Help!! Row over sterile trolleys

  1. There has been a debate in the OR where I work with regards to the positioning of the scrub nurse in relation to sterile trolleys intraoperatively. What do you do in your hospital? Where do you stand in relation to the trolleys and what are the official recommendations??!!
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  2. 11 Comments

  3. by   Marie_LPN, RN
    Um, help, what's a trolley? A tretcher? A cart?
  4. by   dippy7
    Oops sorry - forgot this is an international site!! I wrote "trolley" meaning that which the scrub nurse puts her instrument trays on/works from - is this what you call a "cart"?
  5. by   augigi
    I think it's called a mayo.
  6. by   elcue
    I position the table containing all of my sterile supplies (back table) perpendicular to myself, usually at the foot of the patient's bed. I position my small tray of instruments (Mayo stand) betweeen myself and the back table.
  7. by   Marie_LPN, RN
    We use sterile Mayo trays on orthopedic arthroplasty cases (because of the heavy insrumentation), we set these on the mayo stand after it's been draped. Other cases, we have a non-sterile tray that sits on the mayo stand (trolley) and we put the drape cover OVER the non-sterile tray, the cover the top with cloth towels.

    This stand (trolley) is usually pulled in over top of the pt.'s legs, the back table behind it. The stand (trolley) is to the side of the scrub, the other side of the scrub is the person assisting the surgeon.
    Last edit by Marie_LPN, RN on Sep 30, '06
  8. by   dippy7
    the arguement that has been going on in our theatres is that the scrub nurse should never have her back or her side to sterile instruments - but rather they should be in front of her!! This has led to conflict because when involved in an arthroplasty there may be so many instrument trays that the scrub nurse can't possibly reach across them all to pass the required instruments to the surgeon. We use a Mayo stand (a small table which can be pushed over the patients legs) as a sterile work surface from which to hand the basic instruments from while the bulk of the instruments will be on "trolleys" (1.5metre x 80cm metal tables on wheels) to the sides and behind the scrub nurse.
    When operating on a limb, again the scrub nurse stands with her side to the instruments and uses the end of her trolley as a working area. The argument from one surgeon is that the scrub nurse should be stood with the instrument trolley between herself and the surgeon/patient. We are concerned that this has the scrub nurse leaning over the sterile instruments to hand things to the surgeon. How does this sound to you? (Hope I have explained the scenario well enough!!!)
  9. by   Marie_LPN, RN
    The tray for our totals stays at the end of the bed, to allow clearance for the limb when 'testing' the trial prostheses. The table, oh heck let's see if i can "draw" a picture, because i know i won't explain this so that it can be pictured. This example is for a left total knee set-up:



    Now, from this picture it can be seen that the scrub nurse has her back to the second table, but our second table is appx. 6-7 feet from the back.


    Hope that made sense
    Last edit by Marie_LPN, RN on Oct 1, '06 : Reason: the picture was WAAAAAY too big
  10. by   Marie_LPN, RN
    The argument from one surgeon is that the scrub nurse should be stood with the instrument trolley between herself and the surgeon/patient.
    What is the surgeon's rationale for this?
  11. by   nubes
    Marie, in regards to your diagram, what do you have your 1st and 2nd tray positioned on?
  12. by   Marie_LPN, RN
    Both trays are on a tray stand (Mayo stand).

  13. by   dippy7
    thanks for the diagram Marie, that's really helpful!! We do have a similar set up for arthroplastys which is reassuring!! It is always a bit of a nightmare keeping all the sterile instruments within the laminar flow (ventilation tent) though!!! I think the surgeon in question in this instance felt that the scrub nurse should be behind the trolley with the instruments in front of her rather than with them to one side. He was referring particularly to minor cases where only one trolley is used for the operation. Where would you put that one trolley??!!

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