Intraoperative Positioning

So I know I have mentioned positioning devices so here is a list of positioning devices that help to protect our patients from injury and tissue trauma.  let’s talk about them a little closer! Guys gel rolls are exactly like they sound they are soft, jelly like devices that are placed under a patients chest when they are in the prone position to allow for chest expansion.  We use axillary rolls a lot when the patient is in the lateral position to maintain proper alignment of the patient. A beanbag is used with the trendelenburg position to keep the patient in a secure position to prevent sliding.  I use padding and pillows a ton! Whether it’s around the patients heals, elbows, knees, or pillows under the knees or between the knees to keep the patient comfortable and protect those bony areas is super important! The last thing we want is for our patients surgery to be successful but now they have a pressure ulcer!  Ok guys in this picture we can see the patient is in the reverse trendelenburg position. We want to secure them appropriately and prevent any sliding and we can do this with the help of a footboard seen here! Stirrups are used with our patients in the lithotomy position and guys I would say that patients complain postop the most about this position.  So when you are placing your patient’s legs in stirrups use care that the hips are aligned appropriately. A lot of facilities will do inservices on proper positioning so guys check into that! And finally super common and used everyday are armboards. Armboards help to keep your patient’s arms to be aligned to prevent any nerve injuries from occurring.  Guys where I work the circulating nurse and the anesthesia team work very closely to make sure our patient is in a position that is as safe as can be!

Ok so guys I’m sure because you’ve seen some of the  pictures of positions, there can be some concerns when it comes to positioning.  So an injury can occur with any length of procedure but the risk of pressure related injuries can increase with procedures that are over 2 hours.  Also guys nerve injuries of the lower extremities are of concern with our patients who are in lithotomy so keep that in mind. Shearing is of concern with our positions that tilt the patient like trendelenburg and reverse trendelenburg.  And when our patients are prone there is a lot of pressure on certain body parts like the face, breasts, and male genitalia. So when we place our patients prone be sure you are making sure all body parts are in the correct place and padded adequately.  And guys don’t be surprised if your patient’s tongue is swollen after being prone because the pressure on the face can cause this. Also guys we want to pay special attention to the airway when the patient is prone because now as you can imagine the tube is not in the best of places!

So what should we teach our patients that relates to positioning?  We want to encourage our patients to inform the staff if they have any pains, mobility, or skin issues. We also want them to remove jewelry including body jewelry as these can cause trauma to the patient when positioning them.  And of course encourage your patient to ask any questions they may have!

Ok guys so proper intraoperative positioning ensures that the patient is safe and comfortable during the surgery and also as protects tissue and skin integrity.  Remember your patient is under anesthesia so you as the perioperative nurse must be sure to pay close attention to protecting your patient when positioning. Be sure to check out our lessons on general anesthesia, local anesthesia, and moderate sedation for more information!

Ok guys let’s look at the key points here.  The purpose of intraoperative positioning is to provide exposure of the surgical site which is chosen by the surgeon.  We padding and positioning devices to protect the patient and protect from nerve issues and maintain proper body alignment.  The supine position is back to the OR table, prone position is stomach to OR table, and lateral position is side lying. Trendelenburg position is when the head and torso are lowered and the feet are elevated. In reverse trendelenburg the head is elevated and a footboard prevents sliding.  Lithotomy is typically used for gyne procedures with legs in stirrups, in the jackknife position the buttocks are higher than the body. Encourage patients to report aches, extension, skin and mobility issues. They should always remove jewelry and of course ask questions!

Okay guys I hope you enjoyed this lesson on intraoperative positioning!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!