b. Preparation of the Operating Room.
(1) The setup of sterile instruments and other equipment is done as
prescribed locally. Gauze packing is included for use as a pressure dressing.
(2) The room is darkened before the patient arrives. The surgeon usually
uses an electrical head lamp that will focus a beam into the nostrils. The circulator is to
connect and carefully check all special lighting equipment prior to the start of the
(3) This operation is generally done with the patient under local and/or
topical anesthesia. Before the patient arrives, the operating table is made into a
reclining chair by use of a foot-piece and pillows placed for protection of feet from
pressure and relief of strain on vessels and tendons of the lower extremities. The
reclining chair is adjusted to meet the physical characteristics and comfort of the patient.
The table is raised or lowered to accommodate the surgeon.
c. Preparation of the Patient.
(1) In some cases, the hair of the nostrils may be clipped with fine, curved
scissors. Sterile mineral oil drops or an antibiotic ointment may be put in the eyes of the
patient to protect them from prepping solutions. The face is scrubbed with a mild soap
and water. The face prep and draping of the patient is done prior to anesthetizing. The
circulating nurse should observe changes in the vital signs of the patient. When
cocaine or some similar narcotic agent is used, a thiopental (Pentothal ) sodium setup
and oxygen equipment should be in the room. Topical medications that have
changed color should not be used. The amount of the topical agent dispensed for
the operation must be recorded on the anesthesia record and on the pharmacy's
The patient is draped with sterile towels and sheets as follows:
(a) Place the small sheet with two towels on top of it over the head of
the table and under the head of the patient.
(b) Bring the uppermost towel around the head, including the hairline.
(c) Secure the ends of the uppermost towel with a towel forceps and
tuck the free ends under the patient's head.
(d) Drape a large sheet over the patient, bringing its upper end up to
(e) Place the tray with the instruments in position for the surgeon.
Adjust the lighting system.