Ensure their chest and whole legs are shaved including the groin.
Ensure patient is supine, and the pelvis and the shoulders are square from the end of the table.
The urethral catheter is taken under the thighs and hung on the side.
If the patient has an intra-aortic balloon pump, ensure it is secured appropriately.
If the patient has a hip prosthesis, ensure the diathermy pad is on the opposite posterior thigh. If both sides have prosthesis, place the pad under the shoulder.
If it is an emergency procedure, or if there is a probability of requiring a vein graft, prep and drape as for a CABG, viz. including the lower legs.
Prepping
Use long handle forceps with swab dipped in dyed chlorhexidine to prep.
Start always at the incision site, viz. midline of sternum from the sternal notch and the neck.
Go outwards systematically, do not go back into the incision site.
The chest is prepped with three different sponges in the same manner.
The extent of prepping on the chest and abdomen: superiorly to the neck up to the larynx, inferiorly to the pubis, laterally to the anterior/mid-axillary line.
The groin and umbilicus is avoided until the legs are prepped.
The legs are lifted by an unscrubbed assistant by the heels.
The whole leg is prepped except where the assistant is holding it, starting inferiorly. Avoid the diathermy pad if it is in the posterior thigh as it may lose adhesion.
The anterior and medial parts of the ankle may be obscured by their hand – ask them to change positions if needed. The popliteal fossa can also be missed.
The groin is prepped by retraction by the assistant during prepping.
Ask the assistants if any areas have been missed before handing back the swabs.
Draping
A sterile drape is placed under the legs. This drape might include a segment that covers the lateral aspects of the chest all the way up to the neck. If so, then this segment is placed symmetrically about the sternal midline.
A large sterile swab is used to hold up the leg at the calf closest to the scrubbed assistant, who will apply a sterile foot cover to cover the unsterile foot held by the unscrubbed assistant.
The leg is then gently placed down on the draped bed.
The other leg is covered and placed in the same way.
Superiorly, a drape is placed so the whole sternal notch is visible. The other ends are passed to the anaesthetist to hang them with towel clips.
Inferiorly, a sterile rewarmer (Bair Hugger) may be placed now rolled, and later unrolled after the vein harvest. Or alternately, it may be placed after the vein harvest.
A sterile drape with a clear adhesive window for the chest is then placed in the midline before unrolling. It covers the abdomen and also the legs. Avoid creating air bubbles in the clear segment.
Setting up the operative field
A quiver for suction, diathermy and forceps is placed on the operator side, as well as a diathermy cleaning scratch pad. Diathermy is set to 8.
Stretch the suction tubing and other leads to calculate the length needed for the operative field – avoid having too much or too little length.
Sterile light handles are attached.
The chest or leg incision may be made at this point.
The primed sterile CPB tubes with its tube organiser are handed off to the scrub nurse.
The CPB tube organiser is clipped on the assistant side for CPB tubes (blue venous line, 3 suckers – clear/blue/green, cardioplegia line, red arterial line). The tubes are placed in a bag on the assistant side.