cutting sterile drape

[smoddra]

Hello, I am not an operating room nurse and some of the sterile technique info i learned in school is a little fuzzy.

My question contains a couple of components.

1. If a sterile drape is cut does that break the sterile field and need to be re-draped?

2. If it does not then if a double gloved surgeon reached through the hole to the elbow and then brought their arm back through the hole wouldn't that cause a contaminating break?

3. If those previous actions did not cause a break and the surgeon removed first glove layer and proceded with surgery wouldn't his arm be contaminated also?

Has anyone ever seen this practice?

Any input or opinions would be very appreciated.

[springchick1, ADN, RN]

If the sterile drape is cut on the sterile field with sterile scissors then no, the sterile field would not be broken. I'm not sure I know what you mean about the "hole". Are you operating on the elbow? Normally there are down sheets and a sterile U drape down before you put the top drape on. If that's the case then no, the still wouldn't be contaminated. And removing a top pair of gloves doesn't contaminate. There is a sterile pair on underneath so it doesn't matter.

[Rose_Queen, BSN, MSN, RN]

In addition to what aubgurl said, the drape is usually placed several inches from the edge of the prep, so the drapes could be readjusted a little if more exposure is needed. Although not all surgeons double glove (second pair underneath), it is possible to remove the gloves without contaminating the gown and reglove.

[canesdukegirl, BSN, RN]

OP, can you describe further what you mean about "the surgeon reaching through the hole to the elbow" How was the pt draped? Where was the operative site?

[Rose_Queen, BSN, MSN, RN]

OP, can you describe further what you mean about "the surgeon reaching through the hole to the elbow" How was the pt draped? Where was the operative site?

Now that you mention it, I'm wondering if what the OP saw was a drape with an aperture, like a hand drape.

[smoddra]

The scenario is a c-section is being performed and the baby needs to be disengaged. The surgeon cuts a hole in drape and reaches through to the lady parts and pushes baby up. He then pulls his hand back through the hole and removes top glove since he is double gloved. He then continues with the surgery. Was this a sterile procedure? Were any contaminations made?

[S. Hall, BSN, RN]

The scenario is a c-section is being performed and the baby needs to be disengaged. The surgeon cuts a hole in drape and reaches through to the lady parts and pushes baby up. He then pulls his hand back through the hole and removes top glove since he is double gloved. He then continues with the surgery. Was this a sterile procedure? Were any contaminations made?

The procedure you described above was a sterile procedure until the surgeon reached through the hole to the lady parts. Any surgeries done on mucous membranes: ie: the mouth, nose, lady parts, urethra, and orifice are all unsterile procedures. The surgeon did the correct thing by removing his top glove but his sleeve was still contaminated by him reaching through the hole. He should've removed the top glove and then donned a sterile sleeve. And as long as his sleeve or unsterile hand didn't touch anything on the sterile field, then the field was not contaminated.

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[smoddra]

The current argument is that sterile field is broken when the hole is cut and then contamination is made when surgeon pulls hand back through. When director of surgery was asked scenario she said that as soon as drape was cut the field was broken and pt needed redraped. She could not provide any proof of this. OB director thought that it would be contaminated when he brought his hand back through because the drape would have been touched. I am the infection control nurse and thought it would be okay if a sleeve was worn and removed. We all three have different responses to this question so I was trying to figure out what was the correct procedure.

[kguill975, MSN, APRN, NP]

Just to be sure....Was the patient supine or in lithotomy? If the patient was in lithotomy, are you sure that a LAVH drape wasn't used? It has a fenestration that looks sort of like a cut hole, but it's manufactured that way. If that was a LAVH drape, then removing the top glove, and donning a sterile sleeve would be sufficient. The only contamination would be touching the lady parts with the top glove/sleeve. If the patient was supine and there was a down drape, he would have contaminated his gown and gloves when cutting through both, and reaching through the "hole". Hope that helps.