Physical Preparation for Surgery

IV Access

Avoid surgical extremity or extremity with dialysis shunt, injury, same side mastectomy, radiation, or axillary dissection of lymph nodes.

Refer to facility policy when obtaining blood draws from existing IV—if starting IV, ordered labs can be obtained simultaneously.

18-gauge catheter preferred for possible administration of blood products if needed.
Label IV with gauge, date and time of placement, and nurse initials.
Existing infusion ports (e.g., Port-a-Cath) may be accessed by a certified port access nurse and with surgeon/anesthesia approval.

Preoperative Medication

Antibiotics: Pre-op antibiotics must be administered on time and exactly as ordered to be effective in preventing infection.
Anxiolysis: Pts with pre-op anxiety may be prescribed anxiolytics.
Antiemetics: Pts with a history of post-op N&V (PONV) may be prescribed pre-op antiemetics (e.g., ondansetron).
Analgesia: In order to enhance post-op experience, preemptive analgesia (e.g., acetaminophen) may be included in pre-op process.
Scheduled Pt Medications: Medication for chronic medical conditions (e.g., hypertension, diabetes) that could be interrupted by the fasting and surgical preparation process either will need to be held, so as not to adversely interact with anesthesia drugs, or may need to be administered on schedule, when missing a dose could exacerbate a chronic condition—seek anesthesia/surgeon input.

Bowel and Bladder Preparation

Bowel Prep: Prior to abdominal, gynecological, or rectal surgery, it may be necessary to clear the bowel to prevent risk of peritoneal contamination if bowel is compromised during surgery—administer as ordered. Note: Pts may be asked to self-administer bowel preparation (enema or laxatives) at home the night before surgery—confirm and document preparation has been performed.
Bladder Prep: Pts scheduled for abdominal, gynecological, rectal, or long procedures may also require insertion of indwelling urinary catheter. This will keep bladder empty during surgery, preventing injury to bladder, and will also allow surgical team to monitor output during surgery and in PACU.

Surgical Site Preparation

Pre-op skin preparation helps prevent surgical site infection (SSI).

Jewelry: Confirm all jewelry and body piercings have been removed. Jewelry harbors bacteria and can cause injury during positioning and burn injury with use of electrocautery. If Pt experiences swelling during surgery, jewelry can impede circulation to an extremity.
Nail Polish: Remove all nail polish—seek recommendation from surgeon/anesthesia regarding acrylic (artificial) nails. Nail polish and acrylic nails harbor bacteria and can interfere with SpO₂ reading.
Clipping: Hair clipping may be necessary depending on amount of hair and location of incision—use a sterile electric clipper (razors are not recommended due to risk of infection caused by small nicks in skin that may occur with a razor). Clipping hair of sensitive (e.g., groin) and facial or scalp areas may be done in the OR after induction.
Antiseptic: Apply antiseptic cleansing agent if ordered. Note: Pt may be instructed to shower and wash with Betadine or chlorhexidine antiseptic soap prior to admission—verify and document in chart.

Intact, Clean Site: Cleanse outward using a circular pattern from clean to dirty—follow facility guidelines.
Contaminated, Dirty Site: Cleanse inward using a circular pattern from clean to dirty—follow facility guidelines.

Antiembolic Devices

Require surgeon order for application.

If legs measure differently, obtain two different sized devices.

Antiembolic devices are effective in preventing DVT, VTE, and PE.
Common types include thromboembolic deterrent (TED) hose and sequential compression devices (SCDs).

Follow manufacturer instructions for use of stockinette under SCD.

Thigh-high: Measure each leg from gluteal fold to base of heel. Measure circumference of each calf and thigh at widest points.
Knee-high: Measure from base of heel to middle of knee joint and measure circumference of calf at widest point.

Adverse Outcome Prevention Protocols

Some facilities may implement protocols to minimize adverse outcomes from complications common to the surgical experience.