Wet Field and Gown Strike-Through During Shoulder Arthroscopy
During a right shoulder arthroscopy in the beach-chair position, the surgical technologist notices that clear fluid collecting beneath the patient's axilla has saturated the seam of the impervious U-drape and is spreading toward the edge of the sterile field. The surgeon's gown sleeve is wet from the cuff to mid-forearm, and a resident has just leaned across the wet drape to reach the Mayo stand. The arthroscopy pump has delivered 9 L of sterile saline; the patient is 46 years old, BMI 31, and his systolic pressure is 92 mmHg. The anesthesiologist is asking to speed up closure because of the falling pressure. A replacement gown and gloves are available, but no spare U-drape has been opened. Room humidity is 38%, and the case has been running for 2 hours 15 minutes.
1. Has the sterile field been compromised? Explain the principle involved and state your immediate actions in priority order.
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Treat the field as compromised. Sterile saline is sterile at its source, but once it pools and wicks through a drape seam or along a barrier toward a nonsterile area, capillary action can carry microorganisms back to the field. A gown sleeve that is wet from cuff to mid-forearm is no longer an effective sterile barrier, and the resident leaning over the wet drape adds another contact breach.
Priority actions:
- Call a clear stop and tell the surgeon and resident not to touch the field.
- Have the resident step back and remove the contaminated gown and gloves.
- Change the surgeon's gown and gloves because the sleeve is saturated.
- Remove the wet U-drape and any saturated towels, dry the patient's skin, and re-drape with an impervious drape.
- Obtain the missing drape before proceeding; do not simply blot the sleeve or tuck a towel over the wet seam.
Do not assume that "it is only saline." The safe judgment is to re-establish an intact barrier and keep the field dry with suction and a fluid-collection pouch.
2. The surgeon says, "It's just saline; keep going." How should you respond, and what communication and documentation should follow?
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Use a calm, specific assertiveness statement rather than an argument: "I need to stop for a moment. Your sleeve is saturated and the drape seam is wicking to the nonsterile edge; I need to change your gown and re-drape before we continue." State the observable facts and the patient-safety risk. If the surgeon continues to insist, notify the circulating nurse and the charge nurse or perioperative manager, and ask anesthesia to support the pause because the patient is already hypotensive. Do not physically grab the surgeon or continue passing instruments onto a field you believe is contaminated.
Document factually in the intraoperative record: the time the wet field was identified, the fluid source if known, the saturated gown and drape, who was notified, the replacement supplies used, and any delay. Complete an event or variance report according to facility policy. After the case, participate in a brief debrief about fluid management, drape selection, and keeping the field dry. Documentation should describe what happened and what was done, not assign blame.