Boven Birth Center Cesarean Section Orientation

1. Boven Birth Center Cesarean Section Orientation Beth Kalkman, BSN, RNC-OB

2. Overview of Cesarean Section and Perioperative Considerations for the Pregnant Woman

3. Anatomy and Physiology of Later Pregnancy

4. System Involvement • Skeletal • Gastrointestinal • Reproductive • Respiratory • Circulatory • Nervous • Genitourinary

5. Surgical Considerations in Pregnancy • Thromboembolism • Anemia • Aspiration • Hypoxia • Hemorrhage • TwoPatients

6. The Cesarean Section Cesarean Section Education Video

7. Skin incision is made, then the subcutaneous (sub-q) tissue down to the fascia is incised.

8. Cutting through rectus fascia (in this case, with cautery) SeparatingAbdominalmuscles with fingers

9. Opening the peritoneum Stretching the Abdominal Wall

10. Uterine incision is made Amniotic membranes are ruptured Uterine incision is stretched laterally

11. Surgeon reaches in to identify and lift the presenting part out of uterus through the abdominal incision

12. Head is delivered by hand or, by vacuum assistance

13. 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.

14. Removal of placenta and amniotic membranes Exploration of uterus to insure complete Removal of tissue Uterine incision is closed in one or two layers

15. Fascia is closed Skin is closed with suture, staples, or glue

16. Family is Transferred to Recovery

17. 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

18. Readings: • Nunny, R. (2008) Providing perioperative care for pregnant women. Nursing Standard, 22(47), 40-44.

19. To provide a safe, clean environment for obstetric surgical patients and hospital personnel The Boven Birth Center Operating Room

20. 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

21. Operating Room Suite Divided into three designated areas. Determined by the activities that take place in each area • Unrestricted • Semi-restricted • Restricted

22. Unrestricted • All areas where street clothes may be worn. • Area where surgical and non-surgical personnel interface

23. Semi-restricted: • Scrub attire and caps are required. • Storage of clean and sterile supplies and instruments • Corridors leading to restricted area

24. Surgical procedures are performed • and sterile items are stored. • All areas where scrub attire, caps, and masks are required and traffic is limited. Restricted

25. Semi-restricted Restricted Unrestricted Semi-restricted Semi-restricted

26. Readings: • Preparation and Maintenance of BBC Operating Room 25.2.5.6 • Preparation and Maintenance of the Operating room Environment 25.8.4.21 • Recommended Practices for Traffic Patterns in the Perioperative Practice Setting. Holland Hospital Policies and Procedures AORN Perioperative Standards and Recommended Practices

27. Roles and Responsibilities of the Surgical Team

28. Sterile Team Members(Scrubbed) • Primary Surgeon • Assistant Surgeon • Scrub Technician • Non-Sterile Team Members • Circulator • Anesthesiologist • Infant Nurse • Infant Provider

29. 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

30. 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)

31. 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

32. 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)

33. Culture of Safety: What is it? • Reporting • Flexible • Learning • Wary • Just It’s about Caring, It’s about the Patient.

34. 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)

35. You are a team!!!!

36. Readings: • Responsibilities of the Circulating Nurse 25.8.4.7 • Surgical Assistants in the Operative Room/ Boven Birth Center 25.8.4.38 • Guidance Statement: Creating a Patient Safety Culture Holland Hospital Policies AORN Perioperative Standards and Recommended Practices

37. Infection Control in the Perioperative Setting

38. Pathogenic Microorganisms: Microorganismsthat cause disease Can you name a few? • MRSA • E-Coli • Pseudomonas • Strep

39. 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

40. The Patient-Internal Factors • Lifestyle Choices • Nutritional Status • Age • Existing Disease • Acute Illness

41. External Factors-presence of others • Movement • Talking • Attendance • Security

42. 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.**

43. What Else? • Doors kept closed • Personnel kept to a minimum • Room is Cleanedbefore, during, and after cases

44. Personal Protective Equipment

45. Readings: • Traffic Patterns in the Operating Room 25.8.4.32 • Cesarean section, Personnel in Attendance 25.2.1.5 • 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

46. Hand Hygiene The single most important step in the prevention of infection

47. 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.

48. 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.

49. Condition and cleanliness: • Natural fingernails: < ¼ inch long • No rings, watches, or other jewelry up to elbows. • Free of damage

50. Performing the Surgical Hand Scrub