Craziest Thing You Saw a Surgeon Do.

TakeTwoAspirin, MSN, RN, APRN · Jan 17, 2012

I have seen it many times with many different surgeons on many different procedures. I would say that it is fairly common - to the point where I read your post twice to see what I had missed to explain why you were so upset.

Snowbird17 · Jan 17, 2012

Seen it. The first time, I was a little shocked too.

This surgeon may have had his sterile field compromised in the past... and I think I'd rather have a couple little pokes than the sterility of my surgery compromised. People can be very vigilant of the drapes, but the robot cannot and is more likely to break the field. Although, I do agree that in most cases clipping to the poles works well.

Sorry this upset you.

I assume that you are a student since you said you saw this in your clinical experience. Good job for questioning this practice, sounds like you will be a strong patient advocate. Continue to tactfully question practices that you deem off, but beware you will see much worse in your career!

Something that makes me grimace is residents and students who stick multiple times for line placement. There is typically a hospital policy on the number of attempts, and I stick to it. Pun intended. I ask them to stop once they hit the number or even before if they are completely failing. Those are the punctures on a patient to really worry about, not a couple staples pokes.

Good luck!

Editorial Team / Admin · Jan 17, 2012

It's really not all that uncommon to see drapes stapled to the patient, especially on types of surgery where the drapes just aren't going to stick. Pretty much all of our surgeons will staple the drapes for crani patients, just because it's an odd area to drape out without leaving gaps. The heart surgeons don't actually staple the drapes, but they uses sterile stockinette as a soft tissue retractor by stapling it to the edge of the incision and then stapling it to the drape. These staples are usually quite superficial, and maintain the sterility of the field by not allowing gaps or sliding of drapes to expose unprepped parts of the patient or unsterile items such as monitors/cables, bed linens, or positioning equipment.

There is even some positioning equipment where puncturing skin is an automatic occurrence. One example that comes to mind is the mayfield crani positioner. The one we have involves a clamp where "points" are screwed into the clamps and then the clamp is tightened on the patient's head. I've seen some pretty wicked bleeding from those that actually required staples to close.

I get that you're upset about the patient not consenting about the drape stapling, but that's typically not something included in the consent. No surgeon I've heard getting consent mentions anything about how they drape (stapled or not) or even that the patient's incision will be closed with staples. Most patients don't want the play-by-play, they just want the basics to understand the surgery.

As for the craziest thing I've seen a surgeon do, it would probably be this one cardiac surgeon's method of keeping a patient's chest open. He would cut off the ends of two syringes, protect the incision edges and sternum with esmark bandages, then somehow secure the syringe pieces between the sternum pieces, then covered the whole mess with ioban. Usually left this in for about 24 hours until the patient stabilized enough to tolerate coming back to the OR for closure.

CrunchRN, ADN, RN · Jan 17, 2012

Good question, I can see why you were taken aback, and how interesting to find out that is fairly standard practice with good reasons behind it.

sillywilly · Jan 17, 2012

I worked as a Vet Tech for years before switching to human nursing. One of the Vets I worked with would always staple the drapes to the animals. It seemed to do the trick. I didn't know they did that with people too.

I don't work in the OR yet, but it is where I want to work.

While working as a Vet Tech the craziest thing I ever saw in (veterinary) surgery was during a leg amputation. The assistant accidentally handed the surgeon the wrong instrument, so the surgeon got mad and threw the freshly amputated leg at his assistant!

NP Sam · Jan 18, 2012

I have seen it many times also in Peds OR. It was shocking the very first time but you get used to it.

CheesePotato, BSN, RN · Jan 18, 2012

Staples huh? I assure you, my friend, those staple punctures are the LEAST of that patient's worries.

I assure you, consent for the procedure covers such things as staples, central line starts, ART line starts, etc etc etc. In most consents there is a piece of verbiage that translates to something alone the lines of "We have permission to do XYZ and anything else that catches our eye and needs immediate correction during the process....Oh! And anything necessary to get the job done." Handy bit, that.

Besides, patients are given an antibiotic prior to the start of the case in 99% of cases to prevent operative infection.

Also, staples are nothing. As Poet pointed out, the mayfield pins. mmhm. Delicious bit of crumpet, that is. But again, the pins are the least of the patient's concerns considering that their brain is being poked at, drained, skull flap removed, etc etc etc. I know a few surgeons whom use an instrument called a perforating towel clip to clip the drapes to the patient.

::curses and flails:: I have struggeld in vain to get my picture to post and now that I have opened a bottle of wine and calmed down...just...just google the instrument. I surrender. My archnemisis, the internet, has won once more.

::shakes fist::

Heheh.

If it makes you feel any better, as someone who has been stapled without anesthesia or local, it's really not that bad. Getting my ears pierced hurt worse.

I'm sitting here going through all the crazy crap I've seen in the OR and the scary thing is that it all seems perfectly normal to me. LOL. I guess I forget how shocking some of it can be to one who has not born witness before. I'll keep trying to consider it, but off hand, the only thing that comes to mind is the gratuitous air guitar solo which took place in the middle of an open appy.

::sigh:: I love my docs. Strange little birds.

suanna · Jan 18, 2012

Not in OR, but it was still a surgeon: My post-op patient coded and per protocal the EKG tech had them hooked up to a 12lead-during compressions. The surgeon arrived on scene and promptly hurled the EKG machine, through the air, into the wall across the unit. He was kind enough to explain he didn't need 12 leads of compression artifact to tell the patient was dead! I bet he destroyed many thousands of $ worth of equipment for a hissy fit. I do kinda agree with his point, but he overstated it a bit.

Cessna172 · Jan 18, 2012

A pt. on cardiac stepdown coded. Cpr in progress when cardiac surgeon arrived. He took a large hemostat and promptly “unzipped" all the chest staples, they flew off the patient. He somehow ran the point of the hemostat under the line of staples and forcefully dislodged them. Then he opened the guys chest, there was his heart. It was cool, and the patient lived.

Twinmom06, ASN, APN · Jan 18, 2012

A pt. on cardiac stepdown coded. Cpr in progress when cardiac surgeon arrived. He took a large hemostat and promptly “unzipped" all the chest staples, they flew off the patient. He somehow ran the point of the hemostat under the line of staples and forcefully dislodged them. Then he opened the guys chest, there was his heart. It was cool, and the patient lived.

I'm glad the pt survived and that sounds like something you'd see on TV!

gymnut · Jan 18, 2012

Oh my God am I laughing after reading these posts! I expected to come in here and find all this outrage of a patient being turned into a human curtain rod only to find out it's common. I am actually very relieved to find out that this is not bad practice and I can understand now that if that's the worst that can happen during surgery then I can live with that.

As the saying goes "You learn something new everyday!"