By: 30 March 2018
Case study: How to help your scrub nurse

Firas Arnaout and TF Sibly identify a new technique to help theatre staff recognise instruments during surgery


Some operations, such as certain revision joint replacements, are done infrequently, and involve many trays of instruments. The problem for the scrub nurse is to know which instrument is needed next, and what it is called.

It is difficult for the surgeon to come away from the operative field to find the necessary instrument, and the surgical technique manual is too detailed. Training for scrub nurses can be provided by a workshop [1], but often the details are forgotten by the time the nurse does a case.

The usual solution is for the company representative to attend every time the operation is performed, and guide the scrub nurse through the procedure. However, this does not help the scrub nurse gain confidence in the procedure, as the representative has had the main responsibility for finding the necessary instruments.



We have developed a technique to help theatre staff to recognise the order in which the instruments will be required, without the representative attending.

Once the surgeon has established his technique, the instruments used are photographed, labelled, laminated, and put in order in a ring binder. The circulating nurse shows the scrub nurse the picture of the next instrument needed, and has a photo of how to assemble each jig.

Figure 1: The images show how the circulating nurse is showing a photograph of the required instrument to the scrub nurse.



Theatre staff have found this method easy to use, and it has removed the need for the representative to attend. Our photo guide contains only 26 photos, compared to the manufacturer’s manual which contains 105 images and about 10,000 words.



  1. Nighingale S. Pilot evaluation of theatre training workshops. J Perioper Pract.  2007;17 (10): 462-468.



F Arnaout and TF Sibly, Department of Trauma & Orthopaedic Surgery, Hereford County Hospital, Hereford, UK


Correspondence to:

Firas Arnaout MD MSc MRCS FEBOT FRCS (Tr&Orth)