Overview of Circulator Role Monday, February 20, 2012

Goals and Objectives 1. Develop a broader understanding for the role of the circulator 2. Gain insight into day-to-day functions and responsibilities 3. Develop prioritizing skills

Prioritizing Exercises Have you encountered an event that appeared chaotic or unsafe? What was done well? What could have been done better?

Prioritization Exercise Scenario: Today you are circulating for a procedure involving a 48- year-old female patient who is scheduled for a Laparoscopic Cholecystectomy. This procedure is the second procedure of the day in the OR, and this surgeon is not the same one that you worked with for the first procedure of the day. The patient's previous surgeries include cesarean section, dilation and curettage, appendectomy, and a breast biopsy. She has no allergies and currently is not taking any medications. Her laboratory work was within normal limits. The patient is in the holding room, and you are in OR#3 with the scrub person preparing for the surgery.

Instructions: for Prioritizing Exercise 1.Place in order the first 5 things you would do by numbering them. 2.Explain why you selected this order for these actions. 3.Describe what patient outcome you are trying to achieve for each action. Prepare a specimen container Count Start documentation Check for blood Open sterile supplies Review surgeon preference card; compare supplies on card with those on cart Check for electrosurgical unit Locate patient x-rays and diagnostic studies Check suction and OR lights Call holding to see if physician and patient are here yet Check endoscopy cart (ie, light source, insufflator, monitor, video cassette recorder, printer)

Prioritizing Scenarios Your are in a room when a resident comes in, dries his hands, gowns and gloves and is waiting to be tied up before entering the sterile field. At the same time, your surgeon has starting the case and needs the electrocautery machine and suction hooked up. Lastly, the telephone starts to ring. What do you do?

Prioritizing Scenarios Continued Your patient is on the O.R. table awaiting induction. She is very cold and anxious. There is a lot of noise in the room. The phone is ringing and your surgical technologist is asking for a closing suture they forgot to “pull” before they “scrubbed in”.

Prioritizing Scenarios Continued It is 15 minutes until the end of your case. You must perform counts, place dressings on the field, complete your Intraoperative Documentation, call family waiting and notify the family of the case completing and finally call Recovery and let them know to expect your patient.

S.L.I.C.K. T Start S – Suction L – Lights I – Irrigation/Insufflation C – Cautery K – Kick Bucket T – Tourniquet

Emergent Cases What do you do if your case goes from a Laparoscopic procedure to an Open procedure? Open Lap Sponges 10 Blade Open Major Instrument Set Open surgeon’s preference of self-retaining retractors If not controlled, request assistance, blood if available, more I.V. fluids

Emergent Cases Continued What do you do if your patient starts to bleed out? Request assistance (Anes. Tech/Attending Anes./Circulating help/Front Desk or Supervisor) Get CODE cart if anticipating a need If requested order blood, if available Open more supplies to control bleeding (as requested) Get more I.V. fluids If alone or help unavailable, call a CODE per your facility’s Policies and Procedures If patient’s condition deteriorates slowly, please plan for the worst!

General Review Questions