lindaloo51

In the late 60's, early 70's, I worked with a tech who lived about 15 miles from the hospital. That translated to about 20 minutes to the hospital. If it was a trauma or C-section, she would tie a white bra to her antenna and fly to the hospital. Rural area, everyone knew her and where she was headed. I don't think that she ever got a ticket. (You have to also remember that those were the years that women were burning bras so, at least she had a good use for hers).

We are still using Steris. The FDA letter states that facilities may continue to use the Steris units while evaluating their needs. There are NO reports of patient injuries or infections with the use of the Steris unit. Read the information and the questions and answers on the FDA site and the Steris response on their web site. By the way some of the reports they are concerned about are staff "burns" from the sterillant (am I the only one who has gotten a burn from an autoclave? They aren't restricting them) and a malfunction that could have caused an infection. (I had an autoclave cycle fail last month because of a steam failure) Some how, I get the feeling that FDA is dragging its feet evaluating the information and applications that they have.

We did use the Stryker pump until it was recalled. We didn't use them with articular surfaces because I think that the Marcaine destroys the joint surface. We only used them on total joints. It seems to me that there were a lot of law suits because of this. We now use blocks on most knees and shoulders.

We are a small OR 6 rooms, cysto and endolab. We do 20 - 30 cases a day. We work very closely with our CPD. We have 2 -3 contact people in the OR that CPD contacts about broken or missing instruments or any other issues. (As soon as an instument is missing, we are called so perhaps we can locate it.) When they get swamped, we go and help assemble trays, seal peel packs, wrap instruments etc. They initial each tray and mark with an orange tag any tray that is missing an instrument. One person in CPD is in charge of replacement and repair of instruments. If we have an instrument that is broken or not working correctly, we put it in a zip lock bag with a note to alert them to the problem. The only time that we seem to have issues now is when there is new staff training both in the OR and

I think that seeing is believing. Talk with the OR Director and ask to job shadow for a day or two in the OR. We welcome students who are truly interested in OR as a career path. I have spoken with many students and they get the best picture of what the OR is really like by shadowing an experienced nurse on the job.

If you go to the Ethicon web site, they have charts that explain their sutures, needles, what they are used for and how long they stay. I haven't checked out the other manufacture sites, but I would guess that they have something similar. I have printeed out some of these charts to help our new staff members and then written on what the comparable sutures would be in Auto Suture and some of the others that we stock. We changed from Ethicon sutures more than 10 years ago and some of our Docs still ask for Vicryl but actually use PolySorb. It makes the newbie's job twice as hard.

First of all, different suture companies use different names for their needles. A CT needle in Ethicon suture is a general closure taper needle. In Autosuture, the same needle is a GS21. Here is a link to Ethicon's page there is a huge amount of information here about suture and needle types ( http://ecatalog.ethicon.com/general-info#top) I didn't take the time to look up other suture companies like D & G or Autosuture but I'm sure that they also have similar information available. I don't know if they still do, but Ethicon used to have a whole series of booklets explaining their products.

WHAT ARE YOU PEOPLE THINKING????? You don't think that if your patient goes down the tube while your anesthesia provider is MIA and you have done nothing about it that a lawyer isn't going to rip you to shreds?? In 40 years I have had 1 provider that did this. He lasted about 2 weeks because each circulator notified management each time it happened and wrote him up. It only takes seconds for a patient to go bad. I had a patient throw a PE during ortho surgery recently. In a matter of minutes he was gone inspite of all that we tried to do. If my CRNA had not been there, where would I be now?? I'm quite sure that I would be preparing for a huge law suit. This is not the normal standard of care!!!!! Run, don't walk to risk management. DO NOT PUT YOUR PATIENT AT RISK!!!!! You are your patient's advocate. Put yourself, helpless on the table and tell me that it is all right to be ABANDONED by your anesthesia provider.

We use sterile water. Reasoning was that there are studies out there that show pseudomonas in tap water. Also, Sterile water is also distilled and this prevents mineral build up in the scope channels.

Follow your facilities P&P. I have been in this situation and it isn't pleasant. You must be objective and clear in your concerns. Put it in writing either to your supervisor or through your risk management procedure. We had a surgeon that was clueless and it took us a long time, but his privileges were revoked. The important thing is to document document document. Again always be objective and don't let personalities come into it.

It seems we all have the same problems. We have tried a lot of different things. (long rollers, short rollers, slide boards, plastic bags with a towel) The very best that we have found is something called air pals. It is an inflatable moving device that is put on the OR table before the patient comes in the room. It is covered with the usual linens. After the procedure, it is attached to a canister (looks like a vacum cleaner) which inflates the air mattress. It is then easy for only 2 people to move the patient from the OR table to the stretcher or bed. (I'm not sure of weight limit but easily over 400#) The patient is transported to PACU with air pal under them. They are taken out there when usually the patient can help roll themselves. It is then wiped down and returned to the OR. We have been using these for several months and they have worked better than anything else we have tried. Also, no more back injuries for staff.

We have found that some mfg. do have different outdates. It may be related to the shelf life of the product not the sterility. Catheters are one example, they become brittle after time. Another example is silicone ear tubes. Our mfg only covers 10 years even though they are peel packed and in a closed plastic case inside. If in doubt, check with the mfg. Even though they don't place an outdate on a package, they may not stand behind a product after an extended period of time.

One of my coworkers is allergic to the prepared scrub brushes. They use coconut oil in many of them I think as emolients. She has to use a prepackaged dry scrub brush with regular hibiclens or betadine because they don't have the emolients added. Also, are your gloves powder free? You might try a different glove. Also be sure to wash well each time you take off your gown and gloves. (Not just a quick rinse.)

Well, I've been there on both sides of this type of situation. How are they being disrespectful? I've had new charge nurses who didn't have a whole lot of experience and in my younger days before I learned to consider my words I know that I probably appeared disrespectful when I was trying to help them follow a safe course in a new situation. I've also had new charge nurses who weren't willing to listen to a mere tech about anything. Working together should not be a battle. A good scrub tech can make you look like the best nurse in the hospital and a good nurse can make the tech look like the greatest most efficient scrub around. The whole process takes team work. My advice is not to ignore or laugh, but to forge a bond with the staff. Honest, open communication will turn the trick most of the time. I'm not saying to be best friends, but to become work buddies. Share experiences and knowledge. Share your desires for your department and try to work toward common goals. It won't be quick and often not easy, but the rewards are great. Treat everyone with equality and respect and you will earn their respect. Specific problems should be met with calm open examination between you in private and never ever discuss these meetings with anyone except your own superior and then only if necessary. Don't talk about one staff member to others. Give public thanks for help and encourage public kindness between all staff members. If you can do this you will be a great charge nurse and your staff will reflect the hard work that you have put into pulling them together rather than making it a them or us situation.

During day shift, the charge nurse calls the ER and gets the info on what the trauma is, a room and staff would then be designated if needed.

Question for you, who makes the tray liners?? I have been looking for them in my very limited spare time at work, but haven't found them.

We have the same problem. Our rep told us that someone puts out theBupivicaine in a larger size. Still waiting on the information. If I learn anything, I'll let you know. It's cut down on the pain pumps at our facility since our docs no longer use them for shoulders but only for total joints.

Our anesthesia staff has standing orders that are checked off and they must sign. Verbal orders are written by the nurse and must be signed by the MD or as you say it will come back to haunt them as an unsigned chart.

We follow the NPO after midnoc. Allowable is a sip of water with essential meds in am. For more urgent cases we go with 6 hours NPO. Emergent cases get a "crash" induction. When I had surgery a couple of years ago, it was scheduled for 2pm and I was allowed clear liquids til 6 am. I was grateful. Early in my career, I asked a 6yo T&A patient what he had for breakfast and he told me cereal and juice. I looked at mom & dad and sure enough, they said junior had been up before them and it was possible. Surgery cancelled and I now ask all children what they had for breakfast. Have gotten this type of answer several times over the years.

Our hospital has recently revamped its catheter policies. We are not to preinflate the balloon per mfg policy. Also, we now pre-clense the genitals with either an antibacterial soap and water or the pre moistened bath wipes. Then we proceed with normal insertion using betadine and sterile insertion of the cath. Then we have to label cath bag with time, date and initials of person inserting. By the way why do you suppose the foley says 5cc and the kit directs you to put 10cc in the balloon??

Don't forget about the "knife and gun clubs" as we call them. A number of years ago, the circulator picked up the pants that had been cut off of a patient and a loaded pistol fell out on the floor.

Our educator is also a regular staff nurse as well as being the person in charge of new staff orientation and continuing education for current staff. We are a small hospital (99 beds) and we do about 30 procedures a day. No neuro or open heart. Staff is required to cover all services. (general, gyne, vascular, orthopedics, urology, endoscopy etc.) In an average day, I may scrub a total hip then circulate a bowel resection. So you see, our educator has her work cut out for her. She has to stay current in all areas and help the rest of us do the same.

We have one educator who is also a regular circulator. She precepts in the rooms. There are also several of us who are regular preceptors. (No extra pay for any of us). Our educator does get 1 or 2 days a month as education days when she can plan and do research. If there is a question about how to do something, she is a great resource person. I did this job for 4 or 5 years and found it to be quite rewarding. We did have one educator that was very difficult to work with. I'm happy with the one we have now and has the same philosophy as me that a nurse should know how to scrub before she learns how to circulate. If we can ever get enough staff hired and trained, life will be good.

My grandson is allergic to Pine tree pollen. He develops a rash and his eyes swell. He gets really congested. So what do we have by our front door? Three huge pine trees. Luckily, they only pollinate every other year. While they are doing their thing, he uses the back door and his sister has to mow the lawn. When he was younger, he used a hair product like butch wax to make the front of his hair stand up. He then sat watching tv with his hands on his cheeks. About 2 hours later, the sitter brought him to me at the hospital with huge hives on his face in the shape of his hands and his eyes swollen shut. Of course the company that made the product would not release the ingredients and said that there was nothing in their product that anyone could possibly be allergic to.

I have had foot and ankle pain for years. After nearly 40 years in the OR, I have found my answer. At a big outdoor show recently, I passed by a vendor selling of all things, insoles for shoes. I really didn't believe all of the claims they were making, but after all, it was a place to sit for a few minutes. I sat, they put the insoles in my shoes and the result was amazing. I now wear them all of the time. Within 2 days all of my foot and ankle pain was gone. Even lateral knee pain that I was having has gone away. These thin insoles have glycerine in them. They don't really look any different than any other thin insole that you see at the drug store. The difference is in the walking. I wear them in my New Balance at work(I took out the original insole.) Next payday, I'm getting anothe set for my regular shoes. ( I gave $35 for them at the show) You can find them on the internet at Happyfeet.net. I think that they are about $40 there. It's true. I now have happy feet every day. They still get tired, but they don't hurt!!