Surgical Technology Lecture Series 2000© Power-Point®

Draping the Surgical Patient - Part I Another Step in Creating the Sterile Field

Production Notes Author - Kevin Frey CST, MA Series Editor - Teri Junge CST/CFA

Table of Contents Purposes of Draping Ideal Characteristics of Draping Material Types of Drapes and Draping Material Application of Sterile Technique

Purposes of Draping

Purposes General information Cover the patient to create a sterile barrier Maintain a sterile field throughout the surgical procedure Prevent migration of microbes from nonsterile to sterile areas Prevent surgical site infection (SSI)

Ideal Characteristics of Draping Material

Characteristics General information Blood and fluid resistant to prevent strike-through Resistant to punctures and tears Flexible to contour to patient’s body, surgical equipment, and furniture Flame resistant/retardant

Characteristics (continued) General information (continued) Lint free to prevent contamination of the surgical wound –Cellulose fibers can be the cause of granulomas and arterial emboli Antistatic to prevent sparks –Sparks can be cause of explosion in an oxygen-rich environment and anesthetic gases –Draping material must meet National Fire Protection Association (NFPA) standards

Types of Drapes and Draping Material

Non-woven Fabric General information Most frequently used type of fabric for manufacturing drapes Non-woven fabric drapes are disposable drapes Made of synthetic fibers combined with cellulose through chemical or mechanical means

Non-woven Fabric (continued) Advantages Resistant to tears and punctures Lint free (except when cut or torn releasing cellulose fibers that can become airborne) Antistatic (meets NFPA standards) Flame resistant/retardant Blood and fluid resistant Manufacturer sterilizes and packages; reduces expenses related to laundering, inspecting, mending, folding, and resterilizing drapes

Non-woven Fabric (continued) Disadvantage One-time use; cannot be cleaned and resterilized

Non-woven Fabric (continued) Features Some drapes have multiple layers of draping material surrounding the fenestration to aid in preventing strike-through Absorbable outer layer Impermeable inner layer Drape may have a pocket or loops to aid in retaining the suction and cautery apparatus within the sterile field

Non-woven Fabric (continued) Features (continued) Transparent plastic sheeting covers the fenestration –Prevents migration of microbes into the wound –Antimicrobial solution may be impregnated into the plastic sheeting –Surgical incision made through the plastic sheeting

Non-woven Fabric (continued) Features (continued) Pouches may be incorporated along the sides of a laparotomy drape or arthroscopy drape –Pouch collects fluid –Drainage port incorporated that can be connected to suction system

Laser-Resistant Drape General information Non-woven fabric is flame resistant, but once the cellulose is ignited it burns easily and quickly Polypropylene drapes do not ignite, but can melt and in the process injure the patient Aluminum-coated drapes are the best and safest to use in the presence of a laser

Thermal Drape Aluminum coated drape Reflects body heat back to the patient when the patient is covered by the drape Runners wrap themselves in these drapes after a race on a cold day (to give an idea of what the drape looks like) Available as a sterile or nonsterile product Note: Sterile must be used during the sterile draping procedure

Thermal Drape (continued) Aluminum coated drape (continued) Nonsterile –Placed on patient in preoperative holding area –Covered by sterile drapes and remains in position during the surgical procedure –Remains in place in PACU Note: Recommended for use when at least 60% of body can be covered and the procedure will last more than two hours

Plastic Drape General information Sterile, disposable transparent plastic sheets that can be applied to the skin The entire drape or only a portion of the drape around the fenestration is adhesive Skin incision is made through the plastic (referred to as “incise drape”

Plastic Drape (continued) Features Drapes may be impregnated with antimicrobial agent –Agent is usually iodophor –3M company is a popular manufacturer of these drapes; commercial name is Ioban® drape –Surgical team members often refer to the needed size of the drape by the 3M product number (eg 1040, 1080, etc)

Plastic Drape (continued) Iodophor drape (continued) –Iodophor is slowly released during surgical procedure –Inhibits growth of microbes on patient’s skin –Useful for procedures lasting 2 hours or longer

Plastic Drape (continued) Advantages Resident microbes are prevented from migrating to the surgical wound Microbes cannot penetrate the plastic material Drape is held securely in place with an adhesive Adhesive does not cause abrasions to the skin when removed Plastic conforms to the contours of the patient’s body Transparency allows visualization of anatomical landmarks and condition of the skin

Plastic Drape (continued) Disadvantages Non-porous plastic retains body heat of patient causing build-up of perspiration and prevents evaporation Perspiration and heat provide a medium for bacterial growth Perspiration can cause drape to lose adhesiveness No more than 10% of patient’s body surface should be covered with drape

Plastic Drape (continued) Drape application procedure Skin prep –Scrubbed area of body must be dry for adhesive to stick –Allow to dry by evaporation or blot excess with sterile towel –Alcohol may be applied to speeds the drying process by evaporation - follow electrocautery precautions Free end of drape grasped by surgical technologist Opposite end grasped by surgeon Plastic is incorporated in fenestration of drape; paper cover of adhesive is removed by STSR prior to drape application

Plastic Drape (continued) Drape application procedure (continued) Tension is kept on drape as it is applied to the skin in an even manner A folded woven hand towel is used to smooth the plastic as it is applied to the skin If extremity is draped; surgeon will wrap the drape in a circular fashion Excess drape can be removed with a bandage scissors Regular non-woven drapes can be applied over the plastic drape

Plastic Drape (continued) Aperture drape Opening in the drape for the eye or ear Adhesive surrounds the fenestration 3M is a popular manufacturer of aperture drapes Surgical team members often refer to the needed size of the drape by the 3M product number (eg 1020)

Plastic Drape (continued) Towel drape Square plastic drape with a single line of adhesive across one edge Available in a variety of sizes Uses –Wall off a contaminated area such as a stoma or the anus –Square off the incision site; used instead of woven towels or nonwoven blue bar drape

Plastic Drape (continued) Isolation drape Often used for orthopedic procedures such as hip nailing Isolates sterile field from equipment such as the C- arm Drape extends from the head of the patient to just past the feet Drape is suspended vertically over a steel pole attached to the OR table

Plastic Drape (continued) Isolation drape (continued) Drape may have a pocket or loops to aid in retaining the suction and cautery apparatus within the sterile field Pouch incorporated to collect fluids Incise area may be impregnated with antimicrobial solution

Equipment Drape Tourniquet drape Plastic towel drape is placed around the edge of the tourniquet and used to protect cuff from prep solution Microscope drape Plastic sterile drapes made specifically for microscope Allows sterile team members to move the microscope within the sterile field Fenestrations expose oculars

Equipment Drape (continued) X-ray cassette drape Sterile transparent plastic cassette holder –Resembles a Mayo stand cover (Mayo stand cover may be substituted) –Folded in a similar fashion to a Mayo stand cover –Gloved hands are placed within a protective cuff to apply drape to cassette Nonsterile team member (circulator or radiology tech places cassette inside of cover that STSR has prepared STSR completes the process of covering the cassette with the drape

Equipment Drape (continued) C-arm drape Plastic sterile drape made specifically to cover C- arm Allows C-arm to be placed over the sterile field Similar configuration to Mayo stand cover for ease of application to the C-arm

Equipment Drape (continued) Fiberoptic and power instrument cords –Long, sterile plastic tubes are available to contain fiberoptic cords or power instrument cords –Example: Arthroscopic camera and cable are placed in the sterile tube-like cover

Woven Towels Fan folded and stacked in packages of four or five towels Wrapped and sterilized in Central Sterile Supply Used to isolate the incision site Secured with towel clips –May be sutured or stapled in place

Woven Towels (continued) STSR prepares four wound towels in advance of need –Open towel –Folding one lengthwise edge downward approximately 1” creating a cuff –Fold three towels toward self –Fold one towel away from self –Stack towels in order of anticipated use Note: Instructor will demonstrate in lab setting

Fenestrated Drape General information Drape is positioned so that fenestration (opening) is placed over area of skin incision Fenestration will vary in size, shape, and direction of opening according to the type of needed drape Drape is usually long enough to cover the body from head to past the feet Drape is usually wide enough to cover both armboards

Fenestrated Drape (continued) General information (continued) Drape is marked with directions to indicate head and foot of drape –Orientation may be indicated by arrows, labels, or outline of a body Fenestrated drapes are unfolded according to manufacturers instructions and facility policy

Fenestrated Drape (continued) Laparotomy drape Simply referred to as a lap sheet or drape Available in adult, pediatric, and infant sizes Longitudinal fenestration with reinforcement around the opening Used for vertical abdominal or spine incisions

Fenestrated Drape (continued) Chest Drape Similar to lap sheet except the fenestration is much larger to provide more exposure Used for procedures of the breast(s) and chest (median sternotomy)

Fenestrated Drape (continued) Thyroid drape Similar in size to the lap sheet except the fenestration is transverse and nearer to the top of the drape Used for neck procedures

Fenestrated Drape (continued) Kidney or lateral drape Similar in size to the lap sheet and fenestration is in the same location Fenestration is transverse to accommodate the transverse lateral or flank kidney incision

Fenestrated Drape (continued) Laparoscopy drape Combination of a laparotomy and perineal drape Abdominal fenestration is smaller than that of a lap sheet Second fenestration is in the perineal region to expose external genitalia Leg covers may be incorporated into the drape Used when patient is in lithotomy position

Non-fenestrated Drape 1/2 and 3/4 sheets Square sheet Multi-purpose purpose –Drape a table to create sterile surface –Place under an extremity to create a sterile surface –Wrap around the surgeon’s waist during a procedure in which the surgeon is seated (patient is in lithotomy position; arthroscopy of the knee) –Cover an area of the sterile field that has become contaminated –Wrap around an extremity to permit manipulation of the extremity

Non-fenestrated Drape (continued) Leg drapes or covers (leggings) Must use separate leg drapes if perineal or laparoscopy drape does not have leggings incorporated Drape is folded in such a manner that the proximal end is open and the distal (toe) end is closed Proximal end is folded to create a cuff in which to protect sterile gloved hand to apply drape

Non-fenestrated Drape (continued) Split sheet Drape is cut up the middle about 1/3 of the way to create two tails Called a U-drape when the upper end of the split is “U” shaped Split sheet usually nonwoven material U-drape usually plastic

Non-fenestrated Drape (continued) Split sheet (continued) Edges of tails has adhesive to stick to the skin or other drapes Placement under an extremity with tails wrapped around the extremity to expose circumference of extremity Used when draping patient for hip procedure to isolate perineum Term “place one up/one down” refers to use of two split sheets to expose a lengthy site

Non-fenestrated Drape (continued) Stockinette Tubular drape used to cover an extremity Opening for incision can be cut through the layers of the stockinette to accommodate the incision Two types –One type is made of knit material and is porous so it is not considered a barrier to microbes –Second type has two layers Inner layer is porous stockinette Outer layer is plastic

Application of Sterile Technique NEVER reach across the OR table to drape the opposite side of the patient –Walk around to the other side of the table DO NOT hand drapes, towels or towel clips across the O.R. table to the surgeon –Carry them to the side of the table where the surgeon is standing DO NOT unfold the drape before laying it on the patient

Application of Sterile Technique (continued) Before the patient is draped, maintain a safe distance from the nonsterile OR table –The sterile surgical gown has a tendency to bulge outwards increasing the chance of contamination by brushing up against the OR table

Application of Sterile Technique (continued) Prepare to place the drape on the patient –Hold the drape approximately ” above the intended skin incision site –Do not contaminate the drape or gloved hands on the overhead surgical lights –Estimate placement so fenestration is evenly distributed over the incision site

Application of Sterile Technique (continued) Placing the sterile drape –The STSR removes paper cover over adhesive surrounding fenestration –Place the drape on the patient –DO NOT adjust a drape once it is placed –If the drape is placed incorrectly the circulator will remove the drape and obtain another drape for the sterile team members to use

Application of Sterile Technique (continued) Placing the sterile drape (continued) –Protect the gloved hands by cuffing the drape over them –A drape that falls below the sterile level is considered contaminated –If drape unfolds before use; discard the drape

Application of Sterile Technique (continued) Perforating towel clip –If a towel clip is fastened through the drapes; the points are contaminated –DO NOT move the towel clip to be fastened at another area of the drape –If the towel clip must be removed hand it off to the circulator; do not touch the points –Cover the area from which it was removed from with a sterile drape

Application of Sterile Technique (continued) Hole discovered in the drape –Small hole is covered with a sterile drape –Large hole may require that the drape be replaced Circulator responsible for removing the drape and provide another sterile drape New sterile drape is placed by the sterile team members

Application of Sterile Technique (continued) Hair discovered on sterile field –Remove the hair with a hemostat –Hand of the hemostat to the circulator –Cover the area with a sterile drape