4-11. GENERAL

Most wounds will require sutures or some minor surgical procedure. The medical specialist is frequently called upon to prepare the wound area for the person performing the procedure. The general rules of medical and surgical asepsis must be followed to prevent infection, which could possibly cause loss of limb or life. The procedure for preparing an area for operative treatment is simple, but the consequences of an incorrect procedure could prove fatal.

4-12. PREPARE PATIENT AND MATERIALS

a. Assemble Equipment and Supplies. Obtain a sterilized prep set. Place set near work area so that it can be reached easily. The contents of the set may vary, but should include the following items:

(1) Sponge basin.

(2) Solution cup.

(3) Gauze pads.

(4) Asepto syringe.

(5) Safety razor and blade.

(6) Sterile water or sterile saline solution.

(7) Povidone-iodine (Betadine) solution.

(8) Protective pad (Chux if available).

(9) Sterile gloves in appropriate sizes.

(10) Basin (such as emesis basin).

b. Prepare the Patient.

(1) Explain procedure to the patient to ensure understanding and cooperation.

(2) Position patient as indicated by physician or supervisor.

(3) Place protective pad under area to be treated.

(4) Secure patient to table or litter by using litter straps or other suitable restraints, if needed.

(5) Provide privacy by closing the door, pulling the curtain, or screening the treatment area, if possible.

(6) Expose the site of the injury by removing or cutting away clothing, bandages, and dressings. Do not expose any more of the patient’s body than is necessary.

(a) Use blunt-tipped bandage scissors to cut away clothing and bandages.

(b) If bandage or dressing is stuck, loosen it by moistening it with sterile saline.

(7) Focus light on area to be treated.

c. Wash Hands. Perform a patient care handwash.

d. Prepare the Sterile Field.

(1) Remove caps and stoppers from solution bottles.

(2) Open the prep set.

(a) Open outer wrapper with bare hands.

(b) Glove one hand and use that hand to open inner wrapper. Do not touch any unsterile item with gloved hand. Keep your gloved hand above work surface.

(c) Using your ungloved hand, pick up the sterile solution bottle and pour small amount of solution into a trash receptacle.

(d) Pick up the sterile basin with your gloved hand, step back from the sterile field, and pour the sterile solution into the basin. (The bottle is still held in the ungloved hand.)

(e) Return the basin to the sterile field and replace cap on bottle. (Use ungloved hand to replace cap.)

(f) Using your ungloved hand, pour povidone-iodine into solution cup (bottle held in ungloved hand); then replace cap.

(g) Glove bare hand.

4-13. PREPARE THE WOUND AREA

a. Irrigate the Wound. Irrigate (rinse) the wound using an asepto syringe and large amounts of saline solution. If saline solution is not available, use sterile water. Irrigation is usually performed under the direct supervision of a physician or other appropriate personnel. Bleeding may occur when the wound is irrigated as clots are dislodged and washed away.

(1) Position the basin under the wound area to catch the water.

(2) Fill the syringe with the sterile irrigating solution.

(3) Place the tip of the syringe as close to the wound as possible without touching the wound area.

(4) Depress the bulb and direct the fluid flow to all parts of the wound. Pay special attention to areas with debris, sweat, or drainage.

(5) Repeat the irrigation procedure until loose debris and drainage has been removed from the wound.

(6) Remove the basin.

b. Cleanse the Area Around the Wound.

(1) Place a sterile gauze pad over the wound and hold the pad in place.

(2) Cleanse the skin around the wound with gauze pads and povidone-iodine solution. Use gentle friction and circular motion. Begin working at the wound edges and clean outward until an area three to four inches from the edge of the wound has been cleansed.

(3) Discard the gauze pads after the area has been cleansed.

c. Shave the Area Around the Wound.

(1) Check with the physician, appropriate medical person, or SOP to determine the full area to be shaved.

(2) If a scalp or facial wound involving the hair, clip long, thick hair first; then shave. However, do not shave the eyebrows (cosmetic reasons).

(3) Shave any hair you can see at edges or in the cleansed area.

(a) Begin shaving at the edge of the wound.

(b) Shave outward from the wound edges.

(c) Apply tension by gently pulling skin taut.

(d) Use short strokes.

d. Cleanse the Area Around the Wound. Repeat the cleansing, using the same procedures given paragraph b. above.

e. Rinse the Wound Area. Rinse the area with sterile saline rinse. Rinsing removes loose hair from the skin and prevents hair from entering the wound.

f. Dry the Wound Area. Blot the skin dry with a fresh sterile gauze. Then place a sterile gauze over the wound.

g. Notify Physician. Notify the physician or other appropriate person that the wound area has been prepared.

4-14. FINAL PROCEDURES

a. Remove and discard your gloves.

b. Remove protective pad from under patient and discard. Be careful to not contaminate the clean area.

c. Discard all disposable items in contaminated waste container.

d. Clean and store nondisposable items according to the local SOP.

e. Perform a patient care handwash.

f. Record that the procedure was performed on the patient’s Field Medical Card or Chronological Record of Medical Care, SF 600, as appropriate.