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As an operating room nurse, I’ve had the privilege of assisting in several DIEP procedures. These surgeries are often life-changing for patients, especially for women undergoing breast reconstruction after a mastectomy. The thought of such an intricate procedure can make anyone nervous, and as nurses, we play a crucial role in ensuring everything goes smoothly.
For those who are curious about what happens behind the scenes, I want to share what it’s like from the nurse’s perspective—what we do, how we prepare, and what really happens once the patient is asleep. This post will take you through the entire process of assisting in a DIEP procedure, focusing on the nurse’s role in ensuring a safe and successful surgery.
Preparing for DIEP Procedures: The Nurse’s Role
On the morning of a DIEP procedure, there’s always a mix of excitement and nervous energy in the air. We know how important this surgery is for the patient, and as nurses, we want to ensure everything is perfect.
Team Briefing and Setting Up the OR for DIEP Procedures
The first thing we do on the day of the surgery is hold an early team briefing. This is a crucial moment where the surgical team, including nurses, surgeons, and anesthetists, go over the details of the surgery, discuss any potential risks, and ensure everyone is on the same page. I’ve always found this briefing essential—it helps to ease any nerves I might have and reinforces the importance of teamwork in these complex procedures.
Once the briefing is over, we immediately start setting up the operating room. For a DIEP procedure, there are many instruments, equipment, and consumables that need to be prepared. Every second counts during the surgery, so it’s important to have everything in place and within reach.
DIEP Procedures: Two Scrub Nurses, Two Crucial Roles
In a DIEP procedure, there are typically two scrub nurses. One scrub nurse assists at the bottom, where the surgeon will meticulously locate the perforators—these are tiny blood vessels that are vital to the success of the surgery. The second scrub nurse works at the top, where the anastomosis (the connection of blood vessels) will take place.
While one of us starts preparing the instruments and setting up the operating room, the other begins scrubbing in. Surgical scrubbing is something I take very seriously. It’s a methodical process, and it always reminds me of the weight of the responsibility I hold in my hands. After scrubbing in, we arrange everything for the pre-op count. This involves counting all instruments, sponges, and other surgical tools to ensure nothing is left inside the patient after the surgery.
With DIEP procedures, there are a lot of instruments involved, so it’s essential to work efficiently. I remember during my first DIEP surgery, I felt a rush of adrenaline as I hurried to get everything ready. But over time, I learned that staying calm and focused is just as important as speed.
Once the scrub nurses are prepared and the operating room is fully set up, it’s time to bring the patient in.
Collecting the Patient: Beginning the Journey
When the operating room is ready, one of the most critical moments of the day arrives—collecting the patient. It’s at this point that the reality of the surgery starts to sink in. The patient is usually nervous, and as nurses, it’s our job to reassure them and make them feel as comfortable as possible.
I remember one particular patient who was having a DIEP procedure after her mastectomy. She looked so nervous, and I could see the fear in her eyes. I took a moment to hold her hand, smile, and tell her that she was in good hands. That simple gesture seemed to calm her down, and I realized then how much our presence as nurses means to patients.
After bringing the patient into the operating room, the anesthetist takes over and starts the WHO safety checklist. This checklist is a critical part of the procedure, ensuring that every step is accounted for and that all safety measures are in place. Once the patient is safely asleep, that’s when our work truly begins.
What Happens When the Patient is Asleep?
Once the patient is asleep, there’s a flurry of activity. The surgical trolley is wheeled in, and the atmosphere in the room becomes intense yet focused. The nurses and the rest of the surgical team go through another round of the WHO safety checklist before the real work begins.
Preparing the Surgical Area
One of the first things we do once the patient is asleep is expose the surgical area and begin the skin preparation. I can still remember how nervous I felt during my first DIEP procedure—worried about whether I was doing everything correctly. But over time, I learned that preparation is everything. If the skin prep and draping are done properly, the rest of the surgery flows much more smoothly.
As we prep the patient, the rest of the team is busy gloving and gowning. Once everyone is in position and the drapes are set, the surgeon will give the word: it’s time to begin the incision.
Important Tips for Nurses Assisting DIEP Procedures
DIEP procedures are intricate, and as nurses, we have to stay alert throughout the entire surgery. There are a few critical things I’ve learned over the years that every nurse should keep in mind when assisting with these operations.
Holding the Flap
One of the most important moments in the surgery is when the surgeon begins raising the flap. As a nurse, when the surgeon asks you to hold the flap, you must never let go unless you’ve informed the surgeon to secure it first. The flap is incredibly delicate, and any mistake can lead to complications.
I remember one time when I had to hold the flap for what felt like an eternity. My arms were shaking, and I was starting to get tired, but I knew that I couldn’t let go. The surgeon eventually told me I could relax, and I realized how much trust they place in us as nurses.
Using Liga Clips
Another key part of the procedure involves the use of liga clips, especially when the surgeon is locating the perforators. As a scrub nurse, it’s your job to ensure the liga clips are properly loaded and ready for the surgeon to use. This part of the procedure can be intense because the surgeon is working with such small and delicate structures.
Handling Micro Instruments
During the micro-surgery portion of the DIEP procedure, we use special instruments that require extra care. The surgeon’s vision is limited during this part of the surgery, so it’s essential to handle the instruments with precision and to keep them clean.
The venous coupling device is one of the most important instruments we use during this phase. I always make sure to check that it’s working properly before handing it to the surgeon. There’s no room for error when you’re working with such critical tools.
The Final Stages of the Procedure
As the surgery nears its end, we can’t afford to let our guard down. The micro instruments remain in use until the very last moment, and the counting process becomes even more important. The responsibility of counting falls heavily on the nurse, and it’s something we must take seriously.
I can’t stress enough how crucial it is to be thorough with the counting. Once, during a DIEP procedure, we had a moment of panic when we couldn’t locate one of the instruments. Fortunately, it had simply been misplaced on the trolley, but it reminded me of how important it is to stay focused, even at the end of a long procedure.
The Emotional Impact of Assisting DIEP Procedures
Assisting with DIEP procedures isn’t just physically demanding—it’s emotionally challenging as well. These surgeries are deeply personal for the patients, and it’s impossible not to feel some of that emotion yourself.
I’ve seen patients go through incredible transformations after their DIEP procedures. I’ve seen tears of relief and joy, and I’ve also witnessed moments of fear and uncertainty. Being a part of that journey as a nurse is incredibly rewarding, but it can also take an emotional toll.
There are days when I leave the operating room feeling drained, both physically and mentally. But there are also days when I feel uplifted, knowing that I’ve helped someone through one of the most difficult times in their life.
Final Thoughts: The Nurse’s Role in DIEP Procedures
As an operating room nurse, assisting in DIEP procedures is both a privilege and a responsibility. The surgery is complex, and our role in ensuring its success cannot be overstated. From preparing the instruments to holding the flap, to counting the tools, every task we perform is critical.
If you’re a nurse who is about to assist in your first DIEP procedure, my advice is simple: prepare, stay focused, and trust in your training. You’ll be an essential part of a life-changing surgery, and the work you do will make a real difference in the patient’s life.
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Helpful Link for reference about DIEP Procedures
External Link: Learn more about the DIEP Procedure on Queen Victora NHS Foundation Trust provides a clear explanation of the DIEP procedure, including the use of abdominal tissue for breast reconstruction after mastectomy. You can access it here
Internal Link: If you want to read more about surgical instruments used in these procedures, check out my post on [The Ultimate Guide to Surgical Instruments for Nurses].
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