CVOR training program?

Editorial Team / Admin · Jan 15, 2016

I was supposed to have 12 weeks training when I moved into cardiac. However, I had many years of experience and by the third day was flying solo with my preceptor holding down a chair in the break room. Scrubbing was optional; had I chosen at that point to scrub, I would have had another 12 weeks orientation. It does take time to feel comfortable, just because of the many differences between cardiac and other specialties. In fact, I've exclusively done cardiac for the last 6 years, but I still have yet to see certain cases, like an open descending thoracic aortic aneurysm repair. The one thing that's really helpful is that there's a minimum of cases- we have CABGs, valves, CABG with valve, aorta. They all pretty much get set up the same way as far as circulating and we only add an extra tray of instruments to valve/aorta cases.

NedRN · Jan 16, 2016

There wasn't really special formal training for my cardiac orientation. Monkey see, monkey d. I did buy a book on cardiac surgery and absorbed that.

Comfortable or skilled and competent in hearts was my criteria to travel. If I recall correctly, it was over a year to meet that goal. Mind you, I had an eight month orientation through every service (scrub and circulate, no techs) at a major teaching hospital and then another year of being a generalist (not on a specialty team). After I felt comfortable at my hospital in every type of cardiac surgery and transplants done back then, I did a reality check to see if my skills translated to other hospitals by doing some agency per diem.

After 20 years of travel nursing (perhaps 20% open hearts), I can state categorically that the excellent training and standards of my first staff job prepared me well for every situation I've encountered since then. I'm very confident (whether you are or not, you need to project confidence as it makes surgeons and everyone else less nervous and able to focus on their jobs), but you should never be completely comfortable - some stress is good for coping with new or developing situations, just as some stress is helpful is while dealing with a steep learning curve.

ORRN21 · Jan 17, 2016

Thanks Ned. Sounds like you had very thorough training! Where Im at there isn't a formal X amount of weeks or months of training. But they are putting me to scrub initially and I don't know if that is really the best thing for me since I haven't scrubbed in years, much less in hearts.

NedRN · Jan 17, 2016

I actually think starting you out scrubbing is best. That will give you the big picture that you can only see scrubbed in. Scrubbing is not so hard once you compartmentalize the different stages of the surgery and prepare in time for each. Draping is complex but usually a team effort, opening, dissecting (and LIMA takedown), pursestrings for cannulation, cannulating, with graft harvest getting in your way here and there, distals and proximals, and closing. Every hospital has a different table set up and learning the set up is likely harder than learning the procedure itself.

I was once sent on a travel assignment to a different hospital to orient to hearts - the hospital I was at used the same surgeons but did not have a lot of cases. I arrived after the table had been set up and they had lost their scrub, so I just did the case! A few hints here and there from the first assist was enough.

A book on cardiac surgery would be helpful for you and you will now understand the rationale for each step. At least it was helpful for me because I feel the need to understand what I'm doing, not just learn by rote. Your department might have one. The one I used is dated (perhaps there is a newer version) but still relevant: Mosby's Cardiac Surgery by Seifert. Written for nurses and is readable, but it doesn't condescend.

Argo · Jan 21, 2016

I agree that learning to scrub is best first. I was able to circulate the CVOR independently in about a week(I was also experienced going in). Scrubbing will take longer to learn and give you a better picture of what you will be needing in the room and what to predict if your paying attention. I have not done hearts in a couple years but I would jump in to circ one in an instant, scrubbing I would not.