mcmike55

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

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

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

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

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

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

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

We use Hibiclens (?sp) for the majority of our lady partsl preps. One doc still likes Betadine Scrub for lady partsl 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

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

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

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

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 lady parts first or last for a perineal prep? Last. I tend to do the legs, groin, etc first with my last swipes over the orifice. Then, with a sponge stick, the lady parts. 3. What do you think about the need to change into new sterile gloves after a lady partsl prep and before inserting a Foley? I do no, unless I feel that I've contaminated my gloves prepping, especially considering the orifice prep. Mike

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

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

I don't have the actual documents in front of me, but I saw some info coming down the chute on this in early summer I think. The FDA says Steris made modifications to the System 1 after it got approval. As I understand this, the modifications, in the opinion of the FDA, required another application of some sort. More paperwork I guess. Long story short, the FDA got fed up with Steris and filed this recall, I guess. This includes units made back into the 80's I think. We are still using our Steris, but are in the process of figuring out a good substitute. Initially, we thought the recall did not include our "ancent" unit, but recently discovered it did. We've got a Sterad for most of our stuff that can's handle high temps, but it will not due scopes, etc, that have a long narrow channel. It's my understanding that they now have something out, similar to Sterad, that will do the job. The run time looks to be around 30 minutes, which is about what our Steris is. The search continues....... Mike

My favorite, was the metal Scottie dog from a Monopoly game. A small child swallowed it, and there it was in the AP throat film, just laying there!! Perfect side view!!! Also, I attached (I hope) a photo I found online years ago of a bottle where it should not be. What I found interesting was that this person had a hip replacement. Old enough to know better??!! Mike

How many times have you heard someone say "oh, I didn't recognize you with your clothes on !" That's a classic, though not usually from a S.O. My favorite came actually from another nurse. I was teaching CPR classes many years ago, when we used Annie's with a paper read out. It sort of looked like a large EKG tracing, and documented your compression depth, rate, volume of breaths, etc. I had one student who, just couldn't get it right, and had rescheduled her for another try. The night before, while at a local eatery, this female nurse/student stopped by my table (with my wife there, mind you) and said in a voice much louder than I suspect she meant to....said, "I've practiced, and can't wait to do a strip for you !!" I'm pretty sure I heard a few cervical spines crack as many heads spun towards our table. Nursing,,,,a different language indeed!!! Got 'ta luv it !!! Mike

I can use some input on this one. Our new Ortho Doc wants to use the Moog Pain Pump on shoulder cases. You know, the kind filled with Marcaine and drips in. We used them years ago, (different type) and had no problems. Doing a brief lit review, I see all types of complications. As I see it, the problems are, the catheters are place intra-articular and they shouldn't be, the meds contained Epi (should not), and possibly they were in too long. We've addressed our concerns with the company rep, and surgeon and feel that the problems are recognized and addressed, but those above us, do not. They want a full risk assessment run before we put one in, and the surgeon is none too happy! My questions,,,,,what's your P&P, and experience with pain pumps, and what actually triggers starting a risk assessment?? I mean, when you think about it, almost anything could warrant one, from a new suture on up. Where do you draw the line. Don't get me wrong, I'm all for pt safety and all, but there has to be a line somewhere.....isn't there? Mike

A couple of years ago, our pt's arms looked like a rainbow!!! We, as others, had red, blue, yellow, green etc, etc bands for different types of warnings. It was a disaster if we had to cut them off to start an IV!!! We went to colored dots, attached to one single white ID band. As far as marking....we kept the blue fall precautions bands...the only blue band used in our hosptial. It has a big white area that we mark (or use an ID sticker) the name, site, etc on it. The surgeon marks it and actually applies it to the pt's wrist on the operative side for cysto/stent, ESWL's and the like. It stays with the NPSG's, marking the side, etc and best of all, as the goals indicate, we can see it after draping the pt. Thus far, it's worked with us, and have had no problems. Mike

What I would do....politely ask for those cloth masks, take, them and put in a surgical archive!!!! I've not seen a cloth mask in over 15 years, let alone see anyone wear them! Do they still wash and sterilize their gloves too!!?? How about their surgical gown?? There are reasons that cloth masks and gowns have gone away! I can't cite verse and chapter, but cloth masks are a gonner. They don't filter respirations the way masks do today, and they cannot protect the wearer from fumes, smoke or areosolized blood, etc as masks do today. By the way, how are those masks laundered??? That is yet another infection control nightmare to contend with. I'm an old timer, and admit I have trouble accepting new things, but,,,come on!!!!!!!!!! Mike By the way, we have a number of different masks as well. There are a number of variations, such as filtration rates, some have a plastic across the top that helps keep eyeglasses from fogging, etc. Some of our people break out wearing certain masks, others think that certain types of masks smell, etc The more circular masks with rubber band straps, I believe, are typically for more short term use like in emergency dept. Mike

Agree with the others on this, I suggest you look some where else for your fatigue. I would bet you could leave an anes. machine on full blast in a closed OR all night, and not notice the next morning. If your OR has the correct air flow rates, functioning waste gas scavenger systems, etc, there won't be enough build up to notice the next morning. (not to mention the vaporizer would be dry!) We have a company come in on a routine basis with a "sniffer" type machine that monitors the atmosphere in our rooms. And we've never had an issue in my quarter century of working in the OR. Like others, the only time I've ever taken a hit from Sevo or any of the other gases was when I was holding a child during induction. And then it was only a mild dizziness, that went away very quickly. In fact, your co-workers in PACU are more exposed to off gasing that you are! Let's face it, hard work, stress, long hours, etc, etc, etc is enough to make anyone tired!! Especially if you are new to the job! Hang in there By the way, if you and others are concerned about gas in the air, check with your supervisor, maybe they have a periodic air check done. If not, maybe you all should consider it. Mike

Have not done a lit review in a while, so, I'm not sure of the latest numbers and findings. I figure this is one of those, one is good, two is better type things. Especially in this case as the mechanism is somewhat different. As I understand.... The SCD's mimick the natural action of you walking, in that it stimulates venous return, and the TED's assist that as well. We use them a lot in OR for laparoscopic cases, longer cases, those in lithotomy position, etc. I've seen TED's alone, or both, usually. Again, not sure of any studies, though I've heard that they've not found any real difference between thigh high or knee highs. Kind of think, as long as they are applied properly, it should help. Mike

Great story,,,,, I used to run the CO2 laser in our OR as well. One of our surgeons was vaporizing some skin lesions off a man that I knew, so I stopped by the holding area to say hi. He asked if I was going to be there, and I said I was helping the doc run the laser. And of course, he asked if my hands were steady. I pulled the old "Blazing Saddles" gag on him, holding out my rock steady left hand, and said "sure", then held up a quaking right hand, and said, "but this is the hand I use to run the laser!!!" Everyone got a good laugh, and hopfully made his experience a little better. Laughter is the best medicine right??!! Mike

There is a lot of different sutures and suture companies out their, of course with their own brand names, so it can get confusing. Basicly, sutures come in absorbable, and non absorbable. Absorbable suture is as it sound, is absorbed by the body. In our hospital we use suture from Ethicon, so the names I use are their company names. We use Vicryl, Chromic and Plain. The difference is how fast they go away, etc. Non absorbable suture obviously does not go away. This would be for skin edges, vascular anastomosis, etc. Examples would be PDS, Prolene, Silk and Nylon. Sizes or diameter of the suture uses an "O" scale. A middle of the road size suture for general surgical cases would be 2-0 or 3-0. The smaller the suture the larger the number....4-0, 5-0, 6-0 gets smaller. For an eye case we'll often use 8-0, 9- or 10-0. Larger size sutures run the other way. 2-0, 0, 1, 2, 3, etc. The largest size we have is number 5, and you could tie up your boat with it!!! The needles attached to the suture is another story. Basicly the needle are curved or straight (Keith style). They also have different "edges". If you looked straight at a curved needle, and it was perfectly round, this would be a taper needle, used for bowel and some wound closure for example. A cutting needle, has a bit more of a triangle look to it, and is used for tougher tissue, such as skin edges, ligaments, etc. We've also got some needles that are blunt on the leading edge for things such as livers, that don't like sharp things being poked into them!:chuckle There's a lot more detail on suture and suture needles out there, and this was my worth,,,,hope I didn't mislead you. I'm sure allnurses nation will help you out! Mike

About 6 months ago, or so, we switched from paper charting to McKesson. I'm getting faster, but it's still slower than paper charts! I've heard that now that we are getting this system under our belts, within the next year or two (or so) we will be getting yet another system!! Word has it that it's down to two systems, one that is easier for us, the other nicer for the IS staff, but a bear for us! I do like it in some ways, but, sorry, being in the biz for 30+ years, I still do not completely trust electronic charting. By the way, we carry small laptops around with us, and chart off of those at the bedside, break room, etc. For the record,,,,I've not "dropped" mine yet! :icon_roll Mike