Surgical Technology: Moving, Handling and Positioning the Surgical Patient

Safely Transporting and Transferring Patients

• Principles of Safe Patient Transport and Transfer:

  • Understanding and adhering to safety protocols during patient movement.

• Professional Communication Skills:

  • Communicating effectively with families, addressing their anxieties, and providing reassurance.

• Safe Body Mechanics:

  • Using proper techniques to protect both the patient and healthcare worker.

• Common Transport Methods and Devices:

  • Familiarity with various devices used in the perioperative environment.

Introduction

• Patients are transferred to and from various conveyances, creating physical risks for both the patient and health care workers.

• A patient's condition can affect their stability during transfers.

• Many facilities use lift sheets to manually transfer patients, which is not always safe.

Patient Identification

• Check the patient's identification band. (wrist or ankle band)

• Ask the patient to state their name.

• Ask the patient to confirm the procedure they are undergoing.(scan the patient's ID band using the barcode scanner to ensure accurate matching with medical records. )

Principles of Patient Transport

• Know the potential risks involved.

• Protect the patient’s personal dignity at all times.

• Perform movements deliberately and with focus.

• Ensure one person is in control of the move.

• Be familiar with all equipment being used.

• Never abandon the patient.

• Protect the patient from harm.

• Verify patient identity using ID.

• Inform the patient on what to expect during the transfer.

Talking with the Patient’s Family

• Acknowledge that families are often anxious and nervous.

• Allow family members to accompany the patient as far as possible.

• Reassure the family about the patient’s well-being.

• Provide regular updates on the surgery’s progress and the patient’s condition.

Guidelines of Body Mechanics

• Prepare both yourself and the patient before initiating any movement.

• Ensure sufficient help is available when moving a patient.

• Be aware of your physical limits and do not exceed them.

• Anticipate possible weight shifts during the move.

• Maintain a neutral spine position as much as possible.

• Avoid twisting the spine, especially while lifting or bending.

• Position yourself as close to the patient as possible to reduce spinal load.

• Keep feet well apart to provide a wide base of support.

• When performing lateral moves, avoid bending your knees.

• Bend your knees for vertical moves (up or down).

• Avoid awkward positions that reduce your base of support.

• Never attempt to lift or maneuver a patient while reaching forward away from your center of gravity.

• Utilize a transfer device whenever feasible.

Transfer Devices

• Moving and handling devices

  • Gurney (stretcher)

  • Wheelchair ( use abdominal muscles, bend with your knees, )

• Lateral transfer devices ( decision of which lateral device depends on patient’s weight, physical condition, and level of consciousness.)

  • Air-assisted transfer system ( moved made easily in supine position in any direction )

  • Transfer board ( reducing friction between board surface and transfer surfaces)

  • Roller board ( metal rollers,)

  • Mechanical hoist ( used for lateral transfer, used for patient wards, bariatric patients)

Assisting a Falling Patient

• Position yourself to support the patient.

• Gently ease the patient to the floor.

• Follow the patient’s movement to control the fall.

• Call for assistance.

• Stay with the patient until help arrives.

Patient Positioning and Safety in the Operating Room

• Guidelines for Transporting Special Patient Populations:

  • Understanding specific needs and safety measures for pediatric, hearing- or sight-impaired, bariatric, and patients in police custody.

• Responsibilities of the Surgical Technologist in Patient Positioning:

  • Describing their role in ensuring patient safety and proper positioning.

• Use of Operating Table Accessories and Positioning Devices:

  • Demonstrating the application of common accessories.

• Preventing Patient Injury During Positioning:

  • Describing methods to avoid nerve damage, pressure injuries, and other complications.

• Principles of Safe Positioning:

  • Understanding and applying the principles of safe positioning to prevent patient injury.

• Basic Positions Used in Surgical Procedures:

  • Demonstrating common surgical positions.

• Safety Precautions for Each Position:

  • Discussing specific safety measures for each position.

Special Patient Populations

• Pediatric patients

• Hearing- or sight-impaired patients

• Bariatric patients

• Patients in police custody

Positioning the Surgical Patient

• Patients are placed in specific positions to:

  • Allow optimal surgical access.

  • Reduce potential physiological effects.

  • Permit access for monitoring.

  • Provide unobstructed access for the surgeon.

Duties of the Surgical Technologist

• Understand common surgical positions and the surgeries associated with them.

• Know the required position ahead of time.

• Proactively work to prevent accidents and injuries.

• Question any potential risks.

• Remain alert and focused throughout the procedure.

• Communicate effectively with the surgical team.

General Operating Table Features

• Pads for patient comfort and pressure distribution.

• Remote control for adjusting table positions.

• Head- and footboards for patient support and safety.

• Kidney rest to facilitate specific surgical approaches.

• Perineal cutout for procedures requiring access to the perineal area.

Operating Table Components

• Removable head section

• OR table pad (mattress)

• Kidney lift

• Perineal cutout

• Radiolucent top and removable head section

• Hand control unit

• Hydraulic lift cylinder

• Table base

• Floor locks

• Locking swivel casters

• Side rail locking system

General Operating Table Attachments

• Arm boards or toboggan for arm positioning.

• Shoulder braces for stabilizing the patient.

• Stirrups for leg positioning in gynecological, urological, and some abdominal procedures.

• Headrest for supporting and positioning the head.

• Padded frames to provide support and prevent pressure injuries.

• Footboards to prevent the patient from sliding down the table.

Preventing Patient Injury

• Nerves and blood vessels:

  • Prevent compression injuries.

  • Prevent shear injuries.

  • Prevent pressure injuries.

  • Prevent skeletal injuries and embolism.

  • Prevent respiratory compromise.

  • Prevent eye and ear injuries.

Important Elements of Patient Positioning

• Knowledge of anatomy and physiology

• Planning

• Teamwork

Surgical Positions

• Supine (dorsal recumbent)

• Trendelenburg

• Reverse Trendelenburg

• Lithotomy

• Fowler and modified Fowler

• Lateral decubitus

• Prone

• Jackknife (Kraske) position

• Spinal table

• Orthopedic table