Circulating c-sections

tewdles, RN · Jan 14, 2010

I worked in a regional OB center. All L&D staff were trained to circulate in the CS (we of course had our own OR suites). We employed scrub techs who stocked, cleaned, and provided assistance in the unit when no CSs were in process. All unit RNs were trained to circulate. We were responsible for emergency CS unless it was a trauma requiring delivery...then they went to the OR with NICU support...OB staff stayed in unit.

When new staff were hired into the L&D they received their OR training to circulate, prep rooms, etc from OR staff at orientation and then precepting from the L&D staff. Having the L&D staff provide their own people for CS scrub and circulation can often shave time off of the stat procedure...but it does change the staffing model for the unit.

It was a fun, challenging, and mostly happy place to work.

shebbie · Jan 14, 2010

what staff attend the c sections and what are their duties? Does a RN come from the nursery to care for the baby? Where and who preps the pt? Does she go to a PACU and who does the recovery and for how long?

NewNurseyGirl2009 · Jan 14, 2010

The mothers nurse circulates, the lead is the baby nurse and the tech scrubs. Works well but we are a 14 bed LDRP with our own OR suite

Stacy in North Texas · Jan 14, 2010

When I worked in L&D, we had our own ORs (2 of them) and a 4 bed recovery room. Whether it was a planned C/S or not, the nurse assigned to the pt prepared her for surgery (IV, Foley, Shave, etc.) and circulated. All the RN's were trained to do both circulation and scrubbing just in case a scrub tech was not available (although most of the RNs didn't like scrubbing because they didn't get to do it enough to feel completely comfortable doing it). Present in the OR (besides the surgeons and the anesthesiologist) were the circulating nurse, scrub tech or RN in the scrub tech role, and often an additional RN to assist the circulating nurse if one was available. The circulating nurse did the counts with the scrub tech, assisted with placing the pt on the table, obtained FHR tracing prior to the surgery, and usually took the baby from the surgeon, did apgars, foot prints, weight, etc., and of course charted everything. If, however, there was any chance of the baby having complications, then 1 or 2 nurses from the NICU would attend the delivery and do the baby care. If the baby was known to have serious complications and/or was extremely premature, then even a neonatologist attended the delivery. Then the circulating nurse followed the mother to the RR and did her recovery. If the baby was okay to go to the newborn nursery, then the circulating nurse took the baby to the nursery while another nurse temporarily cared for the pt in the RR. The circulating nurse was responsible for transporting the mother to postpartum and of course giving report. Hope this helps.

tewdles, RN · Jan 14, 2010

what staff attend the c sections and what are their duties? Does a RN come from the nursery to care for the baby? Where and who preps the pt? Does she go to a PACU and who does the recovery and for how long?

In our unit the labor nurse for the mom prepped patient could circulate but often did not because she generally had paperwork/documentation to complete given the turn of events and necessity of an unplanned emergent CS. The prep occured in the labor room, in the hall, and in the OR...sometimes it is occuring while you are also accomplishing other tasks and assessments. Those emergent CS often took the attention and focus of several professionals for a short while to maximize speed to the OR. If possible, the CS/OB surgical team actually covered the stat CS, but was possible that they would already be engaged in a case when you would need the other suite. L&D had their own PACU. NICU generally attended the stat CS to insure that the infant was doing ok and the infant generally went to PACU before the mom. NICU also staffed the PACU to recover the infants. One or two RNs were assigned to the PACU (depending upon the number of scheduled CSs for the day). We had 3 OR suites and accomplished 3500+ deliveries/yr.

NurseNora, BSN, RN · Jan 15, 2010

When I worked in the big city Level 3 busy L&D, all nurses were trained to circulate, many chose to learn to scrub as well. There was a wonderful old scrub tech who trained everyone. Medical students and interns were scheduled time with her and she taught them sterile technique. After she retired, new nurses' preceptors trained them to circulate.

For scheduled C/S (usually 2-3 a day) there was a scheduled circulating nurse. The labor nurse usually circulated for the unplanned ones. For emergency ones (cord between the legs, hot unload off the helicopter, straight to the OR, baby out in 6min from touch down), anyone available did whatever they could, and whoever became the official circulator kind of worked itself out. For a while there was a separate OB RR with its own staff and they recovered. Later they got rid of the RR and the circulator recovered Mom and baby. Nursery staff attended all deliveries and were responsible for the baby's stabilization.

Now I work in a smaller hospital that has started doing it's own C/S within the last year. We started by sending all the techs to the OR to learn to scrub. They did all the sections and hysterectomies, and whatever else was available. As a smaller place, there aren't daily C/S and hysterectomies, so they had to take whatever was available. After they were trained, they scrubbed all the C/S and were scheduled there from time to time to keep up their skills (this was a very long process, both the training and getting our OB OR's ready for use). RN's had to circulate at least 3 sections in the OR, more if the OR circulator thought she needed more. Same with PACU.

Now we do our own C/S. Each RN has to be on emergency call one or 2 days every 2 weeks. This call is only for C/S, not for a generally busy day. The techs are scheduled one week of emergency call a month.

Work closely with your OR and PACU staff. Our OR staff put together a wonderful program for the RNs on sterile technique, how to move in a sterile environment, familiarity with instruments, patient safety in the OR, etc. It was an all day class, offered several times so everyone could get to it before their first time circulating. I'm not sure what we'll do with new nurses as far as training; don't know if they'll send them to OR for some general OR technique, or if we'll be training our own. We're still pretty new at it and haven't had to train anyone new yet.

A circulating nurse can only care for one patient, so there has to be a separate nurse for the baby. In my old hospital, we were probably wrong to let the nursery leave and keep the baby with the mother, usually in Dad's arms, but in the 15 years I was there, there was not a problem. If the baby started grunting or seemed in any way to need more than parental supervision, we were quick to call someone to come for the baby. In this hospital, we don't have separate nursery staff and any of the labor nurses can come in to catch the baby and stabilize. But she does tend to take the baby to the RR pretty quickly.

All the L&D nurses had to take ACLS so they could recover their patients (if it's required for your regular PACU nurses to be ACLS, then your OB PACU nurses must be also). We have one LDR that is set up as a RR, but we often take the patient back to her original labor room and just take the monitor into that room.

Good luck with this process. Take your time and make good friends with OR and PACU staff. It's a hassle for them to train us, but in the long run, they benefit since they don't have to take our OB patients anymore.

Nervous_Nellie · Jan 20, 2010

We are a rural hospital, and perform about 900 deliveries a year. There was a tremendous debate for years about us circulating sections, and it finally came to fruition about two years ago. The staff's concerns was, of course, staffing, and us running short during a section if the unit was busy.

What they decided upon (and it's worked really well, so far), was that we circulate all of the off-shift sections, if we feel safe doing so. As you know, sometimes L&D can be soooo busy, you just can't spare someone for an hour. All of our charge nurses, as well as any new hires or position changes (changes in hours, shifts, etc...) learned to circulate. Our staffing model calls for one extra nurse on these off-shift hours, ideally without an assignment, to be able to circulate if the need arises. If the charge feels they are unable to safely circulate, then OR is always our back-up.

Training was short and sweet. We spent a day in OR with a circulator to see how things went, shadowed for several c/s, and then had a class to learn the documentation...it's a totally different computer system than we use. Then, when each person felt comfortable, the OR person observed, and we were done.

It's really worked out well...I just can't understand how this is financially gainful when you have an extra RN 16 hours a day with supposedly no assignment. It would make soooo much more sense to pay the on-call OR person. However, we do get to do our c/s so much quicker, and everyone from OR's feathers don't get ruffled coming in at 0300 .

How we do the c/s--The charge (or designee) circulates, optimally we don't want the labor nurse to circulate. How we've found it works best is for the labor nuse to catch baby, and then recover.

Good luck!

cubangirl · Feb 4, 2010

On my unit whoever is taking care of laboring mom will circulate and recover the patient. take care of the baby when comes out together with the pediatrician that has to be there when baby comes out. If baby is stable we keep it so mom can bond after surgery. after that nursery staff will come pick up the baby All the RN's know also how to scrub because many times we dont have ob techs at night. in case of emergency everybody tries to help. sometimes gets really crazy.