Stupid question....

inspir8tion · Jun 20, 2007

You can use sterile towels to mop up any pooling - they're sterile, so won't contaminate. Also, in the prep kit there should be extra absorbant paper to use.

RNOTODAY, BSN, RN · Jun 21, 2007

You can use sterile towels to mop up any pooling - they're sterile, so won't contaminate. Also, in the prep kit there should be extra absorbant paper to use.

pooling *on* the site, or pooling that runs down the sides of the pt.... like if you prep the abdomen, and it drips down the sides and pools.....what pooling are we supposed to be avoiding...

GadgetRN71, ASN, RN · Jun 21, 2007

pooling *on* the site, or pooling that runs down the sides of the pt.... like if you prep the abdomen, and it drips down the sides and pools.....what pooling are we supposed to be avoiding...

You don't want a puddle of Betadine pooling under the patient because if left there, it can be damaging to the skin. Before I prep a belly, I'll place two towels, one on each side of the abdomen and I'll just make sure not to touch them with the sponges or swabs. Then when you are done with the prep, just carefully remove them. Also, on our prep table we have a couple of sterile towels that we can blot the abdomen with. I think I heard too that pooling can cause issues with the cautery if there are sparks. We have one general surgeon that preps himself and wants alcohol in place of scrub:o This makes everyone nervous but supposedly, he did research and presented to the PYB that said it wasn't really a danger(he claims it evaporates before it pools.) All I know is, I document every single time that alcohol was used per the orders of Dr.____ and that he performed the prep.

shodobe · Jun 22, 2007

Pooling can be the fuel that can start a fire if the conditions are right. Look at the alcohol content of Duraprep, 70%!!!!

CDNORRN · Jun 22, 2007

Obviously your doc has never witnessed a fire in the OR. Patients have died from use of alcohol and prep solutions with high alcohol content. Many ORs that I have worked in have eliminated alcohol including the hand cleansers on the wall in ORs because of the risk of fire. I never again want to do a wound debridment on a patient because of a fire caused by a prep solution.

passionate · Jun 25, 2007

AORN standards are clear on this. Another good resource is Alexander's and Berry & Kohn. I agree with the placing of towels (impervious) on either side of the belly, making my paint solution as dry as I can before applying it to mimimize the run-off. Patients always look so 2 dimensional and flat in the photos and pictures! *If you have to, throw some extra impervious towels on your prep to use. The real cost to the institution is whether the outcome for the patient is a safe practice or not.

bifurcated · Jul 8, 2007

OK, where I learned to be a OR nurse, the circs didnt prep, the residents did.. so... you kow how you are supposed to avoid pooling of the solution? How am I supposed to avoid that? What if there is some pooling, how do I get rid of it without contaminating? Help is appreciated, I am doing some shifts at a hosp where the circs prep... I was showed how to do it, but I have questions still.... thanks....

As some of the replys have noted, don't use such a "wet" sponge it needs to be wet enough to work from the site of the incision "out" and if it does run, you should be using some sort of towel (impervious or not) at the patients sides or neck or wherever. I learned how to keep my sponges drier by being corrected by an orhopedic surgeon who "hated" seeing the prep run down over the incision site from the "above". It just takes practice you will be doing a great prep in time. Observe others whose preps you admire...... a great way to learn! As far as the alcohol is concerned, it comes and goes...... If you are using it, you have to be very careful about pooling under your drapes......... we did this for an open heart guy and even though it was very distasteful to the "old gaurd" we did it with our little twists......... if it still was wet, we would not begin draping until it was dry.

mcmike55 · Jul 14, 2007

The previous posters are right on the mark here!

Pooling of fluids, especially highly flamable solutions like alchol are just a disaster waiting to happen! Just look at the triangle. You have fuel, and oxygen, all you need is a heat source (helloooo Mr Bovie!)

Seriously, I tuck a couple of disposable chux, or sterile towels under and around where I prep, then pull them before I step away. Our docs are very good about making sure the prep is dry and there are no puddles anywhere, before they start.

We had on doc that just loved to sling the alcohol around as part of the prep, especially when doing feet. I covered the area with disposables before he started, took them all away and made sure the alcohol evaporated long before we started.

Eventually, after much discussion, we were able to come to an agreement, removing that fire potential,and still getting the prep done at the same time.

Our supervisior also pulled the alcohol out of the OR too.

Mike

passionate · Jul 17, 2007

That is a good trick. A very, very, lonnnnnnnnnnnnnnng time ago we had a general surgeon who would not give up on his non-disposable scrub brushes. One day the OR mgr. just took the whole unit off of the wall. There was no discussion at all. The surgeon knew it was bad practice and obviously the mgr. made her point.

RN Zeke · Jul 18, 2007

Excessive liquid + faulty cautery ground = patient grounding the cautery. Not a good out come.

Sammy25 · Jul 19, 2007

Yes, it is very important to prevent ANY type of alcohol based prep from pooling on the skin, under the patient, or under the drapes. It is also important to make sure that the alcohol based prep (prevail, duraprep, ect) is completely DRY before draping if using electrosurgery or cautery. Vapors from the undried prep underneath the drapes ... mixed with the spark from a cautery tip... plus high concentration of oxygen equals danger.

At our facility it is mandatory that we add prep dry time to our time out.... as well as document the time the alcohol based prep was applied to the time it dried and drapes were applied.