Learning to scrub

sunnyjohn · Nov 11, 2006

2 weeks .... wow

I could probably get the basic stuff in General Surgery in two weeks, but I could not imagine two weeks for all of Ortho PLUS total joints or hearts.

Perhaps they are just giving you an overview of every service and will go back in to give you detailed instruction on the ones they want you to focus on? *Wishful thinking*

Do you have a copy of Alexander's Care Patient in Surgery? Maxine Goldman's Pocket Guide to the Operating Room? Berry and Kohn's? Fuller's book for surgical technologist?

Marie_LPN, RN, LPN, RN · Nov 11, 2006

"Instrumentation for the Operating Room" (Mosby publishing) is a color picture book to learn instruments with.

I'll try to work on some pictures of how i set up my tables and trays for different cases.

RNOTODAY, BSN, RN · Nov 11, 2006

ortho is a closed team, so is open heart... so not those two... but we have general, g/u, vascular, neuro, ent, pediatrics,plastics,bariatric, and all the lap stuff that goes with all of that......we have about 20 rooms for all this stuff....and nope, thats it, just the 2 weeks, no going back...

I have all those books mentioned, except the surgical technologist one, which I think I may need..... I guess you just have to *do* it alot to get it? I just want to be able to go into a case confident, and know what I am doing. I just dont know if that will happen in 2 weeks per service. Should it?

and Marie, that would be great if you could do that......you are always a wealth of info..I wish I worked with you!!!!

Marie_LPN, RN, LPN, RN · Nov 11, 2006

ortho is a closed team, so is open heart... so not those two... but we have general, g/u, vascular, neuro, ent, pediatrics,plastics,bariatric, and all the lap stuff that goes with all of that......we have about 20 rooms for all this stuff....and nope, thats it, just the 2 weeks, no going back...
I have all those books mentioned, except the surgical technologist one, which I think I may need..... I guess you just have to *do* it alot to get it? I just want to be able to go into a case confident, and know what I am doing. I just dont know if that will happen in 2 weeks per service. Should it?
and Marie, that would be great if you could do that......you are always a wealth of info..I wish I worked with you!!!!

Can you be a little more specific for particular things you're having problems with?

RNOTODAY, BSN, RN · Nov 12, 2006

Can you be a little more specific for particular things you're having problems with?

OK... setting up, for one. I still dont know yet what I will need for whatever case, what goes on the mayo, I have trouble handling the string,and generally I dont have a system of where everything goes. And, I dont anticipate yet, I need to be asked for something (except the obvious scissor after a tie, etc) And I just feel that I am slow, I sometimes cant understand what I am being asked for, I dont get when I am supposed to hand tie with a debakey, on a pass, in the hand......I sometimes get adson clamps mixed up with... I cant remember what.... and when it comes time to count when we are on skin and I have to pass suture , I get flustered, rushed, and feel like I cant do both!!!! Nobody has said I have been awful or anything, but I just feel very inept, and am not at the stage where I want to be left alone, without the preceptor. Oh, and draping, i get nervous with the draping, I dont know why. Everybody drapes so different.am I supposed to know how to drape for every procedure , even if I have never done it before? Surgicell, how small, how big?? I cant make the roll with the towel, the suction, the bovie cords, how do I keep them from being tangled, do I take that instrument they just put down, or will they need it again in a second??? uggghhhhhhh I just feel ....I dunno..will I ever get it??? :uhoh3: Everybody in the place does things different. In General, some people put the whole tray on the mayo...yes, the whole basket..... then there are some people who say thats rediculous, other hospitals dont do it that way. There are no "standard" set ups at this hospital,I just get a mish mash of everybody's technique, and I cant put it all together yet!!!!!!!!:uhoh21: Does this give you a better idea, Marie????? :lol2: oh, and plus, I am with a different person, EVERY DAY

Marie_LPN, RN, LPN, RN · Nov 12, 2006

OK... setting up, for one. I still dont know yet what I will need for whatever case, what goes on the mayo, I have trouble handling the string,and generally I dont have a system of where everything goes.

Placing the string on a towel roll may make it easier to count. Or holding the string with one arm and using the other hand to count with.

And, I dont anticipate yet, I need to be asked for something (except the obvious scissor after a tie, etc)

Anticipating is something you start doing without even realizing it after awhile. Here's a few tips:

1) typically after the knife, the bovie is next, along with retractors and a DeBakey.

2) If using an abdominal retractor, you'll need damp lap sponges for padding and packing. Warm saline is best. I ask for warm saline right after the doc hands the knife back from his skin incision.

3) For abdominal hysterectomies, the 'routine' is typically clamp, clamp, sometimes one more clamp, scissors or knife, suture, suture, cut or clamp suture.

4) Having a fine-tipped hemostat handy to anticipate that stubborn bleeder that always happens at the beginning.

5) Forceps: Debakeys are for soft tissue, Adson forceps with teeth are for skin.

6) Sutures: "Cutting" needles are for skin, used last thing.

7) Surgeon just asked for a "widow". A widow is a suturing needle with no suture attached (also known as a 'free' needle)

8) The deeper the surgeon is going into a "hole" the longer the instruments should be.

9) Sponge on a stick: Keep your sponge forceps loaded on abdominal cases. If you have medicine cups/glasses that are on your field, you can fold up a sponge just like you're going to put it on the sponge forcep, only put that folded sponge in the cup. The cup keeps it folded, and you can get the sponge forcep loaded faster (handy for emergency spleenectomies)

10) If you're using 8 pack 'control release' suture pack, when you have 3 sutures left, ask the doc how many more he's going to need. This way, you can ask for another pack if needed before you run out.

11) Anything that needs 'tossed off' before the incision goes up on the mayo tray. Suction tip, suction tubing, bovie, light handles.

And I just feel that I am slow, I sometimes cant understand what I am being asked for, I dont get when I am supposed to hand tie with a debakey, on a pass, in the hand.

I don't always know either, so i load one up on a tonsil clamp, one on a right angle clamp, so i can at least try to be prepared. If they are 'grabbing' the tie in the middle with their hand, hold the tie like a piece of dental floss. This keeps it straight.

I sometimes get adson clamps mixed up with... I cant remember what....

And they all call instruments by different names, because what you call an Adson clamp, we call a tonsil clamp lol.

and when it comes time to count when we are on skin and I have to pass suture , I get flustered, rushed, and feel like I cant do both!!!! Nobody has said I have been awful or anything, but I just feel very inept, and am not at the stage where I want to be left alone, without the preceptor.

Do you all count sharps/sponges and instruments twice, or sharps/sponges and instruments once, then just sharps/sponges?

Oh, and draping, i get nervous with the draping, I dont know why. Everybody drapes so different.am I supposed to know how to drape for every procedure , even if I have never done it before?

If someone gets all cranky about draping, i just say "everyone does it differently, i'm just not familiar with everyone's way yet"

Surgicell, how small, how big??

Depends on where it's going. I just ask what size they want.

I cant make the roll with the towel,

Fold the towel in half so that it's a rectangle. With the folded edge to your right or left, fold the seam edge about an inch. Keep folding over and over until you reach the middle of your rectangle. Hold the rolled part, and flip the whole thing upside down. That keeps the roll from coming undone. Place instruments on the roll.

the suction, the bovie cords, how do I keep them from being tangled,

Toss off one at a time.

do I take that instrument they just put down, or will they need it again in a second???

If it's a clamp or scissors, i just slide them over a little bit out of the way. Knives, hypos, sutures or anything else very pointy or sharp, goes back on the tray, i don't care if they whine or not about it. It's a safety issue for everyone involved.

uggghhhhhhh I just feel ....I dunno..will I ever get it???

You will, and the weird thing is, afterwards you'll think to yourself "and this used to be so hard, too"

Everybody in the place does things different.

And of course everyone says their way is THEE right way.

When i was getting trained, i set up the way the preceptors told me to, but once i was on my own, i set up in my own functioning way. It's nothing radically different, but it helps me be more efficient. One example, i use a draped prep table as my 'dirty' table during a colon resection, that sits beside of my back table. Just my preference, but i do it so that the instruments can be seen easily for a count, instead of being piled in a basin.

Anything else? :)

IsseyM · Nov 12, 2006

OMG RNOTODAY!!!!YOU DESCRIBED EXACTLY EVERY THING THAT I AM GOING THROUGH! EXACTLY!!!!!! I am soooo glad you posted this because i could REALLY use the same kind of help you are seeking. We only get to scrub for 1 month and no way am i ready to scrub a case by myself. Thank you RNOTODAY for bringing this up. Thank you Marie for always giving helpful tips and advice! Thank you Sunnyjohn for the recommended textbooks. This is just excellent!

IsseyM.

TracyB,RN, RN · Nov 14, 2006

Wow...you get to learn to scrub!! I am jealous. I've been asking for 6 months. My best response yet, from the charge nurse, "I've never learned how." Geeez! That was helpful.

RNOTODAY, BSN, RN · Nov 16, 2006

Marie, thank you. I have used many of your tips... and they did help!!! I just need to *do* these cases, so I can be more comfortable, I guess....At first I felt like a bumbling idiot up there. And for some reason, the techs where I work all have high expectations in their heads that we (the orientees) have been doing this stuff, or, have gone to school for it.... They said, about another person. "she doesnt know the instruments well, and she is slow passing, maybe shes not good with her hands"...ummmmmmmmmmm ***the girl just graduated , and had been scrubbing for 1 week at that point!!!!!! Most of these people who are training us to scrub have been doing this for years and years, and went to school for it on top of that... I dont know what they expect !!!! I mean, we get about 2 weeks in a service to scrub, then we circ for 2 weeks, then on to another service.....Maybe I am a slow learner,( which I never thought I was) but I may be half way competent at the end of that, but in no way will I call myself a proficient scrub at the end of all this....anyway, thanks so much for the tips.... can I use you for a resource?????

sunnyjohn · Nov 16, 2006

RN TODAY,

Hang in there. It takes time. Don't let folks push you to the point you become so rushed you compromise patient safety by foresaking sterile technique and the principles of asepsis. Never be afraid to speak up if you think you made an error or are being pushed to your safety limit.

When I went to ST school I had completed a Bachelor's degree and a few MPH classes. I STILL felt lost. Believe me, those techs at your hospital had the same experience.

The OR is a new world. You have to re-learn what you thought you know about "clean" and 'dirty'. Every time you think you know all the instruments, they slap you in a new service or some smarty-arty brings in new ones. :rotfl:

Learn as much as you can in you 2-weeks in each service. When you get a chance to go back through, you will be able to develop a routine. You will learn to put your generic items in the same palce, no matter what the case.

Happy Scrubbing!!!

RNOTODAY, BSN, RN · Nov 16, 2006

Thanks sunnyjohn......It sure is good to know that I am not the only one!!!

It seems like once I am up there, I am kind of ok lately, but it seems my biggest thing (now) is SETTING UP. Its a combination of not having a routine where things go, not knowing what I will need on the mayo for a case, (because I have not seen alot of things twice yet, or, if I did, it was too long ago), and not being able to handle and organize all those instruments. I seem to be at a standstill with setting up....I need alot of help with that from whoever is with me.... but then once we get started, I usually take first scrub, with little to no guidance, except for a few "tips" here and there. I dont know..... marie, sunnyjohn, any words of wisdom about setting up? lol