What is "scrubbing" what is "circulating"

Brainyheart · May 27, 2006

Here's a (relatively) newbie answer:

The circulator does a lot of the prep work in the OR (e.g., sets up suction, catheterizes the patient, helps w/positioning, etc.), and then stands outside the sterile field to run errands, open packages, etc. S/he is NOT sterile. The operating/surgical nurse helps the surgeon...s/he is sterile and stays within the sterile field. I am giving you this answer from what I recently saw on my OR observation day. I'm not sure what a scrub nurse does---maybe helps the team glove and gown after everyone has scrubbed? There was another surgeon assisting the main guy, the anesthesiologist, the two nurses, and another doc who stood near to where I was outside the field to talk the main doc thru parts of the surgery and to point to things on the table that the operating/surgical nurse needed to hand the main guy. He used a laser pointer for this, which I thought was a pretty creative way of pointing at thins without contaminating them. The surgery was a TKR. Hope this helps!

Marie_LPN, RN, LPN, RN · May 27, 2006

The circulator does a lot of the prep work in the OR (e.g., sets up suction, catheterizes the patient, helps w/positioning, etc.), and then stands outside the sterile field to run errands, open packages, etc. S/he is NOT sterile.

Oooooooo, all that's an understatement.

The circulator is the pt.'s advocate first and foremost. Never under estimate how important this is, since the pt. is typically asleep and paralyzed. He/she helps get equipment in the room, makes sure the room set-up is appropriate for the case, MIGHT help open packages (that's really up to anyone to do that), interviews the pt. before surgery, starts the antibiotic (if not started already), assists anesthesia for induction, monitors the serile field and pt. at all times, charts the case, including the charges, meds, time in, incision time, time out.

In other words, the circulator is not an errand-person/gopher. There is so much more to it than that: www.aorn.org

Marie_LPN, RN, LPN, RN · May 27, 2006

I'm not sure what a scrub nurse does---maybe helps the team glove and gown after everyone has scrubbed?

The scrub nurse helps get the room ready as well, getting equipment in the room, making sure all supplies needed are in the room, might help with positioning before scrubbing, sets up table and tray, pass instruments, assist the surgeon(s), apply dressing after the incisions are closed.

A scrub nurse is someone who's an LPN or an RN, a scrub tech (depending on the facility) can be an LPN or a CST (certified surgical tech).

Again: www.aorn.org

Marie_LPN, RN, LPN, RN · May 27, 2006

another doc who stood near to where I was outside the field to talk the main doc thru parts of the surgery and to point to things on the table that the operating/surgical nurse needed to hand the main guy. He used a laser pointer for this, which I thought was a pretty creative way of pointing at thins without contaminating them.

That sounds a LOT like an implant rep, and not a doctor.

surgerynomore · May 27, 2006

The Circ is an RN that (my opinion) does alot of scut work for the OR suite. Checks in the pt, paper work, assists in pt possitioning, inserts foleys, helps anesthesia, and is a glorified goofer for the scrub. The scrub and the circ need to have a good relationship as they both can make eachothers life misserable:devil: . The scrubs have taken stugical tech courses ranging from 1-2 years, many have become certified. Many make more $ that the RN. They can continue on to First Assisting. The circ is working with a patient that is ready to go to sleep and then a sleeping patient to RUN or do paperwork and the charges.:bowingpur

subee, MSN, CRNA · May 27, 2006

The Circ is an RN that (my opinion) does alot of scut work for the OR suite. Checks in the pt, paper work, assists in pt possitioning, inserts foleys, helps anesthesia, and is a glorified goofer for the scrub. The scrub and the circ need to have a good relationship as they both can make eachothers life misserable:devil: . The scrubs have taken stugical tech courses ranging from 1-2 years, many have become certified. Many make more $ that the RN. They can continue on to First Assisting. The circ is working with a patient that is ready to go to sleep and then a sleeping patient to RUN or do paperwork and the charges.:bowingpur

I rarely ever ask the circulator to help me with an anesthesia induction. I've only worked with one circulator who knew enough to stand there anyway in case I needed her to press on the trachea for a better view. And I couldn't imagine asking a circulator to start an antibiotic - sometimes the best antibiotic isn't ordered and I wouldn't expect to circ. have read much on the chart. Anesthesiologists must be very spoiled to expect all this "assistance". The circ. usually has plenty of other tasks to do when the case is getting started, but I agree that it is a very "task oriented" type of nursing. No PDA needed here.

Darth Nightingale · May 27, 2006

okay folks. please just dumb it down for me. i have nursing school ahead of me this fall i'm sure that when i get into the clinical setting i'll understand more but until then... in ten words or less..

scrubbing means...[blank] like does scrubbing mean scrubbing the body?

circulating means... [blank] does this mean you go from room to room?

thank you,

sith lord apprentice in waiting (i hear there is an opening)

Marie_LPN, RN, LPN, RN · May 27, 2006

Scrubbing means scrubbing hands and arms, putting on sterile gown and gloves in closed-gloving technique and assisting in surgery.

Circulating is the nurse of the room, who's not sterile.

Check out www.aorn.org for a better description.

Darth Nightingale · May 27, 2006

scrubbing means scrubbing hands and arms, putting on sterile gown and gloves in closed-gloving technique and assisting in surgery.
circulating is the nurse of the room, who's not sterile.
check out www.aorn.org for a better description.

for the record... and from the site.

- scrub nurse - selecting and handling instruments and supplies used for the operation.

- circulating nurse - managing the overall nursing care in the operating room and helping to maintain a safe, comfortable environment.

- rn first assistant - delivering direct surgical care by assisting the surgeon in controlling bleeding, providing wound exposure, and suturing during the actual procedure.

i think it is awesome that aorn.com doesn't even bother to say what "aorn" means... i'm mean, come on... they must be elite if they oversee that. i'm down, yo! (of course it took me ten years to figure out what opp means too).. anyways it definitely appeals to my inner elitist core.

thanks for the link much for me to read there

darth n

ortess1971 · May 27, 2006

The Circ is an RN that (my opinion) does alot of scut work for the OR suite. Checks in the pt, paper work, assists in pt possitioning, inserts foleys, helps anesthesia, and is a glorified goofer for the scrub. The scrub and the circ need to have a good relationship as they both can make eachothers life misserable:devil: . The scrubs have taken stugical tech courses ranging from 1-2 years, many have become certified. Many make more $ that the RN. They can continue on to First Assisting. The circ is working with a patient that is ready to go to sleep and then a sleeping patient to RUN or do paperwork and the charges.:bowingpur

Circulating is not scut work-if you position a patient improperly you can cause them permanent damage. If you don't catheterize them the right way you can give them a UTI and or cause damage(esp. on a male). While there are some techs that make "more money" than an RN, usually you're talking about a new grad RN vs. a tech who's been doing this for 20+ years. RN's also can first assist with added training(RNFA's). The circulator is the patient advocate and we assess the patient before hand and also assess the lab values, EKG's etc. A really good circulator will be monitoring the field and will know what the docs or the tech needs before they even ask. I was a tech for 5 years and am now a GN in the OR. Circulating may look easy but that patient's safety rides on you and your license. Also, about the first assisting thing-many states/facilities will not recognize a tech first assist.(I think this is because not all techs went to formal schooling and many are not certified) I wish I had gone to nursing school sooner because while I loved being a tech, your options are limited in the long run. Ps- at my hospital, we assist anethesia for every case, providing cricoid pressure. The nurses have even had to start an IV(in the room) because anesthesia couldn't get it. The job is what you make it. I disagree that it is merely task oriented. Critical thinking is a must-because patients can go downhill quickly. I'm not surprised that people still think of OR nursing as not "real nursing" because most students don't get exposure to the OR at all. They base their opinions on what some instructor tells them( and many of these instructors would not last 5 minutes in an or room). We do assessments at my hospital and we are kick *ss advocates. OR nurses are real nurses and they are nurses who can think on their feet.

CuttingEdgeRN · May 27, 2006

I rarely ever ask the circulator to help me with an anesthesia induction. I've only worked with one circulator who knew enough to stand there anyway in case I needed her to press on the trachea for a better view. And I couldn't imagine asking a circulator to start an antibiotic - sometimes the best antibiotic isn't ordered and I wouldn't expect to circ. have read much on the chart. Anesthesiologists must be very spoiled to expect all this "assistance". The circ. usually has plenty of other tasks to do when the case is getting started, but I agree that it is a very "task oriented" type of nursing. No PDA needed here.

Our anesthesia team must be very spoiled. It is usually me that hangs the IV antibiotic. I read and absorb almost the whole chart and supplement that by interviewing the patient. (If that patient goes south on induction the RN best know what the medical history is) I ALWAYS stand right next to patients head to assist anesthesia with pressure, handing over ET tube in correct manner, making sure he/she doesn't have to look away from trachea, to retrieve it, Keeping an eye on pulse ox monitor if a difficult intubation. If precepting, I remind the new RN that on induction AND extubation, her eyes and attention are focused on that patient, to ignore surgeon, tech, rep, and whoever else is trying to get her attention!