Intraoperative nursing: scrub and circulating roles, positioning and counts
- Fundamental
In the operating room one nurse works inside the sterile field and another outside it, and together they keep the patient safe.
What it is
During surgery the nursing team usually has two roles. The scrub nurse (or surgical technologist) wears sterile gown and gloves, prepares the instruments and passes them to the surgeon, and guards the sterile field. The circulating nurse stays outside the sterile field: they prepare the room, help position the patient, open sterile supplies, keep the records, coordinate the checklist in many hospitals and fetch what the team needs. Both share three safety tasks: maintaining sterility, preventing positioning injuries, and counting sponges, sharps and instruments so that nothing is left inside the patient. They also identify and label every specimen.
Key points
- Anyone who sees a break in sterility must say so; the item is replaced or the area re-covered.
- Counted items do not leave the operating room until the final count is reconciled.
- A count that is interrupted starts again from the beginning.
- Retained items cause serious harm: infection, reoperation, perforation and even death.
- Long procedures, extreme body weight and steep positions raise the risk of nerve injury, pressure injury and sliding.
Components
- Scrub nurse: surgical hand antisepsis, sterile gown and gloves, preparation of the instrument table, passing instruments, watching the field, receiving specimens.
- Circulating nurse: room and equipment check, patient reception and identification, help with anaesthesia and positioning, skin preparation per protocol, opening sterile items, records and count sheets.
- Shared: counts, the checklist, specimen labelling and handover to the recovery team.
What it is for
- Sterility protects the wound: WHO recommends surgical hand preparation before sterile gloves and an alcohol-based antiseptic for skin preparation.
- Correct positioning gives the surgeon access while protecting nerves, skin, eyes and breathing.
- Systematic counts are a barrier against retained sponges, needles and instruments.
- Correct specimen labelling avoids lost samples and wrong diagnoses.
In nursing practice
- MinSalud includes the count of gauze, compresses and instruments among the safe surgical practices; a missing item is reported immediately.
- When there is no second nurse, the count is done by the surgeon and the circulating nurse.
- Warming devices help keep the patient at a normal temperature, which reduces infection and bleeding problems.
- After surgery, check the skin over pressure points and report any redness, numbness or weakness.
Common mistakes
- Accepting an incomplete count so as not to delay closure.
- Removing gauze from the room before the final count.
- Leaving the elbows or heels resting directly on the hard table.
- Labelling specimens after the patient has left the room.
- Keeping quiet about a possible break in sterile technique.
Test yourself
Think of the answer, then tap the question to see it.
What is the main difference between the scrub and the circulating nurse?
The scrub nurse is sterile and works inside the sterile field with the instruments; the circulating nurse is not sterile and works outside it, preparing, recording and coordinating.
When should sponges and sharps be counted, at a minimum?
Before the start of the procedure, before closing a cavity within a cavity, before wound closure and at skin closure.
What should the team do if the final count does not match?
Recount, tell the surgeon at once, search the field, floor, waste and linen, and if the item is not found, use imaging per protocol and record everything.
How is a surgical specimen labelled safely?
With at least two patient identifiers, the specimen name and site or side; one team member reads the label aloud and another confirms it.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: WHO guidelines for safe surgery 2009: safe surgery saves lives (World Health Organization (WHO), 2009); Global guidelines for the prevention of surgical site infection, second edition (World Health Organization (WHO), 2018); Mejorar la seguridad en los procedimientos quirúrgicos. Paquetes instruccionales, versión 2.0 (Ministerio de Salud y Protección Social (MinSalud), Colombia, 2015); Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes (Revista Brasileira de Ginecologia e Obstetrícia, open access (Europe PMC), 2024).
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Representative model, for educational purposes only.