Standing Prep

[yoga crna]

I have a question for my OR nursing colleagues. First a little background--I am a CRNA in private practice and the owner of a surgery center for plastic surgery. Our surgeons are excellent and have an international reputation. All of the nursing personnel are experienced and we have worked together for years.

My only problem is with one of our new surgeons (trained in the military). He wants his patients who are having lower body lifts -- primarily post gastric bypass patients who have lost a lot of weight--prepped standing on the floor beside the OR table. He wants the table drapped with sterile drapes and then have the patient climb on the table and lay on the sterile drapes. We then proceed with the anesthesia induction.

I really dislike doing this for several reasons including physiologic (patient is cold) psychologic and technical. I want to sit down and talk with him about it, but want to have a good argument in hand. My RNs are not happy with this technique either and we want to show unity in our discussion. The medical director of the facility will back us up if we have good supporting information.

My question to all of you--does anyone know the history of doing this type of prep? Is it performed for any other types of procedures? Can any of you help me?

Please don't give me any legal arguments unless you can cite case law, closed case or insurance information. It is not a legal issue.

Thanks much.

Yoga CRNA, JD

[msurgery1]

We've done a standing prep before, and stopped for several reasons:

It is humiliating for the patient and puts a negative spin on the experience.

Moving onto the table is difficult; patients are unsteady and end up contaminating the prepped area which in turn wastes time due to need for re-prep. Also, the chance for injury increases, especially if preop sedative/anxiolytics were given.

Temperature drops several degrees, and it is hard to warm the patient back up.

ASPSN is the American Society of Plastic Surgical Nurses. To get in the field, I would recommend getting a job as a circulator in an ambulatory surgery center or the hospital. Request the plastic surgery and ENT cases. Learn to scrub as well, which usually is included as part of the training period for OR nurses.

Look at the AORN (Association of Perioperative Nurses) website, as well. You can subscribe to the journal.

[suzanne4, RN]

I know of several well-known plastic surgeons that use this type of prep, especially when doing total body makeovers in the same surgery, the all day cases. And never heard a single complaint from the patients. And sedation is not given prior to them lying down on the table. Specifically for the reason that the patient needs to be standing.

The body is completely prepped, then the face is done in a separate prep later on. They usually start with liposuction of the knees and thighs and then do the abdomen and chest, then the face gets done last. Arms can be done when the chest is done............really total body. A $20,000 surgery plus.