Surgical Draping

Definition

Surgical draping refers to the procedure of covering a patient and the surrounding area with drapes/sheets to create a sterile barrier during a surgical procedure.

Purposes

Draping is done to

• Eliminate the passage of microorganisms between the nonsterile and the sterile area.
• Provide patient comfort and safety.
• Maintain the patient’s dignity and privacy.
• Provide an extra thick surface where some instruments and sponges can be placed for ready use.

Types of Draping Material

• Fenestrated drapes: Have an opening for the surgical site (e.g., laparotomy drape).
• Non-fenestrated drapes: Used to cover large areas or limbs.
• Adhesive drapes: Stick to the skin to secure the sterile field.
• Disposable vs. reusable: Disposable drapes are often made of synthetic, fluid-resistant materials; reusable ones are typically cotton or muslin.

Procedure for Draping

The entire surgical team must be familiar with the draping procedure. The scrub nurse must be adequately prepared and assist with the draping. The circulatory nurse must be on standby for any assistance required in addition to noting any break in the aseptic technique.

Steps

• The scrub nurse will select the drape sheet and hand one end to the surgeon across the operating table, supporting the folds, keeping it high, and holding it taut until it is opened, and then drop it (open fingers and release sheet). If disposable drapes are used, the adhesive strip on the folded edges must be removed before placing it.
• The second drape sheet is handled in the same manner and is placed on the patient, with the edge of the sheet just below the incision site.
• Place the four sterile towels around the line of incision.
• The scrub nurse unfolds the 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 that the towel is placed on the lower side (toward the feet) of the line of incision.
• The third towel is passed the same way, except that the towel is placed on the upper side (toward the 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.
• With non disposable, muslin drapes (e.g., hand towels), the difference in the third step is that the towels are cuffed by the scrub nurse about 3 inches and the folded edge goes next to the line of incision. The first three towels are cuffed toward the scrub nurse; the fourth towel is cuffed toward the surgeon. The towels are held in place by towel clips rather than by adhesive.
• Finally, the scrub nurse will select the surgical drape (lap sheet). This sheet has a fenestration (opening) in the drape for making the incision.
• The scrub nurse places 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 and then open them downward over the patient’s feet and upward over the anesthetist screen.

Special Precautions

Aseptic technique must be observed at all times in the draping process. The scrub nurse must;

• Handle the drapes as little as possible.
• Never reach across the operating table to drape the opposite side, or go around the table.
• Hold the drapes high enough to avoid touching the nonsterile area but avoid touching the overhead light.
• Hold the drape high until it is directly over the proper area, and then drop (open fingers and release the 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).

Draping a Patient in Supine or Prone Position

• 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.

Draping a Patient in Lithotomy Position

• 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.

Draping an Extremity

• If the end of a drape falls below the 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.

Key Principles & Considerations

• Only sterile drapes should be used within the sterile field.
• Draping must be done from the incision site outward, never reaching over non-sterile areas.
• Avoid shaking or flipping drapes to prevent contamination.
• If a drape becomes contaminated, it must be replaced immediately.
• The scrub nurse assists with draping, while the circulating nurse monitors for breaks in sterility.

REFERENCES

1. 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
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
8. 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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