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Nursing procedures in operations theatre

Site: EHC | Egyptian Health Council
Course: دلائل الاجراءات التمريضية لقسم العمليات
Book: Nursing procedures in operations theatre
Printed by: Guest user
Date: Tuesday, 5 May 2026, 11:38 PM

Description

"last update: 6 March 2025"                                                                                       تحميل الدليل

Table of contents

- Prepared by

Operation Room guide

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

 

Prepared by

Title  

Name

NO.

Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University

Dr Afaf Abdel Aziz Abdel Aziz Basal

1

Professor Of Critical Care Nursing

Prof.Dr/Zeinab Hussain Ali

2

Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University

Amal Said Taha Refaie

3

Supervisor Of the Education Sector at Port Said University

Amal Ahmed Khalil Morsy

4

Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University

Dr. Hanan Ahmed Al Sebaee

5

Head of central administration on secondment at MOHP

Dr Neveen ab drab al0nabi Mohamed

6

Director Of Primary Health Care Nursing Department at MOHP.

Maysa Hosny Ahmed Tammam

7

Supervisor Of Technical Education- EHA 

Nancy Alaa Eldeen Abd-Elbaset Ali

8

Supervisor Of Nursing Services Development- EHA

Sherien Mohamed Saad

9

Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University

Assist.Perof. Dr./Heba Mahmoud Mohammed

10

General manager of general administration of health institutes affairs

Dr Mai Galal Ibrahim Al-Assal

11

Participants  

Head of nursing administration at EHA

Mr. Adham Abdel Nasser Okasha

12

member of the Nursing administration at EHA, luxor branch

Mr. Gehad Akram Hussein

13

- Airway Suctioning

Required Equipment:

  1. Sterile gloves
  2. Sterile suction catheter
  3. Antiseptic solution
  4. Sterile container
  5. Sterile gauze
  6. Sterile saline solution
  7. Airway passage

Procedure:

  1. Before starting, check all suction machine components (cord, plug, and connections) to avoid malfunctions during use.
  2. Inspect the suction bottles for cracks or damage; replace if necessary. Ensure the bottles are sealed properly to prevent air leakage, which can reduce suction efficiency.
  3. Turn on the suction machine and confirm it is functioning properly.
  4. Test the anesthesia suction system and its catheters to ensure they are in working condition.
  5. At the start of the procedure, the sterile nurse hands the sterile end of the tubing to the circulating nurse.
  6. The circulating nurse connects the tubing to the suction machine using the designated connector.
  7. Avoid pulling on the suction tubing; ask the sterile nurse to extend it if needed to prevent disruption of the surgical area.
  8. The sterile nurse secures the tubing with a towel clamp to prevent contamination.
  9. Cover the tubing with a small sheet to avoid entanglement with surgical instruments.
  10. The suction machine should not run continuously but only when needed. The non-sterile nurse should be ready to operate it upon request.
  11. Inform the surgical team when the suction container is full.
  12. The sterile nurse should not move the suction tubing across the surgical field. If repositioning is needed, use a new sterile tube.
  13. Replace any contaminated suction tubing immediately to maintain sterility.
  14. The sterile nurse should not touch the towel clamp directly but should replace it if needed.
  15. The non-sterile nurse should handle non-sterile items only to prevent contamination.
  16. Ensure the sterile nurse’s gloves do not come into contact with non-sterile surfaces.
  17. The sterile nurse should place a small towel over the previous clamp area.
  18. Replace the suction tubing with a new one as per the required positioning and secure it with a clamp.

End of Procedure:

  1. Turn off the suction machine.
  2. The non-sterile nurse removes the suction tubing from the machine.
  3. Hold both open ends of the tubing upward and place them in a designated waste bag to prevent any remaining fluids from spilling.
  4. The anesthesia suction system must be prepped with the necessary tubing and catheters and kept operational.
  5. Before discarding the collected fluid, confirm whether the anesthesiologist or surgeon needs to measure the suctioned volume.
  6. Clean the suction machine with an antiseptic solution.
  7. Empty the suction bottles in a designated disposal area, flush with water, and disinfect the area with chlorine solution.
  8. Rinse the suction bottles with cold water first, as heat can coagulate proteins.
  9. Wash the suction tubing with cold water, dry thoroughly, and preferably sterilize them before reuse. If sterilization is not possible, disinfect with an appropriate antiseptic solution.
  10. Send the cleaned equipment for sterilization or return it to the operating room for future use.
  11. Do not store water or disinfectant in the bottles, as unsterile liquid can interfere with blood loss measurement during surgery.

- Water Seal Chest Draining System

Required Equipment:

  • Sterile chest drainage bottles, fully assembled
  • Sterile gloves (for the assisting nurse)
  • Adhesive tape
  • Sterile distilled water
  • Rubber tubing

Procedure:

Single-Bottle System:

  1. Fill the bottle with 5 cm of sterile distilled water. Mark the exact level on tape and place it at eye level after the system is fully set up.
  2. Insert a long glass tube through one opening and a shorter tube through the other.
    • The long tube must be submerged 2 cm under the water level.
  3. Seal the bottle with a rubber stopper to prevent air from entering the chest cavity.
  4. The shorter tube serves as an air vent, ensuring proper drainage from the lungs.
  5. Ensure the vent tube is not submerged under the water.
  6. Secure all tubing connections with a valve near the bottle entry point to prevent air leaks.
  7. The valve remains with the patient at all times to close the system when changing bottles or moving the patient.
  8. Attach adhesive tape to the bottle to record drainage levels and frequency.

Two-Bottle System:

  1. Set up the system similarly to the single-bottle system, ensuring the first bottle collects drainage and the second bottle regulates suction.
  2. Connect the second bottle via a tube attached to the first bottle’s rubber stopper.
  3. A third opening in the second bottle is used to control suction pressure.
  4. If suction is prescribed by the surgeon, attach a third tube to the second bottle and connect it to the suction source.
  5. Fill the second bottle with 5 cm of sterile distilled water, ensuring the glass tube is submerged 1-2 cm under the water.
  6. Secure all connections with adhesive tape.
  7. Insert a rubber tube into one of the bottles.
  8. Use a marked tape strip to track drainage levels over time.
  9. Typical chest drainage is between 1-2 cm of fluid per hour.
  10. Secure the rubber tube to the first bottle with adhesive tape.

Three-Bottle System:

  1. The first bottle collects the drainage from the patient but does not contain water.
  2. The second bottle acts as the water-seal chamber to prevent air from entering the chest cavity.
  3. The third bottle regulates the suction pressure.
  4. The third bottle must contain at least 50 cm of sterile distilled water.
  5. The third bottle’s rubber stopper has three openings:
    • One for air exit.
    • One for suction control.
    • One for connection to the second bottle.

- Handling Pathology Specimens in the Operating Room

Required Equipment:

  • A specimen container with a wide opening
  • Formalin solution or other preservative from the pathology department
  • Identification label (patient information)
  • Pathology request form

Procedure:

  1. The sterile nurse must confirm with the surgeon whether the specimen should be placed in the container immediately or examined first.
  2. Ensure the correct description is recorded on the label as instructed by the surgeon.
  3. Use forceps to handle the specimen and place it in a kidney basin to avoid damage.
  4. Never place the specimen on cotton as it may stick and cause deterioration.
  5. The circulating nurse should transfer the specimen into the container using forceps.
  6. Ensure adequate preservative solution is added to cover the specimen.
  7. Label the container with:
    • Patient’s full name and hospital number
    • Age
    • Type of specimen
    • Date and time of collection
  8. Certain specimens require special handling, such as cultures that must be sent immediately without formalin.
  9. If cancer is suspected, avoid adding formalin and send the specimen promptly to the lab.
  10. The surgeon must complete the pathology request form.
  11. Frozen section specimens should be sent dry, without formalin, and immediately transported to pathology.

- Disposal of Amputated Limbs

Required Equipment:

  • Plastic disposal bucket
  • Two large plastic bags
  • Patient identification tag
  • Adhesive tape

Procedure:

  1. The assisting nurse, wearing sterile gloves, carefully removes any surgical drapes covering the amputated limb.
  2. Place the limb into double-sealed plastic bags to prevent fluid leakage.
  3. Label the limb with the patient’s details (name, hospital number, and diagnosis).
  4. Ensure the surgeon signs the label before sending the limb for disposal.
  5. Extreme care must be taken when entering the information
  6. The following must be written on the patient's card:
    1. Patient's name
    2. Hospital number.
    3. Diagnosis.

    7. The surgeon signs the card. Without any notes or instructions to the lab, the card is affixed to the roll.
    8. The organ is then taken to the lab or designated department as soon as possible for disposal.
    9. The organ must not be left in the operating room, as it decomposes quickly.

- Transferring the patient in case of death from the operating unit

Procedure

1. The surgeon or anesthesiologist writes a report on the cause of death in the patient's file. The surgeon or anesthesiologist writes a report on the cause of death in the patient's file.

2. The airway is elevated if present, and no other tubes, including the infusion device and drains, are left. The airway is elevated if present, and no other tubes should be left, including the infusion and drainage devices

3. Place a cotton dressing on any wound or areas with discharge. Applying a cotton dressing to any existing wound or areas with discharge.

(So that none of the tests leave the body and are left for the pathology lab)

4. He removes all the clothes and places the body in the proper position on its back. He removes all the clothes and places the body in the correct position on its back.

5. Close the eyes and mouth and tie a gauze bandage around the chin for the head. The eyes and mouth are closed and tied with a gauze bandage around the chin for the head.

(Do not leave it open to maintain the shape of the face)

6. The body of the deceased is cleaned of any secretions. The body of the deceased is cleaned of any secretions.

7. The body is placed on the gauze sheet with a cotton pad under the anal and genital openings. The body is placed on the gauze sheet with a cotton pad under the anal and genital areas.

8. A wide dressing is applied in case of discharge from the rectum. A wide dressing is applied in case of discharge from the rectum.

9. The arms are spread beside the body. The arms are spread beside the corpse.

10. The ankles of the feet are tied with a bandage and covered. The heels of the feet are tied with a bandage and covered.

11. The body is covered after completion. The body is covered after completion.

12. The shroud is secured after being folded in the middle with adhesive tape containing the deceased's details, including the time of death. The shroud is secured after being folded in the middle with an adhesive tape containing the deceased's information, including the time of death.

(For the identification of the corpse)

13. The trolley for the morgue is requested. The trolley for the morgue is requested.

14. The body is sent to the morgue, taking into consideration the stabilization of the head and covering the body with an external sheet. The body is sent to the morgue, taking into consideration the stabilization of the head and covering the body with an external sheet.

)After two hours have passed since the death(.