Pharmacology, the Rights and Fluids

This is Unit Five of Tech in Surgery Prep. Unit Four ended with a team whose every preparation came from the anatomy. This unit turns to something else the scrub person prepares and passes: the medications and solutions on the sterile field. One rule frames the whole lecture. The scrub person does not prescribe, choose a dose, or decide whether a drug is given. The surgeon and the anesthesia provider decide that. The scrub person's part is to make sure that what is passed is exactly what was ordered and labelled. This course teaches drugs at the level of class and purpose, never doses. A worked example near the end shows what the rule looks like under interruption. By the end you will be able to explain the rights of medication handling and the transfer checkpoint. To avoid name errors. To describe the drug classes met in surgery. And to recognize allergy and other safety risks, and organize a field with several medications.

Four entries on the medications that reach the sterile field, and on the checks the scrub person makes there.

The scrub person's responsibility.

TSC 101 Medications on the Sterile Field

Medications and solutions used in surgery are often placed on the sterile field, where the scrub person is responsible for them. The scrub person receives them, labels every container and passes them to the surgeon, while the circulating nurse documents each one. A medication on the field is still a medication, under the same safety rules as any bedside.

Eight rights, and the scrub person's share.

TSC 102 The Rights of Medication Handling

Nurses follow the rights of medication administration, and the textbook lists eight: the right patient, medication, dose or concentration, route, time, documentation, reason, and patient response. At the sterile field, the checks that fall to the scrub person are mainly the medication, its strength as printed on the container, and an accurate label, so the surgeon receives exactly what was intended. The scrub person never prescribes, chooses a dose or decides whether a drug is given; those decisions belong to the surgeon and anesthesia provider.

A transfer is a checkpoint.

TSC 103 Receiving a Drug Onto the Field

A medication reaches the field from the circulating nurse, and the transfer is a checkpoint. The circulator shows the container, and both read the name, strength and expiration date aloud. The scrub person holds a sterile receiving container that is already labelled, or labels it at once. The circulator transfers without touching the field, from the side, without splashing, from a sealed, unexpired container. The scrub person keeps the original container's information available until the case ends. An unlabelled cup of clear fluid is a hazard, because several solutions look identical, so the label goes on at the moment of transfer.

Every container, every time.

TSC 104 Label Everything, Every Time

Every medication and solution on the field is labelled, including syringes, cups and basins. The scrub person writes the name and strength on each container as it is received, before anything else is drawn up. An unlabelled container found on the field is not used; it is discarded.

Three entries on the names that cause errors and the routes by which drugs are given.

Names that trick the eye.

TSC 105 Look-Alike, Sound-Alike

Some medications have names that look or sound alike, and they are a known source of errors. A national medication-safety organization lists them and recommends tall man lettering, uppercase letters within names, to tell them apart. Read every label in full, because a quick glance at the first letters is how look-alike errors happen.

Three names for one drug.

TSC 106 Names: Generic and Brand

Every drug has a chemical name, a generic name and a brand name. The generic name is the standard, universal one; the brand or trade name is chosen by the company that markets it. One generic drug can carry several brand names, so preference cards and labels should use the generic name.

How a drug enters the body.

TSC 107 Routes of Administration

The route is the way a drug is given, and the same drug can behave differently by different routes. Routes include oral, intravenous, intramuscular, subcutaneous, inhaled and topical, and in surgery a local anesthetic is often injected into tissue by the surgeon. A drug prepared for one route must never be given by another.

Six entries on the drug classes the scrub person meets in surgery, taught at the level of class and purpose.

Blocking sensation in one area.

TSC 108 Local Anesthetics

Local anesthetics block nerve signals in one area, so a procedure can be done without pain there. The anesthesia provider uses them for spinal, epidural and nerve blocks, and surgeons inject them at the operative site; some act briefly, others longer. They come in more than one strength, so each syringe's label shows exactly what it holds.

Four types, by depth.

TSC 109 General, Regional and Sedation

The anesthesia provider chooses the type to fit the patient and procedure. General anesthesia is a reversible unconsciousness, usually started intravenously and maintained with inhaled agents, with breathing supported by a machine. Regional anesthesia blocks one region: spinal into the fluid around the cord, epidural into the space around it, often through a catheter, and nerve blocks near specific nerves. Moderate sedation leaves the patient relaxed but responsive and breathing unaided. Monitored anesthesia care combines sedation and local anesthetic, and can convert to general. Under sedation or regional anesthesia, the patient may be awake and listening.

Drugs that slow clotting.

TSC 110 Anticoagulants and Bleeding

Anticoagulants and antiplatelet drugs, often called blood thinners, reduce the blood's ability to clot. Patients taking them may be told to stop before surgery, because continuing raises the bleeding risk. Whether and when to stop is the surgeon's and prescriber's decision; the team's part is to report what the patient says.

Preventing infection in advance.

TSC 111 Antibiotics in Surgery

Antibiotics given before surgery to prevent infection are prophylactic antibiotics. They are timed so the drug is already in the tissues before contamination can happen, and the timing is confirmed during the surgical safety checklist. They act on bacteria, not viruses, and overuse helps create resistant organisms.

Drugs that need extra checks.

TSC 112 High-Alert Medications

High-alert medications carry a heightened risk of significant harm if used in error. Safety organizations publish lists of them, and facilities set written processes, such as extra checks, for handling them. Anticoagulants and opioids are among the drug types on such lists, so extra care with them is expected.

Keeping the patient warm.

TSC 113 Warmed Fluids and Irrigation

Irrigation fluid rinses the surgical site, and warmed fluids help prevent heat loss. Warmed intravenous fluids, warmed irrigation and warmed insufflation gases are active warming methods, and the circulating nurse documents wound irrigation. Large volumes of cool fluid can chill the patient's core, so fluid temperature is part of safety.

Seven entries on allergy and reaction, regulated drugs and blood, then two worked examples. The opening rule is paid off at the first.

When contrast causes a reaction.

TSC 114 Contrast Agents and Allergic Reactions

Contrast agents make structures show on imaging, and some contain iodine, which can cause allergic reactions. The risk is identified beforehand by asking about allergies, including reactions to iodine-containing products; the textbook notes that shellfish allergy is now thought to relate to fish protein rather than iodine, so the history matters more than assumption. Signs such as itching, burning, hives or swelling are watched for. If a reaction occurs, the injection stops and the anesthesia provider or physician is alerted at once, then the reaction is documented. The scrub person may be first to see hives spreading under the drapes, and says so immediately.

Allergies, confirmed and spoken.

TSC 115 Allergies Before Anything

Allergies are confirmed before any medication or product is used, and stated aloud at the time out. Common surgical triggers include some anesthetic drugs, latex, antibiotics, iodine-containing products and blood products. An allergy missed beforehand can surface mid-case, so new signs are reported, not explained away.

A rare and dangerous reaction.

TSC 116 Malignant Hyperthermia and Its Antidote

Malignant hyperthermia is a rare inherited reaction to certain anesthetic drugs that can quickly become fatal. It is triggered most often by inhaled anesthetics and some muscle relaxants. Its specific antidote is dantrolene, kept with cooling supplies on a dedicated cart. A family history of a bad reaction to anesthesia is worth reporting before the case.

Drugs regulated by law.

TSC 117 Controlled Substances

Controlled substances are regulated by federal law because of their potential for abuse and dependence. They are placed in five schedules. Schedule One drugs have the highest abuse potential. Schedule Two is the most controlled class in medical use; it includes opioids, whose prescriptions are tightly regulated and cannot be refilled. Schedules Three and Four carry progressively lower potential, and Schedule Five the least. Facilities add rules for storing, counting and disposing of them. Opioids, used in nearly every anesthetic, are handled by the anesthesia provider and nursing staff, and any controlled substance on the field is labelled and accounted for.

When bleeding is heavy.

TSC 118 Fluids and Blood Products

When bleeding is heavy, the anesthesia provider may give intravenous fluids or blood products. Before a transfusion, the anesthesia provider and circulating nurse perform a mandatory two-person check of the product against the patient. Some patients decline blood products for religious reasons, a choice the team knows before the case begins.

Two clear syringes.

TSC 119 Two Syringes, One Label

A worked example, constructed for this course, pays off the opening rule. Jordan, the scrub person, draws a local anesthetic into a syringe, then fills a same-size syringe with saline when the surgeon asks. A clamp request interrupts the labelling, and both clear syringes end up side by side, only one labelled. Later the surgeon asks for the local. Jordan believes the labelled one is right, but cannot be certain the labels were not swapped, and cannot tell the unlabelled one by looking. Jordan says so, discards both, and asks for a fresh transfer, labelled at once. It costs two minutes. From then on, Jordan labels every syringe the moment it is filled. Doubt means discard and start again, because a wrong drug can cost a life.

Five items, one orderly field.

TSC 120 A Field With Five Medications

A worked example, constructed for this course, follows Ana on a shoulder case with five items on the card: two local anesthetics of different strengths, warmed saline, sterile water, and a marking dye. She confirms the patient's allergies with the circulating nurse. Each item is read aloud on arrival and labelled at once with its generic name and strength. Ana places them in a fixed order of use, with the two local anesthetics separated so their syringes never sit together. When she passes the local, she reads the label aloud. Near the end, she tells the circulator how much of each was used, and leftovers are discarded under policy. Her habits are small, take no extra time, and leave nobody guessing what a container holds.

Look at what you can now do. You can explain the rights of medication handling, the scrub person's share of them, and why a transfer is a checkpoint with a label applied at once. You can avoid look-alike errors, use generic names, and keep each drug to its route. You can describe local and general anesthesia, sedation, anticoagulants, antibiotics, high-alert drugs and warmed fluids, by class and purpose. And you can recognize reactions, malignant hyperthermia, controlled-substance rules and blood-product checks, and organize a field with several medications. Unit Six turns to sterilization: how an instrument becomes safe to enter a patient.