Running a code

Depends on the situation... but usually the circulator takes on the role of delegation. Scrub obviously stays scrubbed, then additional people who come in are directed what to do by the circulator. (eg- one assists anesthetist, one works with scrub nurse, one does computer for labs and ordering blood, etc.) Fortunately we have very few true code blue situations. (knock on wood!)

How odd that this question has been asked because just recently I was involved with a code in the OR I work in...at this facility, perioperative RNs DO NOT have to be ACLS trained/certified, but I am. I think that the ACLS knowledge I have helped the code run smoothly...

I am also working on a research paper about codes in the OR. I'm curious, if anyone is willing to give up some info: as perioperative RNs in your facility, does the policy require BLS or ACLS? Also, do you participate in mock codes in the OR to keep skills up?

Any info/help would really be appreciated...there is not a lot of nursing research/literature on the subject!

In my facility, ACLS required for RNFA's only. No code drills.

If the management team offered you a chance to sit on a committee of sorts that deals with codes in the OR, is that something that you would be interested in?

No ACLS required. Our college requires us to have BLS certification. In our code situations, the anesthetists run the show. On shift, our PACU nurses come to assist (and of course they have ACLS). There are a few people who are ACLS, though mostly from previous positions (emerg nurses) but they have kept up their qualifications.

We don't really do mock codes. I think we did one once as an inservice last year. I think it would be good to run mock codes though, and then have a debriefing time afterwards. It would be much more useful than the stuff we often do.

I suspect that it's different for different places, hospital vs surg. center, etc.,,,,also time of day!

In our OR the circulators are BLS/ACLS certified, we also have our TNCC, some have PALS as well.

Knock on big time wood.....it's been a while since we had a true code in the OR, most of the time we get them off the table, or maybe some drug intervention is required.

Our circulators, depending on the situation tend to take over drugs/defibrillator or scribe. Anes. docs run the code, and the rest help out as needed.

Again, depending on the situation, scrub techs may drop out and do compressions, etc.

We've not done mock codes, not in rest of my hospital either. Not saying it's a bad idea, we just don't do it.

I sort of hate to talk about it....sort of like your most feared procedure or recurring nightmare pt...you talk about it and it happens. If we have a code tomorrow,,,I'm coming back to get you!! :chuckle

Just kidding.....

Mike

Thanks for the feedback, I appreciate it! I'm wondering if perhaps I should include simulated malignant hyperthermia crisis...

Humblecirculator, I was wondering if you ever got information about Codes within the OR. We are looking at using the Code team or how to integrate them. I have not seem much research on the subject. Any help would be great

Humblecirculator, I was wondering if you ever got information about Codes within the OR. We are looking at using the Code team or how to integrate them. I have not seem much research on the subject. Any help would be great

Well, I didn't get very far at my facility about codes in our OR ... right now im in Jersey for a seminar, but when I get back home, I will email you the paper if you like ... its been a while since I've touched that subject, but if I recall correctly, the paper was very good (just a lil biased!!)

At our facility, Circs were in charge of the code record.

Only the nurse who was permanently assigned to holding needed ACLS. I happened to have PALS and ACLS from my other job. I think it helped but it also caused some issues when I wouldn't "get out of the way" of people who thought they knew more than me, LOL. A PACU RN usually came to a code but mostly is was the extra anesthesia providers who ran it all. As well they should.

Mock codes are a fab idea (we never did but should have.) MH runs should be part of it.

In my facility:

Anesthesia announces the code.

The circulator pages the charge nurse, and all anesthesia attending physicians.

The scrub moves the mayo and back table out of the way and maintains sterility.

Anesthesia runs the code, pushes all meds, and delegates.

The surgeons give compressions.

The circulator might have to leave the room to get someone/something (ie the defibrillator) or operate the defibrillator.

While working in South Africa in ICU, I got called to the OR for a code. The pt was undergoing a Cystoscopy & TURP (in the old days) .What I walked in on still shocks me today. No one was doing CPR; no code drugs had been given; the anesthesiologist seemed to be in a catatonic state and just bagging the pt through the anesthetic machine and not doing anything else. There was no leader. The surgeon had left the Theatre and gone to the surgeons lounge!! I started from the A (airway secured) check. Pt being ventilated. Check (What is the ETCO2?) If low or absent we have NO perfusion of the pulmonary vasculature.Is there a pulse/cardiac output? No pulse, no SpO2 waveform or arterial waveform if pt has an A Line.Is the ETCO2 low or undetectable? (low or no perfusion state in the lungs?) Then start CPR! Hard and fast 30 compressions.Whats the rhythm on the ECG? is it shockable? 2 minutes CPR then if Vent Fib-> shock.

This got things started.I kept coding for about 30 minutes with all different rhythms but asystole finally ensued and the end was called. It still baffles me today that the surgeon never returned to the room and the anesthesiologist was totally inept in providing any kind of leadership during that situation. Fortunately my ICU experience and ACLS and ICU training stood me in good stead.

It really is the worst thing that can happen and not enough people are prepared to deal with it. My advice would be to have the hospitals code blue team respond to the OR. They are used to dealing with these situations all the time and do not get flustered.