Correct way of prepping a Leg??

[AussieRNinHI]

This is mainly for US OR nurses, as you scrub; dry then paint here....What is the correct way of prepping a leg say for example for a knee arthroscopy/TKA??? scrub knee, then up the leg (circumferential); change sponge; then do the rest of the leg below; dry; then paint? or can one use the same sponge to do the whole leg? so.... knee, upper leg, lower leg in that manner ; dry; then paint?? Thanks for any feedback! :-)

[openheartmary]

I start at area of incision and scrub circum.up the leg, toss sponge; scrub with new sponge starting at incision area and circum. down the leg, (twice each); blot dry; then paint the same way. I'm a little anal about the prep :icon_roll. I shudder to see someone "wipe" rather than blot and peel away.

[IsseyM]

I start at area of incision and scrub circum.up the leg, toss sponge; scrub with new sponge starting at incision area and circum. down the leg, (twice each); blot dry; then paint the same way. I'm a little anal about the prep :icon_roll. I shudder to see someone "wipe" rather than blot and peel away.

Do the same here.

[hotdog19d]

Do the same here.

Me to, except I don't always start at the incision again to work down.

[Rezidentura]

I start at area of incision and scrub circum.up the leg, toss sponge; scrub with new sponge starting at incision area and circum. down the leg, (twice each); blot dry; then paint the same way. I'm a little anal about the prep :icon_roll. I shudder to see someone "wipe" rather than blot and peel away.

Same here. I'm also anal about blotting and not rubbing. I don't spend a great deal of time scrubbing though I use all sponges. I think the money is in the paint (Unless you have gross contamination). The longer that Betadine stays on the skin the more free iodine gets released to disrupt those cell walls.

[ghorjus_hunk]

same here if i prep it myself. however, sometimes its the resident surgeon who would want to do the prepping.

im relatively new as an OR nurse, for about a year and a half now, so im not really familiar with what other hospitals use for their prepping. ive observed orthopedic surgeons using alcohol after we've prepped the site with betadine, and i havent had the chance to ask "why?" does anyone have an idea? i was told that alcohol actually neutralizes that effects of betadine so it wouldnt make sense but after reading this:

The longer that Betadine stays on the skin the more free iodine gets released to disrupt those cell walls.

maybe this is their rationale for using alcohol?

PS >> what do you mean by paint?

[BlueEyedNursey]

this is not directly related but somewhat....if you are prepping for say the amputation of a necrotic toe or foot do you still start your prep at the incision site? i don't do ortho a whole lot but in my opinion the necrotic area is probably dirtiest so i didn't start my prep there but rather further up the leg then down to the necrotic tissue...the resident on the case stopped me however and told me to start from the incision site (which is what i'd do in any other case)...what do you all think?

[Crux1024]

PS >> what do you mean by paint?

Paint is what most people call prepping with a sponge stick on the necessary area. Its not the scrub (usually done after the scrub) and done with betadine/alcohol..whatever the surgeon prefers

[ghorjus_hunk]

this is not directly related but somewhat....if you are prepping for say the amputation of a necrotic toe or foot do you still start your prep at the incision site? i don't do ortho a whole lot but in my opinion the necrotic area is probably dirtiest so i didn't start my prep there but rather further up the leg then down to the necrotic tissue...the resident on the case stopped me however and told me to start from the incision site (which is what i'd do in any other case)...what do you all think?

i still start at the incision site, that is i assume that they will e cutting way above the necrotic area...then work my way down..

Crux: thanks for the info.

[gnom]

we have different prep altogether...it takes 2 people to prep an extremity for an ortho case. so resident or assistant holds the leg and I scrub the foot. then dry and then paint or duraprep depending on the surgeons' preferences. then I would take a sterile cloth towel and hold the leg by the foot. the assistant in the mean time would put on sterile gloves and will take the foot from me. I would then change gloves and prep the rest of the leg starting from incision site. there is one surgeon who would after all that ask for alcohol on the sterile field. then with lap sponge he would wipe all betadine out...then wait until it dries and then reprep with duraprep. so it's super duper prep.....-))))

accourding to some studies the best prep is chloraprep though...it's 8 times more effective as regular betadine wash ans paint....

[surgnurse1]

I was taught the same that alcohol and betadine sol. should not be mixed..but the hospital I work at does it. Anyway, the reason our ortho surgeons like the final alcohol prep around the area is because it is their belief that the Ioban drapes stick better. I think they are right...but of course still has to dry properly or you risk a FIRE hazard with electrocautery use.