Draping Techniques for Common Surgical Positions

Why Draping Matters

Surgical draping creates and defines the sterile field surrounding the operative site. Once drapes are placed, they form the boundary that separates the sterile area from everything outside it. A breach in that boundary — even a small one — can introduce pathogens that cause surgical site infections (SSIs). As the scrub surgical technologist, you are responsible for maintaining the integrity of every drape you handle. Patient safety depends on your technique being consistent and deliberate every single time.

General Principles Before You Begin

Before touching a single drape, confirm that your surgical gown and gloves are intact and that your sterile field is complete. Drapes are folded at the factory so they can be opened and placed with minimal handling. Never reach across or lean over an unsterile area to position a drape. Keep drapes above waist level at all times; anything that drops below your waist is considered contaminated. Always hold drapes high enough to clear the OR table edge before lowering them into position — never drag a drape across an unsterile surface.

When unfolding a drape, form a cuff by folding the top edge over your gloved hands. This cuff protects your gloves from touching the unsterile patient skin or table edge. Once you release a drape, do not reposition it toward the sterile field; you may only move a drape away from the field, never back toward it.

Draping the Supine Patient

The supine position is used for abdominal, chest, and many extremity procedures. The standard sequence is:

1. Towel drapes first. Four sterile towels are placed around the incision site using towel clamps to secure them. Place each towel folded-edge toward the incision so the fold faces inward. Secure with towel clamps before releasing each towel.

2. Leggings or under-buttock drapes (if used) are placed next.

3. Top sheet or laparotomy drape. A fenestrated (hole-in-the-center) laparotomy drape is unfolded lengthwise over the patient, with the fenestration aligned over the towel-draped incision site. Unfold the top half toward the anesthesia provider's end and the bottom half toward the foot of the table. The drape extends over the instrument table at the foot end and over the anesthesia screen at the head end.

Rationale for this order: the towels isolate the incision first, so that the large drape can be placed without contaminating the smallest critical area.

Draping the Patient in Lithotomy Position

Lithotomy position places the patient supine with hips flexed and legs elevated in stirrups. This position is used for gynecologic, urologic, and colorectal procedures.

1. Apply leggings first, one at a time, cuffing the top edge over your gloved hands and slipping each legging over the stirrup and leg from foot upward.

2. Place a under-buttock drape beneath the patient's buttocks.

3. Apply a fenestrated lithotomy drape or a split-sheet configuration, aligning the opening over the perineum. The drape extends over both legs and up toward the anesthesia end.

Special consideration: in lithotomy, gravity pulls drapes downward. Hold drapes firmly and work quickly to avoid uncontrolled unfolding. The perineal area must remain cleanly isolated because it is in close proximity to nonsterile anatomic regions.

Draping the Patient in Lateral Position

The lateral (lateral decubitus) position places the patient on one side, used for thoracic, hip, and kidney procedures. The patient's body is supported by positioning aids (bean bag, kidney rests, axillary roll).

1. Confirm all positioning devices are in place before draping begins — you cannot safely move the patient after the sterile field is established.

2. Place towel drapes around the incision site, typically on the lateral trunk or hip.

3. Apply a split-sheet drape from below (inferior) to above (superior) the incision or use a combination of half-sheets depending on the procedure.

4. Extend drapes over the table edges on both sides to cover nonsterile areas fully.

Because the patient is on their side, drapes can slide more easily. Use towel clamps promptly and do not release any drape until it is secured.

Fenestrated vs. Split-Sheet Drapes

A fenestrated drape has a pre-cut opening that frames the operative site. It is used when the site is clearly defined and central (abdomen, perineum). The fenestration must be precisely aligned over the incision; misalignment cannot be corrected by pulling the drape back toward the field.

A split-sheet drape consists of two panels with tails that wrap around the limb or body part from opposite sides, overlapping to form a barrier. Split sheets are preferred for extremity procedures or when the operative site is near the edge of the body. They allow flexible coverage of irregular shapes.

Contamination Events and What to Do

A contamination event occurs any time a sterile drape contacts an unsterile surface — the patient's skin outside the prepped area, the underside of the OR table, a nonsterile team member, or any item below waist level. When contamination occurs:

• Stop immediately.
• Inform the circulating surgical technologist or surgeon.
• Remove and discard the contaminated drape.
• Obtain a replacement drape and restart the affected portion of the sequence.

Never attempt to "recover" a contaminated drape. One act of honesty at the draping stage prevents a potentially life-threatening SSI.

Documentation and the Draping Log

Recording your technique observations builds critical awareness. Note the drape type used, sequence followed, any challenges encountered, and how you resolved them. Over time your log becomes a personal reference and demonstrates professional accountability — a habit aligned with the standards the NBSTSA CST credential examines.