Quote from RNOTODAY
OK... setting up, for one. I still dont know yet what I will need for whatever case, what goes on the mayo, I have trouble handling the string,and generally I dont have a system of where everything goes.
Placing the string on a towel roll may make it easier to count. Or holding the string with one arm and using the other hand to count with.
And, I dont anticipate yet, I need to be asked for something (except the obvious scissor after a tie, etc)
Anticipating is something you start doing without even realizing it after awhile. Here's a few tips:
1) typically after the knife, the bovie is next, along with retractors and a DeBakey.
2) If using an abdominal retractor, you'll need damp lap sponges for padding and packing. Warm saline is best. I ask for warm saline right after the doc hands the knife back from his skin incision.
3) For abdominal hysterectomies, the 'routine' is typically clamp, clamp, sometimes one more clamp, scissors or knife, suture, suture, cut or clamp suture.
4) Having a fine-tipped hemostat handy to anticipate that stubborn bleeder that always happens at the beginning.
5) Forceps: Debakeys are for soft tissue, Adson forceps with teeth are for skin.
6) Sutures: "Cutting" needles are for skin, used last thing.
7) Surgeon just asked for a "widow". A widow is a suturing needle with no suture attached (also known as a 'free' needle)
8) The deeper the surgeon is going into a "hole" the longer the instruments should be.
9) Sponge on a stick: Keep your sponge forceps loaded on abdominal cases. If you have medicine cups/glasses that are on your field, you can fold up a sponge just like you're going to put it on the sponge forcep, only put that folded sponge in the cup. The cup keeps it folded, and you can get the sponge forcep loaded faster (handy for emergency spleenectomies)
10) If you're using 8 pack 'control release' suture pack, when you have 3 sutures left, ask the doc how many more he's going to need. This way, you can ask for another pack if needed before you run out.
11) Anything that needs 'tossed off' before the incision goes up on the mayo tray. Suction tip, suction tubing, bovie, light handles.
And I just feel that I am slow, I sometimes cant understand what I am being asked for, I dont get when I am supposed to hand tie with a debakey, on a pass, in the hand.
I don't always know either, so i load one up on a tonsil clamp, one on a right angle clamp, so i can at least try to be prepared. If they are 'grabbing' the tie in the middle with their hand, hold the tie like a piece of dental floss. This keeps it straight.
I sometimes get adson clamps mixed up with... I cant remember what....
And they all call instruments by different names, because what you call an Adson clamp, we call a tonsil clamp lol.
and when it comes time to count when we are on skin and I have to pass suture , I get flustered, rushed, and feel like I cant do both!!!! Nobody has said I have been awful or anything, but I just feel very inept, and am not at the stage where I want to be left alone, without the preceptor.
Do you all count sharps/sponges and instruments twice, or sharps/sponges and instruments once, then just sharps/sponges?
Oh, and draping, i get nervous with the draping, I dont know why. Everybody drapes so different.am I supposed to know how to drape for every procedure , even if I have never done it before?
If someone gets all cranky about draping, i just say "everyone does it differently, i'm just not familiar with everyone's way yet"
Surgicell, how small, how big??
Depends on where it's going. I just ask what size they want.
I cant make the roll with the towel,
Fold the towel in half so that it's a rectangle. With the folded edge to your right or left, fold the seam edge about an inch. Keep folding over and over until you reach the middle of your rectangle. Hold the rolled part, and flip the whole thing upside down. That keeps the roll from coming undone. Place instruments on the roll.
the suction, the bovie cords, how do I keep them from being tangled,
Toss off one at a time.
do I take that instrument they just put down, or will they need it again in a second???
If it's a clamp or scissors, i just slide them over a little bit out of the way. Knives, hypos, sutures or anything else very pointy or sharp, goes back on the tray, i don't care if they whine or not about it. It's a safety issue for everyone involved.
uggghhhhhhh I just feel ....I dunno..will I ever get it???
You will, and the weird thing is, afterwards you'll think to yourself "and this used to be so hard, too"
Everybody in the place does things different.
And of course everyone says their way is THEE right way.
When i was getting trained, i set up the way the preceptors told me to, but once i was on my own, i set up in my own functioning way. It's nothing radically different, but it helps me be more efficient. One example, i use a draped prep table as my 'dirty' table during a colon resection, that sits beside of my back table. Just my preference, but i do it so that the instruments can be seen easily for a count, instead of being piled in a basin.