Surgical Technology Lecture Series 2000© Power-Point®

Skin Preparation - Part II Surgical Prep Prior to Draping

Production Notes Author - Kevin Frey CST, MA Series Editor - Teri Junge, MEd, CSFA, CST, FAST

Table Of Contents Eye Prep Thoracoabdominal Prep Breast/Chest Prep Shoulder Prep Forearm/Hand Prep Vaginal Prep Hip Prep Knee Prep

Eye Prep

Eye Remember Procedure NEVER shave the eyebrows Surgeon may order eyelashes to be trimmed Do not use chlorhexidine gluconate (Hibiclens®) for facial preps (including the ear) Explain procedure to an awake patient Procedure Eyelids and periorbital area usually cleansed with warm water using Q-tips®

Eye (continued) Procedure (continued) Start at center of lid and gently work outwards toward brow and cheek Repeat as needed Flush conjunctival sac with warm saline Instruct patient to turn head to side Place a sponge or towel to catch the run off Use a bulb syringe to gently irrigate the area

Thoracoabdominal Prep

Thoracoabdominal Patient is in lateral position Arm is elevated during the prep Prep arm to elbow Include axilla, chest, and abdomen in prep Extends from neck to down to iliac crest at the level of the pubis Extends beyond the anterior and posterior midlines

Breast/Chest Prep

Breast/Chest Remember Patient’s head turned toward nonoperative side If breast malignancy is suspected, only a paint may be performed Patient’s head turned toward nonoperative side Arm on operative side may be elevated to expose axilla if necessary Finger traps hanging from an IV pole may be used to elevate the arm

Breast/Chest (continued) Area includes Shoulder on operative side Axillary region on operative side if necessary Elevated arm up to the elbow if necessary Past the midline (sternum) to the opposite shoulder but not including the shoulder

Breast/Chest (continued) Breast Biopsy Arm not elevated Area includes Entire breast Extends to shoulder on affected side but does not include the shoulder or axillary region Extends to midline (sternum) 1”-2” below the breast

Shoulder Prep

Shoulder Patient will either be in supine or lateral position Arm on operative side elevated by grasping the hand Patient supine: Elevate arm to also slightly elevate shoulder from the OR table

Shoulder (continued) Area includes Entire circumference of elevated arm Axilla Entire shoulder to include scapular region Anteriorly to the sternum Inferiorly to the mid-chest Base of neck

Forearm/Hand Prep

Forearm/Hand Roll towel is placed under shoulder and axillary region If only hand prep, this step is omitted Arm elevated by supporting it above the elbow to allow a circumferential scrub Extent of prep depends on surgical procedure to be performed

Forearm/Hand (continued) Area could include Entire arm including axilla, or Forearm to 3” above the elbow Entire hand

Vaginal Prep

Vaginal Remember If Lugol’s solution will be used during operative procedure, do not use Betadine scrub or paint inside the vagina and on the cervix Sponge forceps are needed in order to prep the inside of the vagina Patient is in lithotomy position

Vaginal (continued) Area includes Pubis External genitalia Perineum Inner aspect of thighs Vagina Anus

Vaginal (continued) Procedure Place towel or pad under the buttocks Begin at the pubis, scrub downward over the external genitalia, perineum and anus Discard the sponge Use a new sponge each time, repeat the above step several times

Vaginal (continued) Procedure (continued) Use a new sponge, start next to the labia majora and scrub inner 1/3 of thigh Do not scrub the circumference Use a new sponge for each leg Scrub the vagina Use circular motion due to the many folds and crevices of the vaginal mucosa

Vaginal (continued) Variations of the vaginal prep Vagina may be prepped last Antiseptic soaked sponge on sponge forceps may be inserted into vagina initially; sponge remains while external prep is completed Complete the external prep, then prep the vagina Reasoning is that residual effect of antiseptic solution will have increased effect inside the vagina if left in contact for a few minutes

Hip Prep

Hip Patient is in lateral position Operative leg is elevated by supporting at the ankle and lower leg Area includes Inguinal region over to the level of the umbilicus and down the midline to the pubis Buttocks extended lateral to table line Circumference of upper thigh extended down to knee joint (may extend to include the foot)

Knee Prep

Knee Patient is in supine position Non-affected leg Lower portion of table is lowered; leg allowed to hang over lower portion supported by a pillow placed underneath Leg is placed in leg holder and positioned to prevent interference with operative side

Knee (continued) Operative leg is elevated by supporting the foot and ankle Depending on surgical procedure area includes Arthroscopy: Entire circumference of leg from mid-thigh to mid-calf Total joint replacement: Entire circumference of leg from groin crease to ankle