Align-ju STUDENT
Box 2
Halsted ' s principles of surgical technique [ 12 ]
• Gentle tissue handling
• Control of haemorrhage
• Preservation of blood supply
• Asepsis
• Minimisation of tissue tension
• Accurate wound apposition
Figure 5. Draping the patient using the four-quarter technique.
Running the kit trolley
Running the kit trolley is an important task for the scrub nurse as it will help the VS perform the surgery as efficiently as possible. The scrub nurse can assist in the following ways:
• Keep all the instruments on the trolley clean and organised. This will help to reduce the surgical time and anaesthesia time for the patient, as instruments will be easy to find and pass quickly
• Pass instruments to the VS. It is important to pass instruments handle first and handle them confidently, so they are ready to be used by the VS straight away and to reduce the risk of an instrument being dropped
• Follow the surgery and prepare the instruments and equipment required for the next steps
• Ask the circulating nurse for more surgical equipment, such as more swabs or suture material
• Dispose of used swabs or empty packets into the kick bucket to keep the trolley clean
• Perform swab, sharps and instrument counts with the circulating nurse at the end of surgery in preparation for wound closure and the check-out step of the surgical safety checklist.
During the surgery
The scrub nurse must follow the surgery step by step to ensure that they prepare the correct instruments and assist the VS when needed. When assisting the VS as the surgical assistant, the scrub nurse must follow Halsted ' s principles to ensure good tissue handling and minimal tissue damage( Box 2) [ 12 ].
• Elimination of dead space
The surgical process
1. A longitudinal incision is made on the ventral midline with a scalpel blade [ 2 ]. Swabs and electrocautery can be used to provide haemostasis at this stage. The scrub nurse can assist the VS by passing the scalpel blade and using a swab to firmly dab any bleeding.
2. The VS dissects through the tissue, including the linea alba, fat, fascia and muscle, into the abdominal cavity using Metzenbaum or Mayo scissors, with Adson forceps to hold the tissue. The scrub nurse can help provide haemostasis and keep the surgical field clear for the VS.
3. When the abdominal cavity is entered, if there is any free abdominal fluid, the scrub nurse may need to use suction to keep the surgical field clear for the VS to continue.
4. A large amount of falciform fat may be present, which the VS can remove with electrocautery to help give a clearer view of the abdominal contents.
5. Abdominal retractors, such as Balfour retractors, can be placed to open the abdomen. The scrub nurse can assist the VS with this process by providing damp laparotomy swabs to be placed either side of the skin incision, and helping to ensure the retractors do not compress the abdominal contents.
6. Now the VS has a good view of the abdomen, the intestines can be exteriorised where possible, and a systematic search of the whole intestines can be performed. The scrub nurse can assist by gently holding parts of the intestines to allow the VS a clear view of other sections.
Volume 41( 5) • October 2026
57