Q. CST intraoperative tasks

With the advent of robotic surgery, the tasks that a Certified Scrub Technologist perform seem to have been expanded. Often times those tasks are no different then usual, but when the surgeon is not at the bedside scrubbed in but at a robotic console, is there a difference? Some of the confusion seems to stem from the definition of “under the direct supervision of the surgeon” and that “the surgeon is immediately available”. What are you doing in regards to this expansion of tasks? Can the CST operate an internal stapling device on an open procedure with the surgeon standing next to them and holding the tissue to be approximated? Is that any different then the surgeon sitting at a console and holding the tissue to be stapled with the clamps of a robot?
A: I would submit that some definitions need to be made and then the scope of practice defined.
CST – Certified SURGICAL Technologist
CSFA – Certified Surgical First Assistant
CSA – Certified Surgical Assistant
SA-C – Surgical Assistant – Certified

Three of these have specific training to their certification to manipulate tissue and to assist a surgeon in an operative role to including but not limited to suturing, stapling, knot tying, cutting tissue and use of electrocautery. The other one does not.

I would argue that Certified Surgical Technologists (CST) should not be placed in a position to work outside their scope of practice. The tasks to assist at the robot are clearly within the scope of practice, assuming the specialized training with the robot, of the surgical assistants.

A: Does anyone have OTC staff? Certified Orthopedic Technologist, or OT Orthopedic Tech’s not certified that scrub in on surgeries?

A: We have had a few but we require proof of training from either a surgical technologist program or previous surgical experience in which they have competence in sterile technique, scrubbing, etc.

A: From the Association of Surgical Technologists website – job descriptions:

The following description of the surgical technologist has been approved by the American College of Surgeons and the Association of Surgical Technologists:

Scrub Surgical Technologist

The scrub surgical technologist handles the instruments, supplies, and equipment necessary during the surgical procedure. He/ she has an understanding of the procedure being performed and anticipates the needs of the surgeon. He/she has the necessary knowledge and ability to ensure quality patient care during the operative procedure and is constantly on vigil for maintenance of the sterile field. Duties are as follows:

  1. Checks supplies and equipment needed for surgical procedure
  2. Scrubs, gowns, and gloves
  3. Sets up sterile table with instruments, supplies, equipment, and medications/solutions needed for procedure
  4. Performs appropriate counts with circulator prior to the operation and before incision is closed
  5. Gowns and gloves surgeon and assistants
  6. Helps in draping sterile field
  7. Passes instruments, etc., to surgeon during procedure
  8. Maintains highest standard of sterile technique during procedure
  9. Prepares sterile dressings
  10. Cleans and prepares instruments for terminal sterilization
  11. Assists other members of team with terminal cleaning of room
  12. Assists in prepping room for the next patient

Circulating Surgical Technologist

The surgical technologist assisting in circulating obtains additional instruments, supplies, and equipment necessary while the surgical procedure is in progress. He/she monitors conditions in the operating room and constantly assesses the needs of the patient and surgical team. Duties are as follows:

  1. Obtains appropriate sterile and unsterile items needed for procedure
  2. Opens sterile supplies
  3. Checks patient’s chart, identifies patient, verifies surgery to be performed with consent forms, and brings patient to assigned operating room
  4. Transfers patient to operating room table
  5. Assesses comfort and safety measures and provides verbal and tactile reassurance to the patient
  6. Assists anesthesia personnel
  7. Positions patient, using appropriate equipment
  8. Applies electrosurgical grounding pads, tourniquets, monitors, etc., before procedure begins
  9. Prepares the patient’s skin prior to draping by surgical team
  10. Performs appropriate counts with scrub person prior to the operation and before incision is closed
  11. Anticipates additional supplies needed during the procedure
  12. Keeps accurate records through out the procedure
  13. Properly cares for specimens
  14. Secures dressings after incision closure
  15. Helps transport patient to recovery room
  16. Assists in cleaning of room and preparing for next patient

Second Assisting Technologist

The second assisting surgical technologist assists the surgeon and/or first assistant during the operative procedure by carrying out technical tasks other than cutting, clamping, and suturing of tissue. This role is distinct from that of the first assistant and may, in some circumstances, be performed at the same time as the scrub role. Duties include but are not exclusive to the following:

  1. Holds retractors or instruments as directed by the surgeon
  2. Sponges or suctions operative site
  3. Applies electrocautery to clamps on bleeders
  4. Cuts suture material as directed by the surgeon
  5. Connects drains to suction apparatus
  6. Applies dressings to closed wound

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Q. ColorCoded tape for instrumentation

Do you use color-coded tape on instrumentation for tracking? Do you know of any specific issues with the use of color-coded tape?
A: Tape harbors organisms.

A: Could someone give me a reference for this. I don’t disagree, I just need some validation. Thanks!

A: Tape chips, cracks and leaves an adhesive residue on instruments. And it harbors itty-bitty bugs.

A: I would like the references for this as well. I need supporting documentation to change practice. I really need references for where I can find recommendations on not using color coded tape and dipping. I am searching my AAMI book but I cannot find that. Please let me know if you know where I can find this information.

A: If you go to the AST website see recommended standards for decontamination of surgical instruments. Standard XIII, sections 1-5, deals with this issue. Hope this helps.