Breast Lumpectomy w/Sentinel Node bx.

I’m not sure how other surgeons do their breast cases, but I wanted to share how ours are done & how I prepare for my breast cases.

Laparoscopic Jejunostomy – On Call

✂️This was a first for me: the procedure & working with the on call Doctor. I had to ask her what she needed for gloves, which scope she preferred, suture, etc.
✂️We grabbed extra supplies/instruments we thought she might want or need later on in the case, just in case she asked for them. We did, however, forget an extra pair of bowel graspers! 🤦
✂️Normally for these we wouldn’t use laparoscopic scissors so I didn’t grab any. I should have brought some in the room just in case. We did open a pair because she had to suture the jejunum up & used the knot pusher & needed lap. scissors to cut the suture at the end. It was cool to see, since I had never seen one done before. And it’s always intersting to see how every surgeon does it differently. I had not used laparoscopic needle drivers before, so that was interesting!! 😂

Laparoscopic Appendectomy – On Call

Our emergency Lap. Appy from our Holiday call. I finally had the chance to break out & get a good photo of one of these for my binder!! We don’t do them too often, but when we do it’s usually an emergency case.

I thought this would be a great opportunity to share my photos & some tips/tricks…

Port Placement Surgery

The thing about surgeons & surgeries is that every surgeon does things differently. I can only give others a general idea of how a case may go & then you just have to adjust to how your surgeon prefers to perform each surgery.

Week 14 as a CST

Total Knee – this was my first. My preceptor set it up & let me take things apart & put them back together. I watched her pass it. She was so amazing. I don’t know how I’ll get the hang of these!

9/17/22:
on call> Suction D&C

WEEK 14
9/18/22:
on call> ORIF L. Distal Lateral Femur (6:22am-11:30am) covid +

Week 13 as a CST

This week was a long week, but I think was still a really good week & I learned a lot! I’m communicating more with the doctors, I’m able to realize when a case isn’t pulled correctly, and communicate to SPD & have it fixed… I’m just working on knowing how many instrument sets we have & when we have a long line-up when I need to call & have them one trayed, etc. I’m working on that! I feel like I’ve come really far, though, since I started! I’m so proud of myself & everyone keeps complimenting me (my boss even emailed me that she has heard nothing but positive comments about me from others) & it feels so great!

Week 12 as a CST

This week was all ortho except for Tuesday, I did a few general cases. I do enjoy general cases. I’m also starting to really enjoy ortho! The ACLs & knee scopes with meniscal repairs have been a favorite. I’m starting to get better at Gamma Nails so I’m enjoying those more & more. I’m learning their trends & what they’ll need next & am able to be more proactive with helping out with holding the leg or knowing when they’ll need an instrument by what they’re doing. It’s exciting when you start to get familiar with their techniques & can have what they need before they ask for it or when they ask for the wrong thing & you have the right thing in your hand & they’re like, “Yeah, that’s what I meant… thanks!” Always makes me laugh. & they compliment me on knowing what they needed when they didn’t. Makes you feel more confident, too. I’m just trying to learn all the gamma instruments. I can put them all together pretty well & know the order pretty well & when they’ll need a mallet or when to switch the wire driver out for the drill bit, etc. Sometimes the rep will try to tell me what they’re asking for or go to instruct me on how to assemble something & I’ve already got it & he’s like, “Yes, you know what you’re doing. Nice job!” That always feels good, too. I’m getting there!! I think I’m finally comfortable with all the cords & pretty quick with them! I remember when I first started & it took me forever & I was fumbling & might accidentally throw off too much or drop one, etc. Now I can do it super fast & have it all ready for them. I can hold a leg with one hand & dis-assemble & re-assemble an ablader, etc. or grab an instrument sterilly without setting something else down. & it’s always nice when your surgeon or someone else in your room compliments you. There’s nothing worse then feeling like you’re improving or doing well & being told you’re not being effecient enough. I’ve definitely had that previously & it makes you feel so crappy.

Anyways, on to what I did this week & some setup photos!

Week 11 as a CST

This week was quite busy. Monday started with a sinus infection. Wednesday I had to call off to see the Dr. for meds. Friday all the cases were running long & we had a trauma come in. Everyone was scrambling. Our boss was roaming the halls in a panic trying to pull people from where she could. We all came together & helped out wherever we could.

Week 9 as a CST

With 2 months of orientation down, I’m feeling a lot more confident in the O.R. My communication is getting stronger each day. I’m more confident in setting up. I’m remembering previous cases & what they need next & am able to have most things ready before they ask for it. I’m conquering cords one day at a time! HA. We are getting there.

I was super nervous to start ortho but I think I’ve really been enjoying it. That mini c-arm gets me, though. I struggle to get it draped but am getting better each time.

Having a Rep is really nice because they help you find what you need! They open things up to you that the surgeon will need & they explain what to do with it, etc.

Suture & Local vs Different Specialties

As I rotate through the different specialties during my orientation I am noticing the differences between suture & the order it’s used & what it’s used for. I also noticed the differences between when local is used & when it’s not used.

The longer I scrub & have to pull suture & put the extra suture back, the more I remember where it all is & what it’s used for. I will share what I have learned so far.

I always have my pile of suture I need & then a pile with 1 extra for each suture pulled, as well as any holds/availables. Gyne is one I have learned you grab more than one extra for! Once you use the last one you always make sure to ask for another!