain or discomfort.
Surgical hand antisepsis is required of all sterile members of the surgical team (scrub