Katrina qualified from the Royal Veterinary College in July 2012 with a Foundation Degree in Veterinary Nursing. She then spent a year and half working in a mixed practice in Nottinghamshire and whilst enjoying her job she felt happiest when she was in theatre, being able to watch the operations, observe normal and abnormal and further her knowledge on the anatomical changes and the theory behind the surgical procedures. Katrina therefore made the decision to find a role as a theatre nurse within a referral practice, allowing her to see a variety of cases different cases, increasing her knowledge further. In 2013, Katrina joined the Langford Small Animal Referral Hospital and here is a taste of Katrina’s role with ‘a day in the life of a surgery nurse’.
Upon arriving in the morning, I check what is due into theatre for the day. This allows me to plan ahead preparing the theatres for the day’s cases and allows me to schedule which case will be going into which theatre. I then start to prepare the appropriate theatres, I do this by damp dusting all equipment – including anaesthetic machine, diathermy unit and the table- and any fittings, lights, switches etc. I connect and check all equipment is working correctly, and ensure there are no leaks with the anaesthetic machine and set up a circuit suitable for the patient. The table and the anaesthetic machine are suitably positioned for the surgery, allowing ease of access for both the surgeons and anaesthesia teams.
When I am happy that the theatre is set up correctly, it is important to ensure it is fully stocked to avoid any rushing or searching during the operation. Once this has been complete the kit can be moved into the theatre and set up ready to be opened.
Once the patient and theatre are prepared, the patient is received at the entrance doors and anaesthesia is assisted with moving the patient quickly and efficiently, keeping the surgical site as clean as possible. We then transfer the patient onto the surgical table and position correctly for the surgical procedure. It may be necessary to then check with the surgeon that they are happy with the positioning before they start scrubbing. After confirming all personnel are wearing the correct attire (scrubs/hat/face mask) the final skin preparation is carried out - with no hand contact onto the skin maintaining sterility. The kit and drapes are then opened ready for the surgeon to start draping. Once I am happy that everything is ready I move round to assist the surgeons with the gowning.
Whilst the surgeons are draping the patient, I make sure anaesthesia and the surgeons are listening and a check list is carried out; this confirms the patient (before any incision is made) the surgical procedure that is going to be carried out, if antibiotics have been given peri-operatively, any additional procedures (e.g. radiographs, feeding tubes), then the surgeon must then do a swab/ sharps count to confirm the amount before the first incision is made.
Whilst the surgery is taking place it is important to keep check on everyone around the sterile area, to certify that sterility is intact, and speak up if it has been broken, allowing kit to be replaced and to keep things as sterile as possible. It is also important to be at hand in case extra instruments or consumables are needed. All consumables are recorded, as are all personnel within the theatre, allowing details to be confirmed at a later date if required.
Once the surgery has finished and before the incision is closed, another swab/ sharp count takes place to guarantee everything is accounted for. The surgeons are then given suture material to close the wound. Once closed, this is then cleaned and dressed correctly (if needed) and the patient is generally checked and cleaned. Once everyone is happy, the patient is transported out of theatre and into the recovery ward or radiography, depending on the surgeon’s request.
It is now time to clean the theatre. First the kit is checked to confirm that all instruments are present and are prepared to be taken for cleaning, the suction canisters, light handles and diathermy also go to be cleaned and sterilised. Anything that is disposable and contaminated goes into the clinical waste, packaging/ paper etc. goes into the general waste, sharps/ bottle go into the appropriate disposable bins. The theatre is then cleaned down using a high level disinfectant to warrant satisfactory cleanliness – the table, anaesthetic machine, diathermy unit, suction unit, bins, table (including the frame, cushions and underneath the cushions). Once I am happy everything is sufficiently clean the floor is swept, and mopped (again using the disinfectant).
The theatre is the reset and restocked ready to receive the next patient.
(If there is time, a quick tea-break takes place before the next patient is due in).
This process is then repeated throughout the day for every case that is planned for the day.
At the end of the day, when all surgeries are finished, and the theatres are all cleaned, it is time to disconnect all the equipment and the anaesthetic machine, set up the kits ready for the next day, and essentially prepare as much as possible for any early starts due for the following morning.
Working at Langford has been challenging, learning all of the new procedures, equipment and instruments. However, it has also been extremely rewarding. I have seen many interesting cases, such as observing how a total hip replacement is carried out, total ear canal ablation and hemilaminectomies.