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| The Surgical Technologist | AUGUST 2016 350 tucked by the draw sheet. Special padding can be used to support irregular curvatures and prevent hyperextension. Foam or a gel pad is used for the patient’s head, and a safe- ty strap is placed across the middle thigh. 6 Since patient safety is always the number one priority, the surgical tech- nologist can ensure safety by communicating with the team members during positioning, and anticipate unfore- seen changes in positioning while table adjustments, or any other body adjustments are being made. If assistance is unavailable, a leg holder device may be attached to the bed during positioning for aid in skin prep. It is important for the registered nurse and surgical technologist to pro- actively prevent further patient injury by making sure all aspects of the device are attached properly to the bed, and the leg is positioned properly in the device itself. S K I N P R E P A R A T I O N A N D D R A P I N G During skin preparation, the surgical technologist should help the registered nurse assess the surgical site for any skin lesions or disruptions on the skin. The surgical tech- nologist may also suggest a separate cleanse if they feel the surgical site needs more attention. A betadine soap and paint solution, mixed with sterile water, will be used, and can be sterilely prepared by the CST. Directions for solution measurements should be followed by the manu- facture’s recommendation. The extremity will elevated, and the skin preparation will begin. For knee surgery, the entire extremity will be prepped from the ankle to groin, beginning at the knee moving outward .6 If a tourniquet is used, skin prep will be from the ankle to the tourni- quet. The surgeon can request to prep the foot as well, but it should remain unexposed and draped separately in a stockinet. It is important for the surgical technologist to watch the solution being applied to prevent the solution from leaking under the tourniquet if one is used. A blue sterile towel will be draped around the tourniquet to pro- tect it from the solution, and to separate the non-sterile device from the sterile field. Once the skin preparation is complete, an impervious sheet, or a split U-drape will be placed under the limb before lowering it to the table. The foot also will be sterilely covered before lowering the limb. At this time, if another sterile personnel is available, the extremity can remain elevated by holding onto the out- side sterile portion of the stockinet, while the rest of the drapes are being placed. A lower extremity drape, or two orthopedic split drapes, will be used for this procedure. If the surgical technologist does not taking part in the drap- ing process, it is important they watch the team members who are, and ensure that aseptic technique is properly used. Throughout the procedure, radiographic imaging will be used, so a sterile drape for the machine will be needed. The surgical technologist, along with the registered nurse should pay special attention to the X-ray machine, for it will come into, and leave the sterile field often. P R O C E D U R E During the procedure, the surgical technologist will need to have any special instruments requested by the surgeon along with an orthopedic tray and/or knee tray, a high-speed power drill, drill bits, chucks, any other accessories pertain- ing to the power source and K-wires that are sharp on both ends. 7 If the K-wires provided are only sharp at one end, the surgical technologist can sharpen the K-wire by using a K-wire cutter, cutting the blunt end at an oblique angle. Before the incision, general or spinal anesthesia with IV sedation will be administered, and a nerve block may be performed. A time out will follow. The incision will be made with a #20 blade, and then switched to a clean blade for further dissection. The patella will be exposed, and any debris will be flushed and cleared away with an irrigation solution. 7 The patella fracture will be reduced using sharp reduction forceps. Extra reduction for- ceps need to be readily available so they be needed. After the fracture has been reduced, the K-wires are inserted using one of two techniques: the “outside in” or “inside out” tech- nique. Surgeon preference will dictate which technique will be used. When using the “outside in” technique, the first K-wire is placed in an axial direction, and drilled through both of the reduced fragments. The second k-wire will be placed parallel to the first. When using the “inside out” technique, the first K-wire will be positioned at one of the fracture’s surface and drilled upward with one end of the K-wire exiting the fragment superiorly. That fragment will be aligned with the other fractured surface. Using the same K-wire, it will be drilled through the other fragment, exiting inferior; hence, the importance of the K-wire being sharp at both ends. The second K-wire then will be inserted parallel. The “inside out” technique may require more adjustments in reduction, but is preferred by most surgeons because the placement of K-wires is less challenging and more exact. Before the surgeon continues with the procedure, the K-wire placement will be checked via X-ray. The K-wire placement