Circulator Presence on Induction?

[Dielsh]

I have a question for OR nurses. I am a CRNA and I had a situation where I was inducing the patient with the help of an anesthesia aide. The circulator left the OR during induction without telling or asking me. After induction, I looked up and all the staff had left the room. Needless to say, I was upset and approached the circulator who informed me that with an anesthesia aide, the RN is not needed. What is the opinion of circulators?

[PositiveVibesRN]

Hi, I work with Anesthesiologists and I would NEVER leave my Anesthesiologist during induction. The second the patient is brought to the room, the patient and the Anesthesiologist has my full attention. Everyone in the room understands this. No one can ask anything from me and everything and everyone else can wait.. including the Surgeon(s). Induction + intubation and extubation are the two most critical moments.

From my experience, everyone in the room is aware and alert prior to induction. We have an Anesthesia Tech but still, even when we have support in the room (additional RNs) or even the Surgeon, everyone is aware, respectful of that moment and everyone is available for the Anesthesiologist.

If there is anything but this type of atmosphere, I speak up as the Circulator. People are talking, I tell them to be quiet. The Nurse orientee is not paying attention, I signal for their attention and make them stand next to the OR Bed. The Surgeon is trying to do something to the patient (i.e. place a tourniquet, try to re-position the patient) or talking to the rep I tell him/her to stop.

I've walked into other Nurses' OR rooms looking for something and notice they're about to induce and I stop what i'm doing and stand next to the OR Bed. I've had Surgeons walk in during induction and stop and stay to be available. (not like they know what to do though, lol.. just kidding.. but they stop and stay) Once the tube is in, End tidal C02 is confirmed and tube is secured, everyone can go back to normal activities. I've never seen it any different.

If we're in a rush, at the very least, an RN will be standing to the right of the patient fully assisting the Anesthesiologist, while another RN does counts or mix meds but is ready to jump in when needed.

You can have multiple individuals in the room assisting but staying yourself as an OR Nurse / Circulator to help assist is promoting Patient Safety and Patient Advocacy and that is an OR Nurse's #1 ROLE and #1 PRIORITY.

Can you tell i'm very passionate about this topic? lol. That's my 2 cents.

[Rose_Queen, BSN, MSN, RN]

I would never leave an anesthesia provider and an anesthesia tech as the only staff in the room. That's not safe. Have I needed to run out at times? Yes, but there are other people in the room to help if needed.

[Dielsh]

I wish you were my circulator! I love that you put the patient's safety first.

[RNOTODAY, BSN, RN]

My job as a circulator, regardless if you have a tech or not, is to be at the bedside, the whole time, until the tube is in, and SECURE

[rn&run]

We don't use anesthesia aides. The only reason I will not be at the bedside during induction is if the anesthesia provider dismisses me. If that is the case, I still won't leave the room until the tube is secure. It's completely appropriate for you to expect backup during induction, and as an RN I would be uncomfortable leaving my patient at just this moment, even with a tech present. On that note, did you also address your aide, who it sounds like left you prematurely?

[Dielsh]

Good question about the aide. Another room had an airway emergency and needed a guide scope. My patient had a secure airway and was completely stable.

[rn&run]

I had to do some research since I'm not familiar with the role of this type of tech -- turns out it is entirely within the scope of an anesthesia tech to assist with induction, and complications therein, so officially the nurse did nothing wrong. The tech should be completely competent to assist with airway management. The circulator made sure you had an extra pair of hands (ensuring patient safety during this critical phase) before exiting the room. You dismissed the aide after determining your patient's airway was safe and secure, then confronted the circulator about being left alone. If you truly were concerned for safety (which you weren't), you would have asked the tech to stay. You can always let the circulator know that you prefer to have an RN immediately available despite the presence of an anesthesia tech, but I don't think she endangered the patient by leaving.

[Dielsh]

Interesting response. My concern was not being left alone after induction, but during induction, the critical phase. The anesthesia personal was an aide not a tech and cannot push any drugs. I had the anesthesia aide in the room becasue I anticipated a difficult airway, which I mentioned during the timeout. During induction I may need someone to make a phone call or act as an additional set of hands, or push drugs. At the very least, inform me that you(the circulator) are leaving the room. The circulator was gone 7 minutes. The anesthesia aide stayed with me for 6 minutes. I had called for additional personnel when the aide had to leave. My question is and has been, do you leave during induction, maybe this is a common practice? I am also dismayed that the surgeon, and surgery tech also left the room, leaving just two people in the room at induction. In the future, as part of time out, I will need to ask the circulator to stay in the room during induction.

[Emloohoo]

I work in the University Setting. We have team anesthesia with a CRNA or Resident along with an attending and often times a Anes. Tech. However, I always make my presence known. If the head of the bed is full I will work on charting or help my scrub. When I went through my perioperative residency it was stressed to ALWAYS be at the head of the bed. I have been a OR nurse for 12 years and worked in a variety of settings. Sometimes, when I worked at stand alone settings I was the only person helping anesthesia. I have had malignant hyperthermia happen, allergy reactions closing the airways, difficult intubation. As nurses we NEED to work as a team with Anesthesia! We are the patient advocate!

[offlabel]

I had the anesthesia aide in the room becasue I anticipated a difficult airway, which I mentioned during the timeout. During induction I may need someone to make a phone call or act as an additional set of hands, or push drugs.

The issue of the circulator attending the induction aside, I'm assuming that there were no other actual anesthesia providers available to be in the room with you at the induction? If there was enough of a concern of a difficult airway that it was mentioned in a "pause" there certainly would be enough to have a second pair of hands immediately there for a lost airway.

If no one else was available, that's one thing, but to have anesthesia folks around and not in the room with you, the circulator question isn't even relevant.

[RobtheORNurse]

As the Circulator, I NEVER leave the side of the patient during induction, even if the supervising anesthesiologist is there. Too many things can go wrong at that critical time.