https://www.thecirculatingscrub.com/orlife daily 0.75 2025-07-02 https://www.thecirculatingscrub.com/orlife/a-beginners-guide-to-norepinephrine-levophed monthly 0.5 2025-07-02 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/54fa5794-8175-4c14-80b8-f9547eb8242b/levo+strip+-+Copy.png Blog - A Beginner’s Guide to Norepinephrine (Levophed) - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/c1e5b531-e8d9-4e83-89eb-5ae6cc2a09ca/Levophed+-+Copy.png Blog - A Beginner’s Guide to Norepinephrine (Levophed) - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/54fa5794-8175-4c14-80b8-f9547eb8242b/levo+strip+-+Copy.png Blog - A Beginner’s Guide to Norepinephrine (Levophed) - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/54fa5794-8175-4c14-80b8-f9547eb8242b/levo+strip+-+Copy.png Blog - A Beginner’s Guide to Norepinephrine (Levophed) - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/rapid-sequence-induction-rsi-in-the-intensive-care-unit monthly 0.5 2025-07-01 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/7e429cc8-ad83-4a0d-aee5-10911743918c/2+-+Copy.png Blog - Rapid Sequence Induction (RSI) in the Intensive Care Unit The standard choice of medications for RSIs at my facility have been Versed, Etomidate, and Rocuronium. Pre procedure sedation is provided by the Versed (midazolam). Once the patient is sufficiently oxygenated and everyone is ready, next is the Etomidate for deeper sedation. Ketamine, Versed, Fentanyl, and Propofol are other options for this step. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/54ad24ba-fee1-4e61-9247-41060ffe7efa/3+-+Copy.png Blog - Rapid Sequence Induction (RSI) in the Intensive Care Unit Preparation Preoxygenation Paralysis Protection Placement Postintubation Management https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/07b78b7b-71fb-4f67-97b3-942e521bd11f/1+-+Copy.png Blog - Rapid Sequence Induction (RSI) in the Intensive Care Unit - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/or-to-icu-culture-shock monthly 0.5 2025-06-25 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b4705201-8f5d-4cff-a1fe-6fcc0eebcb0b/culture.png Blog - OR to ICU | Culture Shock There are countless differences between working as a registered nurse in the operating room and working in the intensive care unit. But, there is one that has had a huge impact on me. I thought it was going to be having more that one patient at a time, nope. Having 4 patients (when I work on the intermediate care side) is a challenge, but it seems to be all about time management. The biggest difference are the patient’s behaviors. I am use to almost every patient being happy to see me, a little anxious, but overall happy to see then nurse who will be with them in the OR. https://www.thecirculatingscrub.com/orlife/crrt-continuous-renal-replacement-therapy monthly 0.5 2025-05-26 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/cb1d5e77-fa06-4b10-b00b-11be2360ea49/2.png Blog - CRRT | Continuous Renal Replacement Therapy This week I learned about CRRT with two different patients. I’m definitely still learning, but I feel that I’ve gotten a good handle on it so far for only having two patients. In both of these cases, the reason CRRT, or continuous renal replacement therapy, was chosen over dialysis was due to hypotension. https://www.thecirculatingscrub.com/orlife/map-mean-arterial-pressure monthly 0.5 2025-05-06 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/85d03813-1fd6-47e2-a148-71ee04fdd4af/4+-+Copy.png Blog - MAP | Mean Arterial Pressure On the monitor the MAP can be displayed in a few different places (this image does not include all possibilities). The top line shows the NBP reading with the MAP in parenthesis. SYS/DIA (MAP). The next is the same order, but with the MAP under the reading. The last line shows the arterial line reading with the MAP next to it in parenthesis. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1260d2dc-3962-4061-8d0e-9c84f04dad09/MAP+divider.png Blog - MAP | Mean Arterial Pressure - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/215f24ac-c4fb-4494-891e-ec37ff82ebb6/2+-+Copy.png Blog - MAP | Mean Arterial Pressure Most monitors with automatically calculate the MAP, but if you’re ever in a pinch and need to calculate the formula is nice to know. To calculate the MAP you take the diastolic blood pressure, multiply it by two, add the systolic blood pressure, then take that sum and divide by three. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1dfecd9d-4d71-488d-b8a6-458723d339ed/MAP+divider.png Blog - MAP | Mean Arterial Pressure - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/496798de-6eaf-4220-a6c2-4eea0cfb4dc8/MAP+divider.png Blog - MAP | Mean Arterial Pressure - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/c23556a2-b175-471a-b8b5-eb5d472d92e3/3+-+Copy.png Blog - MAP | Mean Arterial Pressure - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/icu-orientation-weeks-1-3 monthly 0.5 2025-05-04 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1ef53326-f473-4e5a-8318-82b1ff66166b/ambulance+-+Copy.png Blog - ICU Orientation Weeks 1-3 It’s hard to believe it, but I’ve already made it through week 3 of orientation. I feel as if I’ve learned a lot, but at the same time I feel like it’s my first day every day (it’s really just a lack of confidence). I’m catching on quickly and I feel as is I can use background in surgery to connect a lot of the dots. My preceptor has been great, she’s been supportive, encouraging, and has answered all of my questions without complaint. She also says that my surgical knowledge has taught her a few things! On my 3rd day in ICU, our patient needed transferred to another facility for a higher level of care due to a significant cardiac history. The weather wasn’t perfect, so no flying. Transfer by ambulance was the only option, and they needed an RN for the trip. So we got to go. It was a pretty cool experience and luckily an uneventful trip, plus it made the day fly by. https://www.thecirculatingscrub.com/orlife/items-im-buying-for-the-icu monthly 0.5 2025-04-05 https://www.thecirculatingscrub.com/orlife/or-nursing-to-icu-nursing monthly 0.5 2025-03-20 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/81e08ee9-0adf-401f-9b95-860a4d04a3d7/OR+Nursing.png Blog - OR Nursing to ICU Nursing - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/plastic-surgery-lesion-removal monthly 0.5 2025-03-05 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/41afbafc-8ad2-4cd1-b04e-7aae34de60f4/IMG_9813%281%29+-+Copy.jpg Blog - Plastic Surgery | Lesion Removal Mayo Stand & Back Table Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/ffb80b4b-536f-452b-97b3-24213553973c/IMG_9816+-+Copy.jpg Blog - Plastic Surgery | Lesion Removal Mayo Stand & Back Table Set Up 15 blade (have one per lesion) Adsons (with teeth) Bipolar adson Curved Iris Straight Iris 2 mosquitos (I don’t recall ever actually using these- it just feels naked without!) Raytecs Ruler Marker 10 cc syringe, 27 g. hypo for local https://www.thecirculatingscrub.com/orlife/myringotomy-with-tube-insertion monthly 0.5 2025-02-14 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/06eaa4ce-b0d4-4584-87bc-6af652822091/IMG_6452+-+Copy.jpg Blog - Myringotomy with Tube Insertion - Make it stand out Top: M&T Tray with additional instruments Speculums 3, 3.5, 4, 4.5, 5 Curette Myringotomy knife #3 Frazier suction Alligator forceps Cup foreps Rosen pick #5 suction on suction tubing https://www.thecirculatingscrub.com/orlife/functional-endoscopic-sinus-surgery-fess-set-up monthly 0.5 2025-02-12 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b8b0b597-1de0-48f4-b47f-280f73a8ec96/FESS+Back+Table Blog - Functional Endoscopic Sinus Surgery (FESS) Set Up - Make it stand out Trays: Sinus pan, Nose pan, surgeon specific specials (cobra, giraffe, frontal sinus instruments) Tray: Pitcher with two 20cc syringes and blunt hypos for irrigation, raytecs, kidney basin with trackable suctions, back of tray- various unused forceps, front of tray- various Kerrisons Needle box, #15 blade on long knife handle (comes in pack, didn’t need for FESS, but luckily had it ready when he added a septo), 2 markers, 2 trackable pointers, 0 and 30 degree scope with endoscrub sheath and tubing, ½” x 2” cottonoids, ½“ x 3” cottonoids, gown and gloves Not pictured: Ring stand basin- camera, light cord, microdebrider with 4mm tricut blade, suction tubing x 2, 2 sticky velcro cord organizers (we call them a ‘strip-t’, but I’m not sure if that’s their actual name). Split drape, 3 towels. As I mentioned early on, we ended up adding a septoplasty to this procedure after we started, luckily I had everything already that was needed except for Doyle splints and the suture which were both already in the room! Here is my septoplasty set up. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/784802f1-d4e3-40fe-8aef-e3b536348e76/FESS+Mayo+Stand Blog - Functional Endoscopic Sinus Surgery (FESS) Set Up Top: Left to Right left, straight & right scissors left & right backbiters straight & up biters Ferris-Smith Fragment forceps (not the same as Ferris-Smith Tissue Forceps) Gruenwald forceps Middle: trackable suction, with tracking wire (blue) attached, Kerrison (up, medium), various nasal speculums Bottom: ball probe, seeker, raytecs https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/88fecd9d-3186-4a31-b480-1c911a230a8f/FESS+Train Blog - Functional Endoscopic Sinus Surgery (FESS) Set Up - *NOT MY MAYO STAND After I had another scrub check my set-up, I ended up removing the scissors, the speculums, and the seeker. My tray felt empty! I added one instrument, which was a frontal curette. The picture to the right is the mayo stand set up of the surgical tech that trained me in ENT— BIG difference? There is a handful of instruments on this persons set up that were for a septoplasty which I did not need (until later in the case when he added a septo to the procedure). The surgical tech that trained me in ENT was also a nurse and was the most knowledgeable CST/RN— if you had an instrument question, she had the answer. If you needed help with just about anything, she was your resource. I learned SO much from her and I am thankful to have had her guidance! Also, notice all that tape??? Yikes. https://www.thecirculatingscrub.com/orlife/becoming-a-registered-nurse-as-a-certified-surgical-technologist monthly 0.5 2025-02-07 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/a748d089-b990-40d0-9da4-191343a6b482/cst+to+rn.png Blog - Becoming A Registered Nurse as a Certified Surgical Technologist - Make it stand out I’ll be honest, when I first decided I wanted to get into healthcare I did NOT want to be a nurse. All I could picture in my head was someone working in a nursing home or on a med-surg floor. While there is NOTHING wrong with working at either one of those locations, it wasn’t for me. In one of my previous posts, I discussed how I ended up in the surgical technology program but also how I ended up in a nursing program a few years down the road. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/e5e9a034-01d0-4300-8f1d-e2084986ed0d/TO%281%29.png Blog - Becoming A Registered Nurse as a Certified Surgical Technologist - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/85d4b4e6-8d1b-461e-ae3b-555794603e9a/3.png Blog - Becoming A Registered Nurse as a Certified Surgical Technologist I am one of two RNs in our department that can both scrub and circulate, it is a real benefit to be able to do both. The knowledge and experience I gained as a surgical tech has helped me become a more confident circulating nurse. I am a nurse now, but I am also still a surgical tech. I am very organized and I like to think that is because of the OCD being a surgical tech can trigger, I have some of the neatest nurse set ups! https://www.thecirculatingscrub.com/orlife/robotic-assisted-hysterectomy monthly 0.5 2025-02-05 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/6bdd5f88-9f90-4708-bbe2-a894397dde9e/IMG_1772.JPG Blog - Robotic Assisted Hysterectomy da Vinci scope (warmer attached) with initial gowns. Also, the scope should not be left on this wrap, it should be switched out to a back table cover. There’s no way to ensure sterility if the wrapper isn’t checked for holes. Not Pictured- Ring stand: bipolar/monopolar cords, suction/irrigation, air seal tubing, drapes https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/7cd9e5b1-7261-437a-b5a9-68139adced19/IMG_1774.JPG Blog - Robotic Assisted Hysterectomy #11 knife Verres Insufflation Needle 3 ml syringe (put 1.5 ml NaCl for drop test) Metz (this surgeon did a mini-cut down) Robotic trocars (1st with obturator) Local Raytecs Grasper ( silver handled) Maryland dissector Hook scissors Suction tip Not pictured: Air seal- I wanted to confirm which size before opening (see my note!). https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/8bcedbcc-f245-404b-9811-d5c26d9517e0/IMG_1771.JPG Blog - Robotic Assisted Hysterectomy Instruments: Auvard weighted spec, right angle retractor, tenaculum, uterine sound, uterine dilators. There is a preloaded Vicryl to secure the Zumi to the cervix. To the right are the drapes (only drapes for legs), items needed for cystoscopy, and the additional D&C instrumentation. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/91b0b5e1-23f6-4298-ba86-947094306af1/IMG_1773.JPG Blog - Robotic Assisted Hysterectomy - Make it stand out Instrument tray: extra robotic instruments, laparoscopic needle holder, needle board (so it doesn’t get pushed off accidentally with the robotic instruments), basic instruments in bottom left corner of tray Front of tray: 2 da Vinci needle drivers, da Vinci Maryland, da Vinci scissors Beside tray: Fred (counted as 3 pieces!) gowns https://www.thecirculatingscrub.com/orlife/metrics-in-the-operating-room-and-why-they-matter-part-ii monthly 0.5 2025-02-02 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/ac039d3a-c34c-400b-bcf2-c8611bde523a/4.png Blog - Metrics In the Operating Room and Why They Matter | Part II This is a comparison of how many procedures are scheduled as outpatient- typically less acuity type procedures. The inpatient procedures are patients who were admitted for whatever reason and end up needing a procedure done. Reimbursement for inpatient procedures is impacted by many factors. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/60cd6e41-cfd2-4b4b-b9a3-e08597da9466/1.png Blog - Metrics In the Operating Room and Why They Matter | Part II Volume typically correlates with the number of procedures in a certain time period. For the frontline team, this doesn’t mean much other than the number of cases you’re assigned to each day. Do you have a light day with 3 small cases, a heavy day with 6-7 small cases, or a heavy day with 1 big case? This is typically reported to senior leadership and the finance team. It is usually compared to the previous month or the previous year, but I feel there are a lot of factors that play into this number that make it unreliable. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/85072ece-a0c2-4cbd-ba93-25f6599a8d9f/5.png Blog - Metrics In the Operating Room and Why They Matter | Part II Most facilities use block time scheduling to determine what and when surgeons have access to the OR. There should be a policy on how block time is given, but also how it is removed. You want to be able to give surgeons the opportunity to create a regular schedule for their operating hours, but they also have to prove that they will use it. Being able to refer to the policy on block utilization is very helpful when working with surgeons (or their office managers) on changes that may be necessary for the success of the department. Block time is an extremely touchy subject with most surgeons. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/0f08de3b-7cc3-478a-bc2d-a45becff0590/2.png Blog - Metrics In the Operating Room and Why They Matter | Part II This number means a little bit more I believe. This number doesn’t mean cut time to close time, this means wheels in to wheels out. This is a direct reflection of how many minutes the patient is billed for (dependent on your facilities approach). If you have 8 hours of ‘normal operating time’, that translates to 480 minutes per room each day. If you only had 230 minutes of operative time, that’s 250 minutes of unproductive time when the room was without a patient. Unfortunately, turnover time falls under unproductive time— which I highly disagree with. That time is so important and necessary to prevent mistakes. The operative minutes number is a lot more reflective of your department’s busyness. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/aea37b42-4a35-4b2b-9927-7bce424839b7/3.png Blog - Metrics In the Operating Room and Why They Matter | Part II This metric isn’t one that is typically required to track and report, however during my leadership journey I found this comparison was insanely helpful in showing the growth the department was experiencing. This comparison really just shows if you had a higher number of shorter cases or a lower number of longer cases. Think 8 cystoscopy cases versus 1 CABG. The facility where I was kept saying “more cases, more cases” but while working on the “more cases” part, the bigger cases came, which meant more minutes and less volume. https://www.thecirculatingscrub.com/orlife/the-surgical-timeout monthly 0.5 2025-01-29 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/d312f1fe-1954-4acb-abf9-2c020aaa8ff9/timeout.png Blog - The Surgical Timeout - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/2c25d3b3-2b15-420e-82b2-de66cc78ace8/timeout+charting.png Blog - The Surgical Timeout -Patient Name -Patient D.O.B (for two identifiers) -Scheduled Procedure -Laterality marked (if applicable) -Surgeon -Allergies -Fire Score -Antibiotics -Anesthesia Type https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1b13b38e-cb4f-47f9-b3dc-e97af0ce5385/attn%281%29.png Blog - The Surgical Timeout - Inattention to Timeout Unfortunately, there are times when team members are not attentive during the timeout. If you notice side conversations during the timeout, you need to stop, get the attention of everyone and restart. Do this a time or two and the individual causing the disruption will understand. If you notice fidgeting of the drapes by the surgeon, tech, or assist… just pause and stare until they notice you’ve stopped, they’ll get it. https://www.thecirculatingscrub.com/orlife/metrics-in-the-operating-room-and-why-they-matter monthly 0.5 2025-02-02 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/55f27900-6edf-43a6-a350-c64a8958867c/3.png Blog - Metrics In the Operating Room and Why They Matter | Part I Typically, only the first cases of the day are included in this metric as all following cases cannot have a definite start time. But, it goes along the same lines as turnover time— if the surgeon plans for roughly 6 hours of operating time in the 8 hour day and the OR team its it up with a delay in the morning, excessive turnover time, and excessive in room to cut time that 6 hours of operative time is stretched out too far. Why does this matter? What happens if there are more rooms running after 3 o’clock (typical normal end of elective case hours) and there https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/8441d788-89cc-4e69-aa79-a81e5dcd4b8f/1.png Blog - Metrics In the Operating Room and Why They Matter | Part I Turnover time isn’t JUST about getting the surgeon out for their tee time, it’s about efficiency. A standard goal for (same room) turnover is 28 minutes. That may seem like a long time, however there is a lot that happens during this time. The room must be cleaned, unnecessary equipment out, needed equipment in, sterile field set up, all the safety checks, anesthesia’s set up, and more. If you’re turning over between a tonsillectomy and another tonsillectomy— no big deal. However, if you’re turning over between a exploratory laparotomy and a https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/6c5c4105-4787-47f2-8c7b-d73a2cbfead6/2.png Blog - Metrics In the Operating Room and Why They Matter | Part I Again, this is an efficiency metric. The second the patient is checked as “in the room” is when their dollars start stacking up. If I can prevent my patient from an excess 20 minutes of OR time, I’m going to! That’s the most expensive time there is. Story time. I was about to circulate an endoscopic facelift (first one I had seen, SO cool!) and the surgeon told me I’d need to get her hair parted a very specific way- this takes time. So, instead of getting the patient to the operating room and doing it there (costing significantly more money), I ran https://www.thecirculatingscrub.com/orlife/a-day-in-the-life-circulating-nurse monthly 0.5 2025-01-03 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1735877016927-X0P4G2N581M4NNL7EXJ0/IMG_8698.jpg Blog - A Day in the Life | Circulating Nurse https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1735877017126-SQAV2OF13PU14JDOLYI5/IMG_8526.jpg Blog - A Day in the Life | Circulating Nurse https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1735877018821-SDG60WGKJJBFVAA4JGKX/IMG_7200.JPG Blog - A Day in the Life | Circulating Nurse https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1735877165067-1ICKEM45QM0DFDH85C9A/IMG_7177.jpg Blog - A Day in the Life | Circulating Nurse https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/dcaff7d0-1fca-470b-9556-f23d3979c660/day+in.png Blog - A Day in the Life | Circulating Nurse - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/laparoscopic-appendectomy-set-up monthly 0.5 2024-12-28 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b86e9606-dea6-4818-b602-8ad4798cfb94/2.png Blog - Laparoscopic Appendectomy Set Up - Laparoscopic Appendectomy Mayo Stand Basic graspers (2)(some call these “wavy graspers” some call them “silver handle graspers”) Maryland grasper 30 degree 5mm scope 0 degree 5mm scope placed in warmer (AKA igloo) Knife handle with #11 blade Towel clamps (2) Insufflation needle would be next, however this patient was heavier and I wanted to check if the surgeon wanted long or regular length 5 mm non-bladed trocars (2) 12 mm non-bladed trocar Peon Raytecs https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/c59a86f2-632b-4d7f-bb59-252a1c6de685/1.png Blog - Laparoscopic Appendectomy Set Up - Laparoscopic Appendectomy Back Table Instrument pan; needle drivers, scissors, peon, S retractors, endocatch bag, adson tissue forceps, rat tooth forceps, additional laparoscopic instruments Needle board Med cup for local Dermabond (2) Suture (O-Vicryl UR-6 for closing the 12mm port, 4-0 Monocryl PS-2 for all port incisions) 20 cc syringe for local injection (a hypo should also be opened; the card called for an abnormal size, so I verified before opening) Mayo scissors— I usually leave these in a very easy spot to grab instead of with the other instruments. Basin with saline, extra towels, kidney basin with additional med cup, labels, marking pen, and cloth for scope warmer, gowns and gloves *This surgeon requests that the endocatch bag be open from the beginning, I will say most others I work with ask you to hold it until after they’ve transected the appendix. https://www.thecirculatingscrub.com/orlife/contamination-in-the-or monthly 0.5 2024-12-21 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791601548-XTS7BWVVXE6HE1G4SO7P/18.png Blog - Contamination in the OR This hole in the blue wrap is pretty obvious. Do you see two holes? There is also one in the tape that is a little harder to see. After opening, blue wraps should always be held up to look through and inspect for holes. If your wrap is blue on one side and pink on the other, hold the blue side away from you and look through the pink— holes will be more noticeable! Side note: SPD always gets the blame for holes in wrappers, but they shouldn’t. These holes can happen anytime they are handled. The CST or RN removing it from the case cart, if it’s set on something it shouldn’t be on. These holes are usually a ‘handling’ issue versus a ‘sterilizing issue’. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734795186525-ZX7RY2RU7UIUETVYKH4A/16.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734795213460-C61ES3EIILMPGTKR5AGM/13.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734797451998-1GL4URV9CQGI5Q9P5K2D/11.png Blog - Contamination in the OR This was a sticky drape opened to the field and when the paper strip covering the sticky was removed, the scrub found some ‘fuzz’ looking stuff. She threw it off the field and asked the circulator for another. Something I was taught in the early days of the surgical technology program.. “when in doubt, throw it out”. If you ever question the integrity of an item— throw it out! https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791589012-XNGS6CZO32S7LFLXVE99/15.png Blog - Contamination in the OR A wet tray or a ‘wet pack’ can happen many ways, but it’s an indicator that something within the sterilization process did not go right or it was handled inappropriately. Essentially, if there is any moisture on the inside of your casket, or the blue wrap, it is considered contaminated. Send it back to SPD to reprocess and hope it isn’t a ‘one-of-a-kind’ item. Exception: If you are using a OneTray, or a similar closed system tray, you will almost always see the lining of the tray wet. These were a lifesaver at a previous hospital I worked at. Read about them here. Plus, those case carts looks awesome! https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791566140-ULTMAHDSX6NM6Z1TZCEF/8.png Blog - Contamination in the OR You would think this would be hard to miss, right? Unfortunately, if you don’t inspect your tray’s integrity prior to opening you will likely miss this. When you open the lid on this tray as is, you really don’t notice a difference. Which was also the case in SPD when assembling these specific caskets. They were placed in the sterilizer without a proper inspection and placed on the shelf for use. Here’s another case of send it back to SPD for reprocessing and grab another off the shelf. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791560884-XNOVGDQWC168I7ZDBY45/6.png Blog - Contamination in the OR This is a lovely set of instruments a surgeon took to the floor to help a patient… then just dropped it off at the reception desk. Not the SPD desk, the main OR! He kindly removed the scalpel (surprisingly). Don’t be this guy. Take it directly to SPD. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791548602-WCGPOJEKFIDGCXP0EWT3/1.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791547958-CFK12ZS8TM2U9965VPP4/2.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791554451-Y82U9OU2V1JHEUPAEXQN/3.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791560884-XNOVGDQWC168I7ZDBY45/6.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791555099-EXS4XPN4D1IR1FHM0QD1/4.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791564606-CURQDPNZOMC3SXWUZE1U/7.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791566140-ULTMAHDSX6NM6Z1TZCEF/8.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791560184-RZXWXCJ60TZGHFD5LZFB/5.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791569865-ZA8NEDF0FNRUNZ871NKG/9.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791571595-VN037OA1DL5RSEOEC5EZ/10.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791577278-TAQM5OABPQ5WQGSUOSCY/11.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791577845-898MK54T92V1SSJHORPV/12.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791583883-UVH5AYMJ8PIMDFH0FWX4/13.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791584627-EADBR8Z8H17LCE72KUM6/14.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791589012-XNGS6CZO32S7LFLXVE99/15.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791592548-IMQVHI27O805EYDLAGSK/16.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791597513-PO5HM1ZTYNCXLJ5FBSRM/17.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791601548-XTS7BWVVXE6HE1G4SO7P/18.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791548602-WCGPOJEKFIDGCXP0EWT3/1.png Blog - Contamination in the OR During a procedure a curved metz was dropped, so I ran to SPD and retrieved another. This was the first one I grabbed, and I immediately noticed an issue, so I grabbed another while I was back there and opened it to the field. If you don’t notice what’s wrong in this picture, the point of the scissors have punctured the peel pack. Usually, these will have a special protective tip on them to allow for proper sterilization but also to prevent this from happening. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734799681833-XT311D4M8MT018MJBJV4/7.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734799757434-KZG7Q3LX0WP5D4BCMD91/10.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734800144046-DAIOHLD6RG9VVSIFYRKU/3.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734800144771-1MHDCLIPB4H7L4125EF4/9.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734800792990-VXIGVJXO0FMD3V6PV2IW/2.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734800795854-0L99GPYGNLN6J0T65641/4.png Blog - Contamination in the OR https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1734791597513-PO5HM1ZTYNCXLJ5FBSRM/17.png Blog - Contamination in the OR Instruments should never be sent to SPD looking like this. There is no excuse. Gross bioburden should be removed throughout the procedure and the CST needs to take a few minutes to remove as much as possible before sending to SPD. Get a basin of water (not saline— it causes pitting) and do your best. SPD will appreciate your effort, and it will decrease the chances of bioburden being stuck or dried in places that aren’t easily accessible. https://www.thecirculatingscrub.com/orlife/do-nurses-make-the-worst-patients monthly 0.5 2024-12-19 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/07ef1fad-0d2c-49d4-a203-701a7aa2574b/Untitled+design%285%29.jpg Blog - Do Nurses Make the Worst Patients? - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/2ce496e6-d020-4555-95c5-2a6d3e0bad06/Body.png Blog - Do Nurses Make the Worst Patients? So, I sent my surgeon a little text… Another perk of working in the OR! Side note— he told me to reach out to him if I had any issues or questions. There are things that most surgeons will not mind you reaching out about during their ‘non-work’ time, but there are others that can certainly wait until your next contact or a message into the office. Try to respect their personal time! Don’t take advantage of essentially having them on speed dial. https://www.thecirculatingscrub.com/orlife/a-guide-to-gastrointestinal-gi-staplers-in-surgery monthly 0.5 2024-12-09 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733538908412-UILU39UWXNUMOEE1RRNW/TA%2BStapler.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - TA60 Stapler with reload https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733538952302-HR20OCE7FJYV1FARPWJ2/1.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - 100 mm GIA stapler with reload https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733527062573-DOAFNLZ5XA8NRJAI51RT/2.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - 80 mm GIA stapler with reload https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733539868643-9IFC9MYBDUCYFZCSQNCS/Purstring.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - Auto Purstring Device https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733542558913-U9DRO8ARRISDNOVIA9ZW/Contour%2BStapler%25281%2529.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - Contour Stapler and reload https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1733540044485-9W0LRO4ZOCGQT2L5YOAZ/EEA%2BStapler.jpg Blog - A Guide to Gastrointestinal (GI) Staplers in Surgery - 25 mm EEA Stapler https://www.thecirculatingscrub.com/orlife/my-first-surgery monthly 0.5 2024-11-26 https://www.thecirculatingscrub.com/orlife/inspire-therapy-implantable-neurostimulator-for-obstructive-sleep-apnea monthly 0.5 2024-11-10 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/9d7204dc-b802-4321-aed3-593e32721b92/IMG_8347.jpg Blog - Inspire Therapy | Implantable Neurostimulator for Obstructive Sleep Apnea - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/fe5ce131-8e3b-4bcd-84db-c0bec95c45e2/IMG_7177.jpg Blog - Inspire Therapy | Implantable Neurostimulator for Obstructive Sleep Apnea - Prep Stand Set Up 1% lidocaine with epinephrine 1:100,000, sponges, alcohol wipes, 2 3ml syringes with 27g hypodermic needles, tissue forceps with teeth (longer preferred), gloves for surgeon and RN, NIM electrodes (blue and red placed under tongue by surgeon), green placed by RN, white/red not used, but I never throw off until after all are placed. The RN should assist the surgeon when injecting the local anesthetic and electrodes. The syringes should be refilled as they are used, and dependent on patients anatomy, you will likely need to hold the lower lip and chin when the surgeon places the electrodes under the tongue. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b4212e17-1ae7-4fc6-9d39-a82623a2bbb1/Untitled+design.png Blog - Inspire Therapy | Implantable Neurostimulator for Obstructive Sleep Apnea - NIM Machine The Inspire representative with the help of the Medtronic representative should have created a profile on the NIM machine specifically for Inspire implant insertion. Select this profile, then neck dissection, then you will see this screen. This screen depicts that a NIM endotracheal (ET) tube would be used, however that is not the case. The surgeon will place the red and blue electrodes (pictured above) under the tongue. They will be placed in the red and blue slots on the remote. The remote is housed in the back of the machine and should be removed and placed on a rail of the bed, usually the head of the bed, and secured with a velcro strap (as tempting as tape is- DON’T use it!). The green (grounding) electrode will be placed over the shoulder and plugged into the green slot on the remote. Once the red x’s turn to green check marks advance the screen to monitoring. After draping, the surgical tech will throw off the electrodes for the stimulating bipolar which will be plugged into the “Stim 1” slots according to color. Frequency and volume can be adjusted on the next screen under the direction of the surgeon. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/d1f1e028-92dd-41bd-a418-e4f32db4975f/IMG_7176.jpg Blog - Inspire Therapy | Implantable Neurostimulator for Obstructive Sleep Apnea - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/thyroidectomy-set-up monthly 0.5 2024-12-09 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/c3669dcc-a645-48ef-9b35-da8faaff3e46/Screenshot+2024-10-04+at+5.23.17+PM.png Blog - Thyroidectomy Set Up - Neck Pan Left to Right Cushing vein retractor (2), Senn retractor (2), Volkman Rake retractor (2), Army-Navy retractor (2), 3/4” Richardson retractor (1), Trach spreader (dilator), trach hook, bipolar forcep below Pitcher with asepto, curved Mayo scissors, Straight Mayo scissors, Mosquito clamp (4), Kelly clamp (4), Allis clamp (2), Babcock clamp (2), Jacobsen (Jake) clamp (2), Lahey clamp (2) Tissue Forceps on front lip left to right Brown-Adson tissue forcep (2), Debakey tissue forcep, Rat Tooth forcep, Russian tissue forcep https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/881afdda-7533-4624-8e5f-3e526de96093/Thyroidectomy+Set+Up Blog - Thyroidectomy Set Up - Sharps & Smalls Needle board- ruler slid below, non-guarded bovie tip in #31, dermahook with suture bootie in #32 (usually there are two here, however I dropped one when preparing them), board which will be for bactroban at the end of the procedure, suture bootie foam, Needle Drivers laying up front for easy grabs. Suture- 3-0 silk SH for tagging specimen, if drain add second 3-0 silk. Ensure you do not use the same suture to tag the specimen to secure the drain to prevent malignant cells spreading. 3-0 Vicryl SH control release (pop-offs) to suture first layer. Then a 3-0 Vicryl SH swedged for the runner (not pictured because I forgot to open!). Lastly a 4-0 Vicryl PS-2 for skin closure. 4 Peons with Dermahooks for retraction. We add suture booties so the end of the hook doesn’t get caught or snagged on during the procedure. I place these on a roll for easy grabbing, they are one of the first few steps in the procedure and I pull them up to my mayo immediately before- I don’t like to keep these on my mayo stand. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/42ca2a78-49a9-4968-bfbb-b57f0af4e4fd/04A972F0-408A-439A-AF0B-ACBE8134C403.jpg Blog - Thyroidectomy Set Up - Back Table Set Up Thryoidectomy Here is a look at the back table. I prefer to condense my instruments versus spread them out, mainly because I have short arms and don’t want to have to step off of the step stool to reach what I need! This specific set up was for a thyroidectomy; Starting on the left side of the table I place my instrument tray and lay my retractors along the back lip for easy grabbing. This specific pan contains a trach hook and spreader, which is not needed or this, so I put it under those retractors along with the 2nd (not-preferred) bipolar forcep. Next is my pitcher with an asepto for irrigation prior to closure. Next I lay the two pairs of scissors that are rarely used right next to the remaining clamps that are not placed the mayo stand. I set up like this every single time, so I truly could reach for most of these things without looking. Keeping a routine with your setup is huge in being an efficient scrub. My pick ups are hung on the front lip of the pan and the additional needle drivers are propped up on the front right corner. It’s hard to see this picture, but I put my telfa (to put the specimen on) on the very far left between the first retractors and the left side of the tray. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/67f7e8ba-6f35-4448-93a6-5432dbdd9f21/Thyroidectomy+Mayo+Stand Blog - Thyroidectomy Set Up - Thyroidectomy Mayo Stand Mayo Stand Set Up Thyroidectomy https://www.thecirculatingscrub.com/orlife/advocating-against-compromised-care monthly 0.5 2024-09-19 https://www.thecirculatingscrub.com/orlife/in-honor-of-national-surgical-tech-week-day-in-the-life-of-a-surgical-technologist monthly 0.5 2024-09-17 https://www.thecirculatingscrub.com/orlife/everyday-struggles-in-the-or-part-1 monthly 0.5 2024-09-13 https://www.thecirculatingscrub.com/orlife/liver-mistaken-for-a-spleen-intraoperatively monthly 0.5 2024-09-08 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/9c6850ff-d025-4733-9671-937dab2373f1/anatomy%28liver%2Fspleen%29 Blog - Liver Mistaken for A Spleen Intraoperatively - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/situational-awareness-in-the-operating-room monthly 0.5 2024-09-14 https://www.thecirculatingscrub.com/orlife/pre-procedure-verification monthly 0.5 2024-08-23 https://www.thecirculatingscrub.com/orlife/patient-experience-scores-amp-why-they-matter monthly 0.5 2024-08-17 https://www.thecirculatingscrub.com/orlife/interpersonal-conflict-in-the-or monthly 0.5 2024-09-13 https://www.thecirculatingscrub.com/orlife/exploratory-laparotomy-set-up1 monthly 0.5 2024-12-07 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/bd86d359-13ef-4547-94ed-1f4deeea2b53/Untitled+design-8.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1708490502969-84Q36WCPZH8LRTNPPI2L/Trauma+ex-lap.jpeg Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/cb46a016-7c5e-44f5-b34f-a7cf6264ab2a/Untitled+design-10.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/63179c16-68bf-416b-9a4e-43cafa007515/Untitled+design-9.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/septoplasty-with-inferior-turbinate-reduction monthly 0.5 2024-09-13 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/80937d60-80f8-43ce-ac6d-86c8d9ad836d/IMG_6335.jpeg Blog - Septoplasty with Inferior Turbinate Reduction - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/219966c6-576a-43b7-ac3a-209d22f8dd29/IMG_6334.jpeg Blog - Septoplasty with Inferior Turbinate Reduction - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/mbanurseleader monthly 0.5 2024-09-13 https://www.thecirculatingscrub.com/orlife/leadership-jump monthly 0.5 2024-05-17 https://www.thecirculatingscrub.com/orlife/joimax-endoscopic-minimally-invasive-spine-surgery monthly 0.5 2024-05-15 https://www.thecirculatingscrub.com/orlife/robotic-surgery monthly 0.5 2024-04-26 https://www.thecirculatingscrub.com/orlife/a-day-in-the-life-of-a-surgical-technologist monthly 0.5 2024-04-23 https://www.thecirculatingscrub.com/orlife/choosing-a-specialty-or-non-specialty-team monthly 0.5 2024-04-21 https://www.thecirculatingscrub.com/orlife/best-jobs-while-in-a-nursing-or-surgical-tech-program monthly 0.5 2024-04-11 https://www.thecirculatingscrub.com/orlife/so-you-want-to-work-in-the-or monthly 0.5 2024-04-08 https://www.thecirculatingscrub.com/orlife/higher-education-msn-np-crna-or-mba monthly 0.5 2024-03-26 https://www.thecirculatingscrub.com/orlife/certified-perioperative-nurse-cnor monthly 0.5 2024-03-24 https://www.thecirculatingscrub.com/orlife/working-with-the-da-vinci-robot monthly 0.5 2024-03-24 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/987d8a75-7367-4516-859a-69227a6efafb/Can+I+get+scissors+in+arm+3.png Blog - Working With The da Vinci Robot - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/pediatric-patients monthly 0.5 2024-03-24 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/d9e545e4-a47b-436f-9d45-0f11c5486197/IMG_6095.jpg Blog - Pediatric Patients - 6. Be silly Make them laugh! Don't be afraid to do something goofy to get them to laugh. Sing songs with them. Pretend that the bumps on the way down are part of a crazy rollercoaster, tell them to hold on tight! Let them push the button to open the magic doors. Make their stuffy match them, give them a hat and a mask! Take advantage of the trip from pre-op to the OR and talk about the cool big lights on the ceiling and all of your friends that are going to be there to help take care of them. Tell them about the nice warm blanket you have waiting for them when you get there. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/3dd87e21-1479-47fb-be77-929fea7bb736/Peds.jpeg Blog - Pediatric Patients - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/making-it-count monthly 0.5 2024-03-24 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b122fc41-b0a9-4d75-88b9-0db56d01b418/Raytecs.png Blog - Making It Count - HOW to count? When counted items are added during the procedure, they are added to the count sheet by the nurse and then accounted for during the next count. When receiving something additional to the field, it is best practice for the scrub to state what is being added for closed loop communication. For example, “Plus 1 blade” or “Plus 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 raytecs” or “Plus 1, 2 Kellys”. A nurse should always be involved in the count as the licensed individual. This is documented in the EMR and by likely every policy, it’s a non-negotiable that a nurse must be involved in the count. It’s also extremely helpful when a nurse has a good knowledge of what each instrument is! https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/24da1bef-cc7d-43d0-89db-373d0a2fc0f5/When+to+count Blog - Making It Count - WHEN do you count? All procedures will have a minimum of TWO counts. The initial count and the final count. The initial count should always be done before the incision is made. Some places have policies that the count must be performed before the patient is even in the room. This is doable, but it does but a strain on efficiency. Don’t forget that turnover time goal! The final count is the last count of the procedure. This count is done during the subcutaneous or skin closure. Like I mentioned, the initial and final counts are done on all procedures with countable items. Some procedures like a basic cystoscopy or a myringotomy with tubes don’t require any countable items, so there is no count. https://www.thecirculatingscrub.com/orlife/exploratory-laparotomy-set-up monthly 0.5 2024-12-07 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/cb46a016-7c5e-44f5-b34f-a7cf6264ab2a/Untitled+design-10.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/bd86d359-13ef-4547-94ed-1f4deeea2b53/Untitled+design-8.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/63179c16-68bf-416b-9a4e-43cafa007515/Untitled+design-9.png Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/25331676-b4cc-4dbb-a0e7-3fcd7488f7a0/Trauma+ex-lap.jpeg Blog - Exploratory Laparotomy Set Up - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/what-is-a-circulator monthly 0.5 2024-03-24 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1708310954121-UMIN7GY5BUOXWIXMWLJG/Untitled+design-4.png Blog - What Is A Circulator? https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1708310954580-3LKYBGMC4Y11DPIACJMA/Untitled+design-5.png Blog - What Is A Circulator? https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1708310957069-ZZFR9W8PN7EK3H99OKP9/Untitled+design-6.png Blog - What Is A Circulator? https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1708310957403-1FJ5P62VGM8QGKYMEQ7F/Untitled+design-7.png Blog - What Is A Circulator? https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/b04c7531-4ea3-46d2-89ac-7c8f782f8aee/Acknowledge.png Blog - What Is A Circulator? - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://www.thecirculatingscrub.com/orlife/what-is-a-surg-tech monthly 0.5 2024-04-21 https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/25109cb6-76bc-45a6-af32-4199303e8056/Screenshot+2024-02-11+at+5.00.16+PM.png Blog - What Is A Surgical Technologist? - Make it stand out Accrediting body for surgical technology https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1707693102476-M67IR53R3ZTTVSKVZ3F8/IMG_6452.jpeg Blog - What Is A Surgical Technologist? https://images.squarespace-cdn.com/content/v1/65b848635baec340dec73463/1707693102476-QJQP2A4N3QKMF8VAW9TV/Ex+Lap+Mayo.jpeg Blog - What Is A Surgical Technologist? 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Blog - Where It All Started https://www.thecirculatingscrub.com/orlife/tag/CNOR monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/Surgical+Tech monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/Struggles+in+the+OR monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/PTH monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/CST monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/OR+nursing monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/OR+Nurse monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/surgery+nurse monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/ORRN monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/Scrub+Tech monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/Parathyroid monthly 0.5 https://www.thecirculatingscrub.com/orlife/tag/surgery monthly 0.5 https://www.thecirculatingscrub.com/home daily 1.0 2025-03-20 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