Wednesday, February 10, 2010

The OR Rorschach Test, Part 1

"The abdomen was prepped and draped in the usual sterile fashion." A standard operative note phrase, I've dictated this so often that it spills out of my mouth before I think twice about it. But what does this entail?

Well, it means that the abdomen, or other body part about to see the business end of a scalpel, is exposed and then cleansed with a topical antiseptic agent. The area is then surrounded by sterile towels, and the a large sterile field is created by placing a large drape that covers the patient; the drape contains an opening that frames the playing operative field.

Most of the drapes we use in the US are disposable, allowing us to cut the pre-set opening if needed, and they come with a white piece of paper in that opening that is removed once the drape is in place.

Bear with me. I'm getting to the point.

For years, we have used Betadine® to prep an operative field. Betadine is deep orange-brown in color, and dries slowly. When the white paper of the drape set is placed across the operative field, the wet paint of the Betadine leaves a painting upon it that is unique to each patient.

I like to look at these fresh impressions and try to draw out any image that may be there --- and I am not alone. Anyone that has ever worked in an operating room knows the expression "OR Roschach Test," and just like the real thing, what I see says volumes about the odd way my mind works.

I'd like to share --- what do you see?

Me? I'd say a Lon Chaney, Jr. as The Wolf Man....

...but, then, I spent far too many late nights watching bad movies as an impressionable youth.

How 'bout another?

I'm not much of one for modern art --- my feelings about it are not appropriate for a family discussion. My favorite museums are the Musee d'Orsay and the Kimbell, to give you an idea. However, this gives me an impression of Jackson Pollock working with a bad hangover.

I hate to say it, but the OR Rorschach is a dying art form --- there is reasonable evidence that an alternate prep solution (Chloraprep®) is modestly better than Betadine at decreasing skin bacterial load. Chloraprep is 70% isopropyl alcohol, and therefore very flammable, so it must be completely dry before drapes are placed.....leaving no artwork for us to enjoy. Betadine is still used quite a bit, and will be unless the CDC changes its recommendations. So, I'll have more images to interpret, and so will you when I find time to post.