What would you do...?

[ToryAdore]

We had a man in for a hernia repair yesterday. Not an inguinal hernia but upper gastric...about 2-3 inches above the navel. The warming blanket was on and after removing his gown from under the blanket, I noticed that he was wearing underwear. I mentioned that to the surgeon he said "it's ok, we're not going down that far". I wasn't sure if he said that for the pts. benefit because he was still awake at this point. I didn't say anything else. I was thinking of asking again when the pt. was under but changed my mind. Prepping was a bit more difficult than it had to be but we managed. No foley but prepping from nipple to navel where the shorts had to be moved aside to avoid getting the color changed from gray to "betadine purple". I'm only 8 months into this and haven't seen it before. What would you have done...?

[SFCardiacRN]

Another reason underwear is removed is for placement of the electrocautery return electrode. This hand sized adhesive pad needs to be placed over a large muscle mass. Thighs and buttocks are the preferred location. It is wise to remove hair before application.

[Marie_LPN, RN, LPN, RN]

Before i've stuck a bovie pad on, before the pt. is asleep (or drugged), if i can see that their leg will need manscaped, i'll tell the pt. they will have a hair-free patch on their leg and the reason why. I've had a couple of people tell me that they appreciate the heads-up, so they weren't wondering if the hair just fell out.

[ToryAdore]

I noticed that he was wearing underwear. I mentioned that to the surgeon he said "it's ok, we're not going down that far".

From the responses, it seems that undergarments are removed "without" asking the surgeon first. Are there different proprietary rules at each facility about this..? I was trained (at my facility) to ask the surgeon "before" you do anything to what they, the surgeon, refer to as "their" pt. (funny...I think of the pt. as "mine" too). I can't imagine being written up for what I consider to be part of the prep routine. My thought is that there are sometimes unexpected emergent situations created during the surgery and I'd want umm...forgive the expression...."my" pt., prepared for without the needs for unnecessary time lost by removing anything.

[Marie_LPN, RN, LPN, RN]

From the responses, it seems that undergarments are removed "without" asking the surgeon first.

If it's a rushing emergency, underwear gets cut.

We don't ask the surgeons if they want underwear removed anymore. Otherwise the response would be "yes, we go through this EVERY case, take them off."

[grimmy, RN]

if it's a rushing emergency, underwear gets cut.

we don't ask the surgeons if they want underwear removed anymore. otherwise the response would be "yes, we go through this every case, take them off."

ditto - it is hard work getting undies off, even if we do cut them, from a pt who is asleep. weird as it sounds, i had to straight cath a guy who, at the outset of the case, was predicted to only be a 1 hour case and turned into 4 hours. of course, straight cathing under drapes is a major pain in the butt (thank goodness it was an ent case!) but having to drag undies off, in addition, would have been a nightmare. we all get creative when circumstances get nasty, but there is nothing like being prepared for unpredictable events.

[SFCardiacRN]

Removing everything for surgery is "standing orders". Every patient...every case. This is why we don't understand how underwear still makes it to the OR.

[Marie_LPN, RN, LPN, RN]

This is why we don't understand how underwear still makes it to the OR.

The preop nurse can tell the pt. to remove it but they don't always do it.

[Glimmer]

I had two screws taken out of my knee almost 2 weeks ago (a procedure that I was under for less than 10 mins to do)... I was asked 3 times if I had removed my underwear! LOL Each hospital I have had surgery at has been different (6 knee surgeries - 4 hospitals) 1 gave me paper shorts to wear, one let me leave them on, and the other two had a no "tolerance" rule and said if you were worried about flashing anyone, etc they would give you two gowns and an extra blanket! LOL Just like the whole pregnancy test thing in pre-op... two hospitals insisted on a urine pregnancy test and the other two just took my word for it

Alnee

[Marie_LPN, RN, LPN, RN]

We've had pts. that get a carpal tunnel release done as a local, and they still wet their underwear.

[canoehead, BSN, RN]

Electrocautery can cause jewelry burns.

See, I didn't know that either. I thought it was just a fear of the jewellery getting lost in the OR. This is great information.

[kind_angel]

Where i work, the protocol is patients who are going for op are provided with paper underwear .This is quite easy to tear off if need be.

[Marie_LPN, RN, LPN, RN]

Hmm, we don't have paper underwear.