Draping can seem like a foreign language or a dance where you know none of the steps.
Medical students and new interns often watch from afar as scrub techs, senior residents, and attendings effortlessly and often silently put the blue puzzle pieces together. It is impossible to learn draping from a blog post; it is something that must be seen and done. However, learning the basics here can make you much more comfortable when the time to practice comes.
Although every surgery, attending, and day can change the specifics of draping, the basics remain the same.
Prepping
Draping cannot be discussed without mentioning prepping. Prepping involves cleaning the surgical area (almost always an extremity in ortho) and maintaining its sterility until protectively wrapped in blue. Most institutions use either a candy cane, an IV pole, a bump, or a friendly nurse to hold the extremity in place before draping.
Once prepped and lifted in some manner, specific steps are generally followed.
Layer 1
First: Down drape, also known as a half drape, ¾ sheet, or any combination of the 3. It is a simple square sheet without any stickers or cutouts. The half or ¾ simple means it’s a smaller size drape. The term “down” comes from placing the drape down 1st without any additional steps. This first layer is primarily to protect both the patient and the drapes from contamination throughout the rest of the process.
The down drape is unfolded and passed under the extremity before being dropped down into place. Sometimes a second down sheet will go across the other half of the body, again to protect from contamination. It is imperative to maintain proprioception of your body as you do this, as unsterile things surround you.
Layer 2
After the down sheets are completed, the second stage begins: actually draping the extremity. This can be done with U-drapes, split drapes, Extremity drapes, or other specialty drapes.
A split sheet allows a custom wrap around the extremity with a sticker to seal around. A U-drape or “sticky-U” is a lighter blue color and made of more impervious plastic; it is sometimes used before a U-drape but has the same shape and purpose. Often a surgeon will place one up and one down. That is, one drape will be set below the hung leg with the opening going towards the patient’s head. After this, a second U-drape will be placed “down” by opening it over the patient’s torso with the opening facing the feet.
Release the limb
It’s now time to release the hanging leg, a blue towel is placed around the leg for grip, and one of the drapers will hold the leg up by this towel.
At this point, we must take care of toes or fingers. Toes and fingers tend to both get in the way and be very dirty. For this reason, if they are not being operated on, we tuck them away. Actually, any part of the extremity that will not be part of the surgical exposure should be protected. This is often done with a stockinette that rolls on, followed by a Coban wrap. This allows large portions of the extremity to be covered. If more exposure is needed, the toes or fingers can be covered with just Coban or a glove.
An extremity drape can be used after the digits have been hidden away. Note that this can be used after a split sheet or without a split sheet, but almost always after the digits have been covered, as they will be pulled through the sterile drape.
Specialty drapes are too many to name but include shoulder, hip, bilateral extremity, knee, and arthroscopy drapes. Luckily all these drapes will have a friendly character cartoon showing you the orientation the drape will be placed with respect to the patient.
The most important thing about draping is understanding these steps can be placed in almost any order, as long as sterility is maintained. If you are new to draping, know that opening something wrong is always better than contaminating yourself or the patient and having to start again. Below are 3 videos of extremities being draped, all with different orders of the steps mentioned above.
https://www.youtube.com/watch?v=oXScPPeKTBc&ab_channel=SurgTechAcademy shows how to drape an arm following the same steps.
https://www.youtube.com/watch?v=DrL8O8_cTSM&ab_channel=CaseyGlassburner shows how to drape a leg. Notice two key differences here, a blue towel was used to wrap the leg first, and then they skip a down sheet and move right into a light blue sticky U-drape. After this, they use an extremity drape.
https://www.youtube.com/watch?v=_uAe9W54HRg&ab_channel=PerioperativeNursingProgramatGBC shows a leg being draped with down sheets and split sheets without using an extremity.
Written by: Grace Gilbert, BSN, MS4
