there has been recent discussion as to how and what sequence etc one should do a prep for gyn cases,in particular abdominal hysts at the hospital in which i work.
i am used to prepping from the cleanest site first...prep the abd, then do the vag prep, then do the foley ( change gloves before doing the foley)..some do this in reverse..wearing double gloves, do the vaginal prep first, take off the gloves, do the foley, then move up to do the abd...
so....how do you do your gyn preps?
Sep 23, '06
We frogleg the pt., prep for the Foley and vag prep at the same time. One sponge stick is left in the vagina while the Foley is put in. Circulator removes sponge after Foley is in (calls this outloud as well), legs are put back to straight, Foley tube goes under the pt.'s leg, not over. Then the abdominal prep is done, w/ fresh set of gloves.
Sep 24, '06
Sequence is always in the eye of the beholder. I think evey place you go will have a different way of prepping and there isn't probabbly a wrong way. Now after saying this I myself prep the same way I have for many, many years and have never had a problem. I put in the foley then change gloves and prep the abdomen and lastily a vag prep. Simple, but gets the job done.
Sep 24, '06
I prep below and do the foley and then I use a new prep tray and prep the abdomen...
Sep 24, '06
We do vaginal prep first, new gloves for foley. Abd prep last. Our reasoning is that it would be very possible for fluid from the vaginal prep to get on the abdomen and contaminate the prep there if it was done first. Also it is not a good practice to be replacing the blankets and belt over the legs if the abdomen is already prepped.
Sep 24, '06
Quote from shodobe
Sequence is always in the eye of the beholder. I think evey place you go will have a different way of prepping ... I put in the foley then change gloves and prep the abdomen and lastily a vag prep. Simple, but gets the job done.
Pretty much the same as we do where I work... no problems here either.
Oct 4, '06
Vag prep first, insert foley, then do abdominal prep.
Vag prepping can aerisolize and get on abdomen, contaminating your abd prep.
Use new gloves for abd. (we use DuraPrep for abdomen)
Oct 17, '06
Absolutement!! There have been several recent and not so recent studies that do seem to indicate this exception to the rule of go "clean to dirty". It is believed as CIRQL8 has stated...the aerosolization contaminants from the vaginal canal are released into the air when extracting the sponge stick and therefore lands on the abdomen...so prep the dirty and then prep the clean...times they are a changing...
Oct 24, '06
i agree, we all have to have our own routine. as long as you are working on behalf of the patient. as long as there is not a cross contamination with your prep.
Oct 29, '06
here's aorn's position verbatim:
question: there is disagreement in our or about the correct sequence for performing abdominal-perineal preps, particularly for patients undergoing laparoscopic-assisted vaginal procedures. what is the correct procedure for prepping these patients?
answer: this is a frequently asked question and one that causes controversy among staff members. surgical staff members should prep the perineal-vaginal area first for laparoscopic-assisted vaginal procedures. after the perineal-vaginal prep is completed, the perineal area should be covered with sterile towels while completing the abdominal prep.
the abdominal skin prep is separate from the perineal prep and should be performed with a new prep tray, gloves, and sterile setup. the patient is placed in the lithotomy position for the prep.
the rationale for performing the abdominal prep last is to avoid splashing or aerosolization of perineal prep solutions when the patient's perineum is prepped and the foley catheter inserted. occasionally, it may be necessary to perform crede's maneuver to empty a patient's bladder at the time of foley catheter insertion. crede's maneuver requires the person inserting the catheter to apply manual pressure on the patient's lower abdomen over the bladder area to express urine. the application of pressure on the lower abdomen would contaminate an already prepped abdominal area.
Oct 31, '06
thanks to all for your responses... thank you to mtnrunner for the aorn article as well...good info!
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