Setting Up the Back Table and Mayo Stand

This is Unit Fourteen of Tech in Surgery Prep. Unit Thirteen ended with every part of a retractor counted on its own. This unit builds the field those instruments sit on: the back table and the Mayo stand. Carry one idea through this lecture. A sterile field that is not watched is considered contaminated, because no one can say what touched it, however clean it looks. A worked example near the end shows a scrub person who trusted the rule over appearances. By the end you will be able to plan a setup from the card and open sterile items correctly. To arrange the back table and Mayo stand and do the initial count. To keep the field sterile, watched and labelled. And to check the setup before the patient arrives.

Six entries on planning the setup and opening sterile items without contaminating them.

Planned before opened.

TSC 326 Setting Up Is Planning

Setting up the sterile field is the scrub person's first major task, planned before anything is opened. The scrub person reviews the card, helps gather supplies, then arranges instruments and supplies in a logical order for the case. A hurried setup with no plan usually means searching for items mid-case.

Working from the card.

TSC 327 Gathering Supplies From the Card

Supplies are gathered from the preference card before the room is opened. Confirm the surgeon, procedure and scheduled case match the card. Gather the sets and check their labels; the supplies to open; the supplies pulled but left unopened unless needed; the sutures, medications and solutions; and the equipment and positioning devices. Anything missing goes to the circulating nurse first. The card is a guide, not a guarantee, so if the procedure or plan has changed, ask before opening supplies.

The first sterile surface.

TSC 328 Opening the Back Table Pack

The back table pack is opened first and creates the surface the setup is built on. Open the far flap away from you, then each side, then the near flap toward you, never reaching over the opened field. The pack's outside and edges are not sterile, so only the inner surface is the field.

Opening without touching.

TSC 329 Opening Sterile Items to Yourself

Sterile items are opened so their contents touch nothing unsterile, including their own packaging. Inspect every package first. Open a wrapped item like a pack, holding the flaps back. Open a peel pouch by pulling the sealed edges apart, thumbs parallel to the seal. Small items may be dropped onto the field from about six inches, and heavy or irregular items are held for a gloved person to take. Anything that slides against the edge of a pouch as it is presented is contaminated and set aside.

Taking items from the circulator.

TSC 330 Receiving Items From the Circulator

Once the scrub person is gowned and gloved, the circulating nurse opens items and presents them. The circulator holds the package open so the contents lift out without touching it, and the scrub person takes the item cleanly. If either thinks it touched something unsterile, it is not used.

Pouring solutions.

TSC 331 Solutions on the Back Table

The circulating nurse pours sterile solutions into basins on the back table. Only sealed, unexpired solutions are used, poured from the side, from about six inches, without splashing, and labelled at once. A splash can wick microbes through a drape, so a splashed area is treated as contaminated.

Six entries on arranging the back table and Mayo stand, the basins, the initial count, and suture and sponges.

A table anyone could read.

TSC 332 Arranging the Back Table

A well-arranged back table keeps everything organized, visible and in reach. Keep items in easy reach and clear view, and the surface tidy. Keep counted items where they can be seen, such as sponges in their multiples. Keep needles contained in a counter, their package or a needle holder. Give sharps a defined place, consistent with the neutral zone. Place heavy instruments away from delicate ones, and label every medication and solution. Many arrange the table in order of use. The test is whether someone else could step in and find everything.

The stand nearest the patient.

TSC 333 Setting the Mayo Stand

The Mayo stand is nearest the operative site and holds what the surgeon will need soonest. It carries the first steps' instruments and supplies, is refreshed from the back table as the case moves on, and is included in the counts. Keep look-alikes apart, so a hurried hand reaches the right one.

What basins are for.

TSC 334 Basins and Their Uses

Sterile basins hold solutions such as saline for irrigation and for keeping sponges moist. A basin of saline on the field also gives a quick way to put out a small fire, as the fire guidance advises. Every basin's contents are labelled, because clear fluids look alike.

The baseline count.

TSC 335 The Initial Count at Setup

The initial count, before the procedure begins, establishes what is on the field. The scrub person and circulating nurse count sponges, sharps, small items and instruments aloud together, checking instruments against the tray list, and the circulator records it. A careless initial count makes every later count unreliable.

Suture ready in time.

TSC 336 Preparing Suture Before It Is Needed

Suture is prepared before it is asked for, following the card and the surgeon's plan. Needles are counted by the number marked on the package, verified when it is opened, and kept contained. Open suture as it is likely to be needed, not all at once, so needles stay controlled.

Sponges for the wound.

TSC 337 Preparing Sponges

Sponges for use inside the wound are X-ray detectable, separated one by one, and counted before use, in their standard multiples. A package with the wrong number is removed and isolated. Sponges are never cut, and their marker tapes are never removed.

Six entries on keeping the field sterile, watched and labelled, and on opening only what the case needs.

Unopened until needed.

TSC 338 Opening Only What Is Needed

Supplies that may or may not be used are pulled into the room but left unopened. Cards often separate what is opened before the case from what waits until needed, which reduces waste. Anything opened onto the field must be counted or accounted for, so opening extra adds work at the end.

Rules that start at setup.

TSC 339 Sterile Technique Throughout Setup

Every rule of sterile technique applies during setup. Keep the field in view, never reach over it, keep gloved hands above the waist and in sight, and never turn your back on it. A setup contaminated before the patient arrives contaminates the whole case.

Everything that holds something.

TSC 340 Labeling the Field

Everything on the field that holds a medication, solution or specimen is labelled. Medication containers and syringes get the name and strength on arrival. Every solution container is labelled, saline and water included, because they look like other clear fluids. Specimen containers are labelled before specimens leave the field, and read aloud at the end. Labels are placed where they can be read in use, and an unlabelled container is discarded. In a long case, the person who filled a syringe may not be the one who passes it.

A field that is watched.

TSC 341 Keeping the Field in View

A sterile field that is not watched is considered contaminated, because no one can say what touched it. The scrub person faces the field, and if it must be left unattended, facility policy decides whether it can still be used. Turning your back on a sterile field breaks its sterility.

Close to the time of use.

TSC 342 Set Up Close to the Time of Use

Sterile items open to the air gradually become contaminated, so fields are set up close to the time of use. The national guideline notes that the longer an item is exposed to air, the more microorganisms settle on it. A field opened long before the case and left waiting is gathering contamination.

Supplies close at hand.

TSC 343 Extra Supplies Within Reach

Supplies the case might need are kept in the room, unopened, to be added quickly. The circulating nurse follows the case and opens more when the scrub person or surgeon asks. Ask early, so the circulator has time to find the item before the need is urgent.

Two entries on the final check and late additions, then two worked examples. The opening idea is paid off at the last.

Six checks before the patient.

TSC 344 Checking the Setup Before the Patient Arrives

Before the patient arrives, the scrub person checks the setup. Every opened set's internal indicator passed. The initial count is done and recorded. Every medication and solution is labelled. Needles and sharps are contained, with a place for the neutral zone. Suction and electrosurgical connections are ready to pass off. And the setup matches the card and the scheduled procedure. Fix anything now, while the room is quiet, because once the patient is in, attention moves to the patient.

Counting what arrives later.

TSC 345 Late Additions to the Field

Items added after the initial count are counted as they arrive and added to the record. The scrub person and circulating nurse count each added package aloud, separating sponges one by one, before use. The busiest moment of a case is when additions are most often miscounted.

A laparotomy setup.

TSC 346 Setting Up a Laparotomy

A worked example, constructed for this course, follows Lee setting up for an open abdominal operation. Each package is checked with the circulator, and the back table pack is opened first. After gowning and gloving, Lee checks the set's internal indicator before lifting anything. The table is arranged in order of use: drapes and towels, instruments by family, suture by layer, sponges in counted multiples at the edge. Saline and water are labelled at once, with a needle counter by the suture. The Mayo stand holds the first steps, the pencil holstered. Then the initial count, and the pre-patient check. The layout is one way among many; what makes it safe is the habits underneath.

A field left alone.

TSC 347 A Setup Interrupted

A worked example, constructed for this course, pays off the opening idea. Halfway through a knee replacement setup, Lee is called out urgently, gowned and gloved, and so is the circulating nurse. For several minutes nobody watches the field. When Lee returns, it looks untouched, and the first thought is that it is probably fine. The second thought is the rule. Lee tells the circulator the field was left unattended and asks what policy requires: break it down and set up again. New sets are opened, at a cost of about twenty minutes. The team agrees that next time someone stays, or the field is covered as policy directs. Contamination is invisible, which is why the rule beats appearances.

Look at what you can now do. You can plan a setup from the preference card, open the back table pack and sterile items correctly, and receive items and solutions cleanly. You can arrange a back table someone else could read, set the Mayo stand, label basins, do the initial count, and prepare suture and sponges. You can open only what is needed, keep sterile technique through setup, label everything that holds something, and keep the field watched and timely. And you can check the setup before the patient arrives, count late additions, and treat an unwatched field as contaminated. Unit Fifteen turns to the patient: safety, transfer and positioning.