OPERATING ROOM EQUIPMENT FROM A To Z
When stepping into an operating room, you are entering an area of machines and equipment. Most ORs have the same standard equipment, but this can vary depending on the surgery that will take place. Each OR is staffed with a team of people who know how to use the equipment and machines in the room.
While there may be some variation in how each institution refers to different pieces of equipment, we hope you will get a good idea of the general items you will find.
Regular air won’t do for our patients in the operating room—premium gases are piped in through ceiling mounts (Figure 10.1). Air and oxygen are the two most common. Remember the colors: air is yellow (Figure 10.2) and oxygen is green.
An anesthesia supply cart (Figure 10.3) holds many of the supplies needed for every surgery. A well-stocked cart keeps equipment, from syringes to intubating equipment, at the anesthesiologist’s fingertips.
The anesthesiologist has the important role of keeping the patient asleep and keeping the patient’s pain under control during the surgery. The anesthesia machine (Figure 10.4) is the mechanical workhorse of administering anesthesia during the surgery. The anesthesiologist uses it to keep the patient safe, sleeping, and comfortable during the surgery. The anesthesia machine gives breaths to the patient while it delivers the appropriate mixture of oxygen and anesthetic gas. Until it is time to reduce the medications and wake the patient at the end of the surgery, the anesthesia machine sends information to the anesthesiologist to interpret and use.
Although the anesthesia machine looks complicated, it’s really not that scary (Figure 10.5). The three canisters in the center are the different gases used to keep the patient asleep. The gauges provide information about oxygen and air delivery while the patient is having mechanical breaths given by the ventilator. The bellows mimics the movement of the lungs as it pushes air in and allows it to come back out. The anesthesia monitor displays important information about the patient’s condition to the anesthesiologist during the entire surgical procedure (Figure 10.6).
In the OR, you will notice that we are obsessed with time (Figure 10.7). We note times of everything: in the room, to sleep, time out, when the incision is made, when the procedure ends, and when the patient leaves the room, just to name the most common ones. Counting or timing of almost any type, we can do it in the operating room.
This is the last thing you want to be searching for when you need it. The code button (Figure 10.8) can be pushed to immediately notify other OR staff that a patient is arresting and help is needed right away. Thankfully, the place is filled with anesthesiologists and surgeons, and the ones who are available typically come running in herds when this button is pushed. You will have many OR-experienced hands to help out. When a code happens, your job is to do whatever you are told. Whether that is “MOVE!” or “HOLD THIS,” help, watch, and learn, but always know where the button is.
There is a tremendous amount of electricity used in the operating room, and outlets are everywhere. The outlet boxes are heavy grade and can be moved along the floor and hung from the ceiling (Figures 10.9 and 10.10). These floor boxes are like premeditated trip lines—be cautious.
This is an electrical cutting device that, when activated by the surgeon, cuts through skin and cauterizes vessels at the same time (Figure 10.11). It requires the use of a “Bovie pad” in order to work. This pad, which looks like a large blue sticker, provides a ground for the electrical current that the Bovie sends through the patient’s body. This sticker should go on a spot on the patient that is dry, hairless, free from injury, away from the operative site, and has a healthy amount of fatty tissue (usually the thigh, buttocks, bicep—whatever you can find that is “meaty”). Location of the grounding pad and skin condition when it is removed at the end of the surgical case should be documented.
Both sterile and non-sterile gloves are kept around the operating room (Figure 10.12). Non-sterile should be used for moving patients and other tasks around the operating room. Sterile gloves come in half sizes and are made of various materials, including latex-free if you are sensitive. If you can’t find them, just ask. Double-gloving policies vary by institution—just remember that an additional layer of glove can provide one more barrier between you and getting stuck by a needle.
Even though the OR lights are bright, it can be helpful for surgeons to wear a headlight during cases where they are working in cavernous areas (Figure 10.13). The pinpoint direct light of a headlight provides better visibility. Ideally, the surgeon places the headlight on their head before scrubbing in, and the circulator plugs the cord into the light box when the surgeon is gowned, gloved, and in their operative position. These present a special challenge if the surgeon decides to move and forgets that they are plugged in.
The overhead OR lights are super-bright so the surgical field is flooded like a Friday night football game. The lights can be positioned to illuminate the surgical field, head to toe.
OR lights come in various styles, as do their controls (Figure 10.14 and 10.15). To ensure that the surgeon or others who are up at the field can maneuver them without contamination, handles are attached to the lights (Figure 10.16). When the surgeon, scrub technician, or resident are of varying heights, the handles may get bumped and contaminated. If you feel a bump against your head, speak up, because the handle needs to be changed out.
The mayo stand (Figure 10.17) functions as “instrument central.” This is the place where your scrub technician will place the primary instruments that are in use. Instruments come and go from this location and it can be tempting to reach in, take, touch, move, or hand off something. Unless given specific instructions to do so, don’t assume that the mayo is a self-service station. All instruments, needles, and sponges have to be accounted for. More hands touching counted items result in a higher likelihood of losing something (or getting stuck by something sharp, which can be very dangerous).
In modern ORs, several screens that look like TV screens hang from the ceiling and can be moved into different positions around the OR table (Figures 10.18 and 10.19). These help the surgeon during laparoscopic or microscopic surgeries. The image from the laparoscopic camera or microscope is displayed on the large-screen TV monitor.
With the procedure displayed on the overhead screen, the scrub technician can anticipate what instrument the surgeon may need next and the rest of the OR staff can see where the surgeon is in the procedure. These screens are valuable tools for teaching students and other trainees in the operating room.