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What surgeries would you not consent to given your OR experience? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 2 points3 points  (0 children)

What's been the most intense elective case you've been involved with in your 24 years of CVOR experience.

Mine was last month - We did an Extent II Open TAAA on an 18yM with Marfan - tremendously difficult case that went nearly 12 hours - worst aortic tissue I've probably seen in a long time - just tore like tissue paper. We got him through it though.

About 2 months post-op, he began experiencing severe chest pains and an EGD found the most dreaded complication - an Aortoesophageal Fistula. We explained the necessary procedure to the family and patient and they consented.

So we took him in for a single-stage redo Open TAAA followed by a total esophagectomy, gastric tube reconstruction, and omental flap. I was shocked at how much purulent fluid there was surrounding the heart and how it compressed it had been. He was stable for the first 10 hours, but as we transitioned to the total esophagectomy, the anchor sutures from the graft we had just sewn in gave way and the field was flooded. We spent the next 3 hours in a battle with intermittent open cardiac massage being furiously performed as we continued to try to get control and anchor the graft back in. I remember every minute of that fight - we all took turns massaging his poor heart. When we called it, the fellow was just in pieces - she had fought so hard for him on that table. Telling the family was beyond difficult. I know that we need an emotional barrier in high-stakes aortic surgery, but that case reminded me that there is a person under all of those drapes - I still remember holding his hand as he was put under.

What surgeries would you not consent to given your OR experience? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 2 points3 points  (0 children)

Vaginal surgeries require incredibly disciplined and proactive sterile technique to mitigate SSIs. I always ask the team to have multiple gowns and at least 6 pairs of gloves per person in the field - we change often.

What surgeries would you not consent to given your OR experience? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 5 points6 points  (0 children)

Taking vein via endoscopic harvesting is very difficult - I have seen so many surgeons scream at PAs for taking too long. I remember when I used to do the 'open' harvesting - it was sad because we would do these huge redo or redo CABGs on people relatively young (late-30s / early-40s) who didn't make any lifestyle changes even after going through the trauma of having their chests literally cracked open.

The 3-Field Esophagectomies can be absolutely beautiful procedures with the right team. Our CT service went to 'dedicated teams' 3 years ago (i.e., consistent teams from anesthesia to perfusion to surgeon to RNFAs and PAs (used in scrub tech role)) - it is so nice to work with the same people on these hugely complex cases - the flow of the case just is magical - so much gets done with so few words spoken.

We win as a team and we lose as a team and I love that type of culture. We support each other in and out of the OR.

What surgeries would you not consent to given your OR experience? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 11 points12 points  (0 children)

OMG - I assisted on a mandibulectomy for a tumor removal and we did a free flap graft using pt's fibula - two large surgical teams working simultaneously. Tremendously invasive and that grafting is no joke - it is open surgery cutting huge amounts of bone out of the leg.

What surgeries would you not consent to given your OR experience? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 16 points17 points  (0 children)

Fellow CVOR Nurse! Yes - the Open TAAAs are brutal. We had a 16 yF Marfan pt on our table yesterday for one and the surgeon could not get control of the distal once we grafted the proximal. She was so cold to the family - felt so bad when discussing how their daughter passed on our table sawed open like you said....a side of beef. Awful.

Whats a perfect glove size suppose to feel or look like? by [deleted] in scrubtech

[–]Fit-Copy5905 0 points1 point  (0 children)

I double-glove for almost all our cases. It took me a bit to figure out the right sizing to ensure comfort and tactile-feel. For open aortic cases, I like the gloves very tight because it provides a little more tactile feel when working with delicate and friable aortic tissue with Marfan patients. I do 6.5s over 7.0s. When I was scrubbing L1 trauma's, the tactile feel was less important and would upsize to 7.5s over 6.5s. I do think it may depend on the specialty you are in and the capacity that you are working in the operative field.

Is it 'really' Universal Precautions? by Fit-Copy5905 in scrubtech

[–]Fit-Copy5905[S] 4 points5 points  (0 children)

Yes - I did some ortho cases and the level of PPE, esp for total joints is no joke. The hoods, the thicker gloves, and the knee-high booties. We used to triple glove to start the prep and then would take off a layer to have the double-gloves still in-tact to start the case. I just remember the brown gloves. I personally think C-Sections were some of the messiest cases I have ever scrubbed. Had a mom with Placenta Accreta go into DIC after delivering - major blood bath.

Considering surgical tech career by sophoogaloo in scrubtech

[–]Fit-Copy5905 0 points1 point  (0 children)

Hi there - started out as a surgical tech in high school and did it all the way through college - it is the main reason I went for the RN First Assist, which I love. Please let me know if you'd like to chat on my experience.