Stalwart

Working yesterday with one of our more... um, challenging surgeons. Two huge cases, no disasters, I just kept ahead, or at least up to him, all day. In no small part because of V, a great scrub, although I still often struggle with her accent. She does a lot of non-verbal communication with me, and we are both fluent there.

Arthroscopy is all about keeping the fluid going. Three liter bags of lactated ringers solution, four bags, two pairs spiked with Y adapter tubing, that flow into a double tubing that goes through a pump - with a control on the sterile field. Part of all this fluidity comes back through the suction on the shaver, some simply flows out and onto the floor. For keeping the floor from becoming a lake, puddle guppies, flat floor suctions, round but with a suggestion of fish shapes.

It all pours through the joint, providing the space for visualization, and flushes out debris. Running out (because one is busy doing several other jobs) causes whining (from the surgeon.) Bubbles from an air pocket when spiking a new bag, or letting it run out, get into the working space - which takes a bit of work to get cleared. Which slows down the case.

A normal knee scope, to debride away a torn meniscus, with a surgeon who manages fluid well, takes about two bags. Add in a resident getting practice, add another bag. Regularly for Dr. Challenging, 4-5 bags. In this facility, we have 20 liter self-contained suction daleks, called Neptune. They roll well, and there is a station in decontam where they offload and wash out. Best system I've ever worked with. Most routine knee scopes, they don't even need to be changed for two cases. For an ACL repair, usually one per case is sufficient. On a very large shoulder rotator cuff repair, a second one is fairly normal. That's the background so you will get this next set of numbers.



My long standing record for number of bags on a case - 23, recently fell when I got to 30. Yesterday, 32, THIRTY TWO, and filled the Neptune 5 (five) times, and I had #6 in the room ready. All with Dr. Challenging. All shoulders. And he hates the noise of puddle guppies, but yesterday I ran two throughout the case, and he didn't so much as mention that to me.

Recently, we were given a new stand to hang fluids, square tower, about 6" per side, with a knob and graduated notches to raise and lower each hook individually. This saved me yesterday, because I didn't have to reach up as high, but I could still easily keep the bags at different levels, allowing me to change them out more or less at my leisure, and keep the bubbles out. Raising one half of each double spike so the bottom of that bag is above the top of the other, the pressure of the lower one keeping the higher one from running out, until I had time to respike a full bag, then pinching below the single tube of the confluence to allow the air to flow back into the bags instead of down the tubing. An apparently empty upper bag can happily sit there for quite a while, as long as the lower bag is at least 3/4 full. Dr. Challenging only had to have me describe what I was doing once, and he's trusted me since. Some of the otherwise-less-challenging surgeons still remind me every time that I'm getting low on water, when I'm not. But then, the nurses I work with seem uninterested in my method, and I stopped trying to show them long ago.

Dr. Challenging, after our ten hours together, thanked me for being "Stalwart" - which I appreciated.


(I've gone back and edited this a dozen times, but if anything is still wrong, let me know.)