Bariatric OR Q&A


BariatricQ&A350x250Bright Lights, Sterile Environment: What Patients can Expect in the Operating Room

Prior to going to the operating room, bariatric patients are often anxious and have a lot of questions about their surgical experience. We spoke with Heidee Albano, RN, Clinical Advisor in BIDMC’s bariatric operating room, and OR nurses Anne Bonner, RN, and Celia Barselou, RN, who describe how they ease patient concerns, provide comfort and promote safe, positive outcomes.

What is the role of the Clinical Advisor Nurse in the bariatric operating room?

Heidee: I think of myself as the captain of a ship, overseeing the OR and guaranteeing that we provide quality care to patients. I prepare the staff to answer patients’ questions with compassion and confidence. I have worked in the OR for more than 30 years and collaborate with the nursing staff and [Weight Loss Surgery Center Director] Dr. Dan Jones to assure that all professional needs are met. I also provide required educational updates and trainings to the OR staff.

Describe the responsibilities of a scrub nurse and a circulating nurse.

Celia: A scrub nurse and a circulating nurse each have their specific duties, but work simultaneously to meet the needs of the surgeon and the patient for a successful surgery.

A “scrub nurse” is a nurse or certified surgical technologist who is in charge of keeping the surgical field sterile throughout a procedure. They assure that everything is sterile in the OR to prevent infection and have a specific checklist to review and complete prior to the patient entering the OR. The scrub nurse also provides surgical instruments and supplies to the surgeon during the operation.

 

Anne: For a “circulating nurse,” one of the main duties is to assure that all patient risk factors are addressed by the surgical team. A weight loss surgery patient often has health risks associated with a high BMI. These can include things like safe patient transfers and accurate assessment of obstructive sleep apnea. We follow clear procedures to promote optimal outcomes for patients.

 

Heidee: Simple as it may sound, one of the most important things is to validate that we have the right patient, for the right surgery, at the right time. After that confirmation and the pre-op assessment, the circulating nurse prepares the patient on what to expect in the operating room.

What are patients mostly concerned about before surgery starts? How do you ease patients’ anxiety?

Patients are first admitted to the pre-op holding area before going to the operating room. In the pre-op area, the surgeon, anesthesiologist, nurses and surgical staff introduce themselves to the patient. Family members can be with the patient here. First and foremost, we address all of the patient’s questions. Common ones include:

  • How soon will I wake up after anesthesia?
  • How much pain will I feel after surgery?
  • Will I have nausea and vomiting due to anesthesia?
  • How soon can my family see me?
  • How long will my surgery take?
  • Will my surgeon be there for the entire surgery?
  • Where am I taken after the surgery is completed?
  • Will I be all right? I just want everything to go okay.

We try to comfort patients by explaining that we are trained to handle emergencies, and that our OR staff is a highly specialized team who have worked together to perform many successful bariatric surgeries. We tell them that we are the A-Team — A team that provides the best care a patient needs and deserves.

We address any concerns family members have, too. We tell them how long the surgery will take, and where they are able to wait. Bariatric surgery can take one to four hours, depending on the procedure. We take a cell phone number and Dr. Jones calls immediately after surgery is complete.

Patients usually wake up a few minutes after surgery is complete, and the first thing they ask is if the surgery is done. We generally see smiles when a patient is told it’s over and went well.

What happens in the operating room?

Once the patient is brought to the OR and moved to the operating table, the anesthesiologist sets up monitoring of their blood pressure, heart rate and oxygen level. For general anesthesia, a mask is given and the patient is told to breathe deeply. The OR table has secured, padded boards to keep arms from falling off the table, and safety straps are placed across the patient’s lap, thighs and legs. Special care is provided to assure that bariatric patients’ pressure points are protected.

Right before the surgeon makes an incision, a “time out” is conducted by the entire team as a safety measure to ensure that everyone in the room agrees that we have the correct patient and procedure, knows of any allergies and confirms the correct surgical side. We review medications, the patient’s position, and whether the staff has the necessary equipment.

What happens following surgery?

Once a surgery is complete, patients are transferred from the OR to the Post-Anesthesia Care Unit (PACU), where they stay for about four hours and are monitored by anesthesia staff until they are fully awake. Patients are then transferred to the bariatric surgical floor to begin post-operative care.

Why do you like working in the OR, and specifically with bariatric patients?

Heidee: It is an honor and a privilege to care for this patient population because I know that this is a life-changing measure for them physically, psychologically and emotionally. I love my job because I get to work with a great team under the leadership of Dr. Jones. This is a group of professionals who are caring, dedicated and committed to their job of making a difference in people’s lives.

Celia: Awareness of our patients' undertaking the weight loss process helps me tremendously, and is one of many reasons I love working in the operating room.

Anne: Having had weight loss surgery myself, I realize how brave these patients are. It takes courage to have weight loss surgery. I’m honored to be by their side.

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