Case Four: A Total Knee Replacement

In practice

The implant system for the case arrives from the vendor on several trays. Casey, the scrub person, checks each tray's sterility indicators and counts the instruments against the tray lists with the circulating nurse. The patient is identified, and the surgeon has marked the operative knee. At the time out, the team confirms the side, and that the implants and the special equipment are in the room. Casey sets up the powered saw and drill, inspecting each one before use and setting it up only as its manufacturer directs. During the case, the surgeon uses cutting guides with the saw and prepares the bone with the saw, drills and reamers. Casey keeps the heavy instruments organized and returns each one to its place after use. When the surgeon confirms the type and size of each implant, the circulating nurse reads each implant's label aloud, Casey confirms it, and the final implants are opened only then. The implant stickers go into the record, so each implant can be traced to the patient. Before each implant is opened, Casey and the circulating nurse check its package for damage, moisture and the expiration date. The wound is irrigated, closed in layers, and dressed. At the sign-out, the counts, including the trays' counts, are confirmed correct.