1. Surgical Technology Lecture Series 2000©
Power-Point®

2. Skin Preparation - Part II
Surgical Prep
Prior to Draping

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

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

5. Eye Prep

6. 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®

7. 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

8. Thoracoabdominal Prep

9. 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

10. Breast/Chest Prep

11. 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

12. 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

13. 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

14. Shoulder Prep

15. 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

16. 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

17. Forearm/Hand Prep

18. 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

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

20. Vaginal Prep

21. 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

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

23. 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

24. 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

25. 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

26. Hip Prep

27. 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)

28. Knee Prep

29. 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

30. 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