Place sterile articles on a dry, sterile surface.
Moisture will contaminate the articles.
Only the top portion of a draped instrument
stand should be considered sterile. Sterile
gloves must be used in this area. Any portion of
the wrap hanging over the edge of the stand is
If an instrument becomes contaminated,
discard it immediately.
If a delay occurs in the procedure, the scrub
assistant should cover all unwrapped packs
with sterile drapes.
All sterile articles set out for a procedure must
be cleaned and sterilized or disposed of after
the procedure is completed. This pertains to
articles that were not used.
Never reach behind another draped member of
the surgical team.
Always keep your hands above your waist.
Always face the draped patient and the other
members of the surgical team. If it becomes
necessary to pass another draped member of
the team, pass back to back.
Always pass an unsterile object in the
operating room with your back toward the
object. Unsterile objects include chairs, desks,
cabinets, and similar items.
INSTRUMENT SETUP AND MATERIALS
It is critical that you establish and maintain a sterile
field when preparing for a surgical procedure. A scrub
assistant must have on sterile gloves when a sterile
surgical tray is opened for a surgical procedure. The
corners of the wraps are carefully unfolded and
allowed to drape over the surface where the tray is
positioned to provided a sterile field. The instruments
and materials should be arranged in the sequence in
which they are most commonly used during the
procedure. This expedites the exchange of instruments
between the scrub assistant and the dentist, and avoids
searching the tray for an out-of-place instrument.
Once instruments are used, they should be returned to
their proper location whenever possible. Both the
scrub and circulating assistants should know all the
surgery instruments to be used by name, number,
purpose, and sequence of use.
As part of the preparation, the scrub assistant must
assemble several items on the tray setup, such as
Figure 5-57 illustrates a tray setup for a complex or
impacted surgical extraction. Please note that all the
instruments shown in figure 5-57 may not be in the
same setup that you may use at your command. The
surgical tray setup should be kept covered with a sterile
towel until the procedure begins.
Some of the more common post-operative
procedures that the dentist may direct you to perform
include control of bleeding, post-surgical instructions,
and suture removal.
CONTROL OF BLEEDING
After an extraction, place a moistened pressure
pack made of folded, sterile gauze squares over the
socket (fig. 5-58). It is important that this pack stays in
place to control bleeding and encourage blood clot
formation. Instruct the patient to keep the pack in place
for at least 30 minutes to an hour. Warn the patient that
removing the compress too soon will disturb blood clot
formation, and may increase the tendency of
hemorrhage and delay healing. Give the patient extra
gauze to place an additional pressure pack if
hemorrhage has not stopped after the original pack is
removed. Advise the patient to limit activity and avoid
strenuous work or exercise for a few days after surgery
to avoid hemorrhage at the surgical site.
Post-surgical instructions to patients are important
guidelines that they should follow to prevent
complications and unnecessary discomfort. In many
instances, the dental assistant may be responsible for
giving the post-surgical instructions to the patient. It is
advisable to discuss these instructions with the patient
after the surgery to prevent confusion. If a patient is
sedated, verbal instructions must be given to the
patient before the sedation and to the patient's escort.
In either case, the patient should be given a printed
copy of the instructions to review after leaving the
dental clinic. Patients tend to forget verbal
instructions, especially when they are given right after
anesthetic syringes, scalpel and blade, irrigation
syringe and tip (or bulb syringe if used), surgical
suction tip, and handle with tubing. First, the
circulating assistant fills the metal cup with sterile
saline. After that the scrub assistant fills the irrigation
syringe from the cup.