Published on February 24, 2016
1. Surgical Draping
2. Surgical Draping • Draping procedures create an area of asepsis called a sterile field • Created by placement of sterile sheets and towels in a specific position to maintain the sterility of surfaces on which sterile instruments and gloved hands may be placed • The patient and operating room bed are covered with sterile drapes in a manner that exposes the prepared site of incision and isolates the area of the surgical wound • Objects draped include instrument tables, basin and Mayo stand, trays and some surgical equipment
3. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
4. Draping Materials • Are selected to create and maintain an effective barrier that minimizes the passage of microorganisms between nonsterile and sterile areas • To be effective, a barrier material is resistant to blood, aqueous fluid and abrasion as lint free as possible • Maintain isothermic environment that is appropriate to body temperature • Meet the requirements of the current National Fire Protection Association Standards so that no risk from a static charge exists • Fabric draping materials must be penetrable by steam under pressure or by gas to acheive sterilization within hospital facilities
5. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
6. Reusable Drapes • The performance characteristic of primary concern for drapes (or gowns) to be used repeatedly is fluid impermeability under the conditions of use • The process of steam sterilizing and laundering swells the fabric whereas drying and ironing shrinks the fibers • This cycle increases the propensity for loosened fibers that alter the fabric structure • Most manufactures report a loss of barrier quality after 75 laundryand/or sterilization cycles • A system to monitor the number of times an item has been laundered is essential for barrier quality control
7. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
8. Disposable Drapes • Prevent bacterial penetration and fluid breakthrough • Successfull drapes are soft, lint, free, lightweight, compact moisture resistant, nonirritating, and static free • Lightness and compactness of synthetic drapes prevent heat retention by patients, contribute to ease inhandling and storage and conserve storage space and personnel´s time • Disposable drapes reduce the hazards of contamination in the presence of known infectious microorganisms in body fluids and excretions and in situations in which laundering of grossly contaminated textiles is a problem
9. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
10. Cont’d • Collection, transportation and storage of waste materials can be a problem • Incineration (burning) is a method for destroying waste disposables- but must properly managedto prevent environmental contamination
11. Plastic Incisional Drapes • Impermeable polyvinyl sheeting are available in the form of sterile, prepacked surgical drapes • The incision is made directly through the adherent plastic drape • Facilitates draping of irregular body surfaces as neck and ear regions, extrimities and joints
12. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
13. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
14. Aperineal drape • For operations on the perineum and genitalia with the patient in lithotomy position • A lithotomy drape consists of a fenestrated sheet and two triangular leggings • A commercial disposable lithotomy drape back, is suitable for delivery, cystoscopy, hemorrhoidectomy and vaginal procedures
15. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
16. Standard drapes • A whole , or plain sheet is used to cover instrument tables, operating tables, and body regions • The sheet should be large enough to provide an adequate margin of safety between the surrounding physical environment end the prepared operative field • Surgical towels in one or two sizes should be available to drape the operative site. Four surgical towels are sufficient • Fenestrated or slit sheets are used for draping patients. They leave the operative site exposed,use for (laparatomy draping)abdomen, chest, flank, back, other size for limb, head and neck
17. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
18. Folding drapes for use • Drapes should be folded so that the gowned and gloved members of the team can handle them with ease and safety • The larger, regular sheet is usually fanfolded from bottom to top • The bottom folds may be 4 inches wider than the upper ones • The small sheet is folded in half and then quartered
19. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
20. Draping Procedure • Carry the folded drape to the operative site, where the drape is carefully unfolded and placed in proper position after a drape has been placed, it should not be moved • Hold sterile drapes above waist level until properly placed on the patient or object being draped. If the end of a drape falls bellow waist level, it should not be retrieved because the area bellow the waist is considered unsterile • Protect the gown by distance and the gloved hands by cuffing drapes over them • The scrub nurse should have all parts of the drape under positive control at all times during placement and should use precise and direct motion
21. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
22. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
23. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
24. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
25. Cont’d • Drapping is always done from sterile area to an unsterile areaand by drapping nearest first • The scub nurse should never reach across an unsterile area to drape • When the opposite side of the operating room bed must be draped , the scrub nurse must go around the bed to drape • Do not flip, fan or shake drapes. Rapid movement of drapes creates air currents on which dust, lint and droplet nuclei may migrate • Shaking a drape causes uncontrolled motion of the drape which may cause it to come in contactwith an unsterile surface or object
26. Cont’d • A drape should be carefully unfolded and allowed to fall gently into position by gravity • The low portion of a sheet that falls bellow the safe working level should never be raised or lifted back onto the sterile area • Drape the incisional area first and then the periphery • Use nonperforating towel clamps or devices to secure tubing and other items on a sterile field • When sterility of a drape is questionable, consider it contaminated
27. Draping in spesific region Upper or Lower Extremity Draping •Place a cover sheet over the end of the table to protect the surgeon and assistants from accidentally contaminating their gowns by brushing against the nonsterile operating table. • Roll a double-layered tubular stocking or waterproof cover over the extremity. •Use a folded, sterile towel to cover the tourniquet. Secure it snugly around the thigh or the arm just distal to the tourniquet with one or two towel clips.
28. • Roll the stockinet into place, up to or over the tourniquet, to prevent accidental contamination of sterile gloves and gown. In addition, if incisions are carried far proximally, the towel prevents accidental exposure of unprepared skin. • Place a second half-sheet with the proximal end folded downward 6 inches beneath the extremity, taking care not to contaminate the folded edge. • Lay the limb down on this sheet. Place a second half-sheet with its distal edge folded double for a distance of approximately 1 foot over the proximal portion of the limb, matching the folded edge of the underlying half-sheet. • Secure these two sheets snugly together and to the rolled stockinet with four towel clips.
29. • Next, place the limb through the hole in a large laparotomy or extremity sheet. • If a laparotomy sheet is used, secure it snugly around the limb with two towel clips just below the previously applied two half-sheets. Leave no exposed underlying half-sheets
30. Upper Extremity and Shoulder Drape •For surgery on the upper extremity distal to the shoulder, drape as for the lower extremity; use a hand table if desired. •For shoulder surgery, carry the skin preparation well up on to the neck and anterior and posterior chest wall. Cover the torso and legs with a water-impervious barrier sheet. •Roll a tubular stockinet to the elbow. Secure a sheet into the axilla and across the chest. •Cover the proximal extent of the shoulder with a second sheet posteriorly and a third anteriorly, which meet on the lateral neck.
31. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
32. Dr.AidahAbuAlsoudAlkaissi DevisionofIntensiveCareand AnaesthesiologyUniversityof Linköping-Sweden
33. • Secure these drapes with an adhesive drape and then pass the limb through an extremity or laparotomy sheet, and secure it with staples and another adhesive drape
34. Hip Drape •Position the initial barrier sheet. Roll a tubular or water- impervious stockinet over the extremity to the mid thigh. • Bring the first half-sheet into position, and secure it with staples to the medial surface of the thigh, approximately 8 inches distal to the perineum. • Bring it carefully proximal along the anterior and posterior aspects of the thigh and onto the torso. •Secure this drape to the skin with large skin staples. Towel clips can be used as well, but they tear through paper drapes and interfere with radiography.
35. • Draping for Intramedullary and Hip Nailing
36. • Carry both the skin preparation and drape well proximally onto the rib cage. • Put the second sheet in place, and use skin staples to secure it at the uppermost margin of the operative field, proximal to the iliac crest. • Fold the lower sheet into the groin. Further secure these sheets with application of a povidone-impregnated adhesive plastic drape . • Place the extremity through the hole in a laparotomy sheet, and secure it to the medial thigh in the same location as the previous sheets.
37. • Enlarge the hole in the drape with a pair of scissors; bring it proximally over the extremity, and secure it to the patient with skin staples. • Secure this drape with a large povidone-impregnated plastic sheet. • With this draping arrangement, a number of impervious layers are placed around the operative site. • The limb is free to move because the sheets are not brought directly into the groin, and the groin is well draped out of the field • Bring the extremity through the holes in a laparotomy sheet cut to fit the exposure desired
38. • Staple it in place and secure it with a second plastic drape. This method avoids draping into the groin and gives ample sheet in the groin area for movement of the extremity.
39. Thank You
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