Circulating

IsseyM · May 5, 2007

Nope but when you find a good one let me know. I tried looking when i was going through the training but no luck. I learned how to circulate through numerous preceptors. Some would hardly make me do any circulating and some made me do it all. You're main job is patient safety and comfort...along with making sure your doctors, anesthesiologist and scrub have everything they will need. Making sure the patient is transferred safely. Safety straps are on. Patient is kept warm. All monitors are on and VS are visible on machine, even though anesthesia is mainly focused on this. You may help anesthesia intubate patient, you may not. Some are pretty self-sufficient and don't want help, but always offer. Here are some tips i hope you find helpful.

Tips for a circulator before you bring patient into the room.

*Make sure your OR bed is locked and safety straps available! (For body and arms)

*Make sure your OR bed is in the right position for the type of surgery you're going to do. (Lap Chole. The C-Arm machine needs to fit under the table without the metal part being in the way) (If doing lithotomy or jacknife be sure the bed is positioned to where its supposed to bend) Also some doctors want cassettes on the table in case they want to do a flat plate x-ray, some don't care. Its good to have them on for big bowel cases.

*Make sure all your suction units on the walls work, have enough suction cannisters and tubings available in room.

*Make sure all the lights work.

*Make sure your room is stocked with supplies you will need throughout the day. (All different kinds of prep solutions, dressing supplies, lap sponges, xray detectable sponges, suction tips, towels, drapes, gowns, gloves, sutures, ties, lighthandles, positioners-like gel rolls etc, etc.)

*Make sure you have some kind of warming unit in the room (Baier Hugger or Warming Blanket Unit)

*Make sure your bovie machine works and that you have grounding pads.

*Make sure that your anesthesiologists checks their machine and cart to make sure all drugs and supplies are available, so you won't have to run or call out for it during the case.

*Have step stools available in your room, especially for the short doctors.

*Have 3-4 pillows availabe in the room. You never know when you're gonna need em. I like to put 1-2 pillows under patients knees, especially if they have back problems.

*If doing a Laparoscopic procedure which requires insufflation of gas into the belly. Make sure you have a full tank of gas. I've had to change out numerous tanks (what a pain), thank goodness they were not during the case.

*Check your preference cards and read over them 2-3 times. Sometimes you'll miss an item and then realize it was on the card and end up having to run or call for it during the case. If it takes forever to get it the doctor will have a fit especially if he knows it was on his card.

*If you're unfamiliar with any of the equipment have someone give you a quick inservice on it, or ask if someone can come in during the case to help you with it. It took me a few times to get used to the Laparoscopic monitor because i wasn't sure how to turn on the gas or take the light off, increase pressure or flow.

*Make sure you have a sitting stool for yourself. Haha. Its nice to a seat during the case, you really don't have to be on your feet all day.

Tips for circulating during a case:

*Make sure your scrub person has warm irrigation solution NaCl.

*When giving medication to the scrub person, make sure you look at the bottle closely, tell them what medication you are giving them, some want to see the bottle and check the expiration date!!! Also make sure your scrub person labels their medications. Some doctors will through a huge fit if they don't see anything labeled.

*After the patient has been draped and cords are being tossed off the sterile field. Always hook up the bovie (make sure the grounding is hooked up also), suction or other electrical equipment first before you do anything. Don't stop to answer the phone or run to get anything. One of the first things a surgeon will use after the patient has been draped is the knife, (or local injection) then the bovie. For Laparoscopic cases i like to hook up the bovie first, then the Laparoscopic camera, light and insufflation, then suction. But sometimes they throw off the Laparascopic first and the bovie cord second. You can do either or.

*Watch how many sponges your scrub person is going through. Its nice to notice when they only have 2 or 3 more left, you can ask them if they need another package. This includes sutures/ties/hemoclips. If you notice they go through supplies fast, have them available so you can quickly open it to them when needed. Keep track of supplies you open and your charges.

*Pay attention to your patients IV fluids. When you notice the bag is getting low ask the anesthesiologist if he/she would like another warm bag. Sometimes no one pays attention and the bag ends up going dry.

*Make sure your patients extremities stay on the OR bed. There have been a few times i caught the leg slipping off the table because of the SCD machine. Or arms fall off the armboard because they were not strapped. This is why i like to use arm straps.

*Pay attention to see if doctor may have to switch sides. If doctor is using a headlight you have to unhook him and switch and if he's using foot pedals you just have to move them where he can reach them.

*Pay attention to the case. Listen to what the doctor is telling his assistants, residents, medical students or scrub. This helps me out alot because it can put me one step ahead.

*If there are specimens make sure to ask the doctor what the specimen is and how he would like it to be sent. Also make sure if it is to be sent right away that you write your extension number on the card so the pathologist can call back to the room for results. (However, there could be a different policy depending on what hospital you work at) One time i forgot to write the number and the doctor was asking about the specimen, if i sent it and what was taking so long so i had to call the lab myself.

*If you're not sure what type of dressings the doctor will use then ask. I personally like to ask when they're starting to close, that way i have time to gather all my dressings supplies and have them readily available to open. With ortho cases (broken bones) i like to have them available earlier.

Circulating takes practice and repetition. I didn't think i could ever do it by myself but now i am. You will have many different cases but circulating duties are pretty much the same for each one, the only things that change are the instruments, supplies or anything you will need to call or run for

I know there are so many other tips but this is all i can think of for now.

Great Potential · May 5, 2007

Thanks IsseyM. That is a lot of good info. I am not worrying about the book for now. I am a relatively new nurse attending a Perioperative course at a College and doing my clinical at the same time. I am done with scrubbing and am now circulating. As the new kid on the block, all eyes are on me and I am sure a lot of the nurses there can't wait for me to make a "faux-pas" (mistake). That is why I am trying to get all the info I can get my hands on.

Thanks again.-

IsseyM · May 6, 2007

You're very welcome! I forgot to mention, i think its a good idea to carry a pocket sized notebook and write down every case that you do. I like to start with the doctor's name, the procedure, the position, the type of prep, Meds, equipment/supplies, sutures and dressings. Depending on what facility you work, some preference cards will already have all of this and some do not. Best of luck and keep us updated!

suzanne4, RN · May 9, 2007

Excellent suggestions! I always recommend that a newbie have that little notebook that will fit in a scrub pocket.

RNOTODAY, BSN, RN · May 10, 2007

Issey, great post!!! Really, greatpotential, that post is the bulk of what we need to do, over and over again!!! Our minds need to be tuned to these things automatically. I thought, too, I would never get it, but I did. It does take time.

Picklednerd · May 17, 2007

Wow Issey, thanks for the circulating tips!!! Ive decided to do my only elective placement (8 weeks) in OT, and all going well apply for a new grad position. So your advice is just what the doctor ordered :lol2: Maybe you should think about writing a book for newbies?!

JHRN2BE · May 19, 2007

Issey,

thanks for the incredible tips! I start my OR internship in 2 weeks and have saved your informtaion and will pass it on to the hospital for them to use for the internships as well. I agree with poster who suggested you write a book. GO FOR IT! I bet it would be a staple in every OR!!

thanks again! JH

RN Zeke · May 20, 2007

Issey,

You Rock!!! I value the information you provided for all to share. As I seek to return to surgery as a circulator after being a long time Surg. tech., this will assist me in learning the ropes of the Circulator. My job search has yet to start as graduation was 5-10. Getting ready for the NCLEX is my goal currently. I am looking for jobs this weekend. Any suggestions?

grellen50 · May 28, 2007

Hi There. I'm New To This Site But I'll Ask This Question In Hopes That A Circulating Nurse May Have Encountered The Same Concern. I Would Like To Find Out Who's License An Uncertified Scrub Tech Is Working Under. The Techs In My Or Are Suturing And Stapling Wounds And I've Been Told That It's Ok If The Surgeon Directs Them. Does Anyone Have Any Ideas? Thanks!

TracyB,RN, RN · May 30, 2007

hey grellen.. check your state's board of nursing. They may have some guidelines for you.

Also, just an FYI (for your info) difficult to read your post, with each word being capitalized.

DaizeeD · Jun 23, 2007

Issey, You are a lifesaver!:thankya:

Thank you so much for your wonderful advice. I am a new grad who has one week left before beginning OR orientation. Your tips are wonderful and I really do appreciate the time you took to write them down for us. I will be printing out your tips and laminating them to carry with me in the OR.

Thank you, again.