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Table of Contents
Section One Section Eight
Fundamentals of Theory and Practice Pharmacology and Anesthesia
Chapter 1: Perioperative Education, 1 Chapter 23: Surgical Pharmacology, 411
Chapter 2: Foundations of Perioperative Patient Chapter 24: Anesthesia: Techniques and
Care Standards, 16 Agents, 422
Chapter 3: Legal, Regulatory, and Ethical Issues, 38
Section Nine
Section Two Intraoperative Patient Care
The Perioperative Patient Care Team
Chapter 25: Coordinated Roles of the Scrub Person
Chapter 4: The Perioperative Patient Care Team and the Circulating Nurse, 457
and Professional Credentialing, 56 Chapter 26: Positioning, Prepping, and Draping the
Chapter 5: The Surgical First Assistant, 64 Patient, 489
Chapter 6: Administration of Perioperative Patient Chapter 27: Physiologic Maintenance and
Care Services, 79 Monitoring of the Perioperative
Patient, 526
Section Three
The Patient as a Unique Individual Section Ten
Surgical Site Management
Chapter 7: The Patient: The Reason for Your
Existence, 99 Chapter 28: Surgical Incisions, Implants, and
Chapter 8: Perioperative Pediatrics, 125 Wound Closure, 542
Chapter 9: Perioperative Geriatrics, 160 Chapter 29: Wound Healing and Hemostasis, 573
Section Four Section Eleven
The Perioperative Environment Perianesthesia and Postprocedural
Patient Care
Chapter 10: Physical Facilities, 176
Chapter 11: Ambulatory Surgery Centers and Chapter 30: Postoperative Patient Care, 601
Alternative Surgical Locations, 195 Chapter 31: Potential Perioperative
Chapter 12: Care of the Perioperative Environment, Complications, 607
208
Chapter 13: Potential Sources of Injury to the Section Twelve
Caregiver and the Patient, 214 Surgical Specialties
Chapter 32: Endoscopy and Robotic-Assisted
Section Five
Surgery, 640
Surgical Asepsis and Sterile Technique
Chapter 33: General Surgery, 658
Chapter 14: Surgical Microbiology and Antimicrobial Chapter 34: Gynecologic and Obstetric
Therapy, 233 Surgery, 689
Chapter 15: Principles of Aseptic and Sterile Chapter 35: Urologic Surgery, 723
Techniques, 252 Chapter 36: Orthopedic Surgery, 755
Chapter 16: Appropriate Attire, Surgical Hand Chapter 37: Neurosurgery of the Brain and
Hygiene, and Gowning and Gloving, 267 Peripheral Nerves, 785
Chapter 17: Decontamination and Disinfection, 285 Chapter 38: Spinal Surgery, 804
Chapter 18: Sterilization, 302 Chapter 39: Ophthalmic Surgery, 823
Chapter 40: Plastic and Reconstructive Surgery, 845
Section Six Chapter 41: Otorhinolaryngologic and Head and
Surgical Instrumentation and Equipment Neck Surgery, 872
Chapter 42: Thoracic Surgery, 905
Chapter 19: Surgical Instrumentation, 328
Chapter 43: Cardiac Surgery, 923
Chapter 20: Specialized Surgical Equipment, 350
Chapter 44: Vascular Surgery, 948
Chapter 45: Organ Procurement and
Section Seven
Transplantation, 970
Preoperative Patient Care
Chapter 21: Preoperative Preparation of the Patient,
370
Chapter 22: Diagnostics, Specimens, and Oncologic
Considerations, 386
BERRY & KOHN’S
OPERATING
ROOM
TECHNIQUE
Twelfth Edition
NANCYMARIE PHILLIPS, RN, BSN, BA, MEd, RNFA, CNOR, PhD
Lakeland Community College, Department of Perioperative Education
Director and Professor
Perioperative Nursing
Registered Nurse First Assistants
Surgical Technology
Kirtland, Ohio
with 742 illustrations
3251 Riverport Lane
St. Louis, Missouri 63043
Berry & Kohn’s Operating Room Technique ISBN: 978-0-323-07358-5
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
Copyright © 2007, 2003, 2000, 1996, 1991, 1986, 1978, 1972, 1966, 1960, 1955 by
Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying, recording, or any informa-
tion storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies and our
arrangements with organizations such as the Copyright Clearance Center and the Copyright
Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by
the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Phillips, Nancymarie Fortunato.
Berry & Kohn’s operating room technique / Nancymarie Phillips.—12th ed.
p. ; cm.
Berry and Kohn’s operating room technique
Operating room technique
Includes bibliographical references and index.
ISBN 978-0-323-07358-5 (hardback : alk. paper)
I. Berry, Edna Cornelia. Introduction to operating-room technique. II. Title. III. Title: Berry and
Kohn’s operating room technique. IV. Title: Operating room technique.
[DNLM: 1. Operating Room Nursing—methods. 2. Operating Room Technicians.
3. Perioperative Care—methods. WY 162]
617’.0231--dc23
2011045407
Executive Content Strategist: Teri Hines Burnham
Senior Content Developmental Specialist: Laura M. Selkirk
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Tracey Schriefer
Project Manager: Anitha Sivaraj
Design Direction: Ashley Eberts
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To
Martin
My rock in every storm
and to
Mary Lou Kohn
An inspiration to all of us
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Clinical Consultants
Ruth Bakst, RN, BSN, RNFA, CNOR
Nursing Educator
Parma Community Hospital
Parma, Ohio;
Registered Nurse Midwife
Capetown, South Africa
Patrick Burniston, RN, BSN, RNFA, CNOR
RNFA Educator
Lakeland Community College
Kirtland, Ohio
Regina Elam, RN, CST
General Surgery
Cleveland Clinic Foundation
Cleveland, Ohio
Anita Hornacky, RN, BS, CST
Perioperative Nursing
Fairview Hospital
Cleveland, Ohio
Jennifer Kavran, RN, MSN, CNOR
Nursing Educator
Louis Stokes, Veteran’s Administration Medical Center
Cleveland, Ohio
Martin A. Phillips III, RN, BSN, CNOR, COL USAR
Chief Nurse
United States Army Nurse Corps, Reserve Component
256th Combat Support Hospital
Solon, Ohio;
Cleveland Clinic
Cleveland, Ohio
Mary Shami, CST
Surgical Technology Clinical Instructor
Hillcrest Hospital
Mayfield Heights, Ohio
vii
Reviewers
Michael D. Aldridge, MSN, RN, CCRN, CNS Janet Anne Milligan, RN, CNOR, BSed
Clinical Nursing Instructor Program Manager/Instructor
The University of Texas at Austin, School of Nursing College of Southern Idaho
Austin, Texas Surgical Technology Program
Twin Falls, Idaho
Klebe W. Brumble, RN, CNOR
Joyce T. Moyer, CST, RN
Charge Nurse
Baylor Surgicare at Ennis Department Head of Surgical Technology
Ennis, Texas Greenville Technical College
Greenville, South Carolina
Rachel Hottel, MSN, RN, CNOR
Theresa Pape, PhD, RN, CNOR
Advanced Practice Nurse, Perioperative Division
University of Iowa Hospitals and Clinics Associate Professor
Iowa City, Iowa Texas Woman’s University, College of Nursing
Denton, Texas
Jacki Lausin, RN, ST
Carolyn J. Ragsdale, CST, BS
Nurse
Lake Health and University Hospitals Surgical Technology Faculty
Mentor, Ohio Surgical Technology Program
Parkland College
Sherry M. Lawrence, MSN, RN, CNOR, ONC
Champaign, Illinois
Instructor
Victoria M. Steelman, PhD, RN, CNOR, FAAN
University of South Alabama, College of Nursing
Mobile, Alabama Advanced Practice Nurse, Department of Nursing
The University of Iowa Hospitals and Clinics
Tom Lescarbeau, BS, CST, CFA
Iowa City, Iowa
Program Coordinator, Surgical Technology
Herman Young, BS, BM, CST/CFA
McCann Technical School
North Adams, Massachusetts Program Director Surgical Technology
Oakland Community College
Colleen Lindahl, CST
Southfield, Michigan
Certified Surgical Technologist
Lakeland Community College
Kirtland, Ohio
Elizabeth A. Matos, PhD, MSN, BSN, CNE
Assistant Professor, Department of Nursing
West Texas A & M University
Canyon, Texas
viii
