1. Overview of Circulator Role
Monday, February 20, 2012

2. 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

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

4. 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.

5. 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)

6. 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?

7. 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”.

8. 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.

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

10. 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

11. 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!

12. General Review Questions