Chapter 2: Table of Contents
Drapes are applied around the perimeter of the surgical field to isolate it from the surrounding, contaminated area. Cotton muslin woven at 140 threads per square inch is one of the standard materials for making surgical drapes. Most modern drapes are a polyester-cotton blend. Both products are inexpensive, durable and reusable. Their disadvantage is that when wet, these materials can allow easy passage of bacteria (strike-through).
Disposable paper drapes are typically water repellent and impermeable to bacteria. Their disadvantage is they are not reusable and therefore are relatively expensive and somewhat ecologically unfriendly.
Ground or corner drapes are doubled over at one end (9-10 cm) and placed at the periphery of the surgical field one at a time (to cover the four corners) while preventing contamination of the surgeon’s sterile gloves by wrapping the edge of the drape around the gloved hands. Drapes should not be shaken, fanned or flipped rapidly when handled as this will create air currents and promote contamination of the prepared surgical field.
If draping the abdomen of a male dog, the prepuce should be displaced laterally (away from the side of incision) and held in place using a towel clamp to decrease the risk of contamination (even if it was clipped and flushed for surgery). This should be done prior to draping the area in order to drape over the tip of the prepuce.
The first drape is generally applied at the cranial edge of the proposed incision site. Once the drape is unfolded, it should not be turned around in order to maintain the most sterile portion (close to the hands) sterile. First, the edge of the drape is folded over (9-10 cm) and the drape is applied without ‘fanning’ or ‘flipping’ to prevent contamination of the surgical field with air currents or hair.As drapes are applied, they can be moved away from the proposed incision site, towards the edge of the prepared area (without exposing hair). Conversely, a drape cannot be moved from the site of application towards the center of the prepared area since this may lead to contamination of the prepared field. Remember not to contaminate your gown on the surgical table during draping. An alternative to folding and applying the top of the drape at the cranial edge of the incision, is to fold the side of the drape instead and to gently slide it across the proposed surgical field; however, this technique is not considered as ‘clean’.
Drape 2 is generally applied at the caudal edge of the proposed incision site since it can usually remain in place without falling until towel clamps are applied. The drape is applied in the same manner as drape 1.
Drapes # 3 & 4
Drapes 3 and 4 are applied on either side of the surgical field and affixed to the skin using towel clamps. Pick up two towel clamps before applying drape 3 to ensure it does not fall between application and clamping. Towel clamps should penetrate each of the apposing drapes as well as the skin. Do not remove and replace towel clamps since the clamp is considered ‘unsterile’ after it penetrates the skin.
Draping During Phase III
Draping During Phase III
The approach described above is used in the clinics at the OVC HSC. In Phase III surgical exercises, you will be expected to drape using the “Around the World” technique. With this technique, the cranial (head) drape is placed first, either of the lateral drapes (left or right) is placed next, followed by the caudal (tail) end drape, and finally the remaining lateral drape. This technique may help prevent drape slippage and contamination while you learn.
Applying the Laparotomy Sheet
A laparotomy sheet is placed over the ground drapes and should cover the entire patient / surgery field. When using a cloth laparotomy sheet, it should have an appropriately sized hole placed over the proposed incision site. When using a paper laparotomy sheet, an appropriately sized hole can be cut if the hole provided is insufficient.
Adhesive plastic incise drapes (i.e. Opsite®) can be applied to the surgical field to reduce contamination further. These drapes cover all exposed skin surfaces within the surgical field, they are see through and completely waterproof. These however, do not always stick very well to the patient’s skin.