Abdominal Vaginal Preps?

OR male nurse · Jan 4, 2008

Hi,

We never use Hibiclens in the genital area. That caution is stated right on the container. As far as do we have a written policy, I doubt it, it's just common knowledge I thought. At my current hospital, we use a betadine scrub followed by a betadine paint. At my last hospital we simply used a betadine scrub. I don't think they had a formal policy against using Hibiclens. We just knew not to ?

Hope this is what you were looking for

umakemesmile · Jan 26, 2008

We use Hibicleans despite the bottle warning. I have shown our OB-GYN's the bottle and they have decided to still go ahead and use. So I deem it under Physican preference.

Last I looked, here is what I found in AORN standards. Please correct if I am wrong.

2 seprate preps should be done.

Abdominal first,covered with a drape and then lady partsl prep. I think also they state it should be 2 separate prep trays.

I have 6 sponges + 3 stick sponges in my prep + 4 paper drapes.

Hibicleans should be used as follows:

Scrub 2 min., blot and rescrub 2min.

I take 1st and 2nd sponge and scrub abdomen,

Blot,

3rd sponge rescrub,

Cover with second drape and leave in place while I do vag. prep as usual.

I believe the rationnel behind leaving the abdomen covered is to prevent contamination of the first prep of possible splashing.

Another nifty little trick I do is to tuck a bag under the pt.'s buttocks and i drop the used sponges into the bag.

mcmike55 · Jan 30, 2008

I'm sure there are dozens of threads on this subject, but it's always interesting.

Most of our docs also use Hibiclens. We just don't use it full strength, diluting it with sterile water. Knock on wood. We've not aware of any real problems.

One or two of our docs still like Betadine Scub and Solution.

Again, not sure of any real problems.

I've used dilute Betadine Scub or Hibiclens for vag preps.

I know, I know, I've seen the AORN standards and recommendations!

But we're friends here,,,,,and frankly, I do the vag prep first.

For TAH's, I frogg the legs, vag prep, foley, then reposition to supine, cover with blankets, ESU return electrode, etc.

With a fresh prep and glove, I then do the abd prep.

There,,,,I confess, that's how I've done it for about the past quarter centry.

Can I stay in the OR nurses club? Do I have to resign from Allnurses.com?

Mike

umakemesmile · Jan 30, 2008

I'm sure there are dozens of threads on this subject, but it's always interesting.
Most of our docs also use Hibiclens. We just don't use it full strength, diluting it with sterile water. Knock on wood. We've not aware of any real problems.
One or two of our docs still like Betadine Scub and Solution.
Again, not sure of any real problems.
I've used dilute Betadine Scub or Hibiclens for vag preps.
I know, I know, I've seen the AORN standards and recommendations!
But we're friends here,,,,,and frankly, I do the vag prep first.
For TAH's, I frogg the legs, vag prep, foley, then reposition to supine, cover with blankets, ESU return electrode, etc.
With a fresh prep and glove, I then do the abd prep.
There,,,,I confess, that's how I've done it for about the past quarter centry.
Can I stay in the OR nurses club? Do I have to resign from Allnurses.com?
Mike

I too used to do that, had to change. LOL

nurse624 · Jul 21, 2011

it is not recommended to use hibiclens as lady partsl prep or to dilute it. hibiclens is 4% chg and 4% alcohol. check out this article published in the american college of obgyns showing what can happen when we prep with hibiclens: http://ovidsp.tx.ovid.com/sp-3.4.1b/ovidweb.cgi?t=js&page=fulltext&d=ovft&an=00006250-200405001-00008&news=n&csc=y&channel=pubmed.

the problem with hibiclens is the concentration of chg plus the alcohol. however, many studies support the use of chg in lady partsl mucosa at concentrations less than 1%.

irrisept is a 0.05 chg concentration that is fda cleared as an irrigation system. the company does not have specific claims to be used as vag prep. hospitals are using it off-label due to the published literature showing this concentration is safe and effective.

betadine used in lady partsl mucosa is also off-label. betadine is not effective in the presence of blood and should be allowed to dry. . . we all know it does not dry in the lady partsl vault.

CaliLvr000, BSN, RN · Jul 23, 2011

How do you perform abdominal lady partsl preps? AORN came out with an article this month but they were not positively set on one way or the other. Abdomen, then lady parts? Or lady parts, new prep kit, new gloves, and then abdomen? At my facility people generally start with abdomen and then lady parts then foley. Interested how others do this. Thanks.

Editorial Team / Admin · Jul 24, 2011

Foley first (our foley kits have beta dine swab sticks in them for the foley prep), one prep kit for lady parts/perineum, and a second prep kit for abdomen. That's actually our set policy. That way, if there's any splashing from the lady partsl/perineal prep, it doesn't contaminate the clean abdominal prep.

Florencebyondthepale · Jul 25, 2011

Can't provide you with the evidence for the practice at my facility, but we prep the abdomen and inner thighs with Chloraprep (chlorhexidine gluconate solution which is similar to hibiclens) and prep the groin and lady parts with 3 betadine paint sticks. I believe because of the high alcohol content in the chloraprep, it can be irritating to mucous membranes and you couldn't physically use the prep sticks in the lady parts even if you wanted. However, we do use chloraprep to prep out the entire groin (member and scrotum) in male patients for urology cases.

Cyan8181 · Jul 29, 2011

We open both a vag washoff kit as well as a foley kit. I frog-leg (or stirrup for some of the docs doing a TAH) and use the 6 sponges with scrub, dry and follow with the 3 sponge sticks and paint. I prep from the symphysis pubis to the inner thighs to the lady parts to the orifice. Then I insert the foley throwing away the cleaning stuff that comes in that kit (cotton balls, plastic grasper, packet of betadine). By the time I'm finishing up, someone (surgeon, resident, NP, PA, CST, med student, RNFA, another nurse, whoever!) has started prepping the abdomen with either duraprep or chloraprep.

$fracturenurse$ · Jul 31, 2011

Let's see...A lot of our docs want Chloraprep for the abdomen and betadine solution for the lady parts. I do the bottom first in case something flips up and to contaminate the abdomen. We go back and forth at my facility about this. We get in huge fights over this. As far as Hibiclens, that really is a no-no for the lady parts. After Technicare was recalled we called around and found a lot of the women's hospitals are still using Hibiclens if there is an allergy to betadine. It says right on the bottle though not to use it! It's such a pain. Right now, we are fighting over whether to use betadine scrub in the lady parts. I've always been taught not to use the scrub in the lady parts because it's irritating to the mucosa. I'm quite interested to find out what everyone else is doing though, especially if there is a betadine allergy? For a regular prep, are you using scrub in the lady parts or just solution.

Anyways, as an answer to your question, I do the lady parts and the bottom first with a separate prep kit, and then prep the abdomen. Would love to hear everyone's thoughts on this whole subject!

Rntr · Jul 31, 2011

Mike, this is how I too have done it for years.....can I stay in the club with you?