You are working with a plastic surgeon as the instrument nurse. Your patient is a young model who is having numerous skin lesions excised from her face and neck. Towards the end of the procedure, the surgical assistant is called away to see a patient in the emergency department. You are preparing for the count of instruments and needles with your circulating nurse. The surgeon asks if you are

Question

able to hold the skin hooks to retract the patient's skin. It is the final lesion to be excised and it is on the patient's cheek close to her eye. 1. How will you manage this situation? Provide reasons for your response. Answer: Appropriate responses include: As instrument nurse, you are responsible for the count of instruments and needles with your circulating nurse and should not be interrupted in this process. Assisting surgery is an advanced practice role. Retraction may be a role responsibility of the perioperative nurse surgeon's assistant and/or a nurse practitioner. It may be appropriate for the instrument nurse to assist the surgeon in some situations; however, the specific nature of the assistance needs to be within the scope of practice of the nurses within that facility in general (and preferably documented in policy). In addition, the individual instrument nurse needs to be competent in the skill before agreeing to assist, otherwise should inform the surgeon that the skill is outside their individual scope of practice. An untrained assistant may be increasing the risks to the patient, who in this case is a young model having plastic surgery to her face. These risks include skin and nerve damage as well as damage to her eye by a misplaced skin hook. You have completed your first count and the surgeon is now preparing to suture two remaining incisions on the patient's face, including the incision near the eye.

What will be an ideal response?

Answer 1

Answer:
Appropriate responses include:

Ensure that there is adequate suture material for the remaining incisions.
Enquire about the surgeon's preference for dressings and ointments, particularly considering the sutures near the patient's eye.
Place sterile dressing material in a clean container such as a kidney dish or bowl.
Ensure there is adequate equipment including saline and sponges to clean the patient's face, hair and neck before applying dressings.

You are now able to help the surgeon by cutting the sutures, which is a task commonly performed by the instrument nurse and a skill already within your scope of practice. The surgeon takes time to explain the z-plasty technique to you and the placement of the suture knots for a neat scar. The surgeon then tells you that one of your colleagues regularly sutures the wounds and asks if you would like to suture the last incision.