Sterile Tasks Performed by Nonsterile Team Members
In preparing the patient for a surgical procedure, several sterile tasks are
performed by the nonsterile team members. Two of the more common, Foley catheter
insertion and the surgical skin prep, will be discussed. When performing sterile
procedures, the principles of asepsis must be applied and sterile technique must be
practiced. Repetition is the key to mastery of each skill. Remember, variations in
technique may occur.
Foley Catheter Insertion
Foley catheterization is considered an invasive procedure. Insertion of a Foley
catheter may be considered for one or more reasons. Some of the indications for urethral
catheterization are as follows.



Decompression of the bladder
-
To prevent bladder trauma during pelvic procedures
-
To provide better surgical site visualization during pelvic procedures
-
To facilitate healing of urinary tract structures following GU procedures
Drainage of urine
-
To prevent overfilling of the bladder during lengthy surgical procedures
-
To measure urinary output
-
To obtain a sterile urine specimen
-
Relieve urinary retention
-
Treat incontinence
Irrigation of the bladder
1

Control bleeding
- Balloon may be used to place pressure on the bladder neck
Several factors must be considered prior to and during catheter insertion.

Sterile technique must be used

Catheter insertion may cause patient injury



-
Urinary tract infection
-
Urethral injury
Catheters are available in a variety of styles, materials, and sizes
-
Use the smallest size that will drain the bladder without leakage
-
The surgeon will order the style catheter desired
-
The Foley catheter is the most common style
-
Be aware of the patient’s allergy status, use a latex alternative if necessary
The balloon is inflated with water, rather than air or saline
-
Saline may negatively impact the catheter material
-
Air may escape from the balloon and cause an embolism
10cc of water is necessary to inflate a 5cc balloon completely
-

You must compensate for the fluid that remains in the inflation channel
Drainage of urine occurs by gravity
-
Be sure the tubing is not kinked or compressed
-
The collection unit must be placed lower than the level of the bladder
-
Do not raise the collection unit above the level of the bladder to prevent
retrograde urine flow

Secure the catheter tubing to the patient’s thigh
2
-
To prevent unnecessary tension on the urethra
-
To prevent accidental catheter removal
The Surgical Skin Prep
The surgical skin prep is performed on the surgical patient for the same reasons
that the sterile surgical team members perform the surgical scrub prior to entry into the
sterile field.
1. To remove transient organisms from the patient’s skin
2. To reduce the number of resident organisms on the patient’s skin
Living human tissue cannot be sterilized. Therefore, the goal related to the
principles of asepsis is the basis for performance of the surgical skin prep. “Keep the
microbial count within the sterile field to an irreducible minimum.”
Several factors must be considered prior to and during the surgical skin prep.
Probably the most controversial of these is hair removal from the surgical site. Hair that
may interfere with electrode placement, the surgical site, wound closure, and dressing
application may be removed according to surgeon preference, facility policy, age and
gender of the patient, and the planned operative site. Hair removal should occur as close
as possible to the time of the planned surgical procedure to reduce the risk of microbial
growth in any breaks in the skin surface caused by the hair removal. Be sure that the
privacy of the awake patient is assured to avoid embarrassment during the hair removal
procedure. Several techniques, including the razor (may incorporate the wet or dry
method), clippers, and depilatories, may be used to remove the hair. Hair removal with
the use of a razor is demonstrated in the video entitled “Preoperative Case Management”.
3
Other factors related to the skin prep are as follows.




All necessary procedures are carried out prior to performing the surgical skin prep
-
Anesthesia administration
-
Foley catheterization
-
Positioning
-
Exposure of the surgical site
-
Hair removal
-
Skin marking
Gross soil and skin oils must be removed from the planned operative site
-
May require use of a fat solvent or degreaser
-
May require use of a scrub brush and/or nail cleaner
Prep fluids may not be allowed to accumulate adjacent to or under the patient
-
May cause chemical irritation
-
Increases the risk of electrosurgical or laser burn
Consider the patient’s allergy status prior to application of any chemical (an alternate
antiseptic may be needed)

Certain areas are considered contaminated and may require special attention
-
Mucous membranes
-
Stomas
-
Non-intact skin
-
Sinus tracts
-
Umbilicus
4

Two separate skin preps may be necessary in certain situations (e.g., skin graft –
donor and recipient sites)

The prep is initiated at the planned incision site and carried toward the periphery,
using a widening circular motion

An assistant may be necessary to elevate a large limb that must be circumferentially
prepped

The recommendations of the antiseptic manufacturer must be followed (e.g., exposure
time)

Preoperative skin markings are not removed during the surgical skin prep
Note: Some of the preparatory steps (e.g., hair removal and skin degreasing) may also
apply to the skin sites selected for placement of the dispersive electrode for the
electrocautery and the ECG electrodes.
5