First assistant
Encyclopedia
A surgeon's assistant is a medical or allied health practitioner that provides aide in exposure, hemostasis, and visualization of anatomic structures during the course of a surgical operation. Professionals filling this role come from diverse backgrounds and include medical doctors, surgical residents, surgical physician assistants (PAs), advanced practice registered nurses (such as nurse practitioners), specialized registered nurses (such as registered nurse first assistants or RNFAs), and non-physician surgical first assistant practitioners (SFAs).
According to the American College of Surgeons, "Ideally, the first assistant at the operating table should be a qualified surgeon or a resident in an approved surgical education program. Residents at appropriate levels of training should be provided with opportunities to assist and participate in operations. If such assistants are not available, other physicians who are experienced in assisting may participate. It may be necessary to utilize nonphysicians as first assistants. Surgeon's assistants (SAs) or physician's assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority."
1. Positioning the patient
2. Providing visualization of the operative site by the following:
3. Utilizing appropriate techniques to assist with hemostasis
4. Participating in volume replacement or autotransfusion techniques as appropriate
5. Utilizing appropriate techniques to assist with closure of body planes
6. Selecting and applying appropriate wound dressings, including the following:
7. Providing assistance in securing drainage systems to tissue
Additional job descriptions have been published by the NSAA at http://www.nsaa.net/scope_of_practice.php, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) at http://www.caahep.org/Content.aspx?ID=52, the Association of periOperative Registered Nurses (AORN) at http://www.aorn.org/AORNNews/RNFAGuideToPractice/, and the American Medical Association (AMA) at http://www.ama-assn.org/ama1/pub/upload/mm/40/ah15-surgical-asst.pdf. A sample RNFA job description is available here.
The scope of practice of the surgical first assistant is based largely on these definitions in conjunction with state and local legislation, as well as hospital policy. Therefore, actual practice and privileges may vary greatly depending on the facility and region in which the surgical first assistant works, their level of education and experience, and their professional licensure and/or certification status.
A description of the educational standards for SFA practitioners follows:
The Commission on Accreditation of Allied Health Education Programs (CAAHEP) has established and published guidelines for the profession of surgical first assisting. Programs which meet these criteria are able to be reviewed and obtain accreditation through CAAHEP, which is the premier accreditation body for allied health education programs. Currently, there are several schools in the United States which offer CAAHEP accredited surgical first assistant training programs. Additional programs are approved by the NSAA and ABSA. These programs typically last between 12 and 24 months and lead to a Certificate of Completion or Associate of Science degree . A list of these programs can be viewed at http://www.caahep.org/Find-An-Accredited-Program/. In addition, the Association of Surgical Technologists (AST) has published the Core Curriculum for Surgical Assisting which must be followed by accredited programs in order to assure consistency in education throughout the nation. Although formal programs for surgical first assisting currently lead to a Certificate of Completion or Associate of Science degree, the AST and the Association of Surgical Assistants (ASA) have both adopted the bachelor’s degree in a field related to surgical technology as the preferred entry level educational model to begin a career as a surgical first assistant. However, the bachelor’s degree is not a requirement for certification, nor is it a requirement for many entry-level positions.
Educational programs for SFAs include courses in the following subject areas:
Non-physician surgical first assistant practitioners (SFAs) are credentialed nationally by the American Board of Surgical Assistants (ABSA), the National Board of Surgical Technology and Surgical Assisting (NBSTSA), and the National Surgical Assistant Association (NSAA). Some states, such as Kentucky, Texas, Colorado, Illinois, and Washington DC have additional state certification or licensure requirements. When deciding which professional credential to pursue, the practitioner should consider local legislation, facility policy, and regional practice as some credentials are preferred over others in different parts of the United States. Additionally, local laws and hospital policies may favor or require a specific credential.
The ABSA grants the Surgical Assistant-Certified (SA-C) credential to candidates who meet the following criteria found at http://www.absa.net/2011_exam_prerequisites.htm.
The NBSTSA is the only professional credential accredited by the National Commission for Certifying Agencies (NCCA) and grants the Certified Surgical First Assistant (CSFA, formally CFA) credential to candidates who meet the criteria found at http://www.nbstsa.org/examinations-csfa.html.
The NSAA is the oldest professional certification agency for SFAs and grants the Certified Surgical Assistant (CSA) credential to candidates who meet the following criteria found at http://www.nsaa.net/certification.php.
According to the American College of Surgeons, "Ideally, the first assistant at the operating table should be a qualified surgeon or a resident in an approved surgical education program. Residents at appropriate levels of training should be provided with opportunities to assist and participate in operations. If such assistants are not available, other physicians who are experienced in assisting may participate. It may be necessary to utilize nonphysicians as first assistants. Surgeon's assistants (SAs) or physician's assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority."
Employment
Surgical first assistants are commonly utilized to provide aide to surgeon's during procedures spanning every branch of surgical practice and specialty. Practitioners that lend their services full time (such as surgical PAs, SFAs, and RNFAs) may specialize in areas such as orthopedic, cardiovascular, neurologic, genitourinary, general, obstetric & gynecologic, and oral maxillofacial surgery. Most of these surgical first assistants are employed by hospitals; however, a growing number are employed by physician groups, private SFA practices, medical travel agencies, or are self employed. According to the National Surgical Assistant Association (NSAA), the average annual salary for the non-physician surgical first assistant in 2005 ranged from $50,000 (entry level) to $150,000 annually for full-time practitioners, with top wages reaching $200,000 yearly. The American Medical Association lists the average as $75,000 yearly.Job Description
For the non-physician surgical first assistant (SFA), the American College of Surgeons has accepted the following job duties and technical functions. It is important to note that this job description is currently under review by the Association of Surgical Assistants (ASA) due to its ambiguity and lack of specification.1. Positioning the patient
- The surgeon shall convey the exact position that will give the best exposure for the surgical procedure. The surgical assistant will carry out this order. Consideration will be given to the patient’s comfort and safety.
- Points of pressure shall be padded: elbows, heels, knees, eyes, face, and axillary region.
- Circulation shall not be impaired. (A tourniquet may be required for some procedures.)
- Nerve damage shall be guarded against.
- The temperature of the patient should be discussed with the anesthesia personnel and methods employed to maintain the desired temperature range.
- The surgical assistant shall be familiar with common positions related to the surgical procedure and will be able to use the equipment necessary to provide the position. Competencies will include the following:
-
- Fracture tables
- Head stabilizers
- Body stabilizers
- C-arm extensions
- Head stabilizers
- Body stabilizers
- C-arm extensions
- Any other equipment needed
- Upon completion of the procedure, the patient shall be evaluated for any possible damage from positioning which will include assessment of the skin. The abnormal condition shall be reported to the surgeon and treatment and documentation shall be carried out.
2. Providing visualization of the operative site by the following:
- Appropriate placement and securing of retractors with or without padding
- Packing with sponges
- Digital manipulation of tissue
- Suctioning, irrigating, or sponging
- Manipulation of suture materials (e.g., loops, tags, running sutures)
- Proper use of body mechanics to prevent obstruction of the surgeon’s view
3. Utilizing appropriate techniques to assist with hemostasis
- Permanent
-
- Clamping and/or cauterizing vessels or tissue
- Tying and/or ligating clamped vessels or tissue
- Applying hemostatic clips
- Placing local hemostatic agents
- Temporary
- Applying tourniquets and demonstrating awareness of the indications/contraindications for use with knowledge of side effects of extended use
- Applying vessel loops
- Applying noncrushing clamps
- Applying direct digital pressure
4. Participating in volume replacement or autotransfusion techniques as appropriate
5. Utilizing appropriate techniques to assist with closure of body planes
- Utilizing running or interrupted subcutaneous sutures with absorbable or nonabsorbable material
- Utilizing subcuticular closure technique with or without adhesive skin closure strips
- Closing skin with method indicated by surgeon (suture, staples, etc)
- Postoperative subcutaneous injection of local anesthetic agent as directed by the surgeon
6. Selecting and applying appropriate wound dressings, including the following:
- Liquid or spray occlusive materials
- Absorbent material affixed with tape or circumferential wrapping
- Immobilizing dressing (soft or rigid)
7. Providing assistance in securing drainage systems to tissue
Additional job descriptions have been published by the NSAA at http://www.nsaa.net/scope_of_practice.php, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) at http://www.caahep.org/Content.aspx?ID=52, the Association of periOperative Registered Nurses (AORN) at http://www.aorn.org/AORNNews/RNFAGuideToPractice/, and the American Medical Association (AMA) at http://www.ama-assn.org/ama1/pub/upload/mm/40/ah15-surgical-asst.pdf. A sample RNFA job description is available here.
The scope of practice of the surgical first assistant is based largely on these definitions in conjunction with state and local legislation, as well as hospital policy. Therefore, actual practice and privileges may vary greatly depending on the facility and region in which the surgical first assistant works, their level of education and experience, and their professional licensure and/or certification status.
Education
The educational requirements for entry into the field of surgical assisting vary greatly depending on the professional credential obtained by the individual. Non-physician practitioners come from diverse healthcare and medical backgrounds and include such professionals as surgical technologists, physician assistants, registered nurses, and graduates of surgical first assistant training programs.A description of the educational standards for SFA practitioners follows:
The Commission on Accreditation of Allied Health Education Programs (CAAHEP) has established and published guidelines for the profession of surgical first assisting. Programs which meet these criteria are able to be reviewed and obtain accreditation through CAAHEP, which is the premier accreditation body for allied health education programs. Currently, there are several schools in the United States which offer CAAHEP accredited surgical first assistant training programs. Additional programs are approved by the NSAA and ABSA. These programs typically last between 12 and 24 months and lead to a Certificate of Completion or Associate of Science degree . A list of these programs can be viewed at http://www.caahep.org/Find-An-Accredited-Program/. In addition, the Association of Surgical Technologists (AST) has published the Core Curriculum for Surgical Assisting which must be followed by accredited programs in order to assure consistency in education throughout the nation. Although formal programs for surgical first assisting currently lead to a Certificate of Completion or Associate of Science degree, the AST and the Association of Surgical Assistants (ASA) have both adopted the bachelor’s degree in a field related to surgical technology as the preferred entry level educational model to begin a career as a surgical first assistant. However, the bachelor’s degree is not a requirement for certification, nor is it a requirement for many entry-level positions.
Educational programs for SFAs include courses in the following subject areas:
- Microbiology
- Pathophysiology
- Anatomy and physiology
- Medical terminology
- Advanced surgical anatomy
- Surgical microbiology
- Surgical pharmacology
- Anesthesia methods and agents
- Bioscience
- Ethical and legal considerations
- Fundamental technical skills
- Complications during surgery
- Interpersonal skills
- Clinical application of computers
Non-physician surgical first assistant practitioners (SFAs) are credentialed nationally by the American Board of Surgical Assistants (ABSA), the National Board of Surgical Technology and Surgical Assisting (NBSTSA), and the National Surgical Assistant Association (NSAA). Some states, such as Kentucky, Texas, Colorado, Illinois, and Washington DC have additional state certification or licensure requirements. When deciding which professional credential to pursue, the practitioner should consider local legislation, facility policy, and regional practice as some credentials are preferred over others in different parts of the United States. Additionally, local laws and hospital policies may favor or require a specific credential.
The ABSA grants the Surgical Assistant-Certified (SA-C) credential to candidates who meet the following criteria found at http://www.absa.net/2011_exam_prerequisites.htm.
The NBSTSA is the only professional credential accredited by the National Commission for Certifying Agencies (NCCA) and grants the Certified Surgical First Assistant (CSFA, formally CFA) credential to candidates who meet the criteria found at http://www.nbstsa.org/examinations-csfa.html.
The NSAA is the oldest professional certification agency for SFAs and grants the Certified Surgical Assistant (CSA) credential to candidates who meet the following criteria found at http://www.nsaa.net/certification.php.