So I have noticed a boon on my prior scrub tech posts and have received a few questions about setting up from new grads. The following are tips that I have passed along to my former students, people in training, and techs who may not have done certain procedures. I don’t know if my peers will agree with my techniques, but this is what I found works for me. In no particular order besides the 1st rule.
#1 Trust NO one…
I know it seems mean, but always check your pulled cases. If you ask for an item, verify it is what you asked for before passing to the surgeon. If someone sets up for you, check your field for the appropriate items, look for your sterile indicators. If a count was performed redo a count to yourself to confirm. The bottom line is once you are the tech you will be held 100% for things that happen. I can add more scenarios, but the summary is you cannot throw anyone else under the bus or lay blame because you are the scrub, it’s on you and you should know better.
#2 Effectively communicate
This means talking with the surgeon and talking with your nurse. You and your circulator are a team. Try to plan your moves in advance. Get their advice, they are knowledgeable and experienced.
It is better to speak with your surgeon prior to the case start about anything you don’t know or understand or even to get his/her plan of action in advance to be better prepared. Most of them like to teach and appreciate the communication. Waiting until the middle of the procedure when you didn’t know a step or something was needed is not a good time. This usually leads to flared tempers, especially if you have made not being prepared habitual.
I have always done this even calling my surgeons office to speak to them about a case I am doing with them the next day.
#3 Taking Note
This helps especially when starting out.
Carry a pocket sized notebook. Write the name of the procedure, your set up, draping sequence, surgeons preferences, and any mistakes you have made down.
Now you have a reference. Next time you do a ventral hernia with Dr. X you can look back and say oh yeah he wanted some stitches back handed. Now you will be prepared for that scenario. Perhaps today Dr. T is doing a ventral hernia and you haven’t done it with him before. You have a basis set up to reference in your notepad about Dr. X. Utilize that information for this case and later you can note anything new you have learned for future reference about Dr. T..
All these years later I still have to reference my setup for v.p. Shunt, it just won’t stick, because we do so few.
#4 paying attention
If you are distracted by everything else going on in the room you aren’t picking up key clues to your next moves. Your eye has to be on the field and specifically on the wound at all times. I tell my students to ear hustle the surgeons conversations because a lot of times their discussions are clues about their ( our) next moves. Watching and listening is key. Sometimes I am told “you can read my mind”. It is more I have been watching and can see what’s coming next. Sometimes I have multiple ideas and therefore multiple instruments in my hand ready to go. I am never empty handed .
This being said I recently told a per diem co worker who allowed her entire back table to go to the floor that she has to pay attention to EVERYTHING in the room. She didn’t notice that as the O.R. Bed was being raised it grabbed her table on the end and dumped it over. Her explanation was she was retracting and one on one with the surgeon. I told her to pretend her son was in the room while trying to work. You have to pay attention to everything. Who is coming in and out, your drapes,the surgeons gloves, laying thing on the patient, where is your bovie and suction, your sponges and needles, etc etc. It’s like you are constantly scanning while being totally immersed in the surgery. You just have to split your mind that way.
#5 setting up
Here it is good to be a robot.
Good example here is when I do eye cases, there are generally 12 or 13 in a row. They are primarily cataract extractions with some having stent placements.It is a lot for one tech to do all day alone. My setups for each case are identical. All the instruments the same direction in order of use. Every once in a while I will notice a gap and then it’s like BOOM I forgot something.
Watch others techniques add or subtract what you like or what seems helpful. You are not limited to what you learned in your program. Once you have a routine try to stick to it, after a while setting up becomes rote. I will say that being neat helps a lot. I have a hard time in chaos, I don know too many who can thrive in that environment.
#6 some specialized hints
Frozen specimens/ specimens
I have my specimen cup ready to go with a saline dampened piece of cut telfa inside. Marking stitch if applicable is loaded and ready to go. I, also, write down the name of the specimen/s . Saving gown tags makes a great place for note taking. If in a case that has lymph node dissection I make a grid on my back table and number the boxes 1 - 10 or so.
Sometimes, like in a thoracotomy, the surgeon is moving faster than my nurse. So when he passes me a node from left lower lobe. I repeat what he said, I put the specimen in the numbered box we are on, ie this is the 3rd specimen, I write LLL in the corner of that box and am ready to receive my next specimen until my nurse can get to me.
I’ll give you an lavh and a bowel resection.
2 mayo stands. 1 laparoscopic set up, 1vaginal set up.
Back table = clean set up with 1/8- ¼ of the table reserved for being dirty. I lay towels in this area where I keep my basin with injection for the uterus. A separate needle book, my sutures for the vaginal hysterectomy. And anything else I cannot fit on my vaginal mayo stand. The rest of the table is kept clean just in case we have to open. Have back up gloves and gowns available. Generally, the surgeon puts in a uterine manipulator & Foley catheter (dirty), then goes up top to take down the uterine suspensory ligaments laparoscopically (clean ) then back below for removing the uterus maybe an a&p rx too ( dirty), then back above to check laparoscopically for bleeding , etc (clean). You have to watch your instruments and watch what gets touched. Changing gloves and gowns necessary. I have been in a few of these cases where we should have been finished but had to open due to bleeding. Not keeping clean can lead to peritonitis for the patient. If you suspect a break fix it and alert the surgeon so more antibiotics can be put on deck and irrigating with antibiotic solution can take place.
I notice some people like to reserve an area on their back table for dirty. I don’t do this, I prefer my table to stay clean (no shit allowed) I ask my nurse to make a spot for me to pass off dirty instruments and staplers. At the very start of the case I lay two towels below the incision . Those towels are where the surgeon can lay his dirty tipped instruments once we start dirty work. After all the dirty work is done I lift the dirty towels with instruments on them off the field and place it on the spot reserved in advance. When we do the instrument count at the end my nurse counts those items.
Other tips about bowel resection: have an extra suction tip handy sometimes you have to throw the one you were using off. Load sutures in advance, I generally have a few silks loaded ready to go and at least one vicryl loaded just in case we hit a vessel.
#7 Fully Prepared
Having the instruments and items in the room in advance are a great way to be prepared. It sucks when the nurse has to run out the room every few minutes to get items. When I am doing bowel resection I have all size linear staplers and reloads in the room. Extra long instruments in the room ( what if my patient is obese). Multiple sutures available. If ortho or podiatry extra sutures, saw blades, blades, double the cement, and dressings. If a fracture the box with all the bone reduction clamps, and various screw caddys come in the room ( btw, wipe your drill bit after each use and always measure your screws before passing). Anyway, you get what I mean. Generally, if I think of something I bring it into the room for available. It takes less time to put back whatever you don’t need or use after the case than to watch the surgeon watch you as you both wait for the circulator to find, bring and open what’s needed. On the other side of that coin sometimes these things cannot be avoided. Once you know to be prepared tho, you just can’t go back.
DO NOT BE AFRAID TO INSIST ON GLOVE/GOWN CHANGING, BRINGING UP ASEPTIC BREAKS, COUNTING INSTRUMENTS, NEEDLES, AND SPONGES. FOLLOWING HOSPITAL POLICY. FOLLOWING STANDARDS.
DON’T BE A BULLY , BUT DONT ALLOW YOURSELF TO BE BULLIED EITHER.
I hope some of this was helpful to you newbies or anyone else for that matter. Good luck out there :) 😷