prep solution question

Our plastic surgeons use PCMX for facial surgery diluted with n/s or h2o. Our neurosurgeons use betadine scrub diluted with h2o, then 70% alcohol to let the drapes stick on the skin. A couple then do duraprep over the alcohol. A couple of our general surgeons like using only duraprep, the eye guys do betadine paint diluted with h2o then h2o alone to remove the betadine. Everyone else does betadine scrub and paint unless the patient has allergies, in which case it's PCMX. BTW, we haven't been able to find a substitue for PCMX. What do you guys use in case of iodine/betadine allergy?

Povidone iodine sponge sticks for lady partsl preps, and for any surgeries involving the groin areas, and extremities.

Duraprep for abdominal stuff.

Phisohex on facial surgeries and young ones. Some of our surgeons are going back to betadine on the kidos. we have bounced back and forth on the mucous between the hibiclens and betadine and are currently back to the betadine paint only for vag preps. Most of our ortho docs like the dura prep. Some use betadine then rinse off with alcohol. Gee sounds like a vicous cycle :chuckle Ya know each surgeon has a different method to his madness.

Do all of you who use alcohol allow the use of electrosurgical devices? There is an incredible fire hazard there! CHG and PCMX should never be used on mucous membranes. Phisohex is known to cause cancer. All prep solutions should be allowed to dry on the skin before draping...how many surgeons are willing to watch the stuff dry? NONE!

WOW so many restrictions! We use Betadine Paint for all lady partsl procedures and urological unless there is a sensitivity. Technicare is another good one and is OK to use on mucous membranes and open wounds. Additionally, it is not rendered inactive by blood as betadine is. Technicare has it's down side. NOTHING will stick to the skin after it has been applied. It does such a good job at killing microbes that unless extra care is taken to rinse it out of the lady parts, the patient ends up with a yeast infection. I still like betadine the best.

we use it all, betadine scrub and paint....alcohol and hibiclens....sureclens for eyes...duraprep, just depends on surgeon preference.

The only docs that use alcohol where I work are the neuro guys. We use ESUs but the alcohol has long dried up by the time they use the bovie. They like using the alcohol after the betadine, so that the drapes stick better. Once they inject the local they can't do much else except wait for the circulator to connect and hook stuff up before they can start.

If you look at the stats (you can find them online in various sites) I think AORN publishes something every year, basically everything you guys have mentioned is more than acceptable. Betadine is tried and true (as we all know it works when drying and many nurse and docs wipe it of while its still really wet). All these new prep solutions on the market are USUALLY slightly better then betadine--I think most consider it the "gold standard". They really try to sell you on being more effective or easier to use since you don't have to wait for it to dry at all. I prefer hibiclens cut with just a little 70% alcohol (to add te quick kill). One big bottomline for some people (management) is cost. I have read that betadine is something like half the cost per some square (?) area of skin to prep than hibiclens.... the some comparision had to admit that it was basically 30 cents per some square area vs. 60 cents to prep with hibiclens. We mostly like hibiclens because we've gad a few (very few) betadine burns from a little puddle that was allowed to pool on the sides of the patient. Also, I like hibiclen because 1. it cleans up easier--basically we do nothing at the end of the case Hence (#2) it provides continued protection around the wound in the immediate post-op period. That's it... best of luck!

In regard to Duraprep-it has been banned in OR's around Toledo due to a pt. catching on fire during a craniotomy@ The Toledo Hospital.. This info was gleaned from the ensuing lawsuit. The doc didn't wait for it to dry & the drapes & ET tube (with high O2 concentration) ignited. The pt. suffered severe burns on the face & lungs-she will require O2 therapy for the rest of her life as well as numerous reconstructive surgeries. Be VERY careful using this prep!!! Luann

Luann, sorry to hear about the incident. Is there more info available somewhere that I could get.

OR fire, a nurses worst nightmare in my mind, that, and wrong site surgery.

I hope anyone/everyone reading these posts refreshes in their minds the dangers that prep solutions bring "to the table".

Thanks for your input!!

Mike

I like Betadine gel--one step prep; works on contact. No dripping; no pooling. I've been using it for over 25 years, so it always makes me laugh when I go to some new travel assignment OR and they act like it's some "newfangled" prep solution. They think it needs to "sit" for a while--it does NOT. As I said, it works on contact.

Just a word of caution that bears repeating----Hibiclens (Chlorhexidine) should never, EVER be used on the face (especially anywhere near the eyes; it can cause severe corneal/scleral burns and subsequent blindness) or mucosa---still, you see urologists insisting it be used as their prep of choice for urologic procedures such as cystos. I just refuse to use it.

I have never heard of adding alcohol to Hibiclens--is it really necessary? It probably results in a product similar to Hibitane, which is no longer made--it was a bright pink tincture that you just painted on. I think it was Chlorhexidine paint; probably had alcohol added.

Good old Betadine paint works well, too. In most ORs where I work where they do not have Betadine gel, they just use paint--no scrub.

Duraprep is good, but, yes, just like alcohol, one must wait for it to dry before using a cautery. That's interesting about the fire in the presence of a high concentration of O2--I could see where that could definitely happen. Duraprep, too, should not be used on face or on mucosa, because of the alcohol.

I usually use Phisohex for vag preps or other mucosa when the patient is allergic to Betadine.

I have worked at some facilities where they have switched to Tincture of Iodine for their ortho preps. By the time all the drapes are applied, it's dry.

as most everyone else has mentioned, different stuff for different procedures. for most general/abdomen surgery, we use a triple prep of betadine scrub, prep and alcohol. for gyn, cysto, and eyes, they use paint only. for the transnasal transphenoidal resections, they use shurclens. of course, the big thoracic cases the pt showers with a special soap (the name escapes me at the moment) the night before, & we use triple prep. the plastics folks use mostly paint, with occasional use of alcohol on hand cases.

Grimmy,

Have you ever read the contents of a shurclens prep container? NO ANTIMICROBIAL or MICROBIOCIDAL AGENTS there! Not much more than purified water. Using that to prep before going throught that staph ridden nose and into the brain? How do you avoid infections? Shurclens should only be used for removal of gross contaminants from trauma and other "dirty" type precleaning. Maybe your docs don't really know what they are asking for when they request the stuff. OR Nurses often find these things out when they investigate the rationale for a doctor's choice of one solution over another. Surgeons are often very greatful, when educated about their choices. It demonstrates that you have their patient's best interest and positive outcome in mind. Boy, and won't you be the model of patient advocacy!