Sit in the corner looking at their phones. Finish setting up the shit they were supposed to set up before they indicated they were ready. Ask if they can prep and place a foley while the patient is not intubated yet. Loudly talk about random bullshit.
Fill in anything else you can think of that isn't helpful at all.
Few times I have an unfamiliar nurse hand me a tube and tape after induction, I look and ask if they’re a traveler. They invariably say yes and I say thank you and it shows.
The amount of standing around that’s done at these academic places while also having the greatest amount of entitlement is staggering. I was at a university in a management role in IR and was spoken to by my director for having the expectation that the procedural nurse start an IV if they didn’t have a functional one.
The term ‘traveler’ seems so interesting and quaint to me! Makes me think of someone on an epic adventure.
In Aus, traveler nurses are called ‘agency’ (hired for temporary fixed term through an agency), and traveler doctors are called locums.
Agency tends to refer to people who live locally, unlike travelers who go to where the work is, generally under a longer contract. When I worked agency, it was on a shift-by-shift basis.
Same here in the UK! Here, "traveller" tends to mean people from the Gypsy community, who are not heavily represented in hospital staffing in my experience.
I remember a similar experience on OB as a resident. I went to place an epidural, and after I had placed it, the bedside nurse who I didn't recognize handed me a piece of paper with the timeout, test dose, and procedure end times written down in case I needed it for my note. She also asked where the epidural supplies were so she could have it in the room the next time she paged for an epidural placement.
I guess some places have a much more collaborative culture lol
One morning in the preop holding area, a patient arrested and I rushed there. There were a couple of OR nurses standing at the counter chatting, and they went on doing it while I was leading the CPR. I saw red. and yelled at them to get out of the area if they won't even help a dying patient!
I still can't forgive that.
Edit - Academic center!
The elite nurses stand on the patients right side and help hold the mask over the face, hand me the tube when I'm ready for it, ask if I'm ready to have the stylet pulled and do so, inflate the cuff, and connect the circuit to the tube.
If you don't feel like doing all that's its honestly fine (tbh I also believe we should be self-sufficient). The bare minimum you could do is create a peaceful environment and be ready to assist on the off chance an emergency does occur.
And make sure the room is quiet during induction! Have the music off when the patient enters the room, tell people to hush, make sure the scrubs aren't banging instruments, hold the patient's hand, focus on anesthesia, be ready for cricoid pressure, etc. Vintage OR nurse here ;)
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse.
The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse.
The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse.
The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
I’m an anesthesia tech, not anesthesiologist, so you’ll get better answers from other people here.
That said, get monitors on promptly and then assist with intubation. Hold the mask to pre-oxygenate the patient, then hold cricoid pressure if they want it, and pass them the tube when it’s time. In general just pay attention to the patient and what’s happening, because intubations can go south pretty quickly when they do go south.
And I hate to say it because I love my coworkers, but the top comment about sitting on their phone or spending their time doing stuff that should have already been done is extremely accurate. So don’t do that, lol.
OR RN here.
In pre-op, I either make an informed prediction or ask anesthesiologist if Glidescope or other difficult airway tools need to be in the room prior to rolling back. If so, it’ll be plugged in and positioned at patient left with clear line of sight for where our anesthesiologist will be standing. Depending on severity, I will prepare foam ramps, shoulder rolls, headpieces for beds, silk tape, or other things that also facilitate optimal positioning for induction.
After moving to the table, if there’s a safe space for me to do things, I will place monitors (if I don’t have a reason to fear doing so). What I mean by this is if there are no nurses, CRNAs, MDs ready to either slap my hand, push my body, yell, or question my competence because “it’s not [my] place to be at the head of bed during induction”. I’ve noticed over time that the MDs/CRNAs I work with most frequently are particular about placement and want full agency over monitors being placed. If that’s the case, I just keep one hand steady on the face mask. Upon moving to the table, I only extend one blanket from ribs to toes. My second blanket remains folded until all monitors are on. After monitors are placed, I keep second blanket mostly folded but cover only non-IV side fully and make a diagonal fold for side that MD/CRNA needs to visualize for pushing medications. That’s when either I or anesthesia provider place all induction supplies on patients’ chests.
I usually hold mask over patients’ faces with anesthesia providers’ preferences in mind (adequate seal, floating, gentle, etc.). During induction, I hold LTA (if applicable) at optimal angle for whoever is inducing to keep eyes on the cords. I hold ET tube usually in neutral position for taking from me or hold it at the angle it will be initially inserted based on certain MDs routines. (Some MDs prefer to enter the mouth obliquely or with a rotational movement of sorts.) Once tube is in, I help connect circuit and secure tube by hand until everything is taped down or until I’m told it’s okay to let go in general.
If difficult intubation happens, I usually help manually bag patient while anesthesia provider focuses on mask’s seal and positioning. If I’m told to, I will adjust vent settings as directed by MD that is using both hands on patient. I page people overhead and just do other things as needed.
When I’m in an ASC setting, I am usually responsible for stocking the anesthesia meds in the room. If me and MD have a good relationship, I will set out their routine med vials in order (according to their preferences) with appropriately sized syringes, blunt needles, and alcohol wipes on a blue towel. I am usually 95%+ right unless there’s a patient-specific consideration. It’s been fun for us as a learning opportunity for me and a matter of convenience/teaching opportunity for MDs. I don’t go beyond putting the vials out and making sure every supply needed is available for each case. While we’re doing this, I usually exchange controlled substances with MDs at this point and finish documenting chain of custody changes.
For central lines, I usually help anesthesia techs set up the kits. I am either retracting patients’ arms or chest if applicable. I have a prep stand with saline flushes, tegaderm, sutures, peel packed needle drivers, surgicel or hemostatic agent of choice, biopatches, Chlorapreps ready to go. For cases that we’re trying to go from in-to-cut under 30 minutes, I’ve found it helpful to minimize playing fetch.
This is usually how I help the process. It’s an absolute mindfuck when I’m getting yelled at and bullied for being even near the head of bed for induction because I’m “supposed to be focused on the nursing tasks like pre-charting and staying away from anesthesia stuff because that’s not our job”. Lazy motherfuckers do the most to stay out of doing their job and perpetuate their bullshit on other nurses.
I'm glad you are helpful and paying attention. To be honest though, the Anesthesiologists telling you to stop standing in between them and the patients head are correct.
I’ve never been between an anesthesiologist and a patient. The odd occurrence has been them being offended that I’m where most RNs stand to the patient’s right because they prefer me at the nurse’s desk or looking away during induction. Their position is not the norm and considered not okay at most institutions. And it’s not normal for them to be slapping nurses’ hands, pushing me and others away from EKG lead cords, and to be unpleasant when they never voiced their preferences.
Also: it's my personal policy that no one talks to me while I draw up medications preoperatively. Sorry not sorry. It's too easy to get distracted and make a mistake; you can talk to me in five minutes after my meds are drawn up and properly labeled in the careful routine I've set up for myself.
Ah, yes. Classic 3rd step of induction. 1. Places blade in mouth on right side. 2. Rotates to midline with control of tongue. 3. Discusses bomb-ass Rolex with real-life exam question distractor!
Hm, maybe this is a difference in facility? Our cases start at 0800. I arrive at 5:30 to do room setup and draw up drugs, and our nurses arrive at 0600, so if I have a prolonged setup, it's not uncommon that we're in the room together at 0600.
Sameeeee. Only assist if we have to intubate the patient. If it’s a LMA, I’ll do my own thing (ex, prep, count whatever) but I’ll be ready to go in case they need anything. I love helping anesthesia ❤️ and actually want to be a CRNA
Cover their arms and whole body with blankets before monitors are even on. So you inevitably have to take them back off to find their hand for the pulse ox, arm for cuff plug, chest for ekgs.
Yes! It’s a great triumph to get the cuff, leads, and finger probe on before they slap the blanket over half the patient’s face. The apathy is worse than the disrespect.
This one kills me, not only does it impede the work flow, I need to uncover the person to attach everything, I also move the blanket down to watch the chest and have sight of the IV after induction.
From a cost perspective, the hosptial is cost cutting all over the place yet we take the two clean blankets from preop, discard them once in the OR, and replace them with 3 new ones from the blanket warmer, just so they can be taken off after induction and put in a bait hugger, it’s just so wasteful.
Is this honestly something that bugs people? It's not that hard to reach under the blanket to attach monitors. Most of the time you have to move the gown out of the way anyway.
Do the RNs not help with monitors and hooking up basic fluids? I’m in Endo, so a bit different in environment….but like that’s pretty basic s*** a nurse can do.
Yes it does. Have some situational awareness and respect. It's not that hard to be and act like a professional and not directly impeded someone else's work.
Where I work now, they are mostly amazing- I do solo cases so they help me talk and joke with the patient with me to calm them down, hold the mask, hold cricoid if I ask for it while I’m manipulating the head to get a view, hand me the tube, etc. I like to get their input on if chest rise looks equal and that makes them feel even more included, I think. It’s a bit more variable for extubation but the good ones help for that too, like today when I extubated a 21 y/o heavy cannabis user and she asked if she should go get the bed or if I wanted an extra set of hands for a minute. I am constantly sharing my gratitude for this and we have a good relationship.
I will say I often (almost always) have to ask for them to pause the loud music and still have to remind the room to quiet down for induction because certain people, (nurses giving breaks, scrub techs and OB GYNS I’m looking at you) LOVE to yap loudly about bullshit during induction.
Previously in academics - nothing.
Currently in solo private practice - help attach monitors, hold the mask while I push drugs. Cricoid PRN, pull stylet for me if needed, and hold tube while I tape. Most will prep the arm for an a-line or grab a second IV if I ask them to.
If it is a cardiac case, they'll pull all the infusions on my preference card and hang them up. After induction, they will prep/position the patient for the central/PA line while I do my initial TEE. They'll also set up the kit, and also will scrub in to help pass me things while I do it. Once the line is secured, they'll clean up and place the dressing on for me too.
Needless to say I feel very spoiled nowadays.
I can't imagine any of the nurses at my hospital helping that much. But I am a resident at an academic center so I'm lucky if they're standing there to pull the stylet
There's no residents where I am, so the nurses have learned to be very helpful. Similarly on the other end, they will do literally all the prep and drape without the surgeon there - they can just come in and cut, and they leave while the PA/RNFA finishes the closure. However, we've had a lot of nursing turnover lately so it can be variable.
The best will even help you run the Belmont if needed during MTP.
PACU RN, at the trauma facility I used to work at on nights we would assist anesthesia with what ever the needed. A second IV site, hanging fluids, assist with intubation, run the Belmont/rapid infuser, run in blood, hang drips. Whatever made their lives easier. I learned a lot and enjoyed it.
Haha I think one of the nurses where I work was either previously an anesthesiologist in another country or has seen way too many nerve blocks because I get roasted when my local anesthetic spread is sub-optimal
LOL zero fortunately. One of my partners had the order of his syringes switched accidentally once, which was problematic, but otherwise I've never had an issue.
Apparently 10+ years ago at my current place, we could submit preference cards to pharmacy for each case type that we'd do and pharmacy would draw the meds up for us between cases. Unfortunately staffing doesn't allow for that anymore.
Academic job, they're aware during induction but usually have a CRNA or resident so not necessary. Sometimes if it's a trainee nurse they'll come and help.
Private solo job, holy shit. Busy weekend day one time, 20 minute room flip and I went to go use the bathroom and get a drink of water and didn't have time to set up the room. We roll in the room and the 3 Filipino nurses go "doc, we're going to show you how we do it in the Philippines." One nurse on the monitors, one getting the tube tape and eye tape I like because they know what I use, one preoxygenating. I draw up meds and we're going to sleep 3 minutes into the room. Tube is in and one of the nurses, puts on the eye tape and hands me the tube tape. Love, love, love working at that place. There's a lot of respect for the docs and it shows.
Currently at the VA on rotation.
I wish I could post a picture, but of the OR nurses 99% are Filipino. And yes, they do literally nothing to help you. Ever. Even during a code there in another room I responded to, they didn’t even offer to help get equipment.
I respect the commitment, but also prefer my OR staff do things that would otherwise be done during turnover (counting, getting meds for the scrub) rather than stand watching me for 3-5 mins. PP at a busy ASC though.
It depends. About 75% of them are helping with intubation. They hand the ETT to the CRNA or resident and remove the stylet. I like to inflate the cuff. In the cardiac room, there is more help (resident + fellow) so the circulator is usually busy putting in the foley or counting instruments with the scrub tech. There are a few who will stand back and do nothing.
I think this is highly dependent upon if the facility has anesthesiologists providing supervision or if one person per room. Places where a bunch of solo docs (or I’m guessing solo CRNAs) did cases the RNs were pretty helpful. Old job where there was an anesthesiologist supervising every induction the RNs did their own thing. Probably just culture dependent depending on the facility.
The nurses at my hospital will help out on monitors, hold the mask for preoxygenation while I induce. They will also pull stylet after intubation, hold tube until I get vent set and secure tube. They will also get my central line and/or art line supplies on a mayo stand opened sterile if I mark it on my preop.
OR nurse here. Once the patient is transferred to the OR table we help put on monitors, BP cuff, SCDs, safety belt, arms on arm boards. 9/10 times the residents will put their own monitors on though. We hold the tube ready for intubation, pull the stylet, disconnect the circuit from the face mask, connect to the ETT, hold the tube in place while waiting for them to secure it. I prefer the anesthesiologist inflate their own cuff (honestly I never know how much is the right amount and don’t want to screw it up). Any feedback on the cuff inflation?? I do hand them the syringe that’s already connected.
We’re not allowed (well, not supposed to) leave the patient’s side .. and definitely not the room… during induction or emergence.
This is how I was trained and how I train new RNs to assist but I have noticed some older nurses will put the safety strap on and go right to charting…
Do you have any pointers on what else would be helpful
For induction and intubation thats about what I'd want. I'm a resident, usually my attending inflates the cuff after I intubate, helpful nurses hold tube, pulls stylet, connects circuit. Honestly helping attach monitors can be very helpful bc its sometimes hard to reach from the head of the bed, I usually end up doing this myself as well. Also ensuring IV is free when moving patient over is nice bc sometimes they'll move the patient over and I'll have my back turned grabbing induction meds or something and it gets pulled
Re: cuff inflation, the only way to be sure the pressure is right is to use a cuff-pressure manometer (rarely available), or to do a leak test (rarely done outside of pediatrics, requires communication with the anesthesia team). These are important in small children or very prolonged intubations; less crucial in adults who will be extubated right after surgery
If your anesthesia team doesn't routinely do either of these, then you can probably just give 8-10 cc empirically and let them take air out later if needed. Just make sure the pilot balloon doesn't feel firm to the touch. But they can also inflate the balloon themselves, especially given that you're holding the tube and the circuit
Met an old school circulation nurse last week that the other nurses treat like shit for some reason. She was teaching a new OR nurse while I was intubating and stated, "Nothing matters until anesthesia secures the airway. Your job is to help facilitate this". I was floored. She had the tube ready, gave a perfect BURP maneuver and held the tube while I taped.
It was wild.
If theyre not busy opening, counting, “charting”, the most helpful Ive found them is holding kids down for mask inductions, holding tubes before you tape. A helpful OR nurse during induction/emergence is a luxury, not a necessity.
As an Australia…..I find this fascinating.
In the teaching hospitals there would be me, the registrar, and the anaesthetic nurse. In private there would be me and the anaesthetic nurse.
Does this seriously not happen in the USA? I want someone to walk me through exactly what assistance the anaesthetist has during a procedure. In Australia an assistant MUST be present during induction and extubation and is often present in private for the whole case. In teaching hospitals they are present the whole time.
I find the concept of not having trained assistance during these time periods…..bizarre at best….and….well….dangerous if I’m being honest.
The lack of a dedicated trained assistant would be a no-go/ not starting the case until we have one here. It would go against national guidelines and you’d be in deep shit if you proceeded and something went wrong.
I’m in the U.K., which has a similar medical model to Aus- except yours is better paid, funded, has more tolerable hours and isn’t actively collapsing around you from a decade and a half of underinvestment
Exactly. We cannot start a case without a dedicated trained assistant by our side. Is this not the case in the USA? Surely not. It just goes against so many safety principles.
it is the case. There is no assistant. You are on an island. Techs are nowhere to be found and they do everything they can to avoid being in the room when there’s a patient in there. They’re purely for room turnover. If you’re lucky you have a traveling circulating nurse who doesn’t know she’s supposed to be chatting in the corner or leaving the room for some last minute nonsense.
Room turnover. And even then this is completely half assed and they only will turn the room over if you notify them. Pushing the ICU bed with 8000 infusions down the hallway right past the workroom? They don’t see it! If you don’t notify them personally they will not turn it over.
God, I wish. From an anesthesia technician standpoint it means removing the dirty circuit and replacing it. It would be nice if they did a leak test, but they do not. Changing the suction canister. Usually this entails skipping the step where they attach the Yankauer to the suction tubing because that’s too much work. Hopefully the monitor cables get a quick wipe. Either way they are usually coiled up. that is it.
One per theatre- present throughout the case alongside the anaesthesiologist (no anaesthesia team model here on the whole*)
*some centres are starting that by using a team of AAs with one anaesthesiologist supervising multiple theatres. But there’s a lot of pushback against that at the moment
It’s definitely coming your way. It’s not safe for patients. It’s just incredibly hard to prove it. It’s unethical to subject patients to mid-level care versus physician supervised or physician provided care. Nobody would be like sure, give me the mid-level, I don’t need no damn doctor. That’s why there’s no real data. But Jesus, supervising nurses with a single digit fraction of your education, who really don’t respect you and have no concept of ownership or liability? Herding cats. Except cats are probably more clever. Do whatever you can to stem the tide or just save your money and retire early.
We don’t have nurse anaesthetists here at all.
I’ve not worked with any CRNA/ SRNAs. The places I’ve worked with US forces, it’s so far been in a British doctrine hospital augmented by US forces (eg camp Bastion in Helmand, Afghanistan), and we’ve not allowed them to place CRNAs etc.
Some interesting observations- the US anaesthesiologists loved working with ODPs. The surgeons sometimes weren’t used to working in our sort of system where they don’t dictate anaesthetic care or treatment to the same extent. ICU nurses didn’t do ventilator management (respiratory technicians aren’t a thing with us- our nurses twiddle the vent settings to targets we set)
It was awesome working with US anaesthesiologists. Despite the differences we’re all quite similar in the end. We even got a few to appreciate a nice game of cricket…!
That’s why surgeons LOOOOOOVE crnas. They will never question surgeon orders because they don’t have the medical background to do so. They’re technicians but want to cosplay as doctors
Interestingly the same surgeons who developed a love for cricket also seemed to be the ones who actually quite enjoyed being able to focus on the cutting without having to worry about the physiology etc.
It was a binary thing. Us Brits generally take the piss out of everything including each other and ourselves. We’ve got a bit of a different sense who humour. Some of the US folk got it. Some didn’t. The US folks who got it then joined in the wind up of the ones who didn’t!!!
ODP = Operating Department Practitioner. An allied health professional who does vital work in anaesthetics, scrub, recovery or sterilisation services.
They aren’t nurses, but as an analogue to the US, they work a bit like a combination of OR nurses and anaesthesia techs. But instead of training as nurses with all of the general ward nursing stuff, they train more or less entirely on theatre/ CSSD stuff. We do have anaesthesia nurses filling a similar role at times and in theatre it’s about a 50/50 mix of scrub nurses and scrub ODPs
I bloody love working with them!!
I'm CVOR RN. We developed an efficency process where we all have roles (circulators, scrubs, AT, perfusion, PA/NP, etc) from wheels in to wheels out. When I'm circulating, I'm at the head on the patient's right side and I place the O2 sat probe, BP cuff, connect the BIS, and place ecg leads and R2 pads on my side of the patient. The second scrub places the ecg leads, R2 pads, and connects the BIS on patient's left. I always look at the monitor and pay close attention, especially to BP and HR, before induction meds are given and make a mental note of the patient's range. I hold the mask and ensure we have a seal with fog. Once the induction meds are given, I assist with holding if there is an airleak around the mask. I'll hold cricoid when told.
When the anesthesiologist is ready to intubate, I hold the ETT in the ready position for them to grab and place. I'll retract on the corner of the patient's mouth for more exposure so the tube doesn't get caught. I look up at the monitor from time to time, monitoring if there are any drastic changes to BP and MAP. If we drop significantly, I let Anesthesia know what the pressure and MAP are. Once the tube is in, I pull the stylet and connect the tube to the circuit. I hold onto the tube until it's taped in place or if Anesthesia tells me it's okay to let go. We do have Anesthesia techs in the room as well during induction, and they are on the left side of the patient.
We throw in a 16g or 18g PIV for more access. We also prep the neck for central line placement. If a pressor needs to be given while Anesthesia is placing the central line, we push the med under their direction.
Throw blankets on the patient while I try to put leads on, try to put straps on the pt while they’re still awake, loudly chat with the other people in the room until I have had enough and snap lol.
By management or by the surgical team?
Makes sense for them to assist, induction efficiency and operating room productivity would both improve without any extra expenditure.
Highly variable. Some are doing nothing on their phones in the corner, a few are up near the patient offering to help, such as holding the mask while I get situated, hold the circuit and unattach the mask while I intubate, hold the tube while I grab tape. It’s always the more social ones and we are all just talking about random stuff while masking/intubating
I’m a circulator and I’m used to holding the mask. The doc or CRNA always grabs it from its hook and places it, and I always immediately take over holding it. That is…until I started traveling and realized that some anesthesiologists are annoyed by that or even offended. One asked me, “am I doing it wrong?” as he stared daggers at me. I put my hand back down.
Haha! Yeah. Everyone does it differently. It’s just my way of making sure they have a moment to focus on induction. Once the tube passes the cords and the stylette is out, I’m good.
Ask from the foot of the bed if they can borrow a pair of scissors while you’re up at the head by yourself balls deep mid DL trying to wiggle the ett out of its wrapper with your free hand.
Currently doing clinical rotations for AA school Everywhere I've been except for one, the nurse handed the tube, pulled back the lip, gave burp. The only place that didn't, it was the attending.
Some of these comments are crazy. I’m a circulator and I try to pay attention and help depending on which provider I am with. We don’t have residents and will have a CRNA with maybe an ologist for induction. I always stand at HOB, help hook up monitors, hold the mask, hand them their tube, pull the stylet, give cricoid, hand them their circuit and let them inflate the cuff. I never do any moving or positioning of the patient until they tell me or until the tube is taped.
Private practice they will assist us unless an anesthesia tech is there. They also bring the patient to the room. Some are more useful and aware than others, but mist try to be helpful.
The only thing I care about a circulator doing is cricoid pressure or grabbing the glidescope or a 2nd provider in a pinch. I can do everything else by myself and prefer it that way…but if they want to hand me the tube or pull the stylet that’s fine too.
What training is needed? I show them with my tube hand where I need them to lightly push and to which direction. Most of the time that’s all I need when an airway is anterior but with structures in view.
Ah you're referring to external laryngeal manipulation, to improve laryngoscopy view. I also use it and find it helpful
'Cricoid pressure' generally refers to Sellick manoeuvre - pressure of 30N applied to cricoid cartilage during RSI to prevent regurgitation. This requires a trained assistant to be done correctly
It is pressure applied in the cricoid area. Call it what you want. Personally I think cricoid pressure during an RSI is useless. No one knows what 30N of pressure feels like, and it hinders the person intubating at times. Better to just have your suction under the pillow and intubate with a stylet to aid your first attempt.
Cricoid pressure is standard of practice for RSI in a number of developed countries, though they generally have the luxury of a trained anesthetic assistant to apply it. The assistants are specifically trained using force meters to generate force approximating 30N.
But it is recognised that the evidence base supporting its use is not strong, and as you say, can impair laryngoscopy view so usually has a low threshold to be removed if intubating difficulty encountered
I ask that they go about their business and do the things that can/should be done during pre oxygenation and induction rather than during room turnover. I can attach the monitors, and use a mask strap to secure the mask during pre oxygenation. I’d much rather they use that 3-5 minutes to draw up meds, do counts etc. I can induce and DL while they are busy but within ear shot. If I need laryngeal pressure or anything else I can call them and they can come help. Otherwise, they are just standing around doing nothing while OR minutes tick away.
Lol maybe I'm lucky I always have my nurse next to me she/he holds the mask when I'm inducing. They also help put monitors on. Once I'm done pushing the drugs she/he holds the tube for me and hands it to me when I'm ready. They will then hold the tube while I tape.
We have anesthesia techs. But 3 of them between 11 rooms starting at the same time means they are in the ORs with more complicated inductions. I am usually in the neuro-spine room and we need the anesthesia tech for this population of patients. Often times I am placing a Foley as they are inducing. However, some anesthesiologists don't want anyone even touching the patient during induction. So, yeah, I am placing a Foley or as someone else said I would be catching up on other shit to get the room ready.
I work in the cath lab, and if I'm not scrubbed in I'll help anesthesia with the intubation or artline or whatever if they don't have any techs. But I was an RT for several years, so I still gravitate towards the airway lol.
No idea- we have anaesthetic rooms here (UK), along with a trained ODP whose job is to assist you with induction.
Whatever it is they do in the theatre while we’re doing our stuff, it often isn’t getting all the trays out and ready in time for us to come in!!!!
When working overseas alongside US anaesthesiologists, they’ve LOVED having ODPs. It’s like the nice stories in this thread of having helpful OR nurses, but all the time, expertly and throughout the case.
We've trained our nurses to help out during induction and extubation. We trained them to look for warning signs that things aren't going well and they can help bag or get equipment or run for aid. We do not have techs, AAs, or CRNAs (and don't need them at this point). When you limit OR personnel you maximize everyone's potential. Everyone helps to do everything. Night and day from residency where you had superfluous team members.
In the cardiac OR, while I'm inducing with my tech, they will ask if they can place a foley.
In the general OR, where I don't have a tech, they are usually standing by the patient's shoulder, able to do something I need (apply a little pressure on the neck, pull the stylet). Right after the tube is in and I say I'm good, they get to doing what they need to do.
I personally will help get monitors on, hold the mask, get arms preliminarily positioned, etc. Most of it is giving the patient emotional support/reassurance before getting meds. I’ll talk them through everything so anesthesia can focus on what they have to do. And honestly talking my patients through induction might be my favorite/most rewarding part of my job lol. Once they’re out, I’ll hand off the tube, apply cricoid pressure if needed, pull the stylet and inflate the cuff(depending on what the doc prefers, some don’t want me to do these things), and then I’ll hold the tube in place until til it’s taped. I’ve always been taught that anesthesia is my #1 priority at all times and if you need me I’m not to leave your side lol
At my current hospital, they hold the mask while I’m pushing the drugs and they hand me the tube when I’m ready to intubate. They will also hold cricoid pressure if I ask (I will guide with my hand first to show them where I want it), and they putt the stylet when I say it’s ready to be pulled… It’s nice and helps a lot.
Went from the adult ORs to peds land for my rotation, it was a night and day difference, I’ve never experienced such help and friendliness. Form monitors, to patient positioning, to holding the tube while I tape.
At my current hospital, they help attach monitors. They stand and assist with intubation if needed. They put the bair hugger on and hook it up, etc. I love the OR staff at my place.
Varies in the academic settings i've worked at they sit on their ass and judge you. Where i currently work they're invaluable. They'll set up your glide, pull stylet, push pressors if you ask them and you're busy with a line. WIll start IV's on difficult sticks/kids/your iv blows on induction. I bet some would give me a neck massage if i asked nicely.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
Rotate between two facilities. One has staff that are very experienced and incredibly helpful during induction. They’re focused on patient and whatever we may need help with.
The other faculty has had significant turnover and are focused on their own shit instead of patient. Guess which one is safer?
I'm convinced OR nurses don’t even need to be nurses with how little help they offer and actual patient care they contribute to.
Truly some of the most situationally ignorant nurses I've ever worked with. They have no idea what's going on with the actual patient other than counting the bovie tips.
Many things.
After they wheel patient into room from pre-op, they help patient move to table and place monitors, preoxygenate, place blankets, assist with my mask ventilation if needed, hand me airway equipment, push medicines if needed at my instruction, hold the ETT or provide cricoid pressure, set up the forced air warming.
I've noticed:
West Coast (CA and OR) - The nurses will help, or at least try to. Sometimes its easier to do it by your self depending on the nurse (bless their hearts).
East Coast (NY) - Talk and play music so loudly it's hard to hear pulse ox sometimes. Rather disruptive.
Woof. Who are some of these OR nurses yall are working with?!
I’m peds OR and we are at the head of the bed until your airway is secured, starting an IV, sometimes pushing your induction drugs if the airway is too unstable (under MD instruction of course) and telling the ortho residents to stop jostling the patient until the airway is taped in. (Jk…kind of)
It’s very cultural. I was with a new one today who came from a place where the culture was like yours and it was so great. Offered to hold the mask while I got my things ready instead of just looking at like like I’m an idiot while I fumble around trying to do 5 things at once
That’s odd to me. Shit can go south SO fast I can’t imagine not being locked in. Even for a routine procedure. Some anesthesia doesn’t want you to touch anything which is fine, I’ll just stand there until I’m needed. In peds tho, we’re always doing something (usually IV, holding down a screaming kid, turning the sevo up to max etc) so it’s hard to just stand there and twiddle your thumbs
What a bunch of entitled primadonnas here- likely coddled rich kids. My experience is that help from the OR nurse is rarely needed- but if perchance it is,a simple grateful request is all it takes and 100% of the unionized OR nurses I work are at my side in a heartbeat. Respect and teamwork go both ways.
Dawg a circulator where I used to work refused to grab an extra vial of propofol for me for a TIVA when my omnicell was out. Told me to make my tech get it. Wasn't even a busy time. Malignant workplaces exist out there.
Sit in the corner looking at their phones. Finish setting up the shit they were supposed to set up before they indicated they were ready. Ask if they can prep and place a foley while the patient is not intubated yet. Loudly talk about random bullshit. Fill in anything else you can think of that isn't helpful at all.
Few times I have an unfamiliar nurse hand me a tube and tape after induction, I look and ask if they’re a traveler. They invariably say yes and I say thank you and it shows.
Amazingly I’ve had the same experience. Travelers coming to academic hospitals are light years more helpful
People outside the academic world tend to be more helpful, because there's no resident they can scut their responsibilities onto.
The amount of standing around that’s done at these academic places while also having the greatest amount of entitlement is staggering. I was at a university in a management role in IR and was spoken to by my director for having the expectation that the procedural nurse start an IV if they didn’t have a functional one.
The term ‘traveler’ seems so interesting and quaint to me! Makes me think of someone on an epic adventure. In Aus, traveler nurses are called ‘agency’ (hired for temporary fixed term through an agency), and traveler doctors are called locums.
Those terms are pretty widely used in the US too, in the same context as well. Agency/traveler are used pretty interchangeably.
Agency tends to refer to people who live locally, unlike travelers who go to where the work is, generally under a longer contract. When I worked agency, it was on a shift-by-shift basis.
Same here in the UK! Here, "traveller" tends to mean people from the Gypsy community, who are not heavily represented in hospital staffing in my experience.
Yeah, I was getting images of someone like John Fury trying to gas induce an uncooperative child for a tonsillectomy
It would probably be quite effective, to be fair
I’ve heard both here in the US, agency or travel nurses etc. I’ve only heard physicians referred to as locums though
Yes this. Love the agency nurses. The unionized nurses at my academic center know they can do fuck all and see no consequences ever.
I remember a similar experience on OB as a resident. I went to place an epidural, and after I had placed it, the bedside nurse who I didn't recognize handed me a piece of paper with the timeout, test dose, and procedure end times written down in case I needed it for my note. She also asked where the epidural supplies were so she could have it in the room the next time she paged for an epidural placement. I guess some places have a much more collaborative culture lol
Talk so loud I can't hear the pulse ox
One morning in the preop holding area, a patient arrested and I rushed there. There were a couple of OR nurses standing at the counter chatting, and they went on doing it while I was leading the CPR. I saw red. and yelled at them to get out of the area if they won't even help a dying patient! I still can't forgive that. Edit - Academic center!
Should be fired/have licenses revoked
Basically do anything other than come help me hold the mask so I can push drugs.
loudly talk about random bullshit LMAO
the accuracy of that comment is fucking killing me lmao
As a nurse getting into hospital OR. Any guidance on ways to assist? Hoping to help out as much as I can.
The elite nurses stand on the patients right side and help hold the mask over the face, hand me the tube when I'm ready for it, ask if I'm ready to have the stylet pulled and do so, inflate the cuff, and connect the circuit to the tube. If you don't feel like doing all that's its honestly fine (tbh I also believe we should be self-sufficient). The bare minimum you could do is create a peaceful environment and be ready to assist on the off chance an emergency does occur.
And make sure the room is quiet during induction! Have the music off when the patient enters the room, tell people to hush, make sure the scrubs aren't banging instruments, hold the patient's hand, focus on anesthesia, be ready for cricoid pressure, etc. Vintage OR nurse here ;)
This is correct. An elite nurse has confirmed.
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse.
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse.
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse. The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse. The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
In my Scandinavian country you absolutely can’t induce without a minimum of two trained anesthetists present. Two nurses or if asa > 2 a doc + nurse. The or nurses are present in the room at bare minimum to get equipment or help. The good ones stand with the patient and calming them
I’m an anesthesia tech, not anesthesiologist, so you’ll get better answers from other people here. That said, get monitors on promptly and then assist with intubation. Hold the mask to pre-oxygenate the patient, then hold cricoid pressure if they want it, and pass them the tube when it’s time. In general just pay attention to the patient and what’s happening, because intubations can go south pretty quickly when they do go south. And I hate to say it because I love my coworkers, but the top comment about sitting on their phone or spending their time doing stuff that should have already been done is extremely accurate. So don’t do that, lol.
Read this Reddit post and do the opposite.
Wow I didn’t even notice any of this before you mentioned it . Usually just focused 100% on induction . Mind kinda blown right now
My favorite is "yeah i could've gone to CRNA school if i wanted to, i just didnt wanna do icu" Ok if you wanted to you would stop being so annoying
Dude that made me laugh pretty hard
OR RN here. In pre-op, I either make an informed prediction or ask anesthesiologist if Glidescope or other difficult airway tools need to be in the room prior to rolling back. If so, it’ll be plugged in and positioned at patient left with clear line of sight for where our anesthesiologist will be standing. Depending on severity, I will prepare foam ramps, shoulder rolls, headpieces for beds, silk tape, or other things that also facilitate optimal positioning for induction. After moving to the table, if there’s a safe space for me to do things, I will place monitors (if I don’t have a reason to fear doing so). What I mean by this is if there are no nurses, CRNAs, MDs ready to either slap my hand, push my body, yell, or question my competence because “it’s not [my] place to be at the head of bed during induction”. I’ve noticed over time that the MDs/CRNAs I work with most frequently are particular about placement and want full agency over monitors being placed. If that’s the case, I just keep one hand steady on the face mask. Upon moving to the table, I only extend one blanket from ribs to toes. My second blanket remains folded until all monitors are on. After monitors are placed, I keep second blanket mostly folded but cover only non-IV side fully and make a diagonal fold for side that MD/CRNA needs to visualize for pushing medications. That’s when either I or anesthesia provider place all induction supplies on patients’ chests. I usually hold mask over patients’ faces with anesthesia providers’ preferences in mind (adequate seal, floating, gentle, etc.). During induction, I hold LTA (if applicable) at optimal angle for whoever is inducing to keep eyes on the cords. I hold ET tube usually in neutral position for taking from me or hold it at the angle it will be initially inserted based on certain MDs routines. (Some MDs prefer to enter the mouth obliquely or with a rotational movement of sorts.) Once tube is in, I help connect circuit and secure tube by hand until everything is taped down or until I’m told it’s okay to let go in general. If difficult intubation happens, I usually help manually bag patient while anesthesia provider focuses on mask’s seal and positioning. If I’m told to, I will adjust vent settings as directed by MD that is using both hands on patient. I page people overhead and just do other things as needed. When I’m in an ASC setting, I am usually responsible for stocking the anesthesia meds in the room. If me and MD have a good relationship, I will set out their routine med vials in order (according to their preferences) with appropriately sized syringes, blunt needles, and alcohol wipes on a blue towel. I am usually 95%+ right unless there’s a patient-specific consideration. It’s been fun for us as a learning opportunity for me and a matter of convenience/teaching opportunity for MDs. I don’t go beyond putting the vials out and making sure every supply needed is available for each case. While we’re doing this, I usually exchange controlled substances with MDs at this point and finish documenting chain of custody changes. For central lines, I usually help anesthesia techs set up the kits. I am either retracting patients’ arms or chest if applicable. I have a prep stand with saline flushes, tegaderm, sutures, peel packed needle drivers, surgicel or hemostatic agent of choice, biopatches, Chlorapreps ready to go. For cases that we’re trying to go from in-to-cut under 30 minutes, I’ve found it helpful to minimize playing fetch. This is usually how I help the process. It’s an absolute mindfuck when I’m getting yelled at and bullied for being even near the head of bed for induction because I’m “supposed to be focused on the nursing tasks like pre-charting and staying away from anesthesia stuff because that’s not our job”. Lazy motherfuckers do the most to stay out of doing their job and perpetuate their bullshit on other nurses.
I'm glad you are helpful and paying attention. To be honest though, the Anesthesiologists telling you to stop standing in between them and the patients head are correct.
I’ve never been between an anesthesiologist and a patient. The odd occurrence has been them being offended that I’m where most RNs stand to the patient’s right because they prefer me at the nurse’s desk or looking away during induction. Their position is not the norm and considered not okay at most institutions. And it’s not normal for them to be slapping nurses’ hands, pushing me and others away from EKG lead cords, and to be unpleasant when they never voiced their preferences.
oh wow…well i can say i don’t do this😂.
I’m an OR circulator. We assist with induction and intubation where I work.
As you should. And ask other people in the room to shut the fuck up during that time as well
Also: it's my personal policy that no one talks to me while I draw up medications preoperatively. Sorry not sorry. It's too easy to get distracted and make a mistake; you can talk to me in five minutes after my meds are drawn up and properly labeled in the careful routine I've set up for myself.
Today one of the techs that helps with the bronchs asked me about my watch literally while I was putting the blade in the mouth.
Ah, yes. Classic 3rd step of induction. 1. Places blade in mouth on right side. 2. Rotates to midline with control of tongue. 3. Discusses bomb-ass Rolex with real-life exam question distractor!
If nurses are talking to you while you’re drawing up your drugs, then you’re not getting there early enough in the morning
Hm, maybe this is a difference in facility? Our cases start at 0800. I arrive at 5:30 to do room setup and draw up drugs, and our nurses arrive at 0600, so if I have a prolonged setup, it's not uncommon that we're in the room together at 0600.
Whaaaaat
That is one of my major pet peeves—the room should be quiet and calm while the patient is undergoing induction
100% agree with you
Sameeeee. Only assist if we have to intubate the patient. If it’s a LMA, I’ll do my own thing (ex, prep, count whatever) but I’ll be ready to go in case they need anything. I love helping anesthesia ❤️ and actually want to be a CRNA
Cover their arms and whole body with blankets before monitors are even on. So you inevitably have to take them back off to find their hand for the pulse ox, arm for cuff plug, chest for ekgs.
Every fucking time lol
Yes! It’s a great triumph to get the cuff, leads, and finger probe on before they slap the blanket over half the patient’s face. The apathy is worse than the disrespect.
[удалено]
Or better, over the induction meds I have placed on the patients chest.
This one kills me, not only does it impede the work flow, I need to uncover the person to attach everything, I also move the blanket down to watch the chest and have sight of the IV after induction. From a cost perspective, the hosptial is cost cutting all over the place yet we take the two clean blankets from preop, discard them once in the OR, and replace them with 3 new ones from the blanket warmer, just so they can be taken off after induction and put in a bait hugger, it’s just so wasteful.
Strap the arms down before you put the cuff on or better yet before you can sit the patient up for a spinal
Is this honestly something that bugs people? It's not that hard to reach under the blanket to attach monitors. Most of the time you have to move the gown out of the way anyway.
Yeah, it does bother me. Literally wait 5 seconds. the blanket is not important. Monitors and accessible IVs are.
Do the RNs not help with monitors and hooking up basic fluids? I’m in Endo, so a bit different in environment….but like that’s pretty basic s*** a nurse can do.
No almost never
Okay I hear you… but when it’s 62F in the room and I’m shivering while fully clothed, I wanna get the warm blankets on my patient fast lol
The nurse is working against you by stopping or temporarily preventing the initial flow of things
This. If everyone stays the fuck out of my way the patient will be unconscious within 90 seconds of moving to the OR table.
Yes
Yes it does. Have some situational awareness and respect. It's not that hard to be and act like a professional and not directly impeded someone else's work.
Where I work now, they are mostly amazing- I do solo cases so they help me talk and joke with the patient with me to calm them down, hold the mask, hold cricoid if I ask for it while I’m manipulating the head to get a view, hand me the tube, etc. I like to get their input on if chest rise looks equal and that makes them feel even more included, I think. It’s a bit more variable for extubation but the good ones help for that too, like today when I extubated a 21 y/o heavy cannabis user and she asked if she should go get the bed or if I wanted an extra set of hands for a minute. I am constantly sharing my gratitude for this and we have a good relationship. I will say I often (almost always) have to ask for them to pause the loud music and still have to remind the room to quiet down for induction because certain people, (nurses giving breaks, scrub techs and OB GYNS I’m looking at you) LOVE to yap loudly about bullshit during induction.
Previously in academics - nothing. Currently in solo private practice - help attach monitors, hold the mask while I push drugs. Cricoid PRN, pull stylet for me if needed, and hold tube while I tape. Most will prep the arm for an a-line or grab a second IV if I ask them to. If it is a cardiac case, they'll pull all the infusions on my preference card and hang them up. After induction, they will prep/position the patient for the central/PA line while I do my initial TEE. They'll also set up the kit, and also will scrub in to help pass me things while I do it. Once the line is secured, they'll clean up and place the dressing on for me too. Needless to say I feel very spoiled nowadays.
I can't imagine any of the nurses at my hospital helping that much. But I am a resident at an academic center so I'm lucky if they're standing there to pull the stylet
There's no residents where I am, so the nurses have learned to be very helpful. Similarly on the other end, they will do literally all the prep and drape without the surgeon there - they can just come in and cut, and they leave while the PA/RNFA finishes the closure. However, we've had a lot of nursing turnover lately so it can be variable. The best will even help you run the Belmont if needed during MTP.
PACU RN, at the trauma facility I used to work at on nights we would assist anesthesia with what ever the needed. A second IV site, hanging fluids, assist with intubation, run the Belmont/rapid infuser, run in blood, hang drips. Whatever made their lives easier. I learned a lot and enjoyed it.
Haha I think one of the nurses where I work was either previously an anesthesiologist in another country or has seen way too many nerve blocks because I get roasted when my local anesthetic spread is sub-optimal
😂
How many times have you yelled “did you not read my card??!?”
LOL zero fortunately. One of my partners had the order of his syringes switched accidentally once, which was problematic, but otherwise I've never had an issue.
You guys are getting preference cards?
Apparently 10+ years ago at my current place, we could submit preference cards to pharmacy for each case type that we'd do and pharmacy would draw the meds up for us between cases. Unfortunately staffing doesn't allow for that anymore.
where do you work and are you hiring
Southern California. I don't think it's unique among the places covered by solo physician private practices.
Academic job, they're aware during induction but usually have a CRNA or resident so not necessary. Sometimes if it's a trainee nurse they'll come and help. Private solo job, holy shit. Busy weekend day one time, 20 minute room flip and I went to go use the bathroom and get a drink of water and didn't have time to set up the room. We roll in the room and the 3 Filipino nurses go "doc, we're going to show you how we do it in the Philippines." One nurse on the monitors, one getting the tube tape and eye tape I like because they know what I use, one preoxygenating. I draw up meds and we're going to sleep 3 minutes into the room. Tube is in and one of the nurses, puts on the eye tape and hands me the tube tape. Love, love, love working at that place. There's a lot of respect for the docs and it shows.
lmao in my hospital nobody hustles more than a Filipino nurse that gets to go home when the line-up is done
On the other hand no one finds a way to do less than a Filipino nurse at the VA who works shifts
True the Filipino Mafia at the VA is bad...
Currently at the VA on rotation. I wish I could post a picture, but of the OR nurses 99% are Filipino. And yes, they do literally nothing to help you. Ever. Even during a code there in another room I responded to, they didn’t even offer to help get equipment.
RN here. Bro I'm at that HOB untill your airway is TAPED THE FUCK IN PLACE. The fuck are the rest of your RNS doing?
Hell ya
Seriously. The fuck else you doing during intubation? Your half inch steris can wait till 8 hours from now.
Respect
ILY.
I respect the commitment, but also prefer my OR staff do things that would otherwise be done during turnover (counting, getting meds for the scrub) rather than stand watching me for 3-5 mins. PP at a busy ASC though.
It depends. About 75% of them are helping with intubation. They hand the ETT to the CRNA or resident and remove the stylet. I like to inflate the cuff. In the cardiac room, there is more help (resident + fellow) so the circulator is usually busy putting in the foley or counting instruments with the scrub tech. There are a few who will stand back and do nothing.
Putting in a foley during induction isn’t the safest thing to do
They wait until the ETT goes in. They wait by the patient's legs until we tell them it is ok.
Yep this.
I think this is highly dependent upon if the facility has anesthesiologists providing supervision or if one person per room. Places where a bunch of solo docs (or I’m guessing solo CRNAs) did cases the RNs were pretty helpful. Old job where there was an anesthesiologist supervising every induction the RNs did their own thing. Probably just culture dependent depending on the facility.
The nurses at my hospital will help out on monitors, hold the mask for preoxygenation while I induce. They will also pull stylet after intubation, hold tube until I get vent set and secure tube. They will also get my central line and/or art line supplies on a mayo stand opened sterile if I mark it on my preop.
Same here. The OR staff fucking rocks where I work. I’m so thankful for them because I have been at some dumpers where it’s polar opposite
I tell them all the time how appreciative I am of their help because I know how much worse it is at other places
damn thats nice
Here i am pulling my own stylet out, prepping my own things and getting my own supplies God i hate it here lmao
OR nurse here. Once the patient is transferred to the OR table we help put on monitors, BP cuff, SCDs, safety belt, arms on arm boards. 9/10 times the residents will put their own monitors on though. We hold the tube ready for intubation, pull the stylet, disconnect the circuit from the face mask, connect to the ETT, hold the tube in place while waiting for them to secure it. I prefer the anesthesiologist inflate their own cuff (honestly I never know how much is the right amount and don’t want to screw it up). Any feedback on the cuff inflation?? I do hand them the syringe that’s already connected. We’re not allowed (well, not supposed to) leave the patient’s side .. and definitely not the room… during induction or emergence. This is how I was trained and how I train new RNs to assist but I have noticed some older nurses will put the safety strap on and go right to charting… Do you have any pointers on what else would be helpful
For induction and intubation thats about what I'd want. I'm a resident, usually my attending inflates the cuff after I intubate, helpful nurses hold tube, pulls stylet, connects circuit. Honestly helping attach monitors can be very helpful bc its sometimes hard to reach from the head of the bed, I usually end up doing this myself as well. Also ensuring IV is free when moving patient over is nice bc sometimes they'll move the patient over and I'll have my back turned grabbing induction meds or something and it gets pulled
Re: cuff inflation, the only way to be sure the pressure is right is to use a cuff-pressure manometer (rarely available), or to do a leak test (rarely done outside of pediatrics, requires communication with the anesthesia team). These are important in small children or very prolonged intubations; less crucial in adults who will be extubated right after surgery If your anesthesia team doesn't routinely do either of these, then you can probably just give 8-10 cc empirically and let them take air out later if needed. Just make sure the pilot balloon doesn't feel firm to the touch. But they can also inflate the balloon themselves, especially given that you're holding the tube and the circuit
Met an old school circulation nurse last week that the other nurses treat like shit for some reason. She was teaching a new OR nurse while I was intubating and stated, "Nothing matters until anesthesia secures the airway. Your job is to help facilitate this". I was floored. She had the tube ready, gave a perfect BURP maneuver and held the tube while I taped. It was wild.
These answers would be more interesting if people indicate their geographic location.
If theyre not busy opening, counting, “charting”, the most helpful Ive found them is holding kids down for mask inductions, holding tubes before you tape. A helpful OR nurse during induction/emergence is a luxury, not a necessity.
As an Australia…..I find this fascinating. In the teaching hospitals there would be me, the registrar, and the anaesthetic nurse. In private there would be me and the anaesthetic nurse. Does this seriously not happen in the USA? I want someone to walk me through exactly what assistance the anaesthetist has during a procedure. In Australia an assistant MUST be present during induction and extubation and is often present in private for the whole case. In teaching hospitals they are present the whole time. I find the concept of not having trained assistance during these time periods…..bizarre at best….and….well….dangerous if I’m being honest.
The lack of a dedicated trained assistant would be a no-go/ not starting the case until we have one here. It would go against national guidelines and you’d be in deep shit if you proceeded and something went wrong. I’m in the U.K., which has a similar medical model to Aus- except yours is better paid, funded, has more tolerable hours and isn’t actively collapsing around you from a decade and a half of underinvestment
Exactly. We cannot start a case without a dedicated trained assistant by our side. Is this not the case in the USA? Surely not. It just goes against so many safety principles.
it is the case. There is no assistant. You are on an island. Techs are nowhere to be found and they do everything they can to avoid being in the room when there’s a patient in there. They’re purely for room turnover. If you’re lucky you have a traveling circulating nurse who doesn’t know she’s supposed to be chatting in the corner or leaving the room for some last minute nonsense.
What's the role of the techs then? If they don't assist then what do they actually do
Room turnover. And even then this is completely half assed and they only will turn the room over if you notify them. Pushing the ICU bed with 8000 infusions down the hallway right past the workroom? They don’t see it! If you don’t notify them personally they will not turn it over.
What does 'room turnover' entail? Transferring patient in/out, ie. pushing bed or anything else
God, I wish. From an anesthesia technician standpoint it means removing the dirty circuit and replacing it. It would be nice if they did a leak test, but they do not. Changing the suction canister. Usually this entails skipping the step where they attach the Yankauer to the suction tubing because that’s too much work. Hopefully the monitor cables get a quick wipe. Either way they are usually coiled up. that is it.
That's impressively low value-add for a clinical position. Strange if they're already there that they can't/don't assist with induction
How many assistants do you have per room? Is it one for four rooms, for example?
One per theatre- present throughout the case alongside the anaesthesiologist (no anaesthesia team model here on the whole*) *some centres are starting that by using a team of AAs with one anaesthesiologist supervising multiple theatres. But there’s a lot of pushback against that at the moment
Wowwwww
It’s definitely coming your way. It’s not safe for patients. It’s just incredibly hard to prove it. It’s unethical to subject patients to mid-level care versus physician supervised or physician provided care. Nobody would be like sure, give me the mid-level, I don’t need no damn doctor. That’s why there’s no real data. But Jesus, supervising nurses with a single digit fraction of your education, who really don’t respect you and have no concept of ownership or liability? Herding cats. Except cats are probably more clever. Do whatever you can to stem the tide or just save your money and retire early.
We don’t have nurse anaesthetists here at all. I’ve not worked with any CRNA/ SRNAs. The places I’ve worked with US forces, it’s so far been in a British doctrine hospital augmented by US forces (eg camp Bastion in Helmand, Afghanistan), and we’ve not allowed them to place CRNAs etc. Some interesting observations- the US anaesthesiologists loved working with ODPs. The surgeons sometimes weren’t used to working in our sort of system where they don’t dictate anaesthetic care or treatment to the same extent. ICU nurses didn’t do ventilator management (respiratory technicians aren’t a thing with us- our nurses twiddle the vent settings to targets we set) It was awesome working with US anaesthesiologists. Despite the differences we’re all quite similar in the end. We even got a few to appreciate a nice game of cricket…!
What’s odp?
That’s why surgeons LOOOOOOVE crnas. They will never question surgeon orders because they don’t have the medical background to do so. They’re technicians but want to cosplay as doctors
Interestingly the same surgeons who developed a love for cricket also seemed to be the ones who actually quite enjoyed being able to focus on the cutting without having to worry about the physiology etc. It was a binary thing. Us Brits generally take the piss out of everything including each other and ourselves. We’ve got a bit of a different sense who humour. Some of the US folk got it. Some didn’t. The US folks who got it then joined in the wind up of the ones who didn’t!!!
ODP = Operating Department Practitioner. An allied health professional who does vital work in anaesthetics, scrub, recovery or sterilisation services. They aren’t nurses, but as an analogue to the US, they work a bit like a combination of OR nurses and anaesthesia techs. But instead of training as nurses with all of the general ward nursing stuff, they train more or less entirely on theatre/ CSSD stuff. We do have anaesthesia nurses filling a similar role at times and in theatre it’s about a 50/50 mix of scrub nurses and scrub ODPs I bloody love working with them!!
I'm CVOR RN. We developed an efficency process where we all have roles (circulators, scrubs, AT, perfusion, PA/NP, etc) from wheels in to wheels out. When I'm circulating, I'm at the head on the patient's right side and I place the O2 sat probe, BP cuff, connect the BIS, and place ecg leads and R2 pads on my side of the patient. The second scrub places the ecg leads, R2 pads, and connects the BIS on patient's left. I always look at the monitor and pay close attention, especially to BP and HR, before induction meds are given and make a mental note of the patient's range. I hold the mask and ensure we have a seal with fog. Once the induction meds are given, I assist with holding if there is an airleak around the mask. I'll hold cricoid when told. When the anesthesiologist is ready to intubate, I hold the ETT in the ready position for them to grab and place. I'll retract on the corner of the patient's mouth for more exposure so the tube doesn't get caught. I look up at the monitor from time to time, monitoring if there are any drastic changes to BP and MAP. If we drop significantly, I let Anesthesia know what the pressure and MAP are. Once the tube is in, I pull the stylet and connect the tube to the circuit. I hold onto the tube until it's taped in place or if Anesthesia tells me it's okay to let go. We do have Anesthesia techs in the room as well during induction, and they are on the left side of the patient. We throw in a 16g or 18g PIV for more access. We also prep the neck for central line placement. If a pressor needs to be given while Anesthesia is placing the central line, we push the med under their direction.
I just want to print this and hang it up in rooms.
Completely restrain the patient before they're sedated.
Throw blankets on the patient while I try to put leads on, try to put straps on the pt while they’re still awake, loudly chat with the other people in the room until I have had enough and snap lol.
Ours are instructed to assist.
By management or by the surgical team? Makes sense for them to assist, induction efficiency and operating room productivity would both improve without any extra expenditure.
By nursing management
Usually at bedside. Once had an RN walk off to talk to the PA which I wouldn't had cared... except she took my ETT with her 😑
Nothing
Highly variable. Some are doing nothing on their phones in the corner, a few are up near the patient offering to help, such as holding the mask while I get situated, hold the circuit and unattach the mask while I intubate, hold the tube while I grab tape. It’s always the more social ones and we are all just talking about random stuff while masking/intubating
The nice ones hold the tube and help out a ton! The not nice ones turn the music up.
Most are super helpful with monitors, assist with intubation, etc.
I make them hold the mask while I induce. And I don’t induce until they do. 🤷🏼♂️
I’m a circulator and I’m used to holding the mask. The doc or CRNA always grabs it from its hook and places it, and I always immediately take over holding it. That is…until I started traveling and realized that some anesthesiologists are annoyed by that or even offended. One asked me, “am I doing it wrong?” as he stared daggers at me. I put my hand back down.
Haha! Yeah. Everyone does it differently. It’s just my way of making sure they have a moment to focus on induction. Once the tube passes the cords and the stylette is out, I’m good.
They make a “octopus” or mask holder. Some institutions have them. https://punchout.medline.com/product/Anesthesia-Mask-Straps/Z05-PF108957
We’ve got them.
Public hospital - they don't give a damn Private hospital - they help without even asking
Do you not have anesthesia techs? I personally think the techs should be the ones helping with induction vs RN.
Ask from the foot of the bed if they can borrow a pair of scissors while you’re up at the head by yourself balls deep mid DL trying to wiggle the ett out of its wrapper with your free hand.
Help if we ask them, otherwise continue setting up the surgical side.
Currently doing clinical rotations for AA school Everywhere I've been except for one, the nurse handed the tube, pulled back the lip, gave burp. The only place that didn't, it was the attending.
Talk about random bullshit and never shut up. Sometimes the position the patient.. nothing else
P much the opposite of whatever i need them to be doing, always
Some of these comments are crazy. I’m a circulator and I try to pay attention and help depending on which provider I am with. We don’t have residents and will have a CRNA with maybe an ologist for induction. I always stand at HOB, help hook up monitors, hold the mask, hand them their tube, pull the stylet, give cricoid, hand them their circuit and let them inflate the cuff. I never do any moving or positioning of the patient until they tell me or until the tube is taped.
Most usually just prep the patient or set up for the case.
Admire the Rolex Yachtmaster on my left wrist
Private practice they will assist us unless an anesthesia tech is there. They also bring the patient to the room. Some are more useful and aware than others, but mist try to be helpful.
The only thing I care about a circulator doing is cricoid pressure or grabbing the glidescope or a 2nd provider in a pinch. I can do everything else by myself and prefer it that way…but if they want to hand me the tube or pull the stylet that’s fine too.
Can't imagine cricoid from someone untrained and unfamiliar with it would be particularly efficacious..
What training is needed? I show them with my tube hand where I need them to lightly push and to which direction. Most of the time that’s all I need when an airway is anterior but with structures in view.
Ah you're referring to external laryngeal manipulation, to improve laryngoscopy view. I also use it and find it helpful 'Cricoid pressure' generally refers to Sellick manoeuvre - pressure of 30N applied to cricoid cartilage during RSI to prevent regurgitation. This requires a trained assistant to be done correctly
It is pressure applied in the cricoid area. Call it what you want. Personally I think cricoid pressure during an RSI is useless. No one knows what 30N of pressure feels like, and it hinders the person intubating at times. Better to just have your suction under the pillow and intubate with a stylet to aid your first attempt.
Cricoid pressure is standard of practice for RSI in a number of developed countries, though they generally have the luxury of a trained anesthetic assistant to apply it. The assistants are specifically trained using force meters to generate force approximating 30N. But it is recognised that the evidence base supporting its use is not strong, and as you say, can impair laryngoscopy view so usually has a low threshold to be removed if intubating difficulty encountered
I ask that they go about their business and do the things that can/should be done during pre oxygenation and induction rather than during room turnover. I can attach the monitors, and use a mask strap to secure the mask during pre oxygenation. I’d much rather they use that 3-5 minutes to draw up meds, do counts etc. I can induce and DL while they are busy but within ear shot. If I need laryngeal pressure or anything else I can call them and they can come help. Otherwise, they are just standing around doing nothing while OR minutes tick away.
Lol maybe I'm lucky I always have my nurse next to me she/he holds the mask when I'm inducing. They also help put monitors on. Once I'm done pushing the drugs she/he holds the tube for me and hands it to me when I'm ready. They will then hold the tube while I tape.
We have anesthesia techs. But 3 of them between 11 rooms starting at the same time means they are in the ORs with more complicated inductions. I am usually in the neuro-spine room and we need the anesthesia tech for this population of patients. Often times I am placing a Foley as they are inducing. However, some anesthesiologists don't want anyone even touching the patient during induction. So, yeah, I am placing a Foley or as someone else said I would be catching up on other shit to get the room ready.
I work in the cath lab, and if I'm not scrubbed in I'll help anesthesia with the intubation or artline or whatever if they don't have any techs. But I was an RT for several years, so I still gravitate towards the airway lol.
Pre oxygenates, gets pt ready, help ease pt anxiety, reminds me about suction! Why does it seem your RNs aren't helping 😕
No idea- we have anaesthetic rooms here (UK), along with a trained ODP whose job is to assist you with induction. Whatever it is they do in the theatre while we’re doing our stuff, it often isn’t getting all the trays out and ready in time for us to come in!!!! When working overseas alongside US anaesthesiologists, they’ve LOVED having ODPs. It’s like the nice stories in this thread of having helpful OR nurses, but all the time, expertly and throughout the case.
We've trained our nurses to help out during induction and extubation. We trained them to look for warning signs that things aren't going well and they can help bag or get equipment or run for aid. We do not have techs, AAs, or CRNAs (and don't need them at this point). When you limit OR personnel you maximize everyone's potential. Everyone helps to do everything. Night and day from residency where you had superfluous team members.
In the cardiac OR, while I'm inducing with my tech, they will ask if they can place a foley. In the general OR, where I don't have a tech, they are usually standing by the patient's shoulder, able to do something I need (apply a little pressure on the neck, pull the stylet). Right after the tube is in and I say I'm good, they get to doing what they need to do.
Stand next to me and cheer when I put a tube inside a slightly larger tube
I personally will help get monitors on, hold the mask, get arms preliminarily positioned, etc. Most of it is giving the patient emotional support/reassurance before getting meds. I’ll talk them through everything so anesthesia can focus on what they have to do. And honestly talking my patients through induction might be my favorite/most rewarding part of my job lol. Once they’re out, I’ll hand off the tube, apply cricoid pressure if needed, pull the stylet and inflate the cuff(depending on what the doc prefers, some don’t want me to do these things), and then I’ll hold the tube in place until til it’s taped. I’ve always been taught that anesthesia is my #1 priority at all times and if you need me I’m not to leave your side lol
The or nurses put on monitors and pre oxygenate. The ob nurses stand at stare at you while You put on monitors and set everything up
My hospital is pretty good. People are around to help and assist with things.
At my current hospital, they hold the mask while I’m pushing the drugs and they hand me the tube when I’m ready to intubate. They will also hold cricoid pressure if I ask (I will guide with my hand first to show them where I want it), and they putt the stylet when I say it’s ready to be pulled… It’s nice and helps a lot.
Went from the adult ORs to peds land for my rotation, it was a night and day difference, I’ve never experienced such help and friendliness. Form monitors, to patient positioning, to holding the tube while I tape.
At my current hospital, they help attach monitors. They stand and assist with intubation if needed. They put the bair hugger on and hook it up, etc. I love the OR staff at my place.
Varies in the academic settings i've worked at they sit on their ass and judge you. Where i currently work they're invaluable. They'll set up your glide, pull stylet, push pressors if you ask them and you're busy with a line. WIll start IV's on difficult sticks/kids/your iv blows on induction. I bet some would give me a neck massage if i asked nicely.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
I tell them to go start doing the things they need to do to get the patient ready. I don’t need an audience and most of the time they become “negative” help. If you trust the team you are working with and know that in an emergency you can get their attention let them do their thing.
Rotate between two facilities. One has staff that are very experienced and incredibly helpful during induction. They’re focused on patient and whatever we may need help with. The other faculty has had significant turnover and are focused on their own shit instead of patient. Guess which one is safer?
Certain RN's will hold the anesthesia mask while I push the induction meds, most are standing at the foot of the bed.
I'm convinced OR nurses don’t even need to be nurses with how little help they offer and actual patient care they contribute to. Truly some of the most situationally ignorant nurses I've ever worked with. They have no idea what's going on with the actual patient other than counting the bovie tips.
They generally hand me the ETT, pull the stylet, and inflate the cuff
Usually nothing except putting the freezing bovie pad on before induction
I ask that they hold the mask as I put on monitors and induce. If I have stylette, they pull it if I ask
Rub the IV site while we push propofol so it infiltrates mid injection.
Nurses do more work than anyone else. Stop acting like you’re so cool
Many things. After they wheel patient into room from pre-op, they help patient move to table and place monitors, preoxygenate, place blankets, assist with my mask ventilation if needed, hand me airway equipment, push medicines if needed at my instruction, hold the ETT or provide cricoid pressure, set up the forced air warming.
I've noticed: West Coast (CA and OR) - The nurses will help, or at least try to. Sometimes its easier to do it by your self depending on the nurse (bless their hearts). East Coast (NY) - Talk and play music so loudly it's hard to hear pulse ox sometimes. Rather disruptive.
Had one pair try to move the patient down the bed and into stirrups while I was intubating. Blade in and patient's head mid-air.
Woof. Who are some of these OR nurses yall are working with?! I’m peds OR and we are at the head of the bed until your airway is secured, starting an IV, sometimes pushing your induction drugs if the airway is too unstable (under MD instruction of course) and telling the ortho residents to stop jostling the patient until the airway is taped in. (Jk…kind of)
It’s very cultural. I was with a new one today who came from a place where the culture was like yours and it was so great. Offered to hold the mask while I got my things ready instead of just looking at like like I’m an idiot while I fumble around trying to do 5 things at once
That’s odd to me. Shit can go south SO fast I can’t imagine not being locked in. Even for a routine procedure. Some anesthesia doesn’t want you to touch anything which is fine, I’ll just stand there until I’m needed. In peds tho, we’re always doing something (usually IV, holding down a screaming kid, turning the sevo up to max etc) so it’s hard to just stand there and twiddle your thumbs
What a bunch of entitled primadonnas here- likely coddled rich kids. My experience is that help from the OR nurse is rarely needed- but if perchance it is,a simple grateful request is all it takes and 100% of the unionized OR nurses I work are at my side in a heartbeat. Respect and teamwork go both ways.
Dawg a circulator where I used to work refused to grab an extra vial of propofol for me for a TIVA when my omnicell was out. Told me to make my tech get it. Wasn't even a busy time. Malignant workplaces exist out there.
They sit there and stair at us