Patients Skin Prep on the

Operating Table

Submitted by:

MANUEL, Kristine Nelly M.

BSN III-A

Submitted to:

Ms. Marion D. Capili, RN, RM, MSN

Clinical Instructor

Positions for Surgery

Supine Position

The Supine, or dorsal, position is the usual position for induction of general anesthesia and for entering the major body cavities. The patient lies on his back with his arms in anatomical position and the legs slightly apart. The palms of the hands should be facing the body to prevent undue muscle strain on the arms.

Modified Trendelenburg Position

The modified trendelenburg position is generally is used for lower abdominal surgery (allows gravity to assist in maintaining the intestines in the upper part of the abdominal cavity) and some lower extremity surgery (assist in hemostasis). The patient is positioned as in the supine position, and the entire operating table is slightly tilted so that the patient’s head is lower than his feet by 1 to 5 degrees.

Modified Reverse Trendelenburg Position

The modified reverse trendelenburg position is generally used for upper abdominal surgery and for neck and face surgery. This position permits improved operative exposure because gravity keeps the intestines mostly in the lower part of the abdomen.

Lithotomy Position

The lithotomy position is used in the operation requiring a perineal approach.

Prone position

Patient’s who are having surgery on the posterior part of the body are placed in the prone position.

Lateral Position

The lateral position is generally used for operations on the kidneys, lungs, or hips.

Modified Fowler’s Position

The modified fowler’s position or the sitting position is used mostly in neurosurgery.

Patient’s Skin Prep on the Operating Table

Area:

Done after patient has been anesthetized and positioned on the operating table, skin on the operative site and extensive area surrounding it is mechanically cleansed again with an antiseptic agent immediately prior to draping.

Responsibility:

The first assistant is the person who scrubs the patient after he has scrubbed his own hands and arms.

Basic Preparation Procedure for Clean Areas:

1. Don sterile gloves2. Scrub skin, starting on the sites of incision, with a circular motion or over

widening circles to the periphery. Use enough pressure and friction to remove dirt and microorganisms from skin and pores.

3. Discard sponge after reaching periphery. Never bring a soiled sponge back toward center of area.

4. Repeat scrub with a separate sponge for each round and apply antiseptic.5. Paint area with solution from incision site to periphery with circular

motions.

Contaminated Areas within the Operative Field:

Umbilicus, stoma, draining sinuses, skin ulcers, vagina, anus, colostomy. (In all contaminated areas, follow general rule of scrubbing the most contaminated area last or with a separate sponge.

Lateral Thoracoabdominal Preparation

The area includes axilla, chest, and abdomen from the neck to crest of the illium. Area extends beyond the midline, anteriorly and posteriorly. Patient is in lateral position on the operating table.

Abdominal preparation

The area includes breast line to upper third of thights, from the table line, with patient in supine position. Shaded area shows anatomic area of hair removal.

Chest and Breast Preparation

The area includes shoulder, upper arm down to elbow, axilla and chest wall to the table line beyond sternum to opposite shoulder. The patient may be in lateral position.

Knee and Lower Leg Preparation

The area includes the entire circumference of affected leg and extends from foot to upper part of thigh.

Rectoperineal and Vaginal Preparation

The area includes pubis, vulva, labia, perineum, anus, and adjacent areas including inner aspects of upper thigh.

Hip Preparation

The area includes the abdomen on the affected side, thigh to the knees, buttock to table line, groin, and pubis.