surgery steps anticipation question

[PeriOp]

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I'm a new nurse and I'm trying my best to be anticipating what a surgeon may need during surgery (yes, in canada we scrub too). Can you guys tell me any general actions you perform as a surgeon and therefore need some specific tool from a nurse.

Ok, here's my examples.

If a surgeon asks for a suture, then I'm going to pass him a tissue and the scissors to the assist.

If I pass a vesi loop to retract a vessel then I also pass a kelly so you can clip it to the drape.

To ligate a vessel, I'll pass a couple of lowers, scissors, reel and then scissors to assist.

I know obviously a lot depends on the surgery specifically but those are the things I noticed. What are some other standard steps that will generally be the same all the time and will therefore require a specific tool. I'll take anything.

thanks 🙂

 

[surg]

1st I want to say congratulations for actually caring. Being a great scrub nurse involves understanding the operation and what the surgeon is trying to accomplish. Asking your surgeon's preferences is the best way to figure out what he or she really wants. Really try to make sure you know where everything is on your table and having the right instruments and sutures available will really make your life easier. If you have time, ask the surgeon what he or she wants at the beginning of the case, then make SURE you have those things.

However, things that I would consider to be fairly standard (nothing is universal obviously).

Closing skin layers: having suture loaded on a needle driver, a pair of fine toothed forceps (Adson's are often the choice) and a pair of suture scissors handy.

Closing abdominal fascia: having a strong needle driver loaded, a pair of big toothed forceps (Bonney forceps are often a great choice for this) and the suture scissors. Also have close at hand a small to medium size retractor to pull the fat out of the way to reach the fascia more easily. I prefer a Brewster, but some like a small Eastman or even an Army-Navy. Also, more often than not, people will use 2 sutures, 1 from each end and tie in the middle somewhere.

If someone asks for clamps (e.g. a Mixter or a Schnidt) to clamp blood vessels deep in the wound, the next step after cutting between the clamps (almost always with a metzenbaum scissors or finer) is virtually always a tie on a clamp to pass around it, although some surgeons will still use a reel if it is a wide open space.

If someone is asking for vascular clamps because they are encountering major bleeding, there is a pretty good chance that you should also have some permanent monofilament in the room appropriate for that size vessel (Most surgeons I know prefer polypropylene (Prolene/ Surgipro)) to either ligate or repair the vessel they just injured.