Not on My Back Table!!

Don't even think about lobbing that ovarian cystic teratoma on my back table.

Old school scrub nurses work from 2 horizontal surfaces, a Mayo stand which is positioned just South of the surgical site and a back table that sits at the patient's feet at a right angle to the patient. Every scrub nurse likes to keep an organized Mayo stand with a minimal amount of instruments. When it's time to close all I kept on the Mayo stand was a pick-ups, needle holder, suture  and straight Mayo scissors. This can lead to the back table assuming the role of a dumping ground which got me  angry as a surgeon with a non-functioning suction. Here are some things to keep away from my back table or I will pinch your keister  with a sponge ring forceps. I am experienced with doing this without breaking sterile technique, so beware! I know from personal experience that sponge ring forceps can leave one heck of  a mark and the pain can give you something to really think about.

I don't like basins of water or solutions sloshing around on my back table. This is an OR, not a trout farm. Whatever happened to ring stands for basins of water? When I see photos of contemporary ORs the ring stands have disappeared. Where does all that unused OR  equipment wind up? Probably in the same place as sponge racks and table-side light stands. Bring back the ring stands and get that aquarium sized basin of water of your back table. It's a hazard every time you move or bump the back table. A wet back table is a contaminated back table.

Another thing I hate on my back table is oversize specimens. Trying to land a huge pandus or teratoma on my back table is like landing a 747 jumbo jetliner on an aircraft carrier. Don't do it. Big hunks or globs of tissue should be handed off to the circulator. If the circulator is busy and the surgeon insists on lobbing that Big Tuna of a specimen your way, just drop it in the kick basin. The crash/splat noise it makes when it hits the target will remind everyone not to pull this trick again. Think of that sound as resembling a church bell ringing in a slaughter house as that big side of beef is placed on a cutting table. It's a  very memorable sound like a newborn's first cry or the rales and rhonchi of a patient on his death bed; an acoustic experience that really sticks with you.

Kudos to the person who invented sterile operating room light handles. Surgeons are like patients in that the more they can meet their own needs, the better for all parties concerned. Savvy scrub nurses do not keep sterile light handle adjusters on their back table. Before you set out an instrument, take a couple of seconds to thread those sterile light handles in place. Get them off the back table.  When a surgeon bellows to the circulator for a lighting adjustment you can curtly reply, "The adjustment handles for the lights are sterile, monkey around with them at your leisure." Multiple adjustments of lighting on the same surgical site can be indicative of a poor prognosis. I wrote a post about unusual signs of a bad prognosis, I think it could be located by typing "Prognosis" in the search box. In the new year, I promise to figure out links!

Anything that has the potential to dangle over the edge of the back table does not belong there. Only the very top of any table is considered sterile. Get rid of that suction tubing and potential dangler early in the game to be on the safe side.

Here is something that I have had some painful encounters with. Loaded needle holders on the back table are a real danger to hurried hands. They will stab you right through that glove.  Why do bright, young whippersnapperns wear gloves when handling needles? Gloves provide no defense when it comes to needle sticks and dull tactile sensations. It is hard for oldsters like myself to make sense of healthcare today.

Enough of my foolishness. Thanks so much for indulging in my silliness and I hope the New Year brings you peace and fulfillment in all that you do.