What would you do...?

  1. We had a man in for a hernia repair yesterday. Not an inguinal hernia but upper gastric...about 2-3 inches above the navel. The warming blanket was on and after removing his gown from under the blanket, I noticed that he was wearing underwear. I mentioned that to the surgeon he said "it's ok, we're not going down that far". I wasn't sure if he said that for the pts. benefit because he was still awake at this point. I didn't say anything else. I was thinking of asking again when the pt. was under but changed my mind. Prepping was a bit more difficult than it had to be but we managed. No foley but prepping from nipple to navel where the shorts had to be moved aside to avoid getting the color changed from gray to "betadine purple". I'm only 8 months into this and haven't seen it before. What would you have done...?
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  2. 30 Comments

  3. by   umakemesmile
    That's been a pet peeve for us in our OR for years. I finally just trained myself to peek before they go to sleep. The biggest problem isn't so much the betadine but urinating while pt's are waking up. Now the poor pt. has to go home with wet underware! YUCK! We have asked on several occasions for the floor nurse's to have pt. remove underware to no avail. I don't think they understand why we ask for underware to be removed if they are just having a knee scope(for example). I suggest you train yourself to look before they go to the room.
  4. by   SFCardiacRN
    I always remove them and put them in a ziplock with a patient sticker.
  5. by   grimmy
    Quote from sfcardiacrn
    i always remove them and put them in a ziplock with a patient sticker.

    [font="book antiqua"]ditto. we don't allow clothes on for any gen anesthesia case. for peds, we typically wait until the pt is asleep to remove any underwear or item of comfort, but i'll often ask adults (who are able) to assist me in removing their undergarments once they've gotten to the or table. our preop rns are really good at making sure this happens ahead of time, so its a rare event.
  6. by   NurseEllie
    I always ask about underpants, jewlrey, contact lenses, removable teeth in pre-op even though the pre-op nurses also ask. Someone the patients are just so nervous they say yes without thinking if they've actually taken everything off or not. But anything that slips by leaves the OR in a plastic baggy with a pt. sticker.
  7. by   canoehead
    I know when I worked MS I had no idea why the OR nurses were so freaky about underwear. Funny thing is, they would pitch a fit about it but never tell you why it was so important.(and I never asked)
  8. by   mcmike55
    Ok Ok, once again, it looks like I am going to throw myself in front of the flow of comments.

    In years gone by, taking off the undies was critical.
    When we were still working with flamable anes. gases. Don't want static sparks you know.
    Not too many of those around anymore, but the sacred cow continues to live.
    Now I do agree, if your pt is for, say a cysto,,,,undies off!!!! Like I tell my pts',,,where do you think that scope is going?? Your doc is good,,,,but not THAT good
    In the situation you described, I would likely pull them down, or completely off if they could get in the way.
    I'm all for allowing the pt some shred of dignity and comfort when possible, and if leaving their underpants on for say a knee scope, I'm ok with that.
    I usually make sure that they are not wearing their "Sunday best", because they may have an accident, or if something bad happens, I'm cutting them off if need be. If they have issues with that,,,take 'em off.
    That counts for underpant, not Tshirts, bra's etc.
    Those get in the way of EKG placement, maybe respiratory effort. So those come off.

    I guess the question comes down to, "we have always done it this way", or is their REALLY a good reason to it. My thought is, if it does not affect the procedure, the pt feels a little more at ease with them on, and don't mind the possiblity of soiling or losing them, LEAVE 'EM ALONE!!!!

    The proceeding was MY comments/feeling on the question, and do not reflect those of the staff or management.
    Mike
  9. by   pinefarmgirl
    From a patients point of view- I had to have an emergency appy a couple of years ago, and was floating on ms. The floor nurse comes in to be sure I have no jewelery or bra on, and get me prepped. I asked if I should lose the underwear, and she said no, she didn't think that was needed. I was actually kinda mad when I woke up after and went to the bathroom- I had no underwear and had been shaved, too. I had never been all that hairy, so I never did know why. I complained loudly that the floor nurse needed to be trained better if she was going to prepare patients for surgery. What they did was not that big of a deal- I just got upset because I was not told what they were going to do...
  10. by   SFCardiacRN
    As an OR nurse, I ticks me off when patients come to surgery with jewelry, dentures, underwear etc. There is an OR checklist for the floor nurses to follow and it is specific. It is worse when the floor nurse tells the patient it is OK to keep the wedding band or underwear on. Now I'm stuck trying to explain the reasons without making the floor nurse look like an idiot. Fingers swell, foleys may need to be put in unexpectedly, bowel control is compromised, Electrocautery can cause jewelry burns, the pt. is NPO and doesn't need dentures, things can get lost.
  11. by   Marie_LPN, RN
    It ticks me off as well.

    It REALLY ticks me off when pts come to the OR for a GYN or rectal procedure with their underwear on. I mean, Come ON.

    Not to mention, like someone already said, you never know what'll happen during surgery, that underwear can get ruined in more ways than one.

    (Actually has one ASU nurse say "Oh, they have to take their underwear off for a hemorrhoid removal?" Lady, did you NOT pay attention in Anatomy in college???)
  12. by   Marie_LPN, RN
    I had never been all that hairy, so I never did know why.
    Depends on how small-framed a person is, hair down there can be very close to the incision site.

    We've also shaved pts. to help the tape stick better. And also so the tape wouldn't hurt AS bad when it got removed.

    Pts. SHOULD be clued in on the possibilities of shaving and such. Sometimes we don't even know for sure what and how will be prepped, till we pull the sheet back.
  13. by   Marie_LPN, RN
    [font=book antiqua]
    [font=book antiqua]for peds, we typically wait until the pt is asleep to remove any underwear or item of comfort,

    [font=book antiqua]
    same here.

    and sometimes, the kids wake up to find that ted e. bear is wearing a collar that matches their wristband.
  14. by   SFCardiacRN
    Another reason underwear is removed is for placement of the electrocautery return electrode. This hand sized adhesive pad needs to be placed over a large muscle mass. Thighs and buttocks are the preferred location. It is wise to remove hair before application.

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