A normal Working day in Operating Theatres

Operating Theatres, or Operating Rooms (depending in which part of the world your are), always fascinated me. When i was a kid and watched tv shows that involved some of the action in operating theatres led me to think: How cool would it be just to watch a live surgery! And then i grew up and eventually went to nursing, and one of my placements was in operating theatres. It was just for a week to see how things work but i loved it. I really could see my self working on an environment like that.
Graduation came and i decided that i would work in theatres one day, but first i would have to get some experience. SO my first job as a nurse was on a Surgical Admission and acute surgical ward. Very busy and very stressful that gave me lots of experience and learning opportunities.
A couple years later after i finished my degree, an opportunity to work in operating theatres came and i grabbed it straight away. It was very challenging but very motivating. When someone with no experience in theatres starts working in such environment needs 6 months to be properly trained. That is what happened to me. Even today i found myself still learning so many different things that is hard to keep up some times. But i digress. My main purpose of this article is to show you:

How is a working day in Operating Theatres

Working in a operating room follows a certain amount of routines that need to be done without failure. Normally i start the day buy entering the changing room and get my scrubs. Then i go to the coffee room to relax, take my morning coffee and talk with my fellow work colleagues. Then at 8 AM sharp, we all get up and go to our designated theatre, or check the allocations board if i haven't done so.

The theatre team, normally has 2 scrub practitioners: a nurse or operating department practitioner(ODP), a support worker and a Anesthetic Nurse or ODP for the anesthetic bits.
The team when arriving to the allocated theatre starts doing the routine checking. The Support worker and scrub can start checking the operating lights, putting the equipment at the right place and test it, turning on the computers and check for stocking levels. Basically is just to check that the theatre is ready for the first surgery. The Theatre Practitioner responsible for the anesthetics area will do his own check ups. He will test the ventilators in the anesthetic room and in theatre. Refill the anesthetics gases, swap filters, cut tubing and prepare the drugs for the first surgery. The second scrub nurse, while all this is happening is checking the operating list for the day, see if all the sets needed for each operation are taken out and all the supplements needed are present. Checks if all the necessary hardware is present and if not, take care of it. Normally who does this is the practitioner in charge, which is quite often the Sister or Chief for that specific operating room. But this is team work and everyone does a little bit of everything to make things go smoother.
When everything is in place and ready to rock and roll, which should be done in 30 minutes maximum it is time to do a "group hug". This is when the team gathers with the anesthetist and if possible with the surgeon(s) to go through the list and see any specific concerns or special requirements like: allergies (specially latex allergies), equipment requirements (microscopes,special cameras, life saving fluid giving machines, need for blood) and other concerns that may arise.

After this we get the first patient and take him to the anesthetic room where we do all the check ups for the patient by follow the World Health Organization checklist to prevent any potential error, which basically is to make sure we have got the right patient, we know what the surgery is, and where it is (side, limb, etc).
Meanwhile, one of the scrub nurse starts preparing for the surgery by actually scrubbing his hands and arms, while the other one (for now on: the runner) opens the instruments sets. The scrub nurse is now fully sterilized and can start putting the sets on the trolleys the way he wants them, and can start accepting the supplements from the runner.

Patients comes fully anesthetized, is transferred to the operating table. The anesthetic practitioner will be assisting the anesthetist and will take care of the positioning of the patients, securing arms, iv lines, drips. The runner will put leg pumps on the patients (if it is required) for the prevention of Venous Thrombo Embolism, and insert a Diathermy Pad on patient legs if no metal work is present there. After this he can assist the Anesthetic practitioner if it is still required help. The mechanics can differ from place to place but generally this is what is done to the patient: Airway secured, Breathing properly with no compromise, all iv lines secured and running and safe positioning of the patient.

After all this is done, the scrub nurse and the runner do a check on the patient, to make sure everything is correct. Meanwhile the Surgeon should be finishing scrubbing by now. After the checks are done, the scrub nurse can start preparing the surgical area with Iodine solution or Clorhexidine to sterilize the area. Then help the surgeon to place all the sterile drapes so that only the necessary skin area to work is showing.
Before the surgeons starts the "Knife to skin", everyone should have done the second part of the World Health Organization (WHO) checklist. Only then the surgeon is authorized to start "cutting".
Meanwhile the Runner or Support worker takes care of the suction lead and diathermy lead and plugs them appropriately. One of them updates the board with all the swabs count, needles, blades so that everyone knows with how many of each we start the surgery.
While the surgery proceeds, the scrub nurse will assist the surgeon on the operation if he does not have an assistant and/or hand over any instrument needed. The scrub nurse will advocate for the patient safety during the surgery and the runner will get any thing the scrub needs and will even think ahead of the scrub. The support worker can also do this but generally they take care of the paperwork and the computer bits.

During and almost at the end of the surgery, the scrub nurse and the runner will do counts to make sure nothing is missing, like swabs.
The surgery is finished, patient went to recovery, the scrub will check the paper work, sign anything that need to be signed, finish the computer profile, take care of any specimen if applicable and then handover to the recovery staff. Come back and help the support worker and runner to clean the theatre for the next patient, that should be by now in the anesthetic room.
For the second surgery the runner should become the scrub nurse and vice versa. And this will continue until the end of the list.

In the end of the list, and after the theatre is properly cleanned, the list for the next day is printed and all the sets taken out, supplements prepared and re stocking is done, all to make things easier for the next day staff.

And that is it. Generally this a normal routine of everyday work in a operating theatre. Off course there is much more to talk about but then this article would be too big to read.