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151
Surgical First Assistant: The Essentials of Practice, First Edition. Editedby JulieQuick andMarkOwen.
© 2025John Wiley & Sons Ltd. Published 2025 by John Wiley & Sons Ltd.
Note: Italicized and bold page numbers refer to figures and tables, respectively.
A
abdomen, incisions of, 54
abdominal hysterectomy, 68
absorbable agents, 72
adipose tissue, 78, 104
adjuvant unsterile dressings, 104
adult elective surgery patient, fasting
instructions for, 31
adult emergency surgery patient, fasting
instructions for, 31– 32
advanced scrub practitioner (ASP)
toolkit, 6
AHP see Allied Health Professional (AHP)
alginates, 108
Allied Health Professional (AHP), 33
alpha 2 agonists, 118, 121
analgesia, 117, 122
analgesic medicines, 118
alpha 2 agonists, 121
gabapentinoids, 120– 121
ketamine, 121
local anaesthetics, 121– 123, 122
multimodal analgesia, 118
non steroidal anti inflammatory drugs
(NSAIDs), 118, 119
opioids, 119– 120, 120
paracetamol, 118– 119
antifibrinolytics, 73
antiseptic solutions, 45, 46
arterial bleeding, 66
arterial clamps, 67– 68
artery forceps, handling, 91– 92, 92, 93
ASP toolkit see advanced scrub practitioner
(ASP) toolkit
B
beneficence, 14
bleeding, 43, 65– 67, 72, 83, 101, 106
blue book see City and Guilds’ training book
body mass index (BMI), 44, 103
Bolam test, 15
Bolam versus Friern Hospital Management
Committee, 15
bone, 79
Braden Q Scale, 30
bupivacaine, 122
C
capacitive coupling, 71
carotid incision, 54
Centers for Disease Control (CDC), 56
central sensitisation, 112, 113
certification, 5
chest, incisions of, 54
chevron incision, 54
CHG see chlorhexidine gluconate (CHG)
children, fasting instruction for, 32
chlorhexidine gluconate (CHG), 45
City and Guilds’ training book, 4
clamshell incision, 54
Clinical Frailty Scale, 31
clips
single use clips, 69
clonidine, 118, 121
communication and teamwork, 143– 145
contaminated/infected wound, 104
continuing professional development
(CPD), 8, 13
Index
152 Index
COX 2inhibitors see cyclooxygenase (COX)
2inhibitors
Cox’s (2019) approach to wound
assessment, 105
CPD see continuing professional
development (CPD)
Critical Pain Assessment Observation Tool
(CPOT), 115
‘cutting’ needle, 58
cyclooxygenase (COX) 2inhibitors, 119
D
decision making
and informed consent, 33– 35
leadership and, 145– 146
deep vein thrombosis (DVT), 29
delegation, 16
dexmedetomidine, 121
diabetes mellitus, 27
diagnostic screening, 25, 25
diathermy, 45, 52, 55, 69– 71, 96
diathermy pad, 70, 71
diathermy smoke, 71
direct thermal injuries, 70– 71
dirty dozen, 134, 135
draping the patient, 46– 47
dressings, 104, 107
alginates, 108
self adhesive absorbent dressings, 107
soft paraffin gauze, 107– 108
DVT see deep vein thrombosis (DVT)
E
‘ease and squeeze’ technique, 68
electrosurgery, 70, 71
ENB see English National Board (ENB)
English National Board (ENB), 5
epidermal growth factor, 100
epigastrin/upper midline incision, 54
EST see extended surgical team (EST)
ethical, legal and professional aspects of
SFA role, 13
autonomy, 14
beneficence, 14
case studies, 14– 19
justice, 14
nonmaleficence, 14
extended skills set of SFA, 6, 6
extended surgical team (EST), 9, 87, 88,
99, 141, 142
F
Face, Legs, Activity, Crying, Consolability
(FLACC) behavioural scale tool, 115
fascial plane blocks, 122– 123
fasting instructions
for adult elective surgery patient, 31
for adult emergency surgery patient, 31– 32
for children, 32
fatigue, managing, 146
fat tissue see adipose tissue
Favourable Event Reporting Form
(FERF) tool, 134
femoral incision, 54
FERF tool see Favourable Event Reporting
Form (FERF) tool
fibrinogen, 72, 101
fibrin sealants, 72
fires, risk of, 71
FLACC behavioural scale tool see Face, Legs,
Activity, Crying, Consolability (FLACC)
behavioural scale tool
frailty, 28, 31
functional activity scale, example of, 116
G
gabapentin, 120
gabapentinoids, 120– 121
gamma aminobutyric acid (GABA), 120
gelatin based haemostatic agents, 72
Gibson incision, 54
GORD/reflux, 28
H
haemostasis, 65, 101
clips and ties, 67– 68, 68
diathermy, 69– 71
laparoscopic and, 72
pharmacological methods, 72– 73
pressure, 66– 67, 66
single use clips, 69
suction and visual access, 67
surgical stapling devices, 69
sutures, 67
ultrasonic devices, 71– 72
handheld diathermy pencil, activation of,
70, 70
handheld retractors, 82, 88– 90
handlers, 4
HFE see human factors and ergonomics (HFE)
historical context of SFA, 3
accredited university courses, 8– 9
call for clarity over names, 7– 8
certification, 5
national accreditation, 5– 6
National Association of Assistants in Surgical
Practice (NAASP), 6
national SFA toolkit, 8
Index 153
non medical surgical assistant roles during
conflict, 3
Lewin’s report, 4
responsibilities of SFA, 9, 9
human error, 134, 135
human factors, 129
defined,129
implications of, 130– 134
patient safety incident response
framework, 136
patient safety in surgery, 133– 134
well being of SFA, 136– 137
human factors and ergonomics (HFE), 130,
131, 132, 133
hypertension, 27, 117
hyperthyroidism, 27
hypertrophic scars, 102
hypothyroidism, 27
hypoxia, 103
I
incision
assisting with, 55
instruments used for, 52– 53
knife to skin, before, 49– 51
minimally invasive surgery, 53
of neck, chest, and abdomen, 54
site and length of, 51– 52
skin marking, 53
types of, 54
indirect thermal injuries, 71
inflammation, 101– 102
infraareolar incision, 54
inframmamary incision, 54
infraumbilical incision, 54
inguinal incision, 54
inpatient pain management service, role of, 117
instrument handling for SFA, 87
artery forceps, handling, 91– 92, 92, 93
handheld retractors, use of, 88– 90
minimal access surgery, 95– 96
mounted swab, use of, 96
needle holders, 98
passive diathermy related skills, 96
practitioner with extended skills, 97
retracting away from oneself, 90, 90
retracting towards oneself, 90
skin hooks, 91
suture scissors, 92– 94, 93, 94
tissue forceps, 90– 91
toothed dissecting forceps, 97, 97
instruments used for incision, 52– 53
interdisciplinary inpatient pain team,
117, 123
K
keloids, 102
ketamine, 121
Kocher/subcostal incision, 54
Kraissl lines, 51
L
laissez faire leader, 145
Langer’s lines, 51, 52
laparoscopic instruments, 95
laparoscopic surgery, 72
LA see local anaesthetics (LA)
leadership and decision making, 145– 146
levobupivacaine, 122
Lewin’s report, 4
lidocaine, 121, 122, 122
lithotomy position, 44
Lloyd Davies position, 44
local anaesthetics (LA), 118, 121
characteristics of, 122
fascial plane blocks, 122– 123
nerve blocks, 122
neuraxial analgesia, 122
Local Standards for Invasive Procedures
(LoCSSIPS), 42
M
Malnutrition Universal Screening Tool
(MUST), 32
Maylard incision, 54
Mayo type instrument, 98
McBurney’s/Gridiron incision, 54
Mercedes Benz incision, 54
MIDCAB incision see minimally invasive direct
coronary artery bypass
(MIDCAB) incision
midline incision, 51, 53, 54
minimal access surgery, 51, 95– 96
minimally invasive direct coronary artery
bypass (MIDCAB) incision, 51
minimally invasive surgery, 53
monopolar devices, 70
Morris Retractor, 82
mounted swab, 96
multimodal analgesia, 118
muscle tissue, 79
musculoskeletal injuries, 146
MUST see Malnutrition Universal Screening
Tool (MUST)
N
NAASP see National Association of Assistants
in Surgical Practice (NAASP)
national accreditation, 5– 6
154 Index
National Association of Assistants in Surgical
Practice (NAASP), 6– 8
National Safety Standards for Invasive
Procedures (NatSSIPs) process,
26, 33, 42
NatSSIPs2, 42, 80, 105, 133, 143
NatSSIPs Eight, 49, 50
national SFA toolkit, 8
National Yellow Card Reporting System, 103
NatSSIPs process see National Safety Standards
for Invasive Procedures
(NatSSIPs) process
neck, incisions of, 54
needle holders, 98
needles, 58
Negative Pressure Wound Therapy, 108
nerve blocks, 122
nerves, vasculature and, 79
neuraxial analgesia, 122
neuropathic pain, 113, 113, 120
neurotransmitter, 119, 120
NICE guidance, 26
N methyl aspartic (NMDA) receptor
antagonist, 121
nociceptive pain, 113, 113
non absorbable suture, 58, 60
nonmaleficence, 14, 18
non medical surgical assistant roles during
conflict, 3– 4
non primary wound closure, 57
non selective COX inhibitors, 119
non steroidal anti inflammatory drugs
(NSAIDs), 118, 119
non technical skills, 141
classification of, 142
defined,141
situation awareness, 142
communication and teamwork, 143– 145
leadership and decision making, 145– 146
task management, 145
stress and fatigue, managing, 146
non technical skills for surgeons (NOTSS), 142
NSAIDs see non steroidal anti inflammatory
drugs (NSAIDs)
nurses, 3– 6, 8, 15, 24, 29, 33, 104
O
obesity, 26, 28, 32, 103– 104
Obesity Surgery Mortality Risk Score
(OS MRS), 26
Observational Teamwork Assessment for
Surgery (OTAS) tool, 134
ODPs see operating department
practitioners (ODPs)
operating department practitioners
(ODPs), 3, 6, 8– 9
opioid receptors, 118– 121, 120
organ tissues, 79
OS MRS see Obesity Surgery Mortality Risk
Score (OS MRS)
OTAS tool, 134
P
PACE acronym, 144, 144
pain, 107, 111
analgesia, approaches to, 117
analgesic medicines, 118
alpha 2 agonists, 121
gabapentinoids, 120– 121
ketamine, 121
local anaesthetics (LA), 121– 123, 122
multimodal analgesia, 118
non steroidal anti inflammatory drugs
(NSAIDs), 118, 119
opioids, 119– 120, 120
paracetamol, 118– 119
assessing, 114
tools, 115
classifying, 112– 114
defining, 111– 112
functional activity scale, example of, 116
inpatient pain management service,
role of, 117
managing, 116
patient education, 118
physiology, 113, 114
unrelieved,117
0– 10numerical rating scale, 115, 115
pain assessment questions using PQRST, 115
paracetamol, 116, 118– 119
paraffin gauze, 107– 108
paramedian incision, 54
pararectus incision, 54
Parkinson’s and multiple sclerosis, 27
passive diathermy related skills, 96
patient controlled analgesia (PCA)
infusions, 120
patient education, 26– 29, 105, 118
pain management, 118
preoperative assessment, 26– 29
wound assessment, 105
patient mobility, 31
patient positioning, 43– 44
Patient Safety II, 134
Index 155
Patient Safety Incident Response Framework
(PSIRF), 136
patient safety in surgery, 133– 134
PCA infusions see patient controlled analgesia
(PCA) infusions
pencil grip, 91, 97
performance of SFAs, factors affecting, 136, 136
PERF tool see Positive Event Reporting Form
(PERF) tool
perioperative environment, 5, 19, 143, 145, 146
peri wound skin, 106
PE see pulmonary embolism (PE)
Pfannenstiel/Kerr/pubic incision, 54
pharmacological methods and haemostatic
agents, 72– 73
pinch grip, 91
planned tertiary wound closure, 57
Positive Event Reporting Form (PERF) tool, 134
postoperative risks, 27– 28
post operative wound care, 99
povidone iodine (PVP I), 45– 46
PQRST mnemonic, 115
practitioner with extended skills, 97
pregabalin, 120
preoperative assessment, 23– 26, 27– 28
decision making and informed consent, 33– 34
fasting instructions
for adult elective surgery patient, 31
for adult emergency surgery patient, 31– 32
for children, 32
patient education, 26– 29
patient mobility, 31
surgical site marking, 32– 33
tissue viability, 30
venous thromboembolism (VTE) risk
assessment, 29– 30, 29
pre operative preparation of the patient within
operating theatre, 41
draping the patient, 46– 47
patient positioning, 43– 44
skin preparation, 45
chlorhexidine gluconate (CHG), 45
povidone iodine (PVP I), 45– 46
team brief, 42– 43, 42
timeout, 43
pressure provided by the SFA, 66– 67, 66
presurgery considerations, 27– 28
primary wound closure, 57
proliferation, 102
prone position, 44
PSIRF see Patient Safety Incident Response
Framework (PSIRF)
pulmonary embolism (PE), 29
PVP I see povidone iodine (PVP I)
R
responsibilities of SFA, 9, 9, 80
retracting away from oneself, 90, 90
retracting muscle, 79
retracting towards oneself, 90
retraction, 80
by hand, 81
tissue handling and, 83
retractors
hand held, 82
self retaining, 82
types of, 81
hand held retractors, 82
retraction by hand, 81
self retaining retractors, 82
reverse pain ladder, 116, 116
reverse Trendelenburg position, 44
Rockey Davis/Lanz incision, 54
ropivacaine, 122
S
Scottish Wound Assessment and Action Guide, 56
SCP see surgical care practitioner (SCP)
SDM see shared decision making (SDM)
secondary intention, wound healing by,
57, 104, 106
SEIPS tool see Systems Engineering Initiative
for Patient Safety (SEIPS) tool
selective cyclooxygenase 2inhibitors, 119
self adhesive absorbent dressings, 107
self retaining retractors, 82
shared decision making (SDM), 24, 33
SHEEP model, 133, 133
single use clips, 69
‘sip to send’ guidance, 32
situation awareness, 142
communication and teamwork, 143– 145
leadership and decision making, 145– 146
task management, 145
6 item Cognitive Impairment Test (6CIT), 31
skills set of SFA, 6, 6
skin, 78
skin closure, techniques for, 58
skin hooks, 82, 91
skin lines, 51
skin marking, 33, 53
skin preparation, 45
chlorhexidine gluconate (CHG), 45
povidone iodine (PVP I), 45– 46
156 Index
soft paraffin gauze, 107– 108
SORT see Surgical Outcome Risk Tool v2 (SORT)
square drape, 47
SSI see surgical site infection (SSI)
Staphylococci bacteria, 106
staplers, 69
sterile rulers, 106
sterile saline, 104
sternotomy incision, 54
stress and fatigue, managing, 146
stress ball, 87
subclavicular incision, 54
suction and visual access, 67
superficial wounds, 100
supervised surgical trainee, 55
supine position, 44, 90
supraumbilical incision, 54
Surgerymen, 4
surgical care practitioner (SCP), 55, 65, 68, 69
surgical first assistant, defined,7– 8
surgical incision see incision
Surgical Outcome Risk Tool v2 (SORT), 25
surgical site infection (SSI), 42, 45, 103, 106, 113
surgical site marking, 32– 33
surgical stapling devices, 69
surgical wounds see wounds, surgical
sutures, 58– 59, 67
suture scissors, 92– 94, 93, 94
Systems Engineering Initiative for Patient
Safety (SEIPS) tool, 136
T
TAP block see transverse abdominal plane
(TAP) block
task management, 145
team brief, 42– 43, 42
TeamSTEPPS 3.0, 134
tertiary intention, wound healing by, 57
theatre nurses, 3, 5
theatre practitioners, 144
thermal injuries, 70– 71
thermal spread related injuries, 71
thrombin, 72
thyroidectomy incision, 54
ties, clips and, 67– 68, 68
tissue, 78
adipose, 78
bone, 79
damage, degree of, 106
forceps, 90– 91
handling of, 80– 81
handling and retraction, implications of, 83
muscle, 79
organs, 79
skin, 78
vasculature and nerves, 79
viability, 30, 78
toothed dissecting forceps, 97, 97
tracheotomy incision, 54
tranexamic acid, 73
transverse abdominal plane (TAP) block, 123
Trendelenburg position, 44
Turner Warwick’s incision, 54
U
ultrasonic devices, 71– 72
United Kingdom Central Council for Nurses,
Midwives and Health Visitors (UKCC), 5
university courses, accredited,8– 9
V
vasculature and nerves, 79
venous bleeding, 66
venous thromboembolism (VTE) risk
assessment, 29– 30, 29
W
ward preparation, 31
fasting instructions
for adult elective surgery patient, 31
for adult emergency surgery patient,
31– 32
for children, 32
Weitlaner retractor, 82
well being of SFA, 136– 137
WHO Surgical Safety Checklist, 26, 30, 32, 33
wound
acute, 100
chronic, 100
contaminated/infected,104
non primary wound closure, 57
planned tertiary wound closure, 57
post operative wound care, 99
primary wound closure, 57
superficial, 100
types of, 56
wound assessment, 105
anatomic location and type of wound,
105– 106
infection, signs of, 106– 107
pain, 107
tissue damage, degree of, 106