Emily Hakes

Mrs. Mucci

Professional Nursing 2 Clinical

04 October 2019

My Surgical Experience

During my day observing surgery, I got to see two very different surgical procedures.

The first surgery I observed was an implantation of hernia mesh, which was a quick procedure

that was done laparoscopically by an all female surgery team! This was very exciting and

inspiring to me to see as a student. I also observed a surgery in which the patient’s fistula had

descended too deep into the arm, so they moved the access closer to the skin. This is the surgery

that I will be writing about. I can say that I definitely enjoyed my day in surgery; however, I do

wish that I had been able to observe more surgical cases while I was there.

The patient in surgery was a hemodialysis patient with an arteriovenous fistula in the

right upper arm. His fistula had descended too deep into his arm, and his health care providers

were unable to access it for his dialysis treatments. The surgeon, Dr. Chicchillo, explained to me

that they became concerned when they were unable to feel a thrill from the fistula, so they

performed a magnetic resonance angiography to confirm that it was too deep. The surgical

procedure of moving it closer to the surface was one of the most interesting experiences of my

whole life. They cut into the arm layer by layer until they reached where the fistula had

descended to. Next, they tied a string around the vein and pulled it up and set it on top of the

arm. They then began suturing the lower layers of muscle back together so that they were tightly

sealed. When they had closed the muscle off enough, they placed the vein back onto the muscle

where it would now be closer to the skin allowing it to be accessible for the dialysis. They
sutured up the skin and then sent the patient on his way. The whole procedure only lasted about

one hour which is shorter than I had anticipated.

For preoperative preparation, I watched the arm be cleaned right before the procedure. I

also watched the nurse anesthetist put the patient under for the procedure. During the procedure,

there were seven people in the room: the main surgeon, the assistant surgeon, two nurse

anesthetists, the scrub nurse, the circulating nurse, and me. The scrub nurse has a big job during

the preop phase; she was there to count all of the tools before the procedure and document them

on a white board and in the computer. She had to be positive that everything was sterile and that

it stayed that way throughout the surgical procedure. The circulating nurse managed the

documentation during the procedure. He documented different times through the surgery,

retrieved any equipment that was needed, and answered the surgeons phones when they asked

him to. The surgeons and the nurses carried good communication throughout the procedure.

The anesthetists really did not say much to anyone; they stayed back by their equipment and just

administered the anesthesia as needed.

The nurses performed several actions that advocated for the patient and kept them safe

from harm during the surgical procedure. One thing they did was keep the patient strapped down

while administering the anesthesia to prevent them from falling off of the bed. Before the

procedure they also held a “time out” session where they give the patients name, date of birth,

what procedure they were having, and a small history about the patient. At the end of the “time

out” everyone in the room needs to state that they agree with the information provided. This

ensures that they have the correct patient in the room, and that they are preparing to start the

correct procedure. Both during and after the procedure, the scrub nurse was counting

instruments to make sure she had everything that she started with to ensure nothing got left
behind with the patient. After the procedure, the nurses stayed with the patient until they began

waking up, and made sure they were safe on the bed, and properly cleaned and covered up, then

they transferred the patient to the PACU.