Surgical packs include wrapped collections of sterile drapes, gauze sponges, instruments and other materials often laid out on fenestrated pans. Technicians prepare and sterilise packs for surgery, then store them until needed. Sterilisation occurs through application of pressurised steam in an autoclave, or if low-temperature sterilisation is needed, through gas or plasma sterilisation.
Surgeon's preferences dictate specific packing procedures, however, basic principles apply to all cases. Proper pack preparation is critical to safe and efficient surgery. Pack contents should be clean, organised and easy to unpack.
- Skill level:
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Things you need
- Surgical instruments
- Fenestrated pan (pan with multiple large perforations)
- Ultrasonic instrument cleaner
- Enzymatic surgical instrument cleaning solution
- Surgical equipment lubricant
- Gauze sponges
- Surgical drapes
- Sterilisation indicator strip
- Heat-sealing plastic or paper/plastic pouches
- Nonwoven polypropylene fabric wrap
- Tyvek and Mylar pouches
- Lint-free towel
- Cotton surgical towel
- Square muslin towel
- Paper surgical drape
- Sterilisation indicator tape
- Sharpie pen
Clean and dry surgical instruments and collect other materials for the pack. Use an ultrasonic instrument cleaner after washing instruments, or hand wash with enzymatic surgical instrument cleaning solution. All debris and rust should be eliminated through cleaning. Use neutral pH cleaning solution to prevent instrument staining.
Lubricate instruments as needed. Use surgical lubricant made specifically for this purpose. Allow instruments to dry.
Count all instruments, gauze sponges, suture needles, and other materials prior to loading the pack. Counts will be repeated after surgery to ensure nothing is unintentionally left inside the patient.
Place individual or small collections of instruments in a heat-sealing plastic or paper/plastic pouch. If plasma sterilisation is planned, nonwoven polypropylene fabric wrap or Tyvek and Mylar pouches are used. These packs are ready for sterilisation.
Arrange larger packs according to surgeon's preference. If using a fenestrated pan, place lint-free towel on pan prior to adding instruments and other materials.
Create space between instruments for circulation of steam or gas. Open all box lock instruments, and if possible disassemble multi-part instruments. Open any containers and place with open end up or sideways; if stacked, separate containers with towels or sponges. Flush water through instruments with lumens before steam sterilisation so that water will vaporise during the process.
Place instruments in order so that those needed first during surgery will be on top of the pack. Stack or align like instruments remembering to allow for circulation. Place suture needles and surgical sponges in an easily accessible area of the pack, and place accordion-folded surgical drapes on top of instruments. Place an indicator strip deep in the pack so adequacy of sterilisation can be evaluated.
Place a larger pack on a cotton surgical towel and fold the towel over the top of the pack. Using a "cross over" method, prepare for a first outside wrap by placing the pack on a square muslin or paper surgical wrap in a diagonal orientation. Use nonwoven polypropylene fabric wrap for plasma sterilisation. Fold the near corner over the pack, then fold the tip of the corner back so that it can be easily accessed. Fold the adjacent left and right corners over the pack in similar fashion, then fold the far corner in similar fashion and tuck into the pocket made by the other corners to make a tight wrap.
Alternatively, use a "longitudinal fold" method with wraps at least two to three times longer than the pack. The pack is placed square with wrap, and the wrap is folded over the pack from the top and bottom, using an accordion fold to align the edges of the wrap with each other along the midline of the pack. The extended ends of the wrap on the left and right sides are then folded over the pack and secured with tape.
Repeat step six with a second wrap, then secure with heat sensitive indicator tape. Label the pack on the tape with the date of sterilisation and type of instrumentation. The pack is ready for sterilisation.
Tips and warnings
- Acceptable storage time after sterilisation varies by storage method. An outside sealable dust cover will extend pack storage time.
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