Intraoperative Care
The core of the circulating role
Intraoperative care requires simultaneous management of asepsis, safety, and the sterile field. Key concepts include sterile technique and field boundaries (tabletop is sterile; edges and below are not), gowning and gloving without contamination, and prompt correction when a break occurs. The RN monitors positioning for physiologic alignment and pressure relief, protecting nerves at risk - brachial plexus from arm abduction beyond 90 degrees, ulnar nerve at the elbow, peroneal nerve at the fibular head. Thermal regulation (forced-air warming, warmed fluids, humidity control), glycemic monitoring, and fluid and blood product management require continuous vigilance. Any medication poured onto the sterile field is labeled by the person who prepared it with name, concentration, dose, time, and initials. Electrosurgery safety includes proper dispersive pad placement, dry preps, and no pooling of alcohol-based solutions.
Counts and the traps around them
Surgical counts are performed audibly and sequentially by two people - the RN circulator and the scrub person - never by the surgeon alone. Counts occur before incision, at the start of wound closure, at skin closure, and at the end of the procedure, plus any time a count discrepancy occurs, a team member is relieved, or the patient is transferred. An unresolved discrepancy triggers a search, notification of the surgeon, and an intraoperative radiograph.
Specimens and rule of thumb
Label specimens at the field with patient identifiers, site, and orientation, and verify verbally with the surgeon before transfer. Rule of thumb: if it can be lost, left inside, mislabeled, or counted, a second person verifies it.