What is important to you re: the circulator in the room???

yoga crna · Aug 19, 2006

I give you credit for asking the question.

My opinion.

1. Circulating nurses be more concerned about the patient and less concerned about the surgeon and "things" --equipment and supplies/

2. OR warm and QUIET during induction and wake-up.

3. Learn basics of anesthesia machine

4. Be at patient's side and QUIET for induction

5. Don't tell anesthetist that patient is moving. Trust me, we know

6. Understand your role and WHY with rapid sequence inductions and difficult intubations.

7. it is your job to circulate for the PATIENT, which includes the surgeon, the scrub tech and the anesthetist.

8. PLEASE don't bring your personal issues into the OR. When I am giving anesthesia, I can only deal with the patient and am not interested in your menstrual cramps, headache, boyfriend, husband, children or financial problems. It is not that I don't care, it is just not right now.

9. NEVER talk about legal issues (ex. putting you license on the line) unless you know what you are talking about and can give me documentation.

10. READ, READ, READ and keep current with OR practices, surgery and anesthesia.

11. Be cross trained to scrub, circulate, admit and recover patients. You will be more marketable and a better circulator if you know the other jobs.

12. REMEMBER gossip spreads fast in the OR and everyone loves to hear about bad news. Stay professional.

13. Last thing. We make administering anesthesia look very easy. It is NOT. Behind every med we give, every liter flow, every piece of equipment, every parameter being monitored, every induction, maintainece, emergence and technique is years of education, constant studying and keeping current and information in our head that has to be utilized on a moment to moment basis.

REMEMBER RESPECT IS MUTUAL

yoga crna

versatile_kat · Aug 19, 2006

Well - this is refreshing.

In my opinion - the time during the case in which the circulator is a great asset is during set-up and induction. From assisting with getting the patient onto the OR table, putting monitors on and helping keep the mask on their face (if no mask strap is available) while I get my drugs in line. Then, during induction, holding the ETT out to the right of the patient's face and possibly pulling the lip out of the way for intubation.

We know you're busy throughout the case with surgeon requests/charting, so we try not to bother you with too many of our own requests. The only thing we may request is a new bag of warm LR (if your hospital has those) druing the middle of the case.

Just keep that "team member" attitude you already have and your rooms will be the ones the CRNA's love to work in - you get what you give and vice versa.

jwk · Aug 19, 2006

Well - this is refreshing.
In my opinion - the time during the case in which the circulator is a great asset is during set-up and induction. From assisting with getting the patient onto the OR table, putting monitors on and helping keep the mask on their face (if no mask strap is available) while I get my drugs in line. Then, during induction, holding the ETT out to the right of the patient's face and possibly pulling the lip out of the way for intubation.

I'll offer a little bit of the flip side to this perspective. In practices where the anesthesiologist and anesthetist are BOTH present at induction, I'd rather have the circulator NOT be helping us. I have my own routines of how I do things, where I put certain items before, during, and after induction, and a third set of hands really just gets in the way.

For example - I put my endotracheal tube where I can easily put my hand on it without diverting attention from my view during laryngoscopy. When I reach for it, and it's not there because the circulator has it in his or her hand trying to be helpful, I end up having to take my eyes off the target to get the tube from them, then go back and make sure I can still see what I need to see before I insert the tube.

Don't take this comment to mean I don't like the teamwork. I do. I'd just suggest asking first if we need help, and if we don't, then you have more time to do all the rest of the stuff you still have to do.

miloisstinky · Aug 19, 2006

Just to be a nice person and a team player......i think that's all you need to know;)

versatile_kat · Aug 19, 2006

I'll offer a little bit of the flip side to this perspective. In practices where the anesthesiologist and anesthetist are BOTH present at induction, I'd rather have the circulator NOT be helping us. I have my own routines of how I do things, where I put certain items before, during, and after induction, and a third set of hands really just gets in the way.
For example - I put my endotracheal tube where I can easily put my hand on it without diverting attention from my view during laryngoscopy. When I reach for it, and it's not there because the circulator has it in his or her hand trying to be helpful, I end up having to take my eyes off the target to get the tube from them, then go back and make sure I can still see what I need to see before I insert the tube.
Don't take this comment to mean I don't like the teamwork. I do. I'd just suggest asking first if we need help, and if we don't, then you have more time to do all the rest of the stuff you still have to do.

Good point. I agree re: your routine and assitance being more of a hindrance than a benefit. In most of my clinical experiences, however, all I need to do is (while still visualizing the cords) hold out my right hand and the ETT is placed in it.

gaspassah · Aug 22, 2006

2. OR warm and QUIET during induction and wake-up.

this is a biggie for me, and the scrubs banging instrument trays all over the place on the metal carts doesnt help either.

RNinOR · Aug 25, 2006

As a circulator, I would like to add a couple of things I've learned. If the CRNA is alone, all your attention should be on her/him and the patient. Don't be afraid to shush the room! Turn OFF the radio and ignore the phone. If I don't know the CRNA, I say, "Just tell me what you need." At the time of induction, especially if giving cricoid pressure, THAT is my priority -and until they give you the okay to release, hold that pressure even if you shoes catch fire!! Just keep your focus there and be ready to assist without interferring AND- during fast turn overs, we might hook up BP, 02, and EKG monitors if anesthesia hasn't made it back yet. I couldn't have any more repsect for the CRNAs I work with- they are fantastic.

I hope this helps-good luck!