Definition
The procedure of draping a patient and the surrounding areas with a sterile barrier to create and maintain a sterile filed during a surgical procedure.
Purpose
- To create a sterile field for carrying out surgical operations.
- To ensure successful barrier against bacterial invasion of
- To prevent contamination of operative site with unprepared skin skin surfaces.
Articles
- Big and small mackintosh to lie atop the operating table.
- Sterile/clean bed line to lie atop the operating table.
- Sterile pair glove.
- Sterile preparation tray containing;
- Bowl with betadine or cleaning solution.
- Two sponges holding forceps.
- Sponge
- Sterile drapes and towels.
- Sterile towel clips.
Procedure
| Nursing Action | Rationale | |
| 1 | Before procedure Ensure and double check the patient identification and procedure. | |
| 2 | Ensure that the operating table is lined with appropriate. Sized mackintosh and sterile. | To prevent soiling of the operating table |
| 3 | Transfer the patient to the theater table. | Sterile field is maintained. |
| 4 | Replace patient line with sterile line. | Sterile field is maintained. |
| 5 | During procedure Expose operating site while adequately covering other areas. | A network area promotes proper techniques |
| 6 | Ensure the patient is anesthetized (as per the need of the procedure) and the signaling from the operating team to proceed draping | |
| 7 | Assist surgeon to clean the site with bacterial solution. usually the circulatory nurses with the scrub nurse | |
| 8 | Offers sterile, towels, and towel clip to surgeon and assist in the following manner | Sterile filed id maintained. |
| 9 | Drape patient according to nature, type of surgery, and incision in the following manner. Place first set of drape sheet foot to knees The second drape sheet is placed below the incision site Place the four sterile towels around the line of incision. The towels can be either disposable** with removable adhesive strips or non-disposable*** normal green hand towels Finally, the fenestrated drape sheet or the lap sheet is placed with the opening directly over the skin area outlined by the drape towels and in the direction indicated for the foot or head of the table. The lap sheet will have an arrow or some other indication to identify the head or foot portion of the drape. Drop the folds over the sides of the table, then open it downward over the patient’s feet and upward over the anesthetist screen. This draping sheet provides extra thickness of material under the area from the Mayo tray to the incision where instruments and sponges are placed. It also closes some of the openings in the laparotomy sheet, if necessary. | |
| 10 | Secure towel clips at each corner, viz, above, below, and sides of operative site. | Ensures that the sterile towels remain in place. |
| 11 | Assist surgeon to apply “O psite” evenly without air pockets, soon after cleaning and drying operative site | Sterile field is maintained. Preparation provide s for an organized approach to task. |
The scrub nurse unfolds first towel, passes the towel drape to the surgeon with the strip side facing the scrub, and then removes the adhesive strip. The surgeon places the towel within the scrubbed area on the near side of the line of incision, leaving only enough exposed skin for the incision.
The second towel is placed in the same way, except the towel is placed on the lower side (toward feet) of the line of incision. The third towel is passed the same way, except the towel is placed on the upper side (toward head) the line of incision.
The last towel is passed to the surgeon with the adhesive strip facing the surgeon and is placed on the far side of the line of incision. The adhesive area holds the towel drapes in place. ***The towels are cuffed by the scrub about 3 inches and the folded edge goes next to the line of incision.
The first three towels are cuffed toward the scrub: the fourth towel is cuffed toward the surgeon. The towels are held in place by towel clips rather than by adhesive.
Special Considerations
- Handle the drapes as little as possible.
- Never reach across the operating table to drape the opposite side; go around the table.
- Hold the drapes high enough to avoid touching nonsterile area but avoid touching the overhead light.
- Hold the drape high until it is directly over the proper area, then drop (open fingers and release sheet) it down where it is to remain. Never adjust any drape. If the drape is incorrectly placed, leave it in place and place another drape over it.
- Protect the gloved hands by cuffing the end of the sheet over them. Do not let the gloved hand touch the skin of the patient.
- In unfolding a sheet from the operative site toward the foot or head of the table, protect the gloved hand by enclosing it in the turned back cuff of the sheet.
- If a drape becomes contaminated, discard it immediately.
- If the end of a drape falls below waist level, do not handle it further. Drop it and use another drape.
- If in doubt about sterility, discard the drape.
- If a hole is found in a drape after it is laid down, cover the hole with another drape or discard the entire drape.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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