Setting Up a Laparotomy

In practice

The preference card lists a major laparotomy set, a basic pack, sponges, laparotomy pads, sutures for fascia and skin, an electrosurgical pencil, suction tubing with a Yankauer and a Poole, and warm saline. Lee, the scrub person, checks each package with the circulating nurse. The back table pack is opened first. After scrubbing, gowning and gloving, Lee receives the instrument set and checks its internal indicator before lifting anything out. Lee arranges the back table in sections in the order of use: drapes and towels at one end, then the instruments in families, then suture grouped by layer, from fascia to skin. Sponges and laparotomy pads go in their counted multiples at the edge where they can be seen. The circulator pours warm saline into a basin and sterile water into another; Lee labels both at once. A needle counter sits beside the suture. The Mayo stand gets what the first steps need: a knife for the skin, a second knife, toothed forceps, curved Mayo scissors, a few hemostats, sponges, the electrosurgical pencil in its holster, and the suction. Lee and the circulator do the initial count of sponges, sharps, small items and instruments against the tray list. Then Lee runs the pre-patient check: indicators passed, count recorded, everything labelled, needles contained, lines ready to pass off. The patient enters a room whose field is ready.