MY Operating Room Personnel – The Role of the Circulator Week 3 Surgical Nursing

OPERATING ROOM PERSONNEL - THE ROLE OF THE CIRCULATOR

What is a Circulator?

The circulator is a vital member of the surgical team, serving as the non-sterile surgical nurse within the operating room. Their primary role is to facilitate communication and coordination between sterile and non-sterile personnel to ensure a smooth surgical process.

Attire:

Unlike sterile surgical staff, circulators do not wear sterile attire. They typically wear scrubs, which are designed for comfort and versatility, along with shoe covers to maintain cleanliness of the OR environment. A surgical cap and mask are also worn to minimize the risk of contamination, and during non-surgical periods, a lab coat may be worn for added professionalism and cleanliness.

Functions:

The circulator acts as a mediator between the sterile and non-sterile personnel, managing the flow of surgical items required during the procedure. This involves passing sterile instruments and supplies to the surgical team while keeping track of necessary items that ensure the surgical procedure proceeds efficiently.

Responsibilities:

The circulator holds extensive tasks both before, during, and after surgery, which are critical for ensuring patient safety and optimal outcomes. Ideally, it is preferred that the circulator and the anesthetist are different individuals to maintain clear communication and task management.

Preoperative Duties:

• Supplies Preparation: Gather and meticulously prepare all necessary supplies, equipment, and instruments for the surgical procedure, ensuring nothing is overlooked.

• Operating Room Preparation: Prepare the Operating Room (OR) comprehensively for surgery, considering factors such as cleanliness, organization, and availability of sterile items.

• Patient Preparation: Ensure the patient is properly positioned and ready for surgery, promoting comfort and safety while taking into consideration considerations based on the procedure being performed.

Surgical Preparation:

• Initial Setup: Verify that all equipment, instruments, and supplies needed for the entire procedure are ready. This includes checking that all surgical packs, gloves, sutures, scalpel blades, patient drapes, and other required items are at hand.

• Sterility Checks: Double-check that all sterile items are properly wrapped and not expired. If there is any uncertainty regarding an item’s sterility, it is considered contaminated and should not be used.

• Timing for Opening Sterile Items: It is critical that sterile items are only opened right before the start of surgery to maintain sterility protocols.

Operating Room Preparation:

• Cleaning Protocols: The OR must be thoroughly cleaned before and after each surgery. This includes wiping down horizontal surfaces with a lint-free cloth soaked in disinfectant before the first surgery of the day. Ensuring all surfaces are free from contaminants is vital for patient safety.

• Setup Essentials: Essential equipment like the surgery table, V-trough, warming devices, cautery plate wrapped in a wet towel, and properly placed garbage bags for disposable items in kick bucket must be set up properly to create an efficient surgical environment.

Patient Preparation – Surgical Clip:

Prior to surgery, the patient must be stabilized post-anesthesia and clipped to ensure a clean surgical site.

Clipping Guidelines:

• Clipping Area: The area clipped must be neat, tidy, and symmetric for optimal surgical access. Use surgical clipper blade #40 for effective hair removal.

• Techniques: Hold the clippers with a pencil grip with blades held flat against the patient’s skin while gently tensing the skin with the other hand, facilitating a smooth clipping action.

Clipping Guidelines for Soft Tissue Surgeries:

• Good rule of thumb is to clip 2 clipper blades in every direction from proposed incision site.

• For spays, it requires clipping from the xiphoid to the pubis and laterally to the edge of ribs, while for neuters, the area from the tip of the prepuce to the pubis must be clipped while exercising caution around sensitive areas like testicles.

Clipping Guidelines for Orthopedic Procedures:

• Ensure that clipping extends from the distal joint to the proximal joint of the surgical incision while ensuring complete circumferential clipping around the limb. When in doubt, it is essential to confirm with the surgical team to avoid any errors.

Surgical Clipping Protocol:

• Avoiding Clipper Burns: Always check the blades for heat to prevent clipper burns on the patient. Use lubricant as necessary without compromising sterility.

• Hair Contamination Management: Vacuum any loose hair from both the patient and the surgical team to maintain a sterile field. Ensure a double-check for any missed spots, especially at the intended incision site.

• Bladder Management: Express the bladder if necessary before the procedure to avoid complications during surgery.

Patient Preparation – Surgical Scrub:

The surgical scrub aims to minimize contaminants on the patient’s skin to significantly reduce the risk of post-operative wound infections. Initial gross preparation is conducted in the prep room using exam gloves to decrease hand contamination prior to bringing the patient into the OR.

Surgical Scrub Details:

The final scrub is conducted in the OR once the patient is positioned: Utilize antiseptic scrub products such as povidone-iodine or chlorhexidine for disinfection. Required rinsing agents include 70% isopropyl alcohol, effective for eliminating gram-negative bacteria. Sterile water or saline may be necessary for any open wounds.

Surgical Scrub Applicators:

• Commonly used applicators include gauze sponges for most areas, which can be soaked in antiseptics as needed, cotton balls for smaller areas, and spray bottles for applying final antiseptic solutions.

Surgical Scrubbing – Target Pattern:

Begin from the proposed incision site, moving outward in circular motions until the hair is reached. Discard each sponge after usage to prevent contamination of the incision site. It is essential to perform scrubbing and rinsing a minimum of three times, repeating until the site is thoroughly clean if dirt persists.

• Perform at least a minimum of 3 times OR until no dirt is seen on sponge.

Patient Positioning for Surgery:

The positioning of the patient is determined by the specific surgical procedure being performed. Techniques may involve utilizing V-troughs, sandbags, and towels to support limbs and ensure optimal positioning for access and safety. It is crucial to avoid putting any limb in a forced position beyond natural movement limits.

• Use of Flexible Cords: Flexible cords may be employed to secure limbs in place properly; however, it's important to ensure that pressure distribution is even to avoid circulation issues.

Intra-Operative Duties:

The circulator's responsibilities extend to intra-operative activities, which include:

• Sterile Item Management: Opening and passing sterile packs/items to sterile personnel must be conducted with a solid understanding of aseptic technique and restrictions on handling sterile items.

• Circulator can only touch the outside of the pack

• NEVER reach over a sterile field, and don’t touch any thing that is sterilized

Post-Operative Duties:

Once surgery has concluded, the circulator has specific tasks to complete, including:

• Instrument Management: Remove sharp instruments and separate used versus unused items for soaking to prevent contamination.

• Cleaning and Sterilization: Clean and sterilize instruments, supplies, and the OR area effectively. This includes managing both disposable supplies (e.g., scalpel blades, suture materials) and reusable supplies (such as surgical packs and drapes).

• Maintaining OR Cleanliness: Continue to uphold cleanliness within the OR using designated cleaning equipment to ensure it is ready for subsequent procedures.

Cleaning of the Surgery Room:

Before and after every surgical procedure, all surfaces and equipment must be wiped down thoroughly with disinfectants. After the daily surgical schedule, all equipment and furniture should be scrubbed thoroughly to maintain the highest standards of cleanliness in the operating environment.