As veterinary nurses we are all trained to work in the theatres, it is a big part of our role. A theatre nurse could be the qualified nurse who is going into theatre to monitor a procedure, or the one that is assisting with preparing a patient for surgery – or both. We have to learn about how anaesthetic works, how to monitor patients, what procedures we might come across and so much more. But what does it take to be a theatre nurse? What do we have to do to ensure patients are safe in the theatre and how do we prepare patients for a procedure? There are many roles within the theatre nurse position so let’s have a look at what they are. 

The start of the day 

A theatre nurse’s day will begin with being assigned to a patient that is coming in for a surgical procedure or an investigation like x-ray. They start their day by getting all the equipment, x-ray and theatres ready for the procedures.  

If they have a surgical procedure then they have to get theatre ready, the first step they will do is to damp dust. This means that all surfaces are wiped down to remove any dust, dirt or bacteria that may have settled since it’s been cleaned. Only once this is done, we can then prepare the theatre. 

We can now start putting the anaesthetic equipment together that we need 

We firstly have to ensure our oxygen is connected to our anaesthetic machine. The oxygen may be piped in from big oxygen canisters that will be outside the building, or from smaller ones on the anaesthetic machine, or even generated by an Oxygen Concentrator out of the room air. Whichever system we’re working with, though, we have to check it over, make sure everything is working, and that there is a backup supply in case of an emergency.  

We then need to ensure the volatile agent vaporiser is connected and full. This is the device that turns the anaesthetic liquid into an inhaled vapour which we use to keep the patient asleep. And of course, the exhaled gases need to be safely removed. Most practices use an active scavenging system that will need switching on, this system removes any of the waste air products that the patient has exhaled during their general anaesthetic. Others may use small-scale flusorbers, devices that filter the exhaled air to remove left-over anaesthetic gas to prevent it escaping into the atmosphere.  

We will have to check how heavy the patient is that will be coming into the theatre as we then have to choose a suitable anaesthetic circuit based on weight. The anaesthetic circuits provide the patients with oxygen and anaesthetic gas to keep them asleep. We attach these onto an anaesthetic machine.  

Before using it, it is vital we check the equipment for any leaks, we don’t want the circuit leaking otherwise the patient will not be staying asleep and we don’t want to be inhaling the anaesthetic agents. Finally, we perform a full anaesthetic machine checklist, and leave the machine ready for use. 

Then we can get on with setting up everything else that might be needed 

Once we are happy with this, we can prepare the theatre table, do we need positioning aids? This could mean finding the correct size trough if the patient needs to be kept on their back. We normally use heating aids like heat pads followed by theatre towels on top, lying the patient on bubble wrap is also a great way to keep their body temperature maintained. It is important to keep the patient as warm as possible as during anaesthesia their body temperature will drop.  

At the same time, any monitoring equipment that we will be using needs to be set up, ready for use. In some cases it may also need calibrating to make sure it’s all working correctly. This would typically include ECG (to monitor the patient’s heart), capnography (measuring the carbon dioxide they are breathing out) Pulse Oximeter (measuring the amount of oxygen in their tissues), and blood pressure machines. 

We then need to get the equipment that is needed for this procedure 

All equipment is sterilized so when getting this we need to check it is in sterilisation date. We can then lay out what we need, ready for the patient and vet. If the patient is needing an X-ray, we also have to prepare that room as in most practices it is separate from the theatres. We will need to turn on the X-ray machine, register the patient on the system so we have a record of their X-rays and again prepare the anaesthetic machine in that room with a circuit and ensure there are no leaks. Now the theatre has been prepared we can now look at the patient and prepare them for the procedure… Phew! 

Scrub nurse 

Within the theatre nurse team, we can have scrub nurses. These nurses often assist the veterinary surgeon with a procedure by scrubbing in. This veterinary nurse needs to be confident with handwashing, gloving and gowning, maintaining sterility and have a good understanding of surgical procedures.  

Before going into theatre to assist with a procedure the surgical nurse has to scrub up. Which means they have to handwash correctly and dress with a surgical gown and gloves in a sterile manner. There is a correct method for handwashing to ensure your hands are dirt and bacteria free. The currently accepted correct way to wash your hands to prepare is to follow the WHO hand washing technique, typically using a specialist alcohol or chlorhexidine based hand scrub solution, which must remain in contact with the skin for a specific period of time. 

Once the scrub nurse is dressed and sterile for theatre, they can then go in. When in theatre the first thing they will assist with is taking the sterile instruments from the circulating nurse and placing them on the theatre tray and arrange them so they are easy to find when the vet needs them. Some scrub nurses may drape the patients, which means placing drapes around the surgical site to prevent any hair or dirt getting into the wound. The next vital role of the scrub nurse is to assist the vet with the surgical procedure. They keep instruments organised and keep a count of what they have. They pass the vet instruments when asked. They will also in some cases have to hold body tissue out the way.  

Circulating nurse 

The circulating nurse is a member of the theatre nurse team who helps things keep moving. This means they assist with patients in the prep room and assist with taking patients into theatre. The prep room is where patients are induced with anaesthesia and surgical sites are prepared. When preparing patients in the prep room the circulating nurse will help or place intravenous catheters, taking blood samples and assist with taking vital signs of the patient. 

They will then assist with patient preparation 

Once a patient is induced the circulating nurse will help the theatre nurse by clipping the surgical site. We have to clip a wide patch of hair around the surgical site to ensure no hair contaminates the incision. Once this is done the nurse can then clean the clipped usually with chlorhexidine, but sometimes with povidone iodine, to remove any dirt and bacteria.  

This nurse will then assist with moving the patient into the theatre and do a final clean on the patient.  

Once the patient is ready then the circulating nurse will then open the sterile instrument packs for the scrub nurse or vet and hand them to them. Once the circulating nurse is free, they will then prepare for the next patient that will be going into theatre. Whilst preparing for the next patient the circulating is normally close by to the theatre in case, they are needed again to help the anaesthesia nurse. If there is a problem with the patient then they will be called or if the vet needs extra equipment they will then be called to find and open the equipment.  

Anaesthetic nurse 

One of the main roles of the theatre nurse is to keep a patient under anaesthetic. This nurse needs to be very confident in what they are doing, what vital signs to look out for and have a very good understanding of how anaesthetic works. Let’s have a look from an anaesthesia nurses’ point of view at how we anaesthetise a patient.  

Firstly, we have to ensure the patient is fit and healthy for an anaesthetic, we wouldn’t want to give a patient one that was physiologically compromised, if possible. Taking vital signs like heart rate (does the heart sound normal or does the patient have a heart murmur?), respiration rate (does the chest sound clear) and temperature, this could be slightly high as the patient is bound to be a bit worried/stressed. Taking a blood sample for a pre-anaesthetic profile will check the patients’ vital organs. If this is all OK then we can continue. 

The vet will prescribe a pre-medication. This is medication that is given as an injection, before the anaesthetic, and usually contains some sedation and pain relief. It will be given around 20 minutes before the patient is induced.  

Induction of anaesthesia 

This is the process of getting the animal to sleep, and we use a variety of medications for this purpose. For most of them, the vet is legally required to perform the induction, but the anaesthetic nurse will support the patient and raise veins. The vet or the nurse will then intubate the patient – placing a tube in their throat to help them breathe – and connect the anaesthetic machine (hopefully all set up and ready to go after our early morning checks!).  

Once the patient under, the anaesthesia nurse then needs to monitor them throughout the procedure 

During monitoring we monitor all the vitals, heart rate, pulse rate (which may be different!), respiration rate and temperature, as well as the additional readings from our monitoring equipment. Monitoring heart and respiration function, reflexes, eye position, pulse quality, cardiac electrical activity, capnograph trace, blood pressure, and blood oxygenation throughout anaesthesia is important as it can tell us how the patient is reacting to the anaesthetic and procedure.  

If the heart and respiration rate or muscle tone and reflex activity increase then this can indicate the patient is too light, so is not under a good depth of anaesthetic and is feeling the procedure. If this happens then under the vet’s direction, we can increase the anaesthetic agent or give more pain relief. If they drop, however, then this could indicate that the patient is too deep or they aren’t reacting well to the anaesthetic.  

Monitoring a patient’s blood pressure is vital under anaesthetic. A low blood pressure – with an average (Mean Arterial Pressure) below 60mmHg – can be detrimental to a vital organ, the kidney. Blood pressure will likely drop but there is a safe drop and unsafe drop, and veterinary nurses are trained to recognise the difference! The anaesthesia nurse will watch this very carefully and take measurements continually, making sure everything is recorded at least every 5 minutes.  

Once the procedure it is done the anaesthesia nurse is then responsible to start the patient’s recovery, still monitoring vitals. Recovery begins in the theatre then back into the kennels, once the patient is awake enough to move, they will then be handed over to the kennel nurse.  

Communication 

Communication is so vital in the practice but even more so when a patient is undergoing a procedure. Forms of communication for the theatre nurse will be via consent forms, clinical notes, discussing with the nurse or vet that admitted the patient and with the operating vet. Communication throughout the time in theatre is so vital.  

It is important that the anaesthesia nurse and the vet operating can communicate any concerns with the patient, this might be from the anaesthetic point or the vet being concerned that the procedure isn’t going well. We also communicate via anaesthetic charts and checklists, like this one. These monitoring charts can be looked back on if there were any concerns. It is also a great way to communicate what drugs the patient had at what time, it’s a good checklist for the anaesthesia nurse to ensure they haven’t forgotten anything in preparation, as there is so much to prepare beforehand.  

Conclusion 

Theatre nurses have a very important role within the practice. Safety, confidence, communication and knowledge is all key to running the perfect theatre. This link gives a great look at the role of the theatre nurse or also known as the surgical nurse.