Free flap reconstruction - two scrub teams and one scout

[Picklednerd]

Hi all - I really need your opinions/experience with a particular type of case. Here are the details:

The procedure: Radical parotidectomy (or oral tumour), + neck dissection, tracheostomy, mandibulectomy, maxillectomy, temporal bone resection, sural nerve graft, facial sling, + abdominal (or fibula) free flap reconstruction. Etc etc!

The burning question: if there are two surgeons operating concurrently, independently of each other (i.e one on the head & neck and one raising the flap) - how many nurses are required.

The private hospital I work at is insisting that I be the only circulator for both surgical teams and count for both procedures. They've told me that a good scout nurse should be able to do this - by prioritizing. I feel that in this case I need two scrub nurse, and two scout nurses.

I would really appreciate your insight and experience, as I am unhappy with what's being asked of me. I feel I am very organized and efficient, however doesn't seem safe, or fair. Any advice??

[Argo]

Have done similar cases as a single circulator. Its doable but ideally you would at least have an assistant ofeven if its not a nurse... someone to run for you for supplies and instruments that are being asked for.

[Picklednerd]

I don't mind scouting on my own for some types of free flap recon - it depends on the addition of another surgeon, who for 2 hours is raising the flap, separately from the primary surgeon... Is it too much to ask for a scrub and a scout just for that two hours? There's just so much going on, & the guys I work with are bloody quick. I don't know. Maybe I need to 'harden up'!

[canesdukegirl, BSN, RN]

You should have two teams. This is essentially TWO separate cases. One team per surgeon would be ideal.