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?

[RosesrReder, BSN, MSN, RN]

We use anesthesia aides in our facility; however, the rule of thumb is the RN does not leave. We have "hall help" and if I need to run out for anything then I overhead page or call the hall help to go get it. During induction, nothing else matters. People know not to ask for anything during that time. I also do not let anyone start peeling linen back to start getting patient ready for prep or positioning. I do not allow it until anesthesia has secured airway, and has verbally dismissed me. I also do not allow traffic in and out of my room at that time. If you're willing to pop in and get trapped for the time being then risk it, if not then do not walk into my room. Surgeons are impatient but I quickly remind them to respect induction and stay off the patient. To clarify, the RN does not leave the room and abandon the patient unless there is another RN in the room to the right of the patient.

[GadgetRN71, ASN, RN]

I was always trained to stand by in case I was needed for induction help. Here and there, the anesthesiologist or CRNA would tell me they were fine. But I never leave the room for induction without letting anesthesia know where I am..

[birdie22]

I was initially trained to always be right at the bedside when the patient is awake - that means when they are being intubated and extubated. That being said, it really depends on the hospitals culture/policies what the expectations are. At my current facility, it is not the norm to be at the bedside with the patient, but its habit for me from the other hospitals i have worked in. the nurse usually doesnt leave the room, but isnt necessarily there helping anesthesia w/intubation. If everyone else left the room, who was watching the sterile field? But thats another issue for another discussion...

[megerler]

In there....period.

[ggoodman]

in there during induction and extubation, unless there are extra staff in the room i am at the head of the bed. If im not at the head of the bed(orientee, two MD's, resident) I guarantee you i know whats going on up there.

[romiller]

At my University hospital, there is always an anesthesia faculty as well as an anesthesia resident or CRNA during induction and intubation. Sometimes, it takes several minutes to bag the patient down for intubation. Also, some faculty wants continuous bagging while placing of peripheral lines. With the drive for operating room efficiency, having a circulator popping instrument pans, opening supplies, draping robots, counting, and assisting the scrub tech is time better spent. However, the circulator should never be absent from the room and be available for immediate assistance to the anesthesia provider during induction and intubation. Also, there may be some patients (and anesthesia residence) that may require the circulator to be present at bedside.

The difference between a CRNA and an Anesthesiologist is during the surgical case a CNRA throws their trash in the garbage can.

[mhy12784]

Ive never seen a circulator leave the room during induction (unless theyre asked to get a glidescope or something for anesthesia)

But when a CRNA is inducing there is always an anesthesiologist next to them as well. Sometimes they will not need the circulator as a 3rd set of hands (easy airways etc). But most of the time the circulator is right there with them.

I forget that in NY laws are different, as a CRNA always needs to have an anesthesiologist physically in the room with them for induction. Presumably in other cases this isnt the case

[romiller]

Does anyone know the AORN standards for personal at the head of the bed during induction and intubation?

[LJOHRrn]

As a new OR nurse, when it's time for induction, my job is to hold the mask while oxygenating prior to intubation, holding cricoid pressure when requested, and pulling the stylet when told to.

Until breath sounds are confirmed along with end tidal, the tube is taped and secured, and when I'm told to stop holding cricoid, the CRNA and patient are my first priority always.