NCCT TS-C Tech in Surgery – Certified

Perioperative care encompasses all activities and responsibilities that occur around the surgical procedure, from the moment a patient is scheduled for surgery through recovery. This section represents the largest portion of the TS-C examination, testing your understanding of foundational sciences, sterilization principles, safety protocols, and communication standards essential to surgical technology practice.

Understanding human anatomy is fundamental to surgical technology practice. The surgical technologist must possess comprehensive knowledge of body systems, anatomical terminology, and physiological processes to anticipate surgical needs and assist effectively during procedures.

Anatomical position refers to the body standing erect, facing forward, with arms at the sides and palms facing forward. All directional terms reference this standard position.

Superior means toward the head or upper part of the body. Inferior means toward the feet or lower part of the body. Anterior (ventral) refers to the front of the body. Posterior (dorsal) refers to the back of the body. Medial means toward the midline of the body. Lateral means away from the midline. Proximal refers to closer to the point of attachment or origin. Distal means farther from the point of attachment. Superficial refers to closer to the body surface. Deep means farther from the body surface.

The sagittal plane divides the body into right and left portions. The midsagittal (median) plane divides the body into equal right and left halves. The frontal (coronal) plane divides the body into anterior and posterior portions. The transverse (horizontal) plane divides the body into superior and inferior portions.

The dorsal cavity contains the cranial cavity (brain) and vertebral canal (spinal cord). The ventral cavity contains the thoracic cavity (heart, lungs, great vessels) and the abdominopelvic cavity. The thoracic cavity is separated from the abdominal cavity by the diaphragm. The abdominal cavity contains digestive organs, spleen, kidneys, and ureters. The pelvic cavity contains the bladder, reproductive organs, and portions of the large intestine.

The abdomen is divided into nine regions for clinical reference. The right hypochondriac region contains the liver and gallbladder. The epigastric region contains the stomach and liver. The left hypochondriac region contains the spleen and stomach. The right lumbar region contains the ascending colon and right kidney. The umbilical region contains the small intestine and transverse colon. The left lumbar region contains the descending colon and left kidney. The right iliac (inguinal) region contains the cecum and appendix. The hypogastric region contains the bladder and reproductive organs. The left iliac region contains the sigmoid colon.

The integumentary system consists of the skin and its accessory structures including hair, nails, and glands. The skin is the largest organ of the body and serves multiple protective functions.

The epidermis is the outermost layer, composed of stratified squamous epithelium. It contains no blood vessels and receives nutrients through diffusion. The stratum corneum is the outermost sublayer, consisting of dead keratinized cells that provide protection. The stratum basale is the deepest layer where cell division occurs and melanocytes produce melanin.

The dermis lies beneath the epidermis and contains blood vessels, nerves, hair follicles, and glands. It consists of two layers: the papillary dermis (superficial) and the reticular dermis (deep). Collagen and elastic fibers provide strength and elasticity.

The hypodermis (subcutaneous layer) lies beneath the dermis and contains adipose tissue for insulation and energy storage. This layer anchors the skin to underlying structures.

Protection from pathogens, chemicals, and physical trauma. Temperature regulation through sweating and blood vessel dilation or constriction. Sensation through nerve receptors for touch, pressure, pain, and temperature. Vitamin D synthesis when exposed to ultraviolet light. Excretion of small amounts of waste through sweat. Fluid balance maintenance by preventing excessive water loss.

The skin is the first barrier that must be penetrated during surgery. Proper skin preparation reduces microbial counts and infection risk. Incision placement considers skin tension lines (Langer's lines) for optimal healing. Wound healing occurs through inflammation, proliferation, and remodeling phases.

The skeletal system provides structural support, protection for internal organs, mineral storage, blood cell production, and leverage for movement.

Long bones have a shaft (diaphysis) and two ends (epiphyses). Examples include the femur, humerus, tibia, and fibula. Short bones are roughly cube-shaped and found in the wrist (carpals) and ankle (tarsals). Flat bones are thin and provide protection and muscle attachment. Examples include the skull, sternum, ribs, and scapulae. Irregular bones have complex shapes and include vertebrae and facial bones. Sesamoid bones develop within tendons, with the patella being the largest.

Compact bone forms the dense outer layer and provides strength. Spongy (cancellous) bone contains trabeculae and red marrow for blood cell production. The periosteum is the fibrous membrane covering bone surfaces and contains blood vessels and nerves. The endosteum lines the medullary cavity. The medullary cavity contains yellow marrow (fat) in adults.

The skull consists of 22 bones including 8 cranial bones and 14 facial bones. The cranial bones include the frontal, parietal (2), temporal (2), occipital, sphenoid, and ethmoid. The vertebral column contains 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused). Intervertebral discs provide cushioning between vertebrae. The thoracic cage includes 12 pairs of ribs and the sternum.

The pectoral girdle consists of the clavicle and scapula. The upper extremity includes the humerus, radius, ulna, carpals, metacarpals, and phalanges. The pelvic girdle consists of the two hip bones (ilium, ischium, pubis). The lower extremity includes the femur, patella, tibia, fibula, tarsals, metatarsals, and phalanges.

Fibrous joints allow no movement (skull sutures). Cartilaginous joints allow limited movement (intervertebral discs). Synovial joints allow free movement and include hinge (elbow), ball-and-socket (hip), pivot (atlas-axis), saddle (thumb), gliding (carpals), and condyloid (wrist) types.

Muscles produce movement, maintain posture, generate heat, and stabilize joints. Three types of muscle tissue exist in the body.

Skeletal muscle is voluntary, striated, and attached to bones. It produces conscious movement and maintains posture. Cardiac muscle is involuntary, striated, and found only in the heart. It contracts rhythmically to pump blood. Smooth muscle is involuntary, non-striated, and found in organ walls, blood vessels, and airways.

Each muscle fiber is a single cell containing myofibrils. Myofibrils contain actin (thin) and myosin (thick) filaments arranged in sarcomeres. The sliding filament theory explains muscle contraction. Muscles are surrounded by connective tissue: endomysium (around fibers), perimysium (around fascicles), and epimysium (around entire muscle).

Flexion decreases the angle between bones. Extension increases the angle between bones. Abduction moves away from the midline. Adduction moves toward the midline. Rotation turns a bone on its axis. Circumduction combines flexion, extension, abduction, and adduction. Supination turns the palm upward. Pronation turns the palm downward.

Head and neck muscles include the frontalis, orbicularis oculi, orbicularis oris, masseter, temporalis, sternocleidomastoid, and trapezius. Trunk muscles include the pectoralis major, rectus abdominis, external and internal obliques, transversus abdominis, erector spinae, and latissimus dorsi. Upper extremity muscles include the deltoid, biceps brachii, triceps brachii, and forearm flexors and extensors. Lower extremity muscles include the gluteus maximus, quadriceps femoris, hamstrings, gastrocnemius, soleus, and tibialis anterior.

The cardiovascular system transports oxygen, nutrients, hormones, and waste products throughout the body. It consists of the heart, blood vessels, and blood.

The heart is a four-chambered muscular pump located in the mediastinum. The right atrium receives deoxygenated blood from the superior and inferior vena cavae. The right ventricle pumps blood to the lungs through the pulmonary trunk. The left atrium receives oxygenated blood from the pulmonary veins. The left ventricle pumps blood to the body through the aorta.

Heart valves prevent backflow of blood. The tricuspid valve lies between the right atrium and ventricle. The mitral (bicuspid) valve lies between the left atrium and ventricle. The pulmonary valve lies between the right ventricle and pulmonary trunk. The aortic valve lies between the left ventricle and aorta.

The sinoatrial (SA) node initiates the heartbeat and is the primary pacemaker. The atrioventricular (AV) node delays the impulse before transmitting to the ventricles. The bundle of His conducts impulses through the interventricular septum. Purkinje fibers distribute impulses throughout the ventricular walls.

Arteries carry blood away from the heart and have thick, elastic walls. Arterioles are small arteries that regulate blood flow to capillaries. Capillaries are microscopic vessels where gas and nutrient exchange occurs. Venules collect blood from capillaries. Veins return blood to the heart and contain valves to prevent backflow.

The aorta is the largest artery, originating from the left ventricle. The coronary arteries supply the heart muscle. The carotid arteries supply the head and neck. The subclavian arteries supply the upper extremities. The celiac trunk supplies the stomach, liver, and spleen. The mesenteric arteries supply the intestines. The renal arteries supply the kidneys. The iliac arteries supply the pelvis and lower extremities.

Plasma is the liquid portion containing water, proteins, nutrients, and waste. Red blood cells (erythrocytes) transport oxygen and carbon dioxide. White blood cells (leukocytes) provide immune defense. Platelets (thrombocytes) participate in blood clotting.

The respiratory system facilitates gas exchange, bringing oxygen into the body and removing carbon dioxide.

The nose filters, warms, and humidifies inhaled air. The pharynx (throat) serves as a passageway for air and food. The nasopharynx, oropharynx, and laryngopharynx are its three divisions. The larynx (voice box) contains the vocal cords and protects the lower airway.

The trachea (windpipe) is supported by C-shaped cartilage rings. The bronchi branch from the trachea into the right and left lungs. Bronchioles are smaller airways without cartilage. Alveoli are air sacs where gas exchange occurs across thin walls.

The right lung has three lobes (upper, middle, lower). The left lung has two lobes (upper, lower) and accommodates the heart. The pleura is a double-layered membrane surrounding each lung. Pleural fluid reduces friction during breathing.

Inspiration occurs when the diaphragm contracts and flattens, increasing thoracic volume. External intercostal muscles elevate the ribs during forced inspiration. Expiration is normally passive as muscles relax. Internal intercostal muscles and abdominal muscles assist forced expiration.

The digestive system breaks down food into nutrients, absorbs them into the bloodstream, and eliminates waste.

The mouth begins mechanical digestion through chewing and chemical digestion through salivary amylase. The pharynx and esophagus transport food to the stomach through peristalsis. The stomach stores food, secretes acid and enzymes, and produces chyme. The small intestine (duodenum, jejunum, ileum) is the primary site of digestion and absorption. The large intestine (cecum, colon, rectum) absorbs water and forms feces.

The liver produces bile, detoxifies blood, and stores glycogen. The gallbladder stores and concentrates bile. The pancreas produces digestive enzymes and bicarbonate for neutralizing stomach acid. Salivary glands produce saliva containing amylase.

The urinary system filters blood, produces urine, and maintains fluid and electrolyte balance.

The kidneys are bean-shaped organs located retroperitoneally. The renal cortex is the outer region containing nephrons. The renal medulla contains the renal pyramids. The renal pelvis collects urine and empties into the ureter.

The nephron is the functional unit of the kidney. Glomerular filtration occurs in Bowman's capsule. Tubular reabsorption returns useful substances to the blood. Tubular secretion removes additional waste from the blood.

The ureters transport urine from the kidneys to the bladder through peristalsis. The urinary bladder stores urine until elimination. The urethra transports urine from the bladder to the outside.

The nervous system controls and coordinates body functions through electrical impulses.

The brain consists of the cerebrum, cerebellum, and brainstem. The cerebrum controls conscious thought, memory, and voluntary movement. The cerebellum coordinates movement and balance. The brainstem controls vital functions including heart rate and respiration. The spinal cord transmits impulses between the brain and body.

Cranial nerves (12 pairs) arise from the brain. Spinal nerves (31 pairs) arise from the spinal cord. The somatic division controls voluntary skeletal muscle movement. The autonomic division controls involuntary functions.

The sympathetic division prepares the body for stress (fight or flight). The parasympathetic division promotes rest and digestion.

The endocrine system produces hormones that regulate metabolism, growth, reproduction, and homeostasis.

The pituitary gland is the master gland, controlling other endocrine glands. The thyroid gland regulates metabolism through thyroid hormones. The parathyroid glands regulate calcium levels. The adrenal glands produce cortisol, aldosterone, and epinephrine. The pancreas produces insulin and glucagon for blood glucose regulation. The gonads (ovaries, testes) produce sex hormones.

The ovaries produce eggs and female hormones. The fallopian tubes transport eggs to the uterus. The uterus supports fetal development during pregnancy. The vagina serves as the birth canal and receives sperm.

The testes produce sperm and testosterone. The epididymis stores maturing sperm. The vas deferens transports sperm to the ejaculatory ducts. The prostate gland and seminal vesicles produce seminal fluid. The penis delivers sperm during intercourse.

Asepsis means the absence of pathogenic microorganisms. Surgical asepsis (sterile technique) is essential in the operating room.

Medical asepsis (clean technique) reduces the number of microorganisms and prevents their spread. Surgical asepsis (sterile technique) eliminates all microorganisms from objects and prevents contamination.

Only sterile items are used within the sterile field. Sterile persons touch only sterile items. Non-sterile persons do not touch sterile items. Sterile persons remain within the sterile field. Movement within the sterile field must not contaminate the field. The sterile field is created as close as possible to the time of use. Sterility of an item is compromised if there is any doubt. Items below the level of the sterile field are considered contaminated. The edges of a sterile container are considered contaminated once opened. Gowns are considered sterile only from the chest to the level of the sterile field and from the gloved hands to two inches above the elbows.

Bacteria are single-celled prokaryotes that may be pathogenic or beneficial. They are classified by shape: cocci (spherical), bacilli (rod-shaped), and spirilla (spiral). Viruses are non-living particles that require host cells to reproduce. Fungi include yeasts and molds; some cause infections. Protozoa are single-celled eukaryotes that may cause parasitic infections.

The causative agent is the pathogen capable of causing disease. The reservoir is where the pathogen lives and multiplies. The portal of exit is how the pathogen leaves the reservoir. The mode of transmission is how the pathogen spreads (direct contact, droplet, airborne, vehicle, vector). The portal of entry is how the pathogen enters a new host. The susceptible host is a person unable to resist infection.

Proper hand hygiene eliminates pathogens. Sterilization destroys all microorganisms on surgical equipment. Standard precautions prevent transmission of bloodborne pathogens. Isolation precautions contain specific types of infections. Environmental cleaning reduces pathogen reservoirs.

Anesthetics produce loss of sensation (local, regional, general). Analgesics relieve pain (opioid and non-opioid). Antibiotics kill or inhibit bacterial growth. Anticoagulants prevent blood clotting. Hemostatic agents promote clotting. Anti-inflammatory drugs reduce inflammation. Vasoconstrictors narrow blood vessels to reduce bleeding. Vasodilators widen blood vessels.

Topical application is applied directly to tissues. Local infiltration is injected into tissue. Intravenous administration enters the bloodstream directly. Intramuscular injection is delivered into muscle tissue. Subcutaneous injection is delivered under the skin.

Right patient. Right medication. Right dose. Right route. Right time.

Local anesthetics include lidocaine and bupivacaine. Epinephrine is a vasoconstrictor often combined with local anesthetics. Heparin prevents clot formation in vascular procedures. Thrombin promotes clotting when applied topically. Irrigation solutions include normal saline and lactated Ringer's solution. Contrast media allow visualization of structures during imaging.