Sequence of passing instruments

[NewRN35]

Hi there,

I am about a month into my OR training as an RN. I am have just started scrubbing independently (with my preceptor in the room). I am beginning to pick up on the sequencing of instruments that will be needed (for example, if he asks for a suture, scissors will be required, etc). However, I feel that there is so much I do not know. Does anybody have any tips for learning the sequencing of passing instruments to the surgeon? I know this can be complicated, and varies greatly depending on the surgeon & surgery. However, basic tips would be greatly appreciated!

Thanks.

[Scrubby]

If you see them starting to dissect around a vessel/nerve then have a mixter or lahey handy because they may want to put a neoloop around it. When you hand up a neoloop also give them an artery clip because they'll clip the ends of the loop together.

When they are tying off vessels it's usually clip, clip, cut, tie, cut. So you hand up an artery clip, another clip, metz scissors then a tie of some sort then your straight mayo scissors.

Another thing is if they are doing a laparotomy, when they go deeper into the abdomen you need longer instruments. Instead of handing up say a 7 inch pair of metz, go for a longer pair. Same with forceps, needleholders etc.

My biggest piece of advice is to really just watch what they are doing, what instrument they use and when. If you have some idea on what the surgeon is trying to achieve then you can start anticipating instruments.

[corrupt32]

I'm not a pro in the O.R., i'm also same like you 1 year ago... which reminds me that i also want to learn too much that i ask anyboy on how to know which i will give next, but my advice maybe is not too much help but i hope it will give you small hints....

if you see that there is a bleeding in the fats, in the muscles..they might use artery forceps and ligate it with suture or another is they will use adson tooth forceps and use coagulation cautery... if they prefer ligation then u will need to give artery forcep and tie( it also depend if they want it to put the tip with an artery or simply give the tie/ suture) and scissors to cut...

which scissors to use, if you previously give a suture- give suture scissors

if they will cut a tissue, give metz or tissue scissor..

nontooth is usually use on delicate tissues usually inside already.. while tooth forcep is usually outside (skin and fats)unless preferred by the surgeons...

When suturing give the surgeon need needle with the needle holder and tooth or non tooth forceps, and give the assistant an artery clamp and scissors.

if they are suturing inside or about to expose an organ, give a retractor... this is needed esp. during laparotomy... to expose the organs inside...

You just need to observe and keep in mind the preferences of surgeons also because different surgeons have different approach...

just keep in contact.. and let me know your progress...

i am just interested in persons who are also willing to learn...

[ShariDCST]

basics - the tougher the tissues they are working on, the heavier the instrument needed. for instance, you wouldn't hand up metz scissors to cut skin, or use heavy mayos on peritoneum. the shallower they are, the shorter the instrument, likewise the deeper in they go, the longer the instruments you'll need. you wouldn't hand up toothed adsons to suture inside an abdomen, or use long debakey forceps to suture skin. if they are dissecting, appropriate retractor, or retractors, scissors sized to suit the location, depth and toughness of the tissue or structure being cut. toothed forceps on tougher, surface level tissues, smooth forceps on delicate stuff. if they are going to ligate and cut something, you'll need the appropriate clamps and ligating material, be it stick ties, free ties, ties on mixter or tonsil clamps to go deep, or clips of some kind, and then scissors to cut the tissue and then scissors to cut the tie material unless you're using clips. that's been addressed. clamp, clamp, cut, tie, tie, cut suture/tie. "stick ties" are suture still on the needle - same as any other suture but for a slightly different purpose. plain ties are simply the strand of suture material without any needle. free ties are handed from your hands to the surgeon's hands, stretched out between your two hands for him/her to grasp in the center in their own hand.

if your facility hires csts, you might hunt one or two of them down and see if they can give you any particular pointers to handle specific cases or surgeons, or just general knowledge. that's what we do all day long, and usually we have all sorts of tricks and tips that would help a new person. most - but not all - of us love to teach. i did it all the time, when asked, and it was greatly appreciated.

one thing that might help, is this - if you're not already doing it, keep a small pocket sized notebook in your labcoat or or jacket pocket so you can write yourself notes after the cases are done. it's always helpful to rehash your cases at the end of the day - or at any point during the day where it's appropriate - and write down anything you think would be helpful to remember the next time you do a specific case, or work with dr. x.

good luck, and give yourself a break - it takes us a year in school (after a year of pre-reqs) to learn how to do that job from a beginner level - you won't get it all in 6 months. good luck! :)