Theatre nursing at Fitzpatrick Referrals
by Laura Castell and Natalie Rowe
The theatre day starts early at 8am, opening up the three surgical theatres and setting up the prep room ready for all the operations and sedations that will take place throughout the day.
We have three surgeons operating each day, each with their own surgical list. The first two cases are in theatre by 10am. Two surgeons will operate along side each other.
We have two residents who see re-checks in the mornings; these patients are 6-12 weeks post op and come through to prep for sedation to be radiographed and in some cases CT scanned.
Noel consults in the morning and operates on his cases in the afternoon so we generally get his first case ready for 1.30pm.
A case will be assigned to me by the floor co-ordinator; this is the person responsible for running the surgical list for all the surgeons that are operating that day. For continuity, I will then stay with this patient from pre-medication until recovery.
After assessing and examining my patient I will administer an appropriate pre-medication and then start preparing for the induction and intubation. Once I have a sleepy, well pre-medicated patient I will bring him/her from the kennels to the prep room for a quiet induction. All of our patients have an i/v catheter placed for induction.
Once the patient is settled into an appropriate plane of anaesthesia, I will then prepare for the diagnostics required prior to surgery. All of our patients have radiographs taken before surgery and some need MRI or CT. These images aid the surgeons’ diagnosis, allow them to take measurements and plan the surgery required.
The patient is then prepared for surgery; the hair is clipped from the limb or site of incision and the skin is scrubbed clean. We then move through to a sterile theatre wearing surgical hats and masks. The patient is positioned and the surgical site is scrubbed for a second time. One of the interns will scrub and come into theatre to prepare the instrument table and drape the patient. The surgeon will then come in and perform the procedure. The procedures range from just a few minutes to several hours. All patients in theatre are monitored closely using surgivet monitors. The surgivet has an ECG, capnograph, pulse oximitor, mean blood pressure and temperature probes. These are all very helpful but I constantly listen to the heart via an oesophageal stethoscope and make regular checks on eye position, capillary refill time and mucous membrane colour.
Once the procedure is finished, any patient that has had an implants placed has radiographs taken to check correct placement. The surgeon will then give the all clear to wake the patient up.
Once the patient has been adequately oxygenated we take them back to kennels where they recover in a warm, clean, and quiet environment. I stay with the patient until he/she is responsive and aware of the surroundings. I make sure the patient is comfortable and has adequate analgesia on board and hand over the case to the kennel nurse who along with the ward auxiliaries continues to care for the patient until he/she is ready to go home.
When I have handed over my patient I go back to prep to either be assigned to another patient or to begin the thorough cleaning and shutting down of theatres depending on the time of day or what shift I am on as Noel will often be in theatre until after 11pm.
My job and role within the team is very important and extremely rewarding and I very much enjoy it. Some anaesthetics are long and challenging but I am always delighted to see the patients at Fitzpatrick referrals recover well after surgery in our state-of-the-art kennels where the other members of our highly dedicated team care for them through out their stay.