Do Your Homework!

Lessons Learned Sharing Your Stories and Advice The Stitch

By: Sara Buria, MA, MS, BSN, RN, CNOR, CHES

Published: 10/17/2024

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One clear memory of my first years as a nurse in the OR is all the times I did not do my homework (ie, the prep work prior to a case). Homework involves collecting the correct supplies and instruments for a case, knowing the basics of the type of surgery to be performed, and preparing for the “what ifs.”

The Story

One day in my first year of working in the OR, I was scheduled to circulate in orthopedics. The surgery schedule had knee arthroscopies and carpal tunnels. The day before, I was thinking that this was going to be an easy day. I had circulated in other orthopedic cases, but it had been a while since I had done an arthroscopy, and the first case of the day was a knee arthroscopy. We had the patient positioned, prepped, and draped, and we started the procedure. I had the fluid management system going with two bags of 3000 ml normal saline. I thought this would be enough fluid for the case. It was about 30 minutes into the case when I heard the surgeon ask in a very loud voice, “Who put air into the system?” The bags of normal saline had emptied, and the arthroscopic tubing system was filled with air. “That would be me, doctor,” I said. In those few moments, I felt a mix of emotions, from dread to shame, and I chastised myself for not thinking. To add to the frustration, I did not have extra bags of normal saline in the room and needed to go to the supply area to obtain more.  

The Lesson 

This experience reminded me, and continues to remind me, to do my homework. I precept others in the OR and emphasize the importance of prepping for cases: 

  • Take the extra minutes and review case notes.

  • Communicate with your preceptor or core leader about the case and do a walkthrough or mock scenario of the surgery.  

  • Read and research information from trusted sources, such as AORN, to learn more about specific surgeries and evidence-based practices and procedures.  

    • Arrange a time with your preceptor or core leader to ask specific questions, such as

    • What other supplies might I need for this case? 

    • Where can I find extra trocars or arthroscopy blades if this surgeon wants additional supplies? 

    • What does XX on the preference card mean and what should I do? 

    • What should I do if something goes wrong, like dropping the light cord or breaking the camera? 

Tables 1 and 2 provide example homework checklists for a knee arthroscopy and bowel resection procedures. 

Table 1. Example Homework Checklist for Knee Arthroscopy 

Review the preference card and setup  

Ask the charge nurse if extra supplies are needed 

Ask if a rep will be present and if they are bringing items 

Get extra 3000 mL bags of irrigating saline; burrs, blades, and trocars; tourniquet cuffs; and suction containers 

Watch a video of the procedure  

Review equipment on the arthroscopy cart and needed attachments (foot pedals, plastic covers, electrical cords) 

Make a reminder to place a cautery pad on the patient 

Note surgeon preferences (such as a metal [not plastic] knee holder) 

Ensure there is a metal step for the surgeon (and have an extra one) 

Note that cautery is set at 15 coag and 10 cut 


Table 2. Example Homework Checklist for Bowel Resection

Review the preference card and setup 

Ask the charge nurse and surgeon if extra supplies are needed 

Have extra suture, lap sponges, sterile gowns, and gloves available 

Ensure a Bookwalter retractor (with an extra table and sterile drape) is available  

Always have a Foley catheter available, along with smaller catheters  

Have external pneumatic compression/pneumatic compression sleeves available and ready to use for general or spinal anesthesia cases 

Ensure end-to-end anastomosis staplers are available in the room 

Have the correct count sheet to correspond with tray(s); count instruments with the scrub person prior to the start of the case and at the end of the case to prevent retained surgical items 

Review patient chart: labs, history and physical, etc. 

Check the patient's weight because a different table, arm rests, or padding may be needed, depending on the weight; know the location of extra positioning devices and attachments 

Ask the surgeon about positioning before the patient is brought to the OR 

Be aware that a portable x-ray may be done at the end of the case 

Note that cautery is set at 30 coag and 30 cut (this may need to be adjusted) 

 


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