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  1. mcmike55

    Medication refrigerators

    All meds are kept locked. The majority are in the Pyxis fridge. We keep a small amout of meds (insulin, Pepcid, etc) in an unlocked fridge in our holding area, but the door to the med room is closed and locked when unattended. Our narcs are locked at all times. Mike
  2. mcmike55

    calling report to ct icu.. to the secretary?

    When we are closing, and know for a fact we are going straight back up to ICU, I'll give the nurse that was taking care of that pt a heads up type report. I'll give the nurse a thumb nail report, including what we did, lines added or subtracted, vent or not and basically how the pt is doing. That way they can get the room ready, set up a vent, etc. Once the pt is off the OR table, I'll call the ICU again, and say "here we come, nothing has changed". I'll give this "report" to the secretary or another nurse if they answer. If something changed, of course I'll talk to the pt's nurse. Once in the ICU, the anes. doc and I will give that nurse, resp. techs and others invovlved a full report. If I was secretary, I would not want put in the position of taking a report on a critical pt. I won't put them, or me, for that matter in that position. Makes me wonder what's in their head if they think it's OK. Mike
  3. mcmike55

    Funny things said by ortho surgeons in the OR

    So often something said during surgery can be taken the wrong way, and Ortho seems to be the easiest target!! "that's what she says" it the punch line in our OR. I swear, during one long day in the ortho room, I bet we said that line 90 times!! Some lines that come to mind.... "You hold it, and I'll put it in" during an IM rod insertion "I'm not sure it's big enough" followed by "that's big enough for anyone" again, during an IM rod case "Positioning is very important" getting ready for a hip prosthesis case Making up a T shirt with these printed on it is brilliant !!! This is a posting that could take on a life of it's own! Mike
  4. mcmike55

    Pulling Meds Early

    We have always pulled our meds and put them on that procedure's case cart ahead of time, but I'm hearing that this may need to stop. In the morning, we take our case carts from Sterile Processing into our central hallway, and put them outside the OR that the case will be done. As the day goes on, the circulator will pull the meds that are needed for that case such as Lidocaine, Pitressin, x-ray dye, etc, and puts them on that particular cart. The center hall is a restricted area, but anyone allowed into the OR's may walk through there, including pt care techs, and the occasional vendor. During a medication administration FMEA, I mentioned that, and the administration rolled their eyes. From what I understand, it's some sort of a Joint Commission issue that will require us to pull the meds as we need them, not ahead of time. Has anyone heard of this, are we the only one's pulling meds ahead of time? We are a small rural hospital with only a few OR's, and not just anybody can put on scrubs and walk around our halls. I understand that security is an issue,,,,,but.. Mike
  5. mcmike55

    Beach chair shoulder arthroscopy and fluid control

    We use a beach chair drape from Kimberly Clark that works very well. It's sort of a split sheet, that starts above the shoulder, then pulls around below. It has some really nice sticky strips that hold it. The fluid pouch is separate, which allows you to put it where you want to. We begin with two thin platic like sterile impervious "U" drapes, also by K.C., one above and one below. Usually for shoulders the drape an some absorbent "blue cloud" on the floor is enough. For ACL's we add a puddle guppy or some sort of floor suction device along with our absorbent mat. We did trial a thick yellow disposable mat the other day. Not sure what the manufacturer was. I liked it, the suction tubing was already attached, had some nice sticky tape on it. Just threw it down, stuck it down, plugged it in. Not totaly sure the scrub team and doc liked it as well as I did. It was a bit thicker than we were used to, but as soon as water hit it....it was gone! It did trap a little water underneath, a plastic backing prohibited it from sucking up anything that got underneath. MMc
  6. mcmike55

    LSO training

    I am the Laser Safety Officer (LSO) for a small rural hospital. I've been the LSO for some time, and frankly don't do much. I primarily take care of basic laser safety inservices. We don't do all that many laser procedures, and we don't have an in house laser. We bring them in on a per case basis. The company sends a tech with the laser and takes care of all the technical aspects. My boss the other day said that Joint Commission is looking more into LSO's and wondered if I felt I was up to date, which I do not. We use a lot of holmium YAG and high power green light lasers for prostates in Uro. I "grew up" running basic CO2 lasers, and feel my education could be improved. My question is, does anyone suggest a good LSO course for someone who is not really a beginner, but needs updated badly. Several years ago I attended a Rockwell Labs course, which was very good, and I recently saw an advanced course put on by the Laser Institute of America (LIA), which I really liked the looks of. Any suggestions??? Thanks in advance. Mike
  7. mcmike55

    Where have you lost a sponge?

    First off,,,,,I have got to say,,, sm9796,,I LOVE the terms that you use!! I want to change our lounge into a tea room.......and I am going to try to use the word Quiver for the holster for our bovie. I Love it!!! Anyway, two sponges I can remember, lost....no...temporarily misplaced A Raytec in the back of the throat during a tonsil, found it by doing a direct laryngoscopy. Also had trouble locating a regular gauze 4x4 while putting on a pelvic external fixator. Rarely had done one of these, and with it only being a stab incision, we figured no problem...WRONG. Thank goodness we did count them first, when we couldn't account for one, we figured it was in the incision. Doc of course, said no way, but the tech wouldn't give up and found it tucked in the corner of one of these tiny incisions!! We did a laparoscopy on a lady with pelvic pain one time,,,there was a shiny Kelly clamp if I remember, you could see the hospital's name (not our) stamped right on the side!! Left in there following a C-Section a couple years earlier. Never say "we can't lose that!" Mike
  8. The lithotomy position with pus is a close second,,,but fans I think we've got a winner!!!! Pt. that weighed about 900 lbs. with a lg. pannus came in to get a vertical banded gastroplasty. Raised up pannus to begin prep and found rotting chicken sandwich and a million maggots. Had to power irrigate the maggots into a crani head bag before the prep! I vote for this one!!!! My contributions see pity-ful after that! Other than the assorted pus and "foreign bodies where they should not be", the only one I have is the pt who ate things he shouldn't have. The pt was a repeat offender, and ate anything he could get his hands on, often resulting in exp.laparotomies. We pulled silverware, jewelry, even a radio antenna out. I think the worst was thin strips of linen, which, partially digested, really could send you reeling! Mike
  9. mcmike55

    alternative solutions for a vaginal prep

    We use Hibiclens (?sp) for the majority of our vaginal preps. One doc still likes Betadine Scrub for vaginal preps. We were told a while back that we were to use Hibiclens full strength. I still can't quite bring myself to that. I still dilute with a bit of sterile water. Same for Betadine Scrub, I'll dilute a little. We use Durapreps for our abdominal and extremity preps, unless an open wound or oriface is involved. We did an open fx repair on a wrist the other night....I wen't back to Betadine Scrub and Solution, the doc was good with that. All turned out fine. I know what the back of the bottles say, I've seen the studies, but I've been doing this for over a quarter of a century and have seen little problems. I know that' probably not a real argument....."always done it this way".......but I don't really see a real alternative!! Mike
  10. mcmike55

    X-rays and eyes

    If I remember correctly, long, close exposure to x-ray does put you at risk for early cataract developement. But I've always thought that was for those working in x-ray and cath lab. I've heard of lead glasses, but never seen them, not in the OR anyway. Some x-ray docs, years ago, used to have lead gloves to protect their hands close to the beam. We even had sterile lead gloves when we were doing x-ray guided pain clinic procedures in the OR. Again, I'm not sure, but aprons and thyroid shields are all the basic protection needed. Remember, it's exposure duration and proximity that are key factors. As a circulator, I'm rarely that close to the field during an x-ray procedure. Mike
  11. mcmike55

    Or nurse float to floor?

    Over the years, it always seems the newest RN that comes to the OR from the floor, is fairly routinely called back to help. After a few years, it rarely happens.....guess they are useless up there! For myself, all He-- would have to break loose before I would go to the floor!! Last time I worked the floor was in the early 80's!!! I can float to ED, and help out,,,but that's it. For the most, we are such a small staff in the OR, pulling is rarely an option, unless you want to shut an room in the OR down. I'm sure the surgeons would understand!! To me, it's a legal risk going to do pt care where you are not familure or oriented to. If I'm having an MI, I would find little comfort in a surgery nurse taking care of me with little (if any) cardiac training. Just my... Mike
  12. mcmike55

    Axillary rolls

    We've re-thought our ax rolls. Before, we used an IV bag rolled into a towel. I've always been careful to not have wrinkles or seams before insertion. Recently, we were told that IV bags were not appropriate, despite never having any trouble. So we went to using the disposable perineal post pads from our ortho table inside of a towel. I would like to get a couple of axillary roll gel pads.....where did you get yours?? Kind of like the pillow case idea, may give that a try. Mike
  13. mcmike55

    Contaminated areas within prepping area

    1. Do you prep the umbilicus first or last in an abdominal prep? I usually start with dropping a little prep fluid in the umbilicus, sort of letting it soak. Let's face it, some belly buttons need more help than others. I swear I've discovered new life forms in there at times!!! 2. Do you prep the vagina first or last for a perineal prep? Last. I tend to do the legs, groin, etc first with my last swipes over the anus. Then, with a sponge stick, the vagina. 3. What do you think about the need to change into new sterile gloves after a vaginal prep and before inserting a Foley? I do no, unless I feel that I've contaminated my gloves prepping, especially considering the anus prep. Mike
  14. mcmike55

    Tell me about CALL

    I also work in a small community hospital. Three OR's, Level III trauma center. We have a MD anesthesia doc, RN circulator, Scrub Tech and PACU RN call team. The RN's average about one night a week on call and about 1 in 6 weekends. We are very good about trading if someone needs off for some reason. We also alternate holiday's, usually only one "major" holiday, and one of the smaller ones each year. Our weekday call runs from 1530 to 0700. Like some of the other posters, sometimes you are very busy, sometimes not. No real rhyme or reason to it. Normally if the feces hits the air conditioner, one or more of the off duty staff is available to come in and help. Our kids, over the years have just gotten used to us being on call. That's just the way it goes. Our friends and family are amazed when my wife and I arrive somewhere in the same vehicle!!! Normally we travel in different cars in case I get called out. You just try to take it in stride, don't get overworked about it. It's too stressful otherwise. My only real suggestion it to not get too involved in anything while on call.......long movie,etc....that's a guarentee that you'll get called!!!! Mike
  15. mcmike55

    speeding while on call

    nrsman....if you want, search the prior posts on just this subject in Allnurses.com. I think you'll find..if you are speeding, you are breaking the law. Period. Not many OR nurses I know have the high speed driving skills to handle a high speed run to the hospital. When you think about it, how much time are you really saving?? Do the math, I bet it's not much. At our hospital, you must live within 20 minutes response time to the OR. In some situations, such as bad weather, the scrub tech's in the Child Birth Center, know how to go down to our OR and at least open the basics for us, saving some time. If you are in good with the ED and house supervisor, who ever calls you in, hopefully they would be on the ball enough to get you rolling in ahead of the official call out. Many times I've come in for a trauma, to find out that the OR isn't needed. It's a win/win, if we need the OR, I'm here, if not, I'm here to help the trauma team. I had a good friend, coming in for an appendectomy, almost get killed when someone blew a light in the middle of the night. It wasn't his fault, but to me, drove home the point that you need to get there, but safely. You're not helping anyone by going in a ditch, or worse. Mike