surgical prep for c/s
- 0Aug 12, '03 by elleRNwas never properly taught how to do the sterile prep of abdomen while patient is on the table for c section. it is not always done, only if the doctor requests a scrub before the paint prep which they do. i have asked several of the nurses i work with and watched some and not one of them does the same thing. what do you recommend?
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- 0Aug 13, '03 by Sarah, RNBScNI've seen some surgeons start at the umbilicus in a circular motion, some start from the lt. side of umbilicus and work outwards.
I'm usually scrubbed so I don't prep for them, the medical residents do that.
Check with "Fergus51" she is a pretty good resource as well as "shodobe", "itsjustmezoe" and "hoolahan". I think they could answer this for you and perhaps give you some tips.
- 0Aug 13, '03 by SmilingBluEyesAt our LDRP unit, I do csections, functioning as a circulator. Among my responsiblilities, it is up to me to scrub patients prior to draping and surgery. We use a "kit" premade for this purpose. It contains sterile gloves, white drapes, oranges sponges, qtips and iodophor cleaning solution in a squeeze bottle.
I was taught to place 1/2 of the iodophor solution in a circular motion on the abdomen----inside to outer edges. The other 1/2 gets placed over the scrub sponges. Then, I take the q-tips, dipped in iodophor, and first start by cleaning inside the umbilicus. Then, using the oranges sponges provided, I begin thoroughly scrubbing the abdomen, starting at umbilicus and working outward, in circular motion ----never going over the same spot twice. There are 4 sponges to do this job, which are plenty. I ensure there are no "windows" --or spots I have missed, prior to completing the job. These get cleaned with a fresh sponge I save for that purpose. On "fluffy" patients, you have to be careful not to rub your arm across the abdomen at any point and you may have to have someone look on the other side to be sure you left no "windows" you did not see.
When done, you should have scrubbed her from the upper thighs to the xyphoid to be complete----including the pubic region, thoroughly. After, I use the drapes to "dab" at the scrubbed area to remove excessive skin cleanser, helping the surgical drapes better adhere to the skin, once placed by the scrub tech.
So, like I said, INSIDE, OUT, never touching same spot twice with a used sponge. It's really quite simple. But much better if someone trained in scrubbing for surgery teaches you FIRST. It helps to SEE it done, at least for me.Last edit by SmilingBluEyes on Aug 13, '03
- 0Aug 13, '03 by chartleypjI recommend checking out the recommended practice endorsed by AORN. Their web site has lots of info on all aspects of periop. care.
At the risk of sounding redundant, surgical preps should be done clean to dirty. That is, from the site of incision outward to the periphery. One sponge per pass in a circular motion as Sarah and Deb suggested. If your incision is a Pfanensteil, then start low on the abdomen; for a medial incision about midway between the umbilicus and the mons. Prep high enough and low enough doing the thighs, mons and groin folds last.
- 0Aug 13, '03 by CTRN1We have a kit pre-made with all the supplies needed: side drapes, towels, gloves, 6 sponges, 3 stick sponges and Iodine prep and paint.
The drapes get tucked under either side of the patient to catch the iodine so that it does not pool under her.
We first use the Iodine Prep, with a minimum of 3 sponges, you can use more but its not necessary. If it is a "bikini" incision we do one swipe across where the site will be, then continue up the abdomen back and forth, never over the same spot twice up to the top of the fundus; if it is a "clasical" incision, we start at the umbilicus and make circular movements outward to cover the entire abdomen. We do this with a min of 3 or all the sponges. With the last sponge used we prep the thighs and peri area with downward strokes, careful not to touch the incision site. The reason for only doing this with the last sponge is you do not want to conaminate your sterile gloves by coming in contact with the peri area so you do it last and only once.
We then pat dry the abdomen with one of the towels.
You are then ready to use the Iodine Paint. This is applied with the 3 sponges on sticks. The same method is used, however you paint the thighs and peri area with each one. The reason you can do this is because of the stick, your hands never come in contact with the patient's skin or peri area.
After the paint is applied, we let it air dry while the Docs are scrubbing in, and the side drapes are removed. Just prior to draping the patient, the Docs will towel off any remaining wet paint to better able the drapes to stick.
I hope this helps!
- 0Aug 14, '03 by elleRNwow, all we are given is a lap moist with normal saline from the scrub tech or nurse. we take it with a sterile glove, and use the scrub solution straight from the bottle. some nurses scrub the incision area and then do the circular motion from the umbilicus out. some just do the incision area and then work up just going back and forth. but we only have that one lap to do it.
- 0Sep 13, '03 by fourbirds4meWe use a solution called "Duraprep". It comes preloaded in a wand with a sponge at the end. We go from incision line to above the umbilicus then sweep around without lifting to thighs then pubic area then mons clean to dirty. This is allowed to dry (most of the time) and then the client is draped using prepackaged drapes with incise film and pocket attached.