What does it mean to be on call? Part 7-medications on the field

When we last left the OR, the surgeon was searching for visualization on the appendix.

Hark, he has found it!

I open the stapler and the load as requested. After, I take a visual and auditory survey of the room. Anesthesia seems content, there are no alarms, they have enough IV fluid.

There has been no call for the irrigator. This means that the warm normal saline that is used to irrigate the abdomen through the laparoscopic trocar sites can stay in the warmer. I never pull the warm saline before it is asked for. Some nurses hang it on the IV pole prior to surgery; but not every surgeon uses irrigation. Instead, I head for the other warmer, between the operating rooms, and pull out a bottle of warm saline. If the bag had been used, I would have asked the scrub tech to squirt some in the graduated pitcher that is used as a sterile containment device prior to handing it off to the surgeon.

Not only is there a cost to the patient every time I open and chart a different fluid, there is a cost to the environment from plastic packaging. There is enough of that in the OR already.

This is the time I consider opening and pouring the local medication into a cup on the field. There will be local medication injected by the surgeon during the case. Some inject prior to incisions and you have to remember which surgeon is which so that the scrub tech has it prepared for them and when.

This surgeon is the inject prior to closure type of surgeon. The medication was pulled before the start of case as part of my case prep. All I have to do is confirm the desired medication with the surgeon, open and pour into the prepared cup the scrub tech has left available at the edge of her table. This is when I also discuss expiration dates, or show the bottle to the scrub tech.

All medications poured on the field needs to labeled. There is no way around this. What if the scrub tech faints and a replacement scrub tech appears from no where and has no idea which medication is on the field? I joke but it has happened. It is policy that the medication is labeled with what it is, concentration, expiration date and time (if applicable). I pour the marcaine 0.5%, expiration March 2023 into the specimen cup. And confirm the details with the scrub tech, as they label it.

When the scrub tech hands it to the surgeon, they will confirm with them what is being handed off. Rarely, this is when the surgeon will change their minds and ask for a different medication. But this is a rare occurrence.

All medication given to the field must be labeled. Have I made that clear?

But what if it isn’t medication that you are dispensing to the field? What if it is a betadine, or hydrogen peroxide? You know, stuff that shouldn’t be injected? This is why labeling is so important. As is the use of the opaque cups that are in the basin pack.

Labeling the medication is important. And safe for the patient.