ewattsjt

sounds like prone to me too. even if the pt is positioned correctly but the case is a real long one like multilevel spine surgery, the duration of being prone for so long can do that.

I have no suggestions. Ours is about the same, when it gets nasty enough someone will go through it. I typically do not use ours because it is always so nasty. I bring a large lunch box and leave it sit in the break room. A couple of us do that. Our microwave is in about the same condition but people will clean it more often. There are always signs requesting for the people to clean after themselves. Isn’t it odd that our staff has great patient care and an excellent performance in the surgical theater but they struggle with such simple tasks? I think MamaCheese's facility may have the answer.

It simply takes practice. I am right handed but pass with either hand depending on where I am standing and the where the doctor/assistant is standing. In fact on many occasion, I will be taking one instrument back with one hand while passing to the surgeon with the other. Hand on top is simply a bad habit and you will get used to passing with hand underneath in time. I know that we are supposed to use neutral zones but not everyone does nor is it always possible. If hand is on top while passing suture, you run a huge risk of getting stuck.

We just underwent changes this past fall. My facility had a group of analysis’s come in and audit us to make sure we were within The Joint Commission’s guidelines. A couple of changes that were made were that all our liquids IV or pour are now locked up to prevent tampering and if pour water or NaCl goes in the warmer, it is labeled for 2 weeks out. IV solutions such as Dextrose or Ringers are kept for 48 hours in our warmer because they said that there is a breakdown of electrolytes when exposed to the increased temperature. I never saw the data that reflected our change but assume it is correct.

We do for cases expected to be close to 4 hrs or over. Also on certain procedures we do an in/out to reduce the size of the bladder. We do not do Foley as a routine because of the possibility of UTI.

eent is simply eyes, ears, nose, and throat. it is hard to say with certainty but there should be a lot of different things like for eyes; phacoemulsification and other types of iol replacements as well as retinal banding to blepharoplasty. ears; myringotomy to tympanoplasty to inner ear procedures. nose: deviated septum repair to endoscopic sinus surgery to a balloon sinuplasty http://www.entclinicofiowa.com/sinuplasty-balloon-sinuplasty-video.htm throat: t&a to thyroidectomy to on rare occation something like zenker's diverticula. http://www.nature.com/gimo/contents/pt1/full/gimo41.html to know for sure what they do, you should talk to someone that works at the facility.

My facility has 8, 10, and 12 hour shifts. 8 and 10 are typically day and 12 is typically second shift (lunch relief then finish any running rooms). Our rooms are staggered in shutdown times.

i think it is both not trusting patients, old habits, and lump everyone into one group so nothing gets confused. standard order for my facility is npo after midnight but in cases where the patient does ingest food, they fall back to six hours. i have seen where patients come in and did their npo. they didn’t have any meals but this morning they only ate one bacon strip, half a biscuit, and half a cup of coffee. wasn’t a meal so they were good to go. lol had one patient from the floor who thought the npo wasn’t a big deal and wanted to get their energy up for the surgery and had half a cheese burger before coming to surgery. if patients easily confuse npo with just a little bite of something then how do they react if you say it is ok to have water? it simply adds to their misconception of not being a big deal. the latest data reflects that 6 hr npo is sufficient in most cases. it is however easier and less confusing to everyone to lump everyone into the same group rather than saying that for this person it is 6 hr npo while this one is 8 and this one is 9 and this person can have ice chips or water while this one shouldn’t. the data also reflects that water up to two hours prior to surgery has no effect in most cases. one last thing in my opinion is why would a doctor risk a patient aspirating as well as a malpractice suit for the patients who fall outside this norm? especially when it is proven that npo after midnight works well and has been a standard for years. keep in mind that both the surgeon and anesthesiologist can cancel the case if the patient went outside their npo guideline. maybe the anesthesiologist agrees with 6hr but the surgeon doesn’t. here is a related link http://www.ncbi.nlm.nih.gov/pubmed/10172278

I would like to start by saying that many facilities have varying takes on flashing. The AORN recommends against flashing unless there is a real need to flash something. Before the patient is in the room the case can be delayed without much consequence to the patient. Once the patient has been given meds, it is typically better to run the case than to recover and try again (not only because of the meds but also psychologically as well). Sometimes it is a legal issue too (if they started and aborted-some facilities consider it a new case and the patient can’t sign another consent until after 24hrs because of the meds administered). Central’s autoclaves are set up somewhat different (some are pulse pressure) so while they do similar things, they work on a different scale and sometimes a different system. Two types of flashes are gravity and prevacuumed and the autoclaves are either in a sterile core (where the scrub can retrieve it directly or in another area where it is transported in a pan). As you can see, the second doesn’t really make sense unless you do not want to keep the patient under for an additional 20-45 min. (depending how central’s flash is set up). Ideally, flashes are: gravity for single items and batteries, prevac. for items with lumens or several items ran together (typically 4 or 5). Flashes like in the surgical unit are not designed for the entire set (regardless of how it is used) so full sets should be ran through central. Implants can be ran in a flash on the unit but it has to be prevac. and biological has to be ran with it. Once again this is recommended against unless in a pinch. This is a matter of weighing additional gas time against chance of infection. Facilities base what they do with flashing on the entire recommendations of groups like IAHSCMM, AORN, The Joint Commission, etc.. . There are many more reasons and much more detailed explanations but what I listed is the basics. While this didn’t really answer your question, I hope this helped you to understand that there is more though in the process than sometimes we can and other times we can’t and why it seems to vary in different facilities!

My facility is great and rarely sends pts. with jewelry or undies. If they do, there is a good reason.

As Linda stated, ask your facility. A part of the RNFA is getting an agreement (MOA) between the school and your facility to do an externship there. Most facilities who allow it will also allow you to get the cases while working. That is not a given and you may have to do the cases on your own time (slight probability but still could happen). A requirement for the RNFA programs is to be a CNOR or at least eligible to sit and pass before the program is completed (and a passing of the CNOR exam before the certificate is given). You have to check with the school for that one. A requirement of eligibility for CNOR is two years in the OR. You stated that you are new to the OR so you have time to work it out with your facility. Best of luck!!!!

A gown left tied can lead to pressure sores from impeded circulation just as and unpadded boney prominence so regardless of positioning, the gown should be untied and pulled from underneath because of possible bunching. Typically this is best accommodated while the patient is still conscious. It may have been done while you were conscious but you don’t remember that part because of the Versed. If you were positioned prone, the same rules apply about the gown bunching and it should be removed (my facility waits until the patient is unconscious because of embarrassment but maintains the patient’s dignity and covers as soon as positioning is completed). Bruising on the elbows can range from unpadded boney prominences to a combative patient to you simply bruise easy. There are too many variables to speculate on this.

Just playing devil’s advocate---what constitutes a stable patient after surgery. We all know and have seen patients crash in the blink of an eye. How defendable can the tech be if their patient crashes while they were on an unrelieved break? How defendable is the RN who sends the tech or allows it? The team is supposed to respond during a crash, everyone having their jobs that may be as little as grabbing a crash cart (but a big part) or calling out of the room for help while the others administer CPR. How big could a wrongful death be against the team? As I have posted before, the tech can and sometimes is made an example but in law suites, they tend to go after the docs and nurses more because they tend to have more $$$ and a license to loose. We have a vascular doc that does not have the techs to stay sterile or maintain the backtable in carotids. His reason is that he always does testing that takes about 45 min. and he wants a new setup if he has to go back. If I scrub with him on one of these, I maintain the field. Part of being able to defend in court is if it is reasonable practice (is it done that way in other areas (sometimes regionally and sometimes nationally). I know that the standard is to maintain the field so I do it to protect the team and every time the doc acts like I am a crazy man because I refuse. My point is that if something happens can you defend it in a court? If you don’t think you can, then you need to rethink what you are doing.

At my facility it is a big deal. The scrub is supposed to assist in the transfer of the patient. The patient always is the first priority.

Also if you are thinking of going further with your education and possibly into different areas. The general nursing degree is better for that ASN/ADN or BSN while the surg tech programs are diploma and associate. The advancement opportunities are limited for the surg tech. They include but are not limited to central supply, decontamination, materials management, sales rep., instructing, etc. while the RN can typically transfer to almost anywhere in the facility and if BSN or higher go into instructing etc. Most the facilities in my area pay RNs about a quarter more than techs (Ie. If the tech makes $15 hr to start the RN will make about $20. So as you can see, there would be more money made as well as more advancement opportunities. A downside is like at my facility; the RNs are allowed to circulate and scrub but seldom get the chance to scrub as that role is typically filled by CSTs (policy that surg techs have to make certification within a year of graduation). One would rarely get the chance to scrub unless they became a CRNFA or there were staffing issues. Having said that, places are different across the US and these are generalized statements and area specific statements. You should check for what the differences are at the facility you are looking at. Managers typically will talk to potential employees.