Overview of the skill

Once the client arrives in the operating room there are more preparations necessary before surgery can begin. The client must be positioned on the operating table in a way that will optimize the surgeon's access to the sur­gical site without compromising the client's neurovas­cular status. Once the client is in position the surgical site must be shaved and a final cleansing performed.

The client s position on the operating table will vary according to the type of surgery to be performed. There are several kinds of positions: supine position, Trendelenburg position, reverse Trendelenburg posi­tion, lithotomy position, modified Fowlers position, prone position, jackknife (Kraske) position, lateral po­sition for a chest operation, and lateral position for a kidney operation, to name just a few. The client must be positioned to allow optimal access to the needed body part. The nurse must also bear in mind the cli­ents inability to move during surgery when position­ing a client. Because the client cannot move or tell anyone if the position is painful or impairing circula­tion, the nurse must position the client in a way that will not impair the client's neurovascular status during a lengthy procedure.

Once the client is positioned, the surgical site must be cleansed and prepared in a way that will reduce the possibility of infection. Site preparation is important to reduce infections, promote visualization of the area, and to provide a clean surface for sutures and dressings. In general, surgical sites can be categorized as head and neck, lateral neck, chest, hand and forearm, thorax and abdominal, abdomen, abdominal and pubic, abdomi­nal and perineal, perineal, thigh, lower extremity, lower leg, sacro and perineal, upper back, lower back, and flank The prepared area should be larger than the an­ticipated incision site because of the possibility of an unexpected extension of the incision and to reduce pos­sible accidental contamination of the surgical field Hair should be removed from the surgical site only as neces­sary. The three common methods of hair removal are clipping, depilatory, and wet shaving. To reduce the risk of infection, shaving should be performed as close to the time of surgery as possible, Shaving is the most common method of hair removal. It has the advantage of being easily performed with commonly available in­struments. It has the disadvantage of causing micro­scopic cuts and skin irritation, damaging the skins in­tegrity, and increasing the possibility of infection. In some cases, a depilatory (hair removing cream ) may be ordered the night before surgery. Depilatories use a chemical agent that destroys the hair at the root and causes the hair shaft to break down. The advantage of a depilatory is that it has less potential for cutting the skin compared with shaving. The disadvantage is that the chemical used in depilatories may cause skin irritation and possibly allergic reactions. A patch test using a small area of skin must be performed before using a de­pilatory on a surgical site. Clipping the hair close to the skin without actual shaving is gaining popularity as a method of surgical site preparation. It has the advan­tage of not causing skin damage or irritation. The dis­advantage of this method is reduced visibility of the site during surgery as well as the increased possibility of harboring microorganisms among the hair shafts.

After the site is shaved it must be thoroughly cleansed to remove as many microorganisms as pos­sible. This further reduces the risk of infection. The solutions used for skin cleansing and disinfection vary according to each hospital policy. The solution should not irritate the skin or in any way interfere with the skins normal functioning. The commonly used solutions are soap, detergent, and antiseptic agents such as poviaone-iodine, tincture of iodine, 70% alcohol, hexachlorophene, benzalkonium chlo­ride, chlorhexidine, and iodophor.