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As an operating room nurse, one of the most memorable and meaningful parts of my job is assisting in DIEP procedures. These surgeries can be truly life-changing, especially for women undergoing breast reconstruction after mastectomy.
When I first started working with DIEP procedures, I was nervous and fascinated at the same time. Over the years, I’ve learned just how important our nursing role is in making sure everything goes smoothly—from the first team briefing to the final instrument count.
Let me share what it’s really like behind the scenes, and why assisting in DIEP procedures is both a challenge and an honor.
Getting Ready: Preparing for DIEP Procedures
On the morning of a DIEP procedure, the operating room feels a little different. There’s always a sense of quiet focus mixed with a bit of excitement because we know how important this surgery is for the patient.
Team Briefing: Our First Step
Before anything starts, we gather for a quick but essential team briefing. This includes:
- Going over the details of the DIEP procedure
- Discussing patient-specific considerations
- Making sure everyone knows their roles
These briefings are so important—they set the tone for teamwork and help us feel confident and ready.
Setting Up the OR
After briefing, it’s time to set up:
- Preparing instruments specific for DIEP procedures
- Organizing sutures, retractors, and special micro instruments
- Checking equipment like the venous coupler device
During my first DIEP procedure, I remember my hands shaking slightly as I laid out the instruments. Over time, I’ve learned that preparation is everything—it’s what keeps the whole surgery running smoothly.
Two Scrub Nurses, One Goal
In most DIEP procedures, there are usually two scrub nurses, each with their own critical role:
- Bottom scrub nurse: Assists the surgeon working on the abdominal area to locate and raise the flap and find the tiny perforator vessels.
- Top scrub nurse: Focuses on the chest area where the surgeon performs the anastomosis (joining blood vessels).
Both roles require complete focus because DIEP procedures can last several hours and involve many delicate steps.
Collecting the Patient: A Personal Moment
One part of DIEP procedures that people rarely talk about is collecting the patient from the ward or holding area.
Often, patients are nervous or emotional. I remember a woman scheduled for a DIEP procedure who was visibly anxious. I simply held her hand and reassured her that the team was ready and she’d be cared for every moment. Her eyes softened, and that moment reminded me why nursing is more than just technical work—it’s deeply human.
When the Patient Falls Asleep: Focus Mode
After bringing the patient into the OR, the anesthetist takes over. Once the patient drifts off to sleep, the atmosphere shifts:
- The surgical trolley comes in
- The team performs the WHO safety checklist again
- Everyone gowns and gloves up
- We prepare the surgical field carefully
Skin prepping and draping are crucial in DIEP procedures. Proper prep helps prevent infection and keeps the field sterile for hours of delicate work.
Key Responsibilities: What Nurses Do During DIEP Procedures
Over the years, I’ve discovered that the work nurses do in DIEP procedures is a balance of skill, anticipation, and teamwork.
1. Holding the Flap
One of the most delicate moments is when the surgeon raises the flap:
- The flap contains vital perforator vessels
- We must hold it steady without stretching or damaging it
- Never let go unless the surgeon says it’s secure
I still remember the first time I held the flap. My arms grew tired, but I focused on keeping it perfectly still because the consequences of slipping could be serious.
2. Loading Liga Clips
During the DIEP procedure, the surgeon may ask for liga clips to secure vessels:
- Make sure they’re loaded correctly
- Pass them quickly but carefully
These small tools might seem simple, but they’re vital to control bleeding and protect delicate structures.
3. Managing Micro Instruments
For the micro-surgery phase of DIEP procedures, special instruments are used:
- Tiny forceps and needle holders
- Venous coupler device to connect veins
We must keep them sterile, organized, and in perfect condition.
4. Counting and Recounting
Before, during, and after the DIEP procedure, scrub nurses must:
- Count all instruments, sponges, and sharps
- Double-check everything before closing
I can’t stress this enough: accurate counts prevent life-threatening retained items.
Challenges and Lessons Learned from DIEP Procedures
Working in DIEP procedures has taught me patience, focus, and compassion.
- Staying calm under pressure: Long hours and unexpected challenges can happen.
- Communication: Even without speaking much, clear signals and anticipation are essential.
- Never stop learning: Each DIEP procedure brings new lessons—different patients, surgeons, and techniques.
There were days when I doubted myself, especially early on. But every DIEP procedure built my confidence a little more.
The Emotional Side of DIEP Procedures
These surgeries aren’t just about technique—they’re deeply emotional for patients. Many women see DIEP proceduresas reclaiming part of themselves after cancer.
Watching patients wake up and knowing you helped them take a step toward healing is humbling.
Some days, I leave the OR exhausted but grateful. Other days, I’m moved to tears by a patient’s relief. It’s a reminder of why I chose this path.
Why DIEP Procedures Matter to Me
Being part of DIEP procedures is more than just assisting in surgery. It’s about:
- Protecting patients during some of their most vulnerable moments
- Supporting surgeons so they can focus entirely on delicate reconstruction
- Being part of a team that helps transform lives
If you’re a nurse stepping into your first DIEP procedure, my advice is simple:
✅ Prepare thoroughly
✅ Trust your training
✅ Stay calm and focused
✅ Remember you’re making a difference
Why I’m Proud to Assist in DIEP Procedures
At the end of every DIEP procedure, as the patient heads to recovery, there’s a quiet moment when the team exchanges tired smiles. We all know we’ve done something meaningful.
As nurses, our role in DIEP procedures might not always be visible to the outside world—but it’s critical. We hold the flap, load the clips, keep the field sterile, and support the team every step of the way.
And for me, that’s what makes being a nurse in the OR so special.
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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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