Nursing. It’s a dirty job. But I’m glad to do it.

One of the things that is not so glorious about being an operating room nurse is the bodily fluid that can cover you from head to toe. The worst case I have experienced would be doing a de-clot of an arterial-venous fistula. An A-V fistula is what allows a patient with kidney failure to undergo dialysis. A shunt is placed usually in the forearm or groin which allows for placement of the dialysis needles, which are very large in diameter. The shunts are typically a little larger than a large drinking straw and can withstand repeated punctures …much more than our veins.

With puncture of the shunt one of the complications that can occur is clot formation. This inhibits the ability of the patient to be dialyzed which can be life threatening, therefore further surgery is required to restore blood flow. This is done by surgically opening up the shunt and running a long catheter into the vessels. A small inflatable balloon located on the very end of the catheter is then expanded with heparinized saline and the catheter is pulled back in the opposite direction to dislodge the clot. Once the clot is no longer blocking the arterial flow it can get pretty messy. I guess a simple way to describe it would be like squeezing the handle of a power nozzle on the end of a garden hose.

Now mind you in the operating room we are provided with an ample supply of protective gear. Anytime I scrubbed for a declot I always had on a mask with a built in shield, 2 hats and of course the gown and gloves.

I was on call and as luck would have it I got called in to assist in a declot. It was just the surgeon and I without any extra help, which for a case like this is not abnormal. The downside to only 2 people in this procedure is the scrub nurse has to fully assist the surgeon with retraction, instruments, suture and patient care. Many times this procedure is done with a local anesthesia and some sedation. This particular case the shunt was placed in the forearm and it was not easy keeping the patients arm still. I still don’t know what happened but as the clot was dislodged I was holding retractors and the arm so needless to say I did not have a loose hand. The artery opened up and the blood flow shot up over my mas and eye shield and all and started rolling down my face inside of my mask!!! I could not let go of the retractors as that would put the patient at risk. As I sat there with blood rolling down my face my surgeon stays calm but in a stern voice tells me “DON’T MOVE, DON’T MOVE!” As I sat there with my eyes squeezed shut and my lips pursed as tight as I could get them my hands didn’t move. Anesthesia then rushed over with a towel covered in alcohol and attempted to prevent any more blood from running into my mask. Once we got past the critical part of the case I went to literally hose my whole face off with soap, water and alcohol.

Long story short I took a very, very long shower in the dressing room after we were finally done. There was even blood down my neck, into my shirt. It was one of the grossest things I ever had happen to me in the operating room but, by far not the only thing. I think something like this happens to most nurses no matter what field you are in be it the emergency room, labor and delivery or home health. When you are dealing with wounds, fluids and patient care eventually you are going to end up messy. The upside to this story is that things like this don’t happen every day and it feels good knowing that I helped save a life.
I just hope people realize what nurses sometimes go through to ensure their health and safety. It’s a dirty job, but someone has to do it.