CST Certified Surgical Technologist Exam

Preoperative preparation encompasses all activities required to ready the patient and operating room for surgery.

Preoperative assessment begins with chart review. The surgical technologist verifies the following: patient identification, allergies, NPO status, consent forms, history and physical documentation, laboratory results, imaging studies, blood availability if applicable, and special equipment or implant orders.

Key laboratory values include hemoglobin and hematocrit (oxygen-carrying capacity), platelet count and coagulation studies (bleeding risk), electrolytes (cardiac and neuromuscular function), blood glucose (metabolic status), and creatinine (kidney function). Abnormal values are communicated to the surgical team.

The operating room is prepared based on the scheduled procedure and surgeon preference. Activities include checking suction and ensuring adequate levels, testing electrosurgical equipment, positioning the operating table, adjusting room temperature, and gathering positioning devices.

The back table and Mayo stand are set up using sterile technique. The back table holds instruments, supplies, and basins organized by category or order of use. The Mayo stand is positioned over the patient and holds instruments immediately needed during the procedure.

Most facilities use a case cart system where supplies are picked according to surgeon preference cards and delivered to the operating room before the procedure. The surgical technologist verifies contents against the preference card, checks expiration dates, and inspects packaging integrity.

Patient preparation in the operating room includes verification of identity and procedure, positioning, skin preparation, and draping. Hair removal, if required, is performed using clippers immediately before skin preparation. Razors are avoided as they cause microabrasions that increase infection risk.

Skin preparation removes transient microorganisms and reduces resident flora. Antiseptic agents include chlorhexidine gluconate, povidone-iodine, and alcohol-based solutions. Application begins at the incision site and moves outward in circular or linear strokes. Prepared areas extend beyond the planned incision to allow for extension if needed.

Surgical technologists must understand common diagnostic procedures that guide surgical intervention.

Plain radiographs use x-rays to visualize bones, foreign bodies, and some soft tissue abnormalities. Chest x-rays assess cardiac silhouette, lung fields, and mediastinal structures. Abdominal films identify bowel obstruction, free air, and calcifications.

Computed tomography combines multiple x-ray views to create cross-sectional images. CT provides detailed visualization of soft tissues, organs, and vascular structures. Contrast agents enhance visualization of specific structures.

Magnetic resonance imaging uses magnetic fields and radiofrequency pulses to generate images without ionizing radiation. MRI provides superior soft tissue contrast and is particularly useful for neurological, musculoskeletal, and cardiac imaging. MRI is contraindicated with certain implants and pacemakers.

Ultrasound uses high-frequency sound waves to create real-time images. It is commonly used for abdominal, pelvic, cardiac, and vascular assessment. Ultrasound guides needle placement for biopsies and vascular access.

Fluoroscopy provides continuous x-ray imaging and is used intraoperatively for orthopedic procedures, vascular interventions, and gastrointestinal studies. Radiation safety precautions include lead aprons, thyroid shields, and distance from the source.

Endoscopy allows direct visualization of hollow organs and body cavities. Upper endoscopy (esophagogastroduodenoscopy) examines the esophagus, stomach, and duodenum. Colonoscopy visualizes the large intestine. Bronchoscopy examines the airways. Cystoscopy visualizes the bladder and urethra.

Laparoscopy uses a camera inserted through a small incision to visualize the abdominal cavity. It is used diagnostically and therapeutically. The surgical technologist manages camera systems, insufflation equipment, and specialized instrumentation.

Biopsies obtain tissue samples for pathological examination. Excisional biopsy removes the entire lesion. Incisional biopsy removes a portion of a larger lesion. Needle biopsy uses a hollow needle to obtain a tissue core. Fine needle aspiration uses a small-gauge needle to obtain cells for cytology.

Frozen section analysis provides rapid intraoperative diagnosis. The specimen is frozen, sectioned, stained, and examined by a pathologist while the patient remains on the operating table. Results guide surgical decision-making regarding margins and extent of resection.