Giving meds in OR

Gompers, BSN, RN · Aug 21, 2006

Are meds (other than those needed for anesthesia) often administered during surgeries? If so, who is responsible for giving them (circulator? scrub?)?
What about if the patient needs blood products? Who hangs these?

I believe the anesthesiologist or CRNA administers all meds and transfusions, but I could be wrong. That's what they do at our hospital, anyways. I only have experience with pediatric surgery.

Marie_LPN, RN, LPN, RN · Aug 21, 2006

Depends on the drug. One of the most common ones that the circulator pushes at work is the Decadron during tonsil surgeries (surgeon preference). Indigo Carmine (surgeon preference during the end of our lady partsl or abdominal hysterectomies, turns urine blue, checking for ureteral patency during and after-procedure cysto) is drawn up by the circulator, and the MDA gives it where i work. Methelyne Blue is sometimes used during breast or lymph node biopsies, the circulatior draws that up, squirts it on the sterile field into a med cup, the scrub draws it up, surgeon injects it.

The surgeons (if they perfer some for a general case) does the local injections of Lidocaine (with or without epi, depends on the pt.'s condition and the location of the incision) or Sensorcaine (same about the epi). We also have surgeons who inject vasopressin in the cervix prior to incision on a lady partsl hysterectomy. The scrub gets any field med ready for the surgeon beforehand (and because of the medicines, our policy is that the person getting it ready has to be an RN or an LPN).

For minor cases, the surgeon injects the Lidocaine.

The circulator hangs the abx, and if it's been 3 hours (depending on the abx protocol), will re-hang another bag of abx.

Sometimes heparin is given IV during the case. The MDA gives that where i work.

The circulator gets the blood ready to hang by getting the necessary supplies, the MDA actually connects the tubing to the pt. where i work. (after a T and S of course.)

NurseRoRo · Aug 21, 2006

In our facility, antibiotics are usually started in pre-op before belly cases. Indigo carmine is in the anesthesia carts so they give when needed. Local anesthetics and mixables (vasopressin with saline, lidocaine with saline, etc) are made by the circulator and either given to the field or drawn up in syringes for surgeons to inject prior to prepping (plastics cases).

On occasion, the circulator gives IM injections but that is physician preference at the time.

Blood is administered per anesthesia after cross-checking with circulator.

mcmike55 · Sep 10, 2006

Pre op,,,the nurses have the primary job. After the anes. doc sees the pt, he leaves an order for a light pre op sedative, usually Versed/Fentanyl.

We normally give it, but sometimes they push it.

Preop antibiotics, ordered by the surgeon, are left to us to start at the correct time.

In the OR.....anything IM/IV is by the anesthesiologist. The circulator (RN) can, and does help. But it's all up to them. Hanging blood too.

On the field.....shared responsibility. The RN circulator obtains the correct medication (usually locals, various eye drops, etc) and then transfers them to the sterile field. The circulator holds the bottle, so the scrub can see the label, including expiration date, and we both speak out loud so all are in the loop. The scrub then labels the medication container, and syringe, and hands off to the surgeon, saying out loud again, what the med is, strength, etc.

Many of our medication bottles are sterile, which eliminates one possible problem of confusion. This eliminates putting the med in yet another container before reaching the pt.

Some meds, especially those with Epi, etc, we also make sure the anesthesiologist is informed about the med the surgeon is injecting.

Mike

Marie_LPN, RN, LPN, RN · Sep 10, 2006

I forgot to add, the scrub calls out the name of the med when the surgeon is about to inject ("Injecting 1% Lidocaine with Epi") so the MDA knows about it.