DUTIES OF THE SCRUB
The scrub should anticipate the needs of the surgeons and have instruments,
sponges, sutures, and other equipment ready for use. The usual procedures are as
a. Hand the scalpel used to incise the skin (skin scalpel) to the surgeon. An
alternate method of handing a scalpel is to place it on a hand towel or in an emesis
basin. This is referred to as the "no touch" technique. Some local policies mandate this
method because it reduces the likelihood of puncturing a glove with the scalpel blade.
b. After the skin incision is made, put the skin scalpel into a basin and remove
it from the operative field onto the back table or cover the blade with a suture package.
The blade of this scalpel is considered contaminated because the skin cannot be made
sterile. The scalpel is to remain where you have placed it unless it is needed for
enlarging the incision or for making stab wounds for drainage later during the case.
c. Pass instruments and supplies to the surgeon as he needs them; handing
each instrument in the position that the surgeon will use it and in such a way that he can
grasp it easily. There is to be NO hand contact when handing instruments (see Figures
4-3, 4-4, and 4-5).
d. Remove used supplies from the operative field. Keep the Mayo tray and the
back table neat and orderly at all times. Keep the sterile field clean and dry.
Keep instruments free of blood with a moist sponge.
f. Clear the operative field of all loose sponges when the surgeon is ready to
open the peritoneum. Once the peritoneum is open, use only laparotomy tapes and
sponges on forceps.
g. Hand a threaded suture in a needle holder with the needle positioned so
that the surgeon can use it without having to shift the instrument. When you pass the
needle holder, hold the end of the longer strand of suture in your other hand to keep it
out of the surgeon's way and to prevent it from dragging over the operative area.
h. Keep a mental count of the suture needles. Do not allow needles to lie
loose on either the operative area or the Mayo table; they should be clamped in a
holder. Make sure that you receive a needle holder and a whole needle from the
surgeon in exchange for another. If part of a needle has been broken off, report this to
the surgeon immediately so that he may take appropriate measures.