Case Selection, Research, and Surgical Case Packet Development

What Is a Surgical Case Packet?

A surgical case packet is a comprehensive, written record that documents everything a scrub surgical technologist needs to prepare for, execute, and close a specific operative procedure. Think of it as a blueprint: before the first instrument is touched, the packet defines the anatomy involved, why the procedure is done, how the patient is positioned, what the sterile field contains, and exactly what the scrub technologist will do at every phase. Hospitals and ambulatory surgery centers rely on similar documents—called preference cards, count sheets, and procedure guides—to promote consistency and reduce preventable errors. Producing an accurate packet from scratch is one of the most powerful ways to demonstrate surgical technology competence, and it directly reflects the knowledge base tested on the NBSTSA CST examination.

Why Accuracy Is a Patient Safety Issue

Every item in a case packet has a safety consequence. An incorrect instrument count sheet can lead to a retained surgical item (RSI)—one of the most serious never-events in perioperative care. A missing step in aseptic setup can contaminate the sterile field and expose the patient to surgical site infection. An incorrect positioning note can result in a pressure injury or nerve damage. The Association of Surgical Technologists (AST) and accrediting bodies treat these categories as critical safety items, meaning one unresolved error is enough to require revision regardless of overall score. Approach every line of your packet as if a real patient depends on it—because in your career, one will.

Step 1: Procedure Overview

Begin by researching the assigned procedure using the AST Core Curriculum for Surgical Technology and approved anatomical references. Your procedure overview must cover three areas:

• Anatomy and physiology: Identify the structures directly involved and immediately adjacent. For a laparoscopic cholecystectomy, this means the gallbladder, cystic duct, cystic artery, common bile duct, and surrounding hepatic structures. For a total knee arthroplasty, it means the distal femur, proximal tibia, patella, and associated ligamentous anatomy.
• Indications: State the clinical reasons a surgeon would choose this procedure—for example, symptomatic cholelithiasis for laparoscopic cholecystectomy, or end-stage osteoarthritis for total knee arthroplasty.
• Surgical steps: Summarize the operative sequence in logical order, from incision or trocar placement through closure. Use standard surgical terminology throughout.

Staying anchored to published, evidence-based references (the AST Core Curriculum is the primary standard) ensures your facts are defensible during faculty review and on the credentialing examination.

Step 2: Patient Positioning

List the assigned procedure's positioning requirements clearly: the position itself (supine, lateral decubitus, lithotomy, prone, etc.), required positioning devices (arm boards, leg holders, bean bags, safety straps), and any nerve or pressure-point protections specific to that position. Note who is responsible for each positioning task and when padding is placed. Positioning errors are a leading source of intraoperative injury, so this section demands the same precision as any other critical safety item.

Step 3: Equipment and Supply List

Using the AST Core Curriculum and facility-style preference card templates, compile a complete list of:

• Major equipment (electrosurgical unit, laparoscopic tower, C-arm, tourniquet, etc.)
• Specialty supplies (trocars, stapling devices, implants, suture sizes and types)
• Draping supplies and their sequence
• Irrigation solutions and any medications placed on the sterile field (labeled immediately per AORN and facility policy)

All medications and solutions on the sterile field must be labeled at the time they are received onto the field—this is a non-negotiable patient safety standard. Include this labeling requirement explicitly in your supply list.

Step 4: Instrument Count Sheet

The count sheet documents every countable item: sharps (needles, blades), soft goods (sponges, towels, cottonoids), and instruments. Your count sheet must:

• List items by category
• Record the initial count before incision, subsequent counts (before cavity closure, before skin closure), and the final count
• Include a signature line for both the scrub technologist and the circulating nurse

When you compare your draft count sheet against the faculty-provided answer key, note every discrepancy and research why the correct item is included or excluded. A count sheet is only as reliable as the discipline of the person who completes it.

Step 5: Scrub Role Narrative

The scrub role narrative describes your actions chronologically, in first-person or procedural language, across five phases:

1. Room setup: Arrange furniture, bring in equipment, verify implants or special supplies are available.

2. Sterile field establishment: Open sterile supplies using correct aseptic technique; never reach over or turn your back on an open sterile field.

3. Gown and glove procedure: Perform surgical hand antisepsis, receive gown, and don sterile gloves using the closed-glove technique.

4. Instrument organization: Arrange instruments on the back table and Mayo stand in a consistent, logical order so you can hand any instrument immediately without looking away from the surgical site.

5. Intraoperative phase: Anticipate surgeon requests at each step, maintain the sterile field, perform counts on cue, and manage specimens per facility policy.

Anticipation is the mark of a skilled scrub technologist. Document not just what you will hand, but when and why—for example, knowing that during a laparoscopic cholecystectomy the surgeon will call for clips before dividing the cystic duct allows you to have the clip applier loaded and ready.

Peer Review and Revision

After completing your narrative, you will review a classmate's work using the faculty-supplied rubric. Provide specific, written feedback: identify what is accurate, flag omissions, and suggest corrections with a source citation. Good peer feedback is not vague praise—it names the exact step that is missing or incorrect and points to the reference that supports the correction. After receiving feedback, revise your own narrative before final submission.

Scoring and Advancement

Your completed packet is scored by faculty using the program rubric. An overall score of 80% or higher is required to advance. Any critical safety error—on the count sheet, in the aseptic setup steps, or in instrument identification—must be corrected regardless of your overall score. This mirrors real-world practice: in the OR, there is no partial credit for a retained sponge.