(7) Once the anesthetist begins his work with the patient, you are to be
available only to the anesthetist until the patient is anesthetized. During the induction
stage of anesthesia, stay beside the patient and assist the anesthetist if necessary.
During the induction of anesthesia, do not touch the patient. Also, be as quiet as
possible. Hearing is one of the last senses to dissipate during induction. Noise is
accentuated for the patient during this time and even minor noise will increase his
b. Assist in placing the patient in the position for surgery after the anesthetist
indicates this is to be done.
c. Arrange the sheet covering the patient so that the operative area is
exposed. Do not expose the patient more than is necessary. Assist the surgeon with
the skin preparation, if necessary. Position a kick bucket so that it is convenient for the
surgeon when he is discarding sponges and other material.
NOTE: The surgeon may request the circulator to perform the preoperative skin
PERFORMING PREOPERATIVE SKIN PREP
a. After the patient is anesthetized and positioned on the operating room table,
the preoperative skin prep is done by the surgeon, assistant surgeon, or circulator. This
means the skin of the operative site and an extensive area round the site is
mechanically cleansed again with an antiseptic solution prior to draping. A sterile skin
prep tray is opened on the prep table. Usually, the prep tray is disposable, but the prep
tray always contains two or more towels, small basin for solutions, sponges (these
sponges must not be confused with the counted sponges on the instrument tray), and
b. Expose the skin area to be cleaned by folding back the sheet. Double-
check the operative site and procedure against the patient's chart and operative permit.
c. Place sterile towels above and below the operative area to isolate the area
and to protect gloved hands while performing the prep.
Don surgical gloves using the open method as follows:
(1) Make sure the glove package has not been contaminated (torn, etc.)
and that the gloves are the proper size. Place the package on a clean, dry surface.
(2) Peel back the outer wrapper.
(3) Remove the inner package and place it so that the end marked "cuff" is