Draping the patient

The whole of the shoulder, arm and hand of the side to be arthroscoped is prepared with chlorhexidine in spirit, paying particular atten­tion to the axilla. The preparation must extend to the midline of the chest to back and front, and include the neck (see Figure 4.11). A glove is placed over the hand, after preparation, and the arm is held by the assistant. A stockinette is then rolled down the arm (Figure 4.12).

Figure 4.11 Preparation of the skin must be adequate, extending to the midline and up onto the neck.

Figure 4.12 After the hand has been prepared, a stockinette is rolled down the arm.

Figure 4.13 Drapes are then placed over the patient's body, from the axilla down.

Figures 4.14 and 4.15 A sterile 'U-drape' is placed to prevent irrigation fluid leaking over the patient's hair and face during the procedure.

Figure 4.16 Draping is completed with an arm drape through which the arm is placed.

Figure 4.17 When starting to perform shoulder arthroscopies, it is useful to mark the landmarks of the acromion, the clavicle and the coracoid with a skin marking pen prior to portal placement.

The draping starts with waterproof drapes being placed to cover the patient's body, from the axilla downwards (Figure 4.13). A water­proof 'U-drape' is then placed over the patient's head to prevent irrigation fluid and blood from reaching the unprepared parts of the patient (Figures 4.14 and 4.15). A further drape with a hole in the centre is then placed over the arm (Figure 4.16). The skin markings of the clavicle and acromion are marked with a sterile skin marker, as well as the coracoid process and the posterior portal entry site, one thumb's breadth below and medial to the posterior angle of the acromion, as shown before drap­ing in Figure 4.17.