prep solution question - page 2

by mcmike55 33,413 Views | 18 Comments

I'm sure this is a topic that has been covered before, but I told my supervisor that I would ask. What do you, "all knowing surgery nurses" use as prep solutions. We use Dura Prep for most things, betadine and alcohol in a... Read More


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    I like Betadine gel--one step prep; works on contact. No dripping; no pooling. I've been using it for over 25 years, so it always makes me laugh when I go to some new travel assignment OR and they act like it's some "newfangled" prep solution. They think it needs to "sit" for a while--it does NOT. As I said, it works on contact.

    Just a word of caution that bears repeating----Hibiclens (Chlorhexidine) should never, EVER be used on the face (especially anywhere near the eyes; it can cause severe corneal/scleral burns and subsequent blindness) or mucosa---still, you see urologists insisting it be used as their prep of choice for urologic procedures such as cystos. I just refuse to use it.

    I have never heard of adding alcohol to Hibiclens--is it really necessary? It probably results in a product similar to Hibitane, which is no longer made--it was a bright pink tincture that you just painted on. I think it was Chlorhexidine paint; probably had alcohol added.

    Good old Betadine paint works well, too. In most ORs where I work where they do not have Betadine gel, they just use paint--no scrub.

    Duraprep is good, but, yes, just like alcohol, one must wait for it to dry before using a cautery. That's interesting about the fire in the presence of a high concentration of O2--I could see where that could definitely happen. Duraprep, too, should not be used on face or on mucosa, because of the alcohol.

    I usually use Phisohex for vag preps or other mucosa when the patient is allergic to Betadine.

    I have worked at some facilities where they have switched to Tincture of Iodine for their ortho preps. By the time all the drapes are applied, it's dry.
    Last edit by stevierae on Mar 12, '05
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    as most everyone else has mentioned, different stuff for different procedures. for most general/abdomen surgery, we use a triple prep of betadine scrub, prep and alcohol. for gyn, cysto, and eyes, they use paint only. for the transnasal transphenoidal resections, they use shurclens. of course, the big thoracic cases the pt showers with a special soap (the name escapes me at the moment) the night before, & we use triple prep. the plastics folks use mostly paint, with occasional use of alcohol on hand cases.
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    Grimmy,
    Have you ever read the contents of a shurclens prep container? NO ANTIMICROBIAL or MICROBIOCIDAL AGENTS there! Not much more than purified water. Using that to prep before going throught that staph ridden nose and into the brain? How do you avoid infections? Shurclens should only be used for removal of gross contaminants from trauma and other "dirty" type precleaning. Maybe your docs don't really know what they are asking for when they request the stuff. OR Nurses often find these things out when they investigate the rationale for a doctor's choice of one solution over another. Surgeons are often very greatful, when educated about their choices. It demonstrates that you have their patient's best interest and positive outcome in mind. Boy, and won't you be the model of patient advocacy!
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    Quote from huckfinn
    grimmy,
    have you ever read the contents of a shurclens prep container? no antimicrobial or microbiocidal agents there! not much more than purified water. using that to prep before going throught that staph ridden nose and into the brain? how do you avoid infections? shurclens should only be used for removal of gross contaminants from trauma and other "dirty" type precleaning. maybe your docs don't really know what they are asking for when they request the stuff. or nurses often find these things out when they investigate the rationale for a doctor's choice of one solution over another. surgeons are often very greatful, when educated about their choices. it demonstrates that you have their patient's best interest and positive outcome in mind. boy, and won't you be the model of patient advocacy!
    next time i do a tph, i'll be sure to mention it. quite honestly, we've had no infections that i'm aware of...a few csf leaks, now and then, but no infections. i won't mention it to the hos because i'm guessing that i'll be pooh-poohed. thanks for bringing this to my attention!
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    Stevierae, sorry, guess I'll be the dumb one, but I've not heard of Betadine Gel. I guess I can figure what it is from the name, but how do you apply it, and is it better than good old paint and scrub???
    I remember Hibitane. Seems like it was out only for a short time. If I remember, it was basically Hibiclens and Alcohol.
    The reason I even brought this issue up was that we had one, maybe two minor mucous membrane irritation, following vag. surgery. One was Betadine, the other Hibiclens, I believe.
    The more I study this, I'm not sure there is one right answer. Frankly, I'm tempted to go back to a slightly diluted Betadine scrub and then Betadine paint like I did for the better part of two decades. The odds seem to be there!!
    When we first got Durapreps, one nurse wanted to try it on a hemorrhoidectomy. We told her we would all come back to haunt her if she did!!! Could you imagine?!?!?
    By the way, I really can't find any lit. help. Our one doc wants alcohol, Betadine sol. and Hibiclens prep. In what order?? I've been doing alcohol, Hibiclens, then Betadine. Not really sure, he isn't much help, and can't find anyone else helpful. Mike
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    Mike,
    Perhapse your infection control pratitioner or OR Educator could help you out. There is also a vast resource at AORN. They usually have an article on the subject annually. AJN and other professional journals also address this from time to time. GOOD LUCK! TAKE ACTION TO IMPROVE YOUR DEPARTMENT PRACTICES! If you don't you'll be letting your patients and all the rest of us down.
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    Techni-care prep will be on the market in 6-8 weeks. I e-mailed the company and asked them. Since we have trying to find an alternative to vaginal preps until they come back on the market, my research has found that CHG, Chloroprep, any scrub solutions - Hibliclens - beatdine scrub- Phisohex is definitely contraindicated. We have removed Hibliclens from our OR, so RNs will not be confused and accidently use it on the vag preps, which has known to cause a dermatitis and scarring in the vag vault. Soals of any kind can produce fat embolus. Betadine paint is the preferred choice and if a patient is allergic to betadine, then the only alternative I have come across is sterile Normal Saline. Use the sponge brushes in the betadine kit, just dip the brush in the sterile normal saline instead of the betadine. Techni-care, which is the best so far for vaginal preps, has provided the FDA with all of the paperwork requested and so they are now waiting for the go sign from the FDA to start filling back orders.
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    I dont' have the reference handy at this time, but there is a published study from a few yrs back saying Johnson's baby shampoo (NOT baby wash) diluted 50/50 in NS is an acceptable and effective vag prep for the pt with an iodine sensitivity.
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    I can't agree more with the posters who have stated that Duraprep MUST dry before using the bovie. We had an arrogant young doc who refused to listen to us tell him that he must wait for the duraprep to dry before using the bovie on an inguinal hernia case and guess what? BOOM! Fire. It was awful.

    Our hospital has gone to Chloraprep now. We have one rather OCD surgeon that uses HCG first, then duraprep, then Betadine scrub, then Betadine paint. We all tease him about how long his prep time is before incision, but his infection rates are very low. We hung a stocking in his OR full of all of the prep solutions we could find!


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