Term
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Definition
Optimal exposure
Access to the surgical site
Maintaining body alignment
Supporting circulatory and respiratory function
Protecting neuromuscular and skin integrity
Allowing access to intravenous sites and anesthesia support devices |
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Term
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Definition
Type of surgical position
Length of time patient is in that position
Operating room bed
Padding
Positioning devices used |
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Term
| Anatomical and Physiological Considerations |
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Definition
Skin and underlying tissue
Musculoskeletal system
Nervous system
Cardiovascular system
Respiratory system
Other areas, eyes, breasts, perineum, fingers, genitalia |
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Term
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Definition
Pressure
Shear
Friction
Moisture
Heat
Cold
Negativity |
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Term
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Definition
| force placed on underlying tissue |
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Term
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Definition
| folding of underlying tissue when the skeletal structure moves while the skin remains stationary |
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Term
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Definition
| force of two surfaces rubbing against one another |
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Term
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Definition
| in excess exacerbates the effects of pressure, shear and friction |
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Term
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Definition
| can increase tissue metabolism, increase oxygen and nutritional demands |
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Term
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Definition
major surgery can cool core of body
reduce O2 to underlying skin
reduce peripheral circulation |
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Term
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Definition
| occurs when layers of materials are placed over the OR mattress or padding |
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Term
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Definition
Injury to the skin and underlying tissue as the result of unrelieved pressure
Most frequent location was the sacrum or coccyx
Second most frequent location was the heels
cost more to heal than to do |
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Term
| what does ulcer development depend on? |
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Definition
Extrinsic factors
Include the physical forces and conditions the patient is subjected to during surgery
Intrinsic factors
Include the internal health conditions and physical body structure of the patient |
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Term
| extrinsic factors for ulcer formation |
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Definition
Pressure is the physical force most responsible for formation of pressure ulcers
Intensity and duration are primary factors
Greater the pressure, the shorter the time it takes to cause ischemic changes
Pressures >32mm Hg (capillary interface pressure)
Occlude flow of arterioles, which nourish and oxygenate tissue at the capillary level |
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Term
| preventive measures for ulcers |
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Definition
Pressure relieving OR mattresses
Padding applied under or around areas such as heels, elbows and sacrum |
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Term
| Compartment Syndromes define |
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Definition
Develop if perfusion to extremity is inadequate characterized by ischemia, and hypoxic edema
layman==> when something is lifted too long, and blood does not reach the area |
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Term
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Definition
Peripheral nerves can be injured during positioning
Basic types of injuries
Stretch related
Compression |
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Term
| Peripheral Neuropathies factors to increase injury |
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Definition
Diabetes mellitus
Cancer
Alcoholism
Smoking
obisity |
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Term
| most common nerve injurys (by extrimity [low and upper]) |
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Definition
Upper Extremities
Ulnar nerve
Brachial plexus
Lower Extremities
Peroneal,
Sciatic, and
Femoral Nerves |
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Term
| what is the main factor of Brachial Plexus Risk |
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Definition
| >90° extension of arm boards |
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Term
| Ulnar Nerve injuries facts |
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Definition
Injuries occur primarily from pressure on the vulnerable location of the nerve (Placing arm on unpadded edge of table)
2:1 predominance of ulnar nerve injuries in males versus females
Attributable to 3 anatomic differences between the elbows of men and women
Main goal in protecting the ulnar nerve is to eliminate pressure on it. |
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Term
| Lower Extremity Neuropathies (intrinsic risk factors) |
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Definition
Thin body build
Smoking
Diabetes
Rheumatoid arthritis
Previous hip surgery
Presence of anatomic anomalies |
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Term
| Lower Extremity Neuropathies (extrinsic risk factors) |
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Definition
Length of time in high or exaggerated lithotomy
Positioning the extremities beyond their comfortable range of motion when awake
Hip extension should be limited only to the amount required for access |
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Term
| Standard Surgical Positions (list them include variations as well) |
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Definition
Supine
Trendelenburg
Reverse Trendelenburg
Fracture Table
Lithotomy
Fowler
Semi-fowler
Prone
Prone variations
Jackknife
Knee –chest
Lateral
Lateral chest
Lateral Kidney |
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Term
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Definition
Head,
Shoulders
Elbows
Sacrum
Coccyx
Heels
Crossing patients arms across chest may cause respiratory interference |
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Term
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Definition
Armboards level with mattress <90° extension
Palms up
Legs & Ankles uncrossed
Safety strap mid thighs |
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Term
| what does supine gain access to ? |
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Definition
Peritoneal
Thoracic
Pericardial
Also to
Head
Neck
Extremities |
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Term
| where does the safty strap go for supine position? |
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Definition
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Term
| how do you set up the arms and hands for supine? |
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Definition
Arm boards should be padded and extended no more than 90°
Palms up (supination) |
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Term
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Definition
Diminished lung capacity
Venous pooling toward the head
Sliding and shearing |
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Term
| Trendelenburg- interventions |
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Definition
Flex knees slightly
Limit time in position
Shoulder braces |
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Term
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Definition
Facilitates visualization of the pelvic organs
Shoulder braces should be used to prevent sliding
Weight of abdominal viscera impedes diaphragmatic movement
Modification of trendelenburg may be used for patients in hypovolemic shock |
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Term
| Reverse Trendelenburg- risks |
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Definition
Deep vein thrombosis lower extremities
Sliding and shearing |
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Term
| Reverse Trendelenburg-interventions |
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Definition
Antiembolic and/or sequential stockings
Padded foot board |
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Term
| Reverse Trendelenburg -access and set up |
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Definition
Provide access to the head and neck
Thyroid, neck or shoulder surgery a pillow or soft roll is placed under the shoulders to hyperextend the neck
Arms normally tucked at side for closer access to surgical site
Minimally invasive approaches laparoscopic Nissen fundoplication ,Steep reverse Trendelenburg is required
Bean bag inflated under the patient
Leg holders stirrups knees flexed 20 -30°
Return to Supine position should be done slowly to avoid overload to cardiovascular system |
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Term
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Definition
Risks
Pressure to foot and ankle in traction
Pressure to genitalia |
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Term
| fracture table- interventions |
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Definition
Interventions
Adequate padding
Properly padded and positioned perineal post |
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Term
| Fracture Table- access and set up |
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Definition
Hip fracture or closed femoral nailing
Arm on operative side is generally secured over the patient’s body in a padded sling or a post-supported arm holder |
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Term
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Definition
Hip dislocations, fractures, muscle and nerve injuries
Pressure injuries to foot, ankles and knees
Back strain
Diminished lung capacity
Venous pooling toward head
DVT in lower extremities
Crushed fingers |
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Term
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Definition
Interventions
Securely fasten stirrups to bed
Avoid candy canes when possible
Avoid contact with stirrup bars
Avoid hyper abduction
Buttocks should not hang off the edge of the bed
Ensure fingers are away from the break
Antiembolic stockings and/or SCD’s |
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Term
| lithodomy- access and set up |
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Definition
Used for gynecologic, rectal and urologic procedures
Legs placed in stirrups
Both stirrups should be at equal height and attached to the OR bed at the same level
Both legs should be raised simultaneously to prevent strain on the patient’s lower back, requires two people so that both legs are supported
Legs raised and knees flexed in slow, smooth movements
Buttocks should be even with the edge of the OR bed to reduce lumbosacral strain
Arms supported on arm boards, placed across the trunk, or tucked at patients side (when tucked fingers flat and away from table break) |
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Term
| fowler- set up and access |
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Definition
Used for some ear and nose procedures, Craniotomies posterior and occipital approach,shoulder, facial ,breast reconstruction
Foot rest used to prevent foot drop
When used for posterior fossa craniotomy or cranial ventricular procedures special craniotomy headrest is used
Buttocks at the flex in OR bed and knees over lower break |
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Term
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Definition
Risks
Pressure to scapulae, sacrum, coccyx, ischium, back of knees, and heels
Air embolism if venous sinus is opened
Shearing
DVT
Venous pooling shifts toward lower limbs |
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Term
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Definition
Interventions
Pressure reducing mattress
Doppler probe over chest wall, insert central venous catheter
Momentarily tilt torso slightly away from OR bed to allow skin to realign with skeletal structures
SCD’s
Slow smooth postural transitions to dimish cardiovascular effects |
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Term
| Semi-Fowler (Beach Chair)- risks |
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Definition
Risks
Similar to fowler,but not as severe
Pressure to cheeks, eyes, ears, breasts, genitalia, patellae and toes
Falls & dislodgment of airway & monitoring cords & IV lines
Diminished lung capacity
Injury to shoulders, arms and upper extremity nerves |
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Term
| semi- fowler- interventions |
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Definition
Interventions
Pressure reducing mattress
Doppler probe over chest wall, insert central venous catheter
Momentarily tilt torso slightly away from OR bed to allow skin to realign with skeletal structures
SCD’s
Slow smooth postural transitions to dimish cardiovascular effects |
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Term
| semi-fowler- access and set up |
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Definition
Crainial, shoulder, nasal, abdominoplasty, breast reconstruction procedures
Arms placed over the abdomen
Safety strap over the thighs |
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Term
| knee chest (jackknife)- risks |
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Definition
Risks
Extreme pressure on knees & ankles
DVT |
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Term
| knee chest( jackknife)- intervention |
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Definition
Interventions
Additional padding to areas
Check distal pulses before, during, & after positioning |
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Term
| jackknife (knee chest) - access and set up ; also for what procedures is this used? |
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Definition
Sigmoidoscaopy, culdoscopy
Extension attached to foot section
Patient kneels on the lower section
Knees are flexed at right angle to the body
Bed flexed at the center break
Safety strap above the knees
Arms extended forward with the elbows flexed palms down |
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Term
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Definition
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Term
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Definition
Interventions
Check distal pulses before, during,& after positioning
Antiembolic stockings
SCD’s |
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Term
| jackknife- access and set up |
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Definition
Rectal area procedures pilonidal sinus, hemorrhoidectomy
Hemorrhoidectomy buttocks retracted with wide tape strips
Chest rolls under the chest if patient under general anesthesia
Arms extended on angled armboards with elbows flexed and palms down |
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Term
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Definition
Risks
Pressure to structures on dependent side ears, shoulder, ribs, hips, greater femoral head, knees, & ankles
Risk of tilting and falling during procedure
Brachial plexus injury
Venous pooling shifts toward dependent side
Diminished lung capacity of dependent lung
DVT
Induction in supine position, patient turned lateral |
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Term
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Definition
Interventions
Pressure reducing mattress, additional padding as needed
Earlobes not folded over
Pillow between knees
Flex dependent leg for support
Support abdomen and back
Padded roll under axilla
Lower shoulder brought slightly forward
Lower arm on board palm up
Upper arm on elevated armboard or pillow
Double lumen ET |
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Term
| lateral- access and set up |
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Definition
Patient is lying on the non-operative side
Provides access to the upper chest, kidney or upper section of the ureter
Bottom leg flexed at the knee and the hip, top leg is straight or slightly flexed
Pillow placed between the knees
Upper arm is placed on elevated armboard
Lower arm is flexed and rests on armboard |
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Term
| lateral chest- set up and access |
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Definition
Modification allows operative approach to the uppermost part of thoracic cavity
Uppermost arm is flexed at elbow and raised above the head to elevate the scapula, providing access to the underlying ribs and widen the intercostal spaces
May be supported on a raised armboard |
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Term
| lateral kidny- set up and access |
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Definition
Allows approach to the retroperitoneal area of the flank
Lower iliac crest is positioned just below the lumbar break where the kidney rest is located
Kidney rest is raised to render kidney region more accessable
Bed is flexed so that the area between the twelfth rib and the iliac crest is elevated
For torso stabilization kidney braces may be used longer one is placed anteriorly against the iliac crest and the shorter one placed against the back
Kidney rest is lowered prior to wound closure to
facilitate approximation of the wound edges |
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Term
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Definition
Risks
Initally hazardous as the anesthetized patient is turned from supine to prone
Respiratory system most vulnerable
Dislodgement of airway, monitoring cords & IV lines |
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Term
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Definition
Interventions
Both bed & stretcher locked
Four persons to do log roll
Arms on armboards or tucked at side elbows, facing up, padding
Armboard, elbows flexed, palms down, padding
Head turned eyes protected correct neck alignment
Cheek, ear, patella and toe padding |
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Term
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Definition
For all procedures with dorsal or posterior approach
Log roll patient from supine position
Appropriate personnel needed 4-6 persons |
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Term
| Positioning Materials (list) |
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Definition
OR table mattress
Most consistent and important positioning device
Linens sheets, towels, blankets smooth as possible
Ring cushions (Donuts)
Evacuatable Devices (Bean bag)
Shoulder braces
Kidney braces
pillows |
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Term
| give characteristics of support matierials |
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Definition
Ideal positioning materials include
Stability
Firmness,
Pressure reduction
Ability to control distribution of pressure without bottoming out |
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Term
| which materials are used for posistioning (what are they made out of?) |
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Definition
Foam
Fiber (linen)
Do not provide good platform for pressure control
Contributes to abrasion of the skin
Creates high pressure
Gel
Provides a degree of buoyancy. heel& elbow protectors |
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Term
| responsibility for position |
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Definition
Positioning responsibility rests with the surgeon, anesthesiologist and the circulating nurse
Always ask anesthesia before changing the position of any anesthetized patient
They have the last word
Repositioning after the surgery should be done slowly to account for hemodynamic changes
Use a team approach for any positioning
Lift do not drag the patient
Make sure bed and transfer vehicle are locked
Maintain patients privacy |
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