Standing Prep

  1. I have a question for my OR nursing colleagues. First a little background--I am a CRNA in private practice and the owner of a surgery center for plastic surgery. Our surgeons are excellent and have an international reputation. All of the nursing personnel are experienced and we have worked together for years.

    My only problem is with one of our new surgeons (trained in the military). He wants his patients who are having lower body lifts -- primarily post gastric bypass patients who have lost a lot of weight--prepped standing on the floor beside the OR table. He wants the table drapped with sterile drapes and then have the patient climb on the table and lay on the sterile drapes. We then proceed with the anesthesia induction.

    I really dislike doing this for several reasons including physiologic (patient is cold) psychologic and technical. I want to sit down and talk with him about it, but want to have a good argument in hand. My RNs are not happy with this technique either and we want to show unity in our discussion. The medical director of the facility will back us up if we have good supporting information.

    My question to all of you--does anyone know the history of doing this type of prep? Is it performed for any other types of procedures? Can any of you help me?

    Please don't give me any legal arguments unless you can cite case law, closed case or insurance information. It is not a legal issue.

    Thanks much.

    Yoga CRNA, JD
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  2. 13 Comments

  3. by   sirI
    Hello, Yoga,

    What is his rationale for prepping in this manner?
  4. by   stefanitenzi
    I actually have a question for you instead of an answer. I am a nursing student that will be graduating in December. I want more than anything to be a nurse to a plastic surgeon. Can you please let me know what kind of experience I would need to get into the field?? Honestly it is really the only part of nursing that I am interested in. Any info would help.

    Thanks,
    Stephanie
  5. by   yoga crna
    Sirri.
    There is no rationale, except that it was how he was taught to do it.
    I was hoping that some of you on this forum would know the rationale.

    Stephanie
    There is an oraganization for plastic surgery nurses. I don't have the information close at hand, but you should be able to find it on the internet. I do know that my surgeons want nurses who are VERY EXPERIENCED operating room nurses who can scrub, circulate and recover. There are many aspects to plastic surgery nursing, particularly in reconstructive surgery. My practice is almost totally cosmetic surgery in an ambulatory setting. Do some investigating, see if you can locate a nurse in that specialty and get some personal information.

    Yoga
  6. by   stefanitenzi
    Thank you so much for getting back to me so quickly. The reason that I went into school for nursing is because I wanted to get into the cosmetic/plastic surgery nursing part of the field.....and it is so hard to get any info. on it b/c the only thing the professors talk about is med/surg....sorry...puke!!! So I guess that the best thing for me to do would to get a job in the OR as a Scrub/or Circulating nurse?? That is what I figured.

    Thanks again!!!

    Stephanie
  7. by   sirI
    Quote from yoga crna
    Sirri.
    There is no rationale, except that it was how he was taught to do it.
    I was hoping that some of you on this forum would know the rationale.


    Yoga
    I have not seen this done except in equine surgery, so , unfortunately I cannot help you with a rationale.

    Why not just approach him with your concerns and I am sure he would comply with a change????
  8. by   mwbeah
    Quote from yoga crna
    I have a question for my OR nursing colleagues. First a little background--I am a CRNA in private practice and the owner of a surgery center for plastic surgery. Our surgeons are excellent and have an international reputation. All of the nursing personnel are experienced and we have worked together for years.

    My only problem is with one of our new surgeons (trained in the military). He wants his patients who are having lower body lifts -- primarily post gastric bypass patients who have lost a lot of weight--prepped standing on the floor beside the OR table. He wants the table drapped with sterile drapes and then have the patient climb on the table and lay on the sterile drapes. We then proceed with the anesthesia induction.

    I really dislike doing this for several reasons including physiologic (patient is cold) psychologic and technical. I want to sit down and talk with him about it, but want to have a good argument in hand. My RNs are not happy with this technique either and we want to show unity in our discussion. The medical director of the facility will back us up if we have good supporting information.

    My question to all of you--does anyone know the history of doing this type of prep? Is it performed for any other types of procedures? Can any of you help me?

    Please don't give me any legal arguments unless you can cite case law, closed case or insurance information. It is not a legal issue.

    Thanks much.

    Yoga CRNA, JD
    Yoga,

    I have been the anesthetist for several GS's in the military who have performed these procedures and that sounds whacky! I never have worked with anyone who has done that in the service (was he Army?)

    Mike
  9. by   sharann
    I would think a standing prep(never heard of one either) is humiliating for the patient. Just thinking of it makes me uncomfortable.
  10. by   sunnyjohn
    Quote from sharann
    I would think a standing prep(never heard of one either) is humiliating for the patient. Just thinking of it makes me uncomfortable.
    It would seem rather humiliating standing there naked from the nipple line down being prepped.

    What about the drugs you give in pre-op to relax the patient? Versed? Wouldn't they be to sleepy or goofy to stand up safely? I would hate to have to catch a falling Gastric bypass patient!

    *sniff* smells lawsuit.
  11. by   MissJoRN
    I agree with Mike that it probably isn't military related. I wish I could be more helpful but all I can really say for sure is that one of our plastic surgeons does request this type of prep for his circumferential tucks but not for routine abdominoplasty which would be prepped and draped pretty much like any other abdominal case. I have never personally done this prep and obviously it's not something I'm going to observe unless I have to but as I understand we do have the pt step onto a sterile drape sheet and into sterile booties , prep front and back, then assist onto the draped table. I agree that warmth is an issue, and as I understand it, they really crank the heat. Privacy is certainly an issue, the room is la bled as do not enter and the door is taped as a reminder. Only the circulators (2 for the prep), scrub, and anesth. are in the room. I know I've always been glad that I'm not part of that "chosen team" Hope there's more info to follow! My luck is that I'll be assigned to do one tomorrow!
  12. by   shodobe
    I have heard of this in the past for burn cases where the patient could stand for the prep. This is not the case anymore and have not heard of this for well over 20 years. Mike
  13. by   jrgrad1912
    Maybe you could suggest the Pt have a betadine shower in private before they put on a gown. This was done here for GYN cases, of course they have to prep the patient after positioning.
    You could check out the AORN standards. AORN my say the patient needs to be positioned before they are prepped. Any part below the waist or table height is not sterile and will need to be re-prepped.
  14. by   msurgery1
    We've done a standing prep before, and stopped for several reasons:
    It is humiliating for the patient and puts a negative spin on the experience.
    Moving onto the table is difficult; patients are unsteady and end up contaminating the prepped area which in turn wastes time due to need for re-prep. Also, the chance for injury increases, especially if preop sedative/anxiolytics were given.
    Temperature drops several degrees, and it is hard to warm the patient back up.


    ASPSN is the American Society of Plastic Surgical Nurses. To get in the field, I would recommend getting a job as a circulator in an ambulatory surgery center or the hospital. Request the plastic surgery and ENT cases. Learn to scrub as well, which usually is included as part of the training period for OR nurses.
    Look at the AORN (Association of Perioperative Nurses) website, as well. You can subscribe to the journal.

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