Some of the bypass cannulas are two feet long and unpredictably floppy. Ever since I contaminated one trying to drop it and realized those suckers cost 35.00 each, my new plan has been to wait until the scrub nurse has everything else set up and then open them so she can grab them. Some scrubs have no problems with this. Some are raging beotches that say ' you know, you really need to learn to open better. you won't always have time to stand around waiting for me.' Etc.

I asked a couple of our perfusionists for recommendations and both said they would always recommend having the scrub grab the longest pump pieces because of the danger of contamination. What does everyone else do?

And a side note. Why are so many OR nurses cold, catty, backstabbing, two-faced, condescending, snarky, impatient witches? As a new grad OR intern I've been laughed at, mocked, marginalized, ignored, etc. till I could scream. And don't give me any BS about having thick skin. My skin is thick. And I don't use that as an excuse to treat other people like total crap!

And I take notes, take the DPCs home to study, watch surgeries on CTSnet, read cardiothoracic textbooks and keep all of the inserts from valves and grafts and read that stuff too. I keep a positive attitude even when I feel like crying. Anesthesia providers are nice and polite. Perfusionists are nice and polite. Surgical fellows are nice and polite. Surgical assistants are nice and polite. It seems to be ONLY the STs and other nurses who treat us newbies like crap. And that makes me sad!

Human nature. Lots of people are arrogant and mean. Once you are good at your job, you can stick up for yourself more.

Stand your ground on opening ANYTHING to a person rather than to the back table. We open all our cannulas (and a lot of outher stuff) to a person.

As far as "Why are so many OR nurses cold, catty, backstabbing, two-faced, condescending, snarky, impatient witches? As a new grad OR intern I've been laughed at, mocked, marginalized, ignored, etc. till I could scream. "

I just don't know, I think they forget how hard it is when starting in the OR. We have a nice long orientation/trainng period now and a LOT of the more seasoned nurses (and some scrubs) get pretty snarky about it. Just because we used to get maybe a couple months orientation (if you were lucky) doesn't mean we don't need to do the right thing now.

Nurses on the floor (and folks in general) can be cold, catty, backstabbing, two-faced, condescending, I think it's just easier to see and hear in the OR due to the closeness of our area.

Good luck, and remember how to treat newbies 10 years from now.........

In our facility, we don't do hearts, but in terms of opening items, the only items we DON'T hand to the scrub nurse are drapes, towels, gowns, and things like that. Everything else is handed directly to the scrub. This is a fairly new policy for us, and it's taking a bit of getting used to.... but I think over all it's good.

I've been working in a CVOR since July 2008 and I was fresh out of LPN school. We don't have a specific policy pertaining to opening up cannulas. However, our perfusionists wait until we are scrubbed in and know for sure what type of cannula the surgeon wants, then THEY hand them off to us. I have NEVER just opened up a cannula onto the field unless there was someone scrubbed in, as everything is so expensive. Just talk with the perfusionists and ask them to open it to you while you are scrubbed in to prevent any problems. If they cannot do it, then just stick to your guns and don't open anything you are uncomfortable with. We are a close knit team and all have each other's back and are all working towards the best interest of the patient. Hope this helps, and good luck with all the "witches" who try to get to you. Everyone learns from each other, whether you are a new grad or an old hag. :)

I've been on the heart team for almost 10 years, working at 3 different hospitals, and when I circulate I never open cannulas until the scrub is ready for me to had them to him/her. I have scrubbed on occasion, and when I scrub I will ask the circulator to wait until I'm ready to have the cannulas handed to me.

If it's something that I feel safe opening onto the field and the scrub is busy or not scrubbed in, I will open it onto the field. Other than that, I always prefer to open to the scrub.

~~~let me make 2 assumptions. ~~~~

when i scrub, first of all, i confirm the types and sizes of the cannula with the surgeon and perfusioninst, then i would ask the circulator to open it up, and grab with my hand.

when i circulate, i would wait till the scrub tells me what the cannula they want to open. i would ask the scrub to grab it when i open the pack. if it's in emergency, when there is almost nill-chance for scrub to grab them, and the surgeon decides to go bypass urgently, once the cannula is confirmed, i would open the rigid ones such as dlp arterial and single or 2-stage venous cannula in the sterile trolley, but if they are very floppy and i'm unsure if i can keep them sterile, i would wait and ask the scrub to get them asap when i find a chance comes. opening the cannula is still a team work, and we do communicate with each other.

as to the or nurses with 2-faced, cold, snakey personalities, i agree with linda2097, that's human nature. but i always tell myself, i will not be like this to anyone esp. new staff, never and ever.

just hang in there, be strong! lilla_fjaril

hope it helps.

anita

hi lilla_fjaril & eeryone. i am rn in australia. in australia we have no technician working in or settings, so we have the choice of working as scrub/scout rn oras anaesthetic rn. i do scrub/scout in 'cvor' - here we call it 'cardiac / cardiothoracic theatres' so no one here would know what cvor means as we are more in tune with the british ways of doing things.

in regard to bypass cannulas, we don't rely on perfusionist to tell or hand us cannulas as we manage all of them and we know what our surgeons' preferences are. so it's pretty set routine unless complicated by the patient's anatomy. we always open cannulas to scrub rn & that applicable to all sterile items. we never open sterile items onto sterile tables/trolleys, not even sterile gloves (scrub rn and surgeons recieve their gloves while they're putting on their sterile gowns - they will grab those gloves from scout rn with no fingers exposed). for some of the surgeons we don't even open bypass cannulas and bypass accessories for cabg since these surgeon do a lot of off-pump cabg cases, and i'm sure the same as other surgeons worldwide like to inspect the heart first. if they decide to do on pump cabg then we have individualised emergency bypass box for each surgeons.

i have been fortunate in my workplace to not have any issues with other staff members and was well orientated and precepted when first came to cvor with no prior or experience. mainly because we are close knit unit, and very well respected by each other and the surgeons. i am sorry to hear that you haven't had the best welcoming experience into or setting. but hang in there as you a strong person, and soon enough others will realised you effort and contribution to the unit as a valuable team member.

best of luck.