2.4 Intraoperative Nursing Care
The intraoperative period is a critical phase in the client’s surgical journey, encompassing the time from when the client is wheeled into the operating room until they are transferred to the Post-Anesthesia Care Unit (PACU), Same-Day Surgery Suite, or Intensive Care Unit (ICU) following the surgical procedure. See Figure 2.5[1] for an image of intraoperative care. During this phase, nurses play a pivotal role in ensuring safety, promoting well-being, and advocating for the client.
In the intraoperative environment, nurses perform a wide range of essential tasks to provide comprehensive care to clients undergoing surgery. Nurses in the intraoperative environment must be highly skilled, detail-oriented, and capable of working efficiently in a fast-paced and high-stress setting to ensure the best possible outcomes for their clients.
One of the primary safety goals of nursing staff during the intraoperative period is to maintain a vigilant, safe, and controlled environment. They work collaboratively with the surgical team to confirm the client’s identity, verify the surgical site through a “time-out” procedure, and ensure all necessary equipment and supplies are readily available.
The surgical time-out is a safety procedure that includes a purposeful pause before all surgeries begin. It is performed to address one of The Joint Commission’s National Patient Safety Goals to reduce mistakes in surgery. During the surgical time-out, the entire operating room team reviews the client’s identity, the procedure, and the location of the surgical site to prevent wrong-site, wrong-procedure, and wrong-person errors. The time-out is also a time designated for team members to voice any concerns about the client’s safety or the procedure.[2],[3]
Monitoring
Nurses assist with continual monitoring and documenting of the client’s vital signs, anesthesia levels, and responses to the surgical intervention and assist with identifying the development of potential complications.
Ensuring adequate ventilation and oxygenation during surgery are essential for preventing respiratory complications and maintaining client safety throughout the intraoperative period. The nurse collaborates closely with the anesthesia provider to address any signs of hypoventilation promptly. Nurses continuously monitor the client’s vital signs, including heart rate, blood pressure, oxygen saturation, and respiratory rate, as well as the client’s breathing pattern and end-tidal carbon dioxide (ETCO2) levels, to detect any deviations from normal and to promptly address any changes to prevent hypoventilation. These assessments are typically documented every five minutes to detect any deviations from the baseline.[4]
Intraoperative Nursing Interventions
Intraoperative nursing interventions play a critical role in ensuring the safety and well-being of clients undergoing surgical procedures. Throughout the intraoperative period, nurses are actively involved in a range o