3-10. ASEPTIC TECHNIQUES AND SAFETY MEASURES
a. Aseptic techniques in skin preparation and draping must be carefully
maintained. Difficulty may be encountered in cleansing and preparing the perineal area.
Spray apparatus may be preferred to gauze sponges on forceps for application of
antiseptic in perineal skin preparations.
b. Draping procedures for laparotomy are described and illustrated in Subcourse
c. The disposable O'Connor perineal drape with finger cot may be used.
d. Transurethral passage of instruments and catheters requires meticulous
aseptic technique to prevent retrograde infections of the urinary system. The use of
transurethral instruments is facilitated by darkening the room. There should be
provision for proper adjustments in lighting.
e. Electrosurgical units and battery cords are frequent adjuncts in urological
surgery. The staff must be familiar with their use and with the precautions necessary to
prevent fire, explosion, or burns.
3-11. DISTENTION OF THE BLADDER
When the bladder is to be opened or manipulated, it is frequently distended with
irrigating fluid prior to surgery. Provision must be made in positioning and draping of the
patient and in instrument selection for filling and draining the bladder prior to or during
the course of the operation.
3-12. DRAINAGE TUBES AND CATHETERS
a. Ureteral catheterization may also precede radical operations. Preoperative
preparations of the patient and cystoscopy instruments with catheterizing telescopes
b. Whenever the urinary tract is opened, there is the danger of leakage of urine.
All such wounds require careful drainage. Drainage tubes in the urinary tract must be
kept open at all times and the surgeon should be notified immediately if there is no
drainage. The tube or catheter used to drain the bladder suprapubically must be stiff
enough to prevent collapse. An angulated tube or catheter may be useful in preventing
kinking if bulky dressings are used. The catheters or tubes should be tested for
patency, flushed and suctioned prior to use. Modern vacuum drainage collectors (of the
Hemovac type) have been successful in maintaining drainage and keeping wounds dry.
c. Ureterostomy and nephrostomy tubes must be carefully identified, fixed in
position, and guarded to prevent dislodgment or obstruction. There are various types of
catheters available for specific situations. Catheters are used for diagnostic purposes