Circulate

For those who have not been reading all this time, I feel I need to explain what I actually do. This is not clear to most people, even other nurses.

Circulating. This means I meet the patient, make sure Pre-op nurses have the consent, ID bracelet, allergies, identified, and I ask the patient the name they prefer, that their surgery side has been marked, and know what friends/family are waiting for them, or not as the case may be.

I set up the room, with the scrub tech(or nurse), make sure the video is working, set up for all the charting, get all needed equipment is in the room, the bed is made appropriately for the position, all positioning aids are present, name is on the whiteboard, suction, bovie (electrocautery) x-ray, drill power, compression boots, warmer, padding, and prep all ready.

Patient rolled in by anesthesiologist, I get time recorded, warm blankets brought, untie the gown so they don't get caught or choked, move them over to the correct position, deal with any special needs, put the armboard on the gurney side, and take the gurney out to the hallway. Add any padding, safety strap, warming blankets needed. For a prone position, or a shoulder positioner, this adds several additional steps. Compression boots, foam pads, clamps on the bed for later additions. All with patter.

If there is a resident, I can start counting sharps and sponges with the scrub, giving them fluids, local, putting on a tourniquet, charting. If not, I hang out and am available for hand holding, helping with the intubation (holding cricoid pressure, or moving it to assist visualization of the airway, pulling the stylette, whatever) or holding the O2 mask.

I put the patient in the correct position, with the resident/fellow/surgeon. Strapped, taped, padded, depending on what is being worked on. Legs go up in stirrups, shoulders have beach chair positioners with wedges under the knees, with the other arm on a padded holder, or lateral with bean bags and axillary rolls, hands are the easiest, with just a working side table. Warming blanket placed, monitors so they can be seen, camera, pump, shaver on.

Tie gowns as the surgical staff come in scrubbed, plug in bovie pad, compression boots, warmer. Available for draping, catching strips from the adhesive stripes, plugging in camera, bovie, drill, fluids (with controller) for the arthroscopy &/or backtable, shaver, suction to the neptune, lightsource. Grab the hand from the suspension for the surgeon to drape it, make sure the scrub has everything, including closing sutures. Dim the lights, or make sure they are on, depending.

Chart like the wind, get implants to the correct size, chart and charge for medications, implants and drapes. Then I stand, or I run, not much in between. If the inside is not exactly as expected, I get other instruments, implants, grafts, as needed, then chart them, often extensively. I get local for post op pain, draw it up for the scrub, deliver it to the field and chart it. Then dressings, splint supplies or slings/boots/immobilizers, call Recovery, move the patient over to the gurney, O2 on, chart with them, walk them over to PACU and give report.

Rinse, repeat.