A new drape for the total hip replacement surgery through the ASI approach

Abstract

Before operation, the patient needs to be sterile draped. In a total hip replacement surgery through the anterior supine intermuscular approach, the surgical incision is made from the front side (anterior) of the hip, by which the patient lies down on the back on the operating table. During the surgery, both legs are maneuvred. Due to this, both legs are draped separately. In the current patient-draping procedure within the total hip replacement surgery through the ASI approach, many drapes are used, there are too many actions and holding up both the legs simultaneously is experienced as unpleasant. Above all, the pubis, perineum and groins area, which is considered as a dirty area, is draped in a way that it is questionable whether the sterility is guaranteed. After an analysis of the draping procedure in the current situation, done by an observational research, concepts were created in the conceptualization phase on the hand of defined design guidelines and the interaction vision, which is stated as: The new drape is easy and understandable to use, where the pubis, perineum and groins area is covered with one drape and the amount of actions is reduced. The design consists of three main parts: a double layered drape with integrated stocking and integrated drape for beneath the legs (available for left and right leg), a separated stocking and a top sheet that creates a barrier between the surgical and anesthesia field. The double layered drape should be put over the non-operative leg of the patient when the orthopedic team is not sterile scrubbed and gowned yet. This way, the pubis, perineum and groins area can be covered in an early stage of the draping procedure. The drape will then be unfolded and with an adhesive strip it is attached around the disinfected groin area of the operative leg. The outer layer is allowed to be in contact with a non-sterile environment, the inner layer is sterile. Then, the orthopedic surgeon and the assistant leave the operating theater for sterile preparation. In the meanwhile, the nurse puts the separate stocking, which also has an outer layer, at the knee of the operative leg. When the orthopedic team is back and sterile gowned, the patient-draping procedure continues with disinfection of the incision area and the operative upper leg, and the removal of the outer layer of the drape and the stocking in order to expose the sterile inner layer. Next, the stockings are unrolled and the drape beneath the legs is unfolded. The ends of the stockings at the feet are closed by means of tape. The top sheet is put on top of the patient. Finally, an incision drape is used to cover the incision area.