Draping Sequences by Procedure Type

Principles of Draping

Draping creates and maintains the sterile field by isolating the surgical site from all non-sterile surrounding areas. Drapes are placed after the skin prep is complete and dry, moving from the incision site outward, and once placed a drape is never repositioned by pulling it toward the incision.

General Draping Rules

• Hold drapes higher than the level of the OR table until properly positioned; never let a drape fall below waist level before placement.
• The person draping should protect gloved hands by cuffing the drape edge over the hands.
• Drape the nearest area first, then move to the far side, minimizing reaching across an unprepped area.
• Once a drape touches an unsterile surface, it is contaminated and must be replaced.
• Allow adequate margin around the incision site (fenestration placement) to accommodate the planned procedure.

Basic (Laparotomy) Sheet Sequence

1. Place folded towels around the immediate incision site and secure with towel clips or clear adhesive strips.
2. Apply the fenestrated laparotomy sheet, positioning the opening directly over the prepped incision site.
3. Unfold the sheet toward the foot of the table first, then toward the head, keeping hands protected by the cuffed drape edge.
4. Secure tubing, cords, and suction to the drape with a nonpiercing clamp to keep the field organized.

Extremity Draping Sequence

1. An impervious stockinette is applied to the distal extremity first (often before final prep or immediately after), then rolled proximally.
2. A split (fenestrated) sheet or extremity drape is applied so the limb passes through the opening.
3. The limb is then secured to allow free manipulation while maintaining sterile drape coverage.
4. An impervious drape/leggings and a limb holder or tourniquet may be incorporated depending on the procedure.

Lithotomy Draping Sequence

1. Drape each leg individually with a leggings drape once the legs are placed in stirrups.
2. Apply the lower sheet to cover the lower body and stirrup poles.
3. Apply the fenestrated sheet (perineal/lithotomy sheet) with the opening over the perineum, connecting to the leggings to complete the sterile boundary.

Craniotomy (Head) Draping Sequence

1. Head towels are placed to frame the surgical site over the head drape or headrest.
2. A craniotomy drape with a fenestration is applied, often incorporating a fluid collection pouch.
3. An anesthesia screen/barrier is created to separate the sterile field from the anesthesia provider at the head of the table.

Ophthalmic Draping Sequence

1. A split sheet or eye drape with an adhesive aperture is applied directly around the orbit.
2. An adherent plastic incise drape may be used to isolate lashes and secure the surgical field directly to the skin.
3. Fluid collection pouches are frequently incorporated to manage irrigation fluid during the procedure.

Key Exam Points

• Draping order generally follows: towels/site isolation first, then the larger sheet establishing the full sterile field boundary.
• A 1-inch (or per facility policy) margin around the incision site is considered the minimum sterile margin once draping is complete.
• If a drape is discovered to be torn, wet-strikethrough, or misplaced, it must be addressed immediately - covered with a sterile towel or replaced - never ignored.
• Impervious drapes are used wherever fluid strike-through risk is high, since a wet drape is considered contaminated (strikethrough breaks the sterile barrier).