Patient Positioning During Surgery

Patient Positioning
During Surgery
Objectives
 Exam importance of proper positioning in various
surgical procedures
 Define and demonstrate appropriate patient
positioning during general and regional anesthesia
 Identify common injuries related to inappropriate
positioning
 Define expected and potential physiologic
changes related to patient position
Why is positioning important?
 Patient cannot make clinician aware of
compromising positions
 Enables IV lines and catheters to remain patent
 Enables monitors to function properly
 Facilitates the surgeon’s technical approach
 Patient safety (aka Don’t Let The Patient Fall
Off The Table)
Various Positions
 Supine  Prone Jackknife
 Prone  Prone/Kneeling
 Lateral  Prone/Knee-chest
 Lithotomy  Sitting
 Lawnchair  What ever bizarre
 Jackknife position the surgeon
 Lateral Jackknife wants the patient in
Supine
Supine
 Patient on back
 Arms on arm boards
 Check orientation of arm (arms < 90 degrees)
 Make sure arm is supinated (palm up)
 Place additional padding under elbow if able
 Arms tucked
 Check fingers
 Check IV lines and SaO2 probe
Prone
Prone
 Face down
 HEAD PLACEMENT
 Head straight forward
 ET tube placement and patentcy
 Check bilateral eyes/ears for pressure points
 Head turned
 Check dependent eye/ear ETT placement
 Be aware of potential vascular occlusion
Prone continued
 Arm placement
 Tucked – similar concerns to supine
 Abducted
 Check neck rotation and and arm extension to avoid
possible brachial plexus injury
 Make sure elbows are padded
 Chest Rolls
 Often up to surgeon as to what type of rolls are
used
Prone continued
 Illiac support
 Make sure some sort of padding is placed under
illiac crests
Lateral
Lateral
 Patient on side (lateral decubitus position)
 i.e. left lateral decubitus position means right
side up
 Most important to maintain body alignment
 Keep neck in neutral position
 Always place axillary roll
 Place padding between knees
 Try and place padding below lateral aspect of
dependent leg (prevent peroneal nerve damage)
Lateral continued
 Position arms to parallel to one another
 Place padding between arms or place non-
dependent are on padded surface
 Check pulses
Lithotomy
Lithotomy
 Various types of stirrups
 Candy cane
 Allen stirrups
 Knee cradles
 Various degrees of lithotomy
 Low
 High
 Move legs at same time when positioning
patient in and out of lithotomy
Stirrups
Sitting Position
Sitting Position
 Position used in neurosurgery procedure to
facilitate access to posterior fossa
 Potential complications from sitting position
 Venous air emboli
 Need to take measures to detect and extract VAE
 Hypotension
 Brainstem manipulations resulting in
hemodynamic changes
 Risk of airway obstruction
Jack-Knife
Common Injuries Secondary to
Positioning
 Ulnar Nerve Injury
 Most common nerve injury in anesthetized
patient
 Often injured when compressed between the
posterior aspect of medial epicondyle of elbow and
armboard or bed
 More likely with elbow flexed or forearm pronated
 Symptoms include loss of sensation of lateral
portion of hand and inability to abduct or oppose
the fifth finger (claw hand)
Common Injuries continued
 Brachial plexus nerve injury
 Second most common type of nerve injury
 Injury occurs often when plexus is stretched or
compressed between the clavical and first rib
 Seen in prone and supine procedures where head
rotated and laterally flexed to the same side and/or
arm is extended posteriorly past the plane of the torso
 Can occur due to compression from shoulder braces
placed too close to the neck
 Manifestations depend on which nerves are
injured in the plexus:
 Median – “Ape hand” deformity, inability to
oppose thumb
 Axillary – inability to abduct the arm
 Ulnar – “Claw hand” deformity
 Musculocutaneous – inability to flex forearm
 Radial – wrist drop
 Radial nerve injury
 Can be injured if compressed against spiral groove
of humerus and other object (i.e. ether screen or
excessive cycling of NIBP)
 Symptoms include wrist drop, weakness of
abduction of thumb, and loss of sensation in web
space between thumb and index finger
 Common peroneal nerve injury
 Injured when lateral aspect of knee is compressed
against stirrup
 Sciatic nerve injury
 Can become stretched by exaggerate flexion of hips
(foot drop)
 Femoral nerve injury
 May become kinked under inguinal ligament from
extreme flexion and abduction of thighs
 Saphenous nerve injury
 May be injured when the medial tibial condyle is
compress by leg supports.
 Obturator nerve injury
 May be injured during difficult forceps delivery or
by excessive flexion of the thigh to the groin
 Anterior tibial nerve injury
 Foot drop will occur if the feet are plantar flexed
for extended periods of time (sitting or prone)
Injuries Occurring From
Prolonged Positioning
 Eye compression in prone position
 The retinal artery can be compressed by external pressure
resulting in retinal ischemia and blindness
 Constantly check eyes during such positioning and make
sure they are lubricated and taped to decrease incidence of
corneal abrasions
 Skin breakdown due to prolonged positioning
 Make sure bony prominences are well padded
 Avoid direct focused pressure on scalp (can lead to
alopecia) ? Head straps?
Physiological Changes Related to
Change In Body Position
 Most changes are related to gravitational
effects on cardiovascular and respiratory
systems
 Changes in position redistribute blood within
the venous, arterial, and pulmonary
vasculature
 Pulmonary mechanics also change with
varying body positions
Cardiovascular Changes with
Positioning
 Changing from erect to supine increases
venous return and stroke volume
 Parasympathetic stimulation regulate heart rate and
contractility to adjust to increased preload
 Obesity, pregnancy, and abdominal tumors can
reduce venous return (preload) when in the supine
procedure
Pulmonary Changes with
Positioning
 In supine position, functional residual capacity
and total lung capacity are reduced
 This is exaggerated in obese patients
 Anesthesia and muscle relaxants further reduce
these volumes due to diaphragm position with
relaxation
 Trendelenburg position also reduces lung volumes
Questions

Patient Positioning During Surgery

Uploaded by

Copyright:

Available Formats

Patient Positioning During Surgery

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Patient Positioning During Surgery

Uploaded by

Copyright:

Available Formats

Patient Positioning

You might also like