Instrument Passing and Mayo Stand Organization During a Simulated Case

Why Instrument Passing and Mayo Stand Organization Matter

The scrub surgical technologist is the surgeon's closest partner at the sterile field. During a procedure, the surgeon's hands and eyes are focused on the operative site—not on reaching for tools. Your role is to anticipate every move, organize every instrument, and place each item securely in the surgeon's hand before it is requested. A hesitation, a wrong instrument, or a breach of sterile technique can slow the case, compromise patient safety, or cause injury. Mastery of instrument passing and mayo stand organization is therefore one of the most essential practical skills you will develop.

The Mayo Stand: Your Primary Workspace

The mayo stand holds only the instruments that are immediately needed for the current phase of the procedure. For an appendectomy, the opening phase typically requires skin knife, tissue forceps, retractors, electrosurgical pencil, and clamps. As the case progresses, you replace used or contaminated instruments and add those needed for the next step.

Organize the mayo stand so that:

• Sharps (blades, needles, electrosurgical tip) are always in a defined, consistent zone—never loose on the field.
• Instruments are grouped by function: cutting, clamping, retracting, suturing.
• The most-needed instruments face toward you for quick retrieval.
• The stand is never overcrowded; excess instruments stay on the back table until needed.

The back table is your reserve: it holds the full instrument set, suture, sponges, drains, and specialty items organized by anticipated use. Know where every item lives so you can retrieve it without searching.

Anticipatory Technique: Thinking One Step Ahead

Anticipatory technique means you are always preparing the next instrument before the surgeon asks. Study the scripted sequence of an appendectomy:

1. Incision — scalpel (number-10 or number-15 blade, depending on surgeon preference)

2. Tissue dissection — Mayo scissors, Metzenbaum scissors

3. Hemostasis — hemostatic clamps, electrosurgical pencil

4. Retraction — Richardson or US Army retractors

5. Identification and ligation of appendix — babcock clamp, Kelly or curved hemostats, ties or suture ligatures

6. Transection — scalpel or scissors

7. Closure — suture on a needle holder, tissue forceps, irrigation, closure suture

As the surgeon completes step 3, you should already have the retractor in your non-dominant hand, ready to pass. When the surgeon extends an open hand or makes eye contact, the instrument is already moving toward them.

Correct Passing Technique

Every instrument pass follows the same principles:

Hand-off angle and position. Present the instrument so the surgeon can grasp it and use it immediately without repositioning. Clamps and scissors are passed handle-first, with rings oriented toward the surgeon's thumb. Scalpels are passed handle-first with the blade facing away from both parties—never blade-forward. Needle holders are passed so the surgeon's thumb drops naturally into the ring.

Tactile cue. Place the instrument firmly—with deliberate, gentle pressure—into the surgeon's palm. The surgeon should feel the instrument arrive. A gentle, confident slap (not a hard toss) is standard practice. The surgeon should not have to look down.

Return and exchange. When the surgeon returns an instrument, receive it with your non-dominant hand while simultaneously passing the next item with your dominant hand. Never let a sharp instrument leave your control unaccounted for.

Voice and eye contact. In simulation, call out the instrument name as you pass it. This builds the verbal habit that helps prevent errors in actual cases.

Sharps Safety at the Sterile Field

Sharps injuries are among the most serious occupational hazards in the OR. Follow these non-negotiable rules:

• Use a designated sharps zone on the mayo stand (a small basin or marked area).
• Never pass a scalpel or loaded needle holder hand-to-hand; use the hands-free (neutral zone) technique when the surgeon and scrub are close together.
• Count all sharps aloud with the circulator before the case begins, before closing begins, and at skin closure.
• If a blade is handed back, immediately place it in the sharps zone—never set it loose on the drape.

AORN guidelines support neutral zone passing as a standard of practice to reduce percutaneous injuries to OR personnel.

Sponge and Instrument Counts

Counts are a patient-safety procedure, not a paperwork task. A retained surgical item can cause serious patient harm. For every simulated case:

• Count sponges, sharps, and instruments with your circulator (or instructor) at the start, before closure, and at skin closure.
• If a count is incorrect, report it immediately. Never assume an item will "turn up."
• Document your counts on the count sheet as directed.

Managing the Closing Phase

As the surgeon begins to close, transition the mayo stand to closing instruments: needle holders, tissue forceps, appropriate suture, scissors for cutting suture tails, and skin closure materials. Remove instruments no longer needed to reduce clutter. Maintain your count awareness throughout.

Sterile Field Integrity

A sterile field break occurs any time a non-sterile item or surface contacts the sterile field, or when your sterile gown or gloves contact a non-sterile surface. Common causes include:

• Reaching below table level
• Leaning over a non-sterile area
• Allowing an instrument to fall off the field without declaring it contaminated

If you suspect a break, announce it immediately. Patient safety always takes priority over speed or embarrassment.