Surgical Positioning and Aids Study Guide
Positioning Aids in Surgery
Underneath the Mattress: This setup aids in keeping the patient's arms tucked against their sides and protects them from pressure by surgeons or the positioning of others leaning on their arms.
Footboard:
Utilizes the same attachment part as the stirrups.
Consists of a flat piece that slides into the designated slot at the foot of the bed.
Provides a place for the patient’s feet to dangle.
Draw Sheets:
Essential for moving the patient.
Used for tucking in the arms.
Must be used with every patient.
Pillows:
Placed under various body parts including the head, legs, hips, and feet.
Donuts:
Used specifically for supporting the head during surgery instead of using a traditional pillow.
Often referred to as "jelly donuts". They may have a faint artificial chocolate smell.
Shoulder Brackets and Braces:
Designed to cup around the shoulders, providing stabilization.
Bumps:
Can be created with rolled-up blankets to provide padding.
Bean Bag and Pegboard:
The bean bag starts off flexible and is shaped around the patient’s side when in a lateral position. It is then hardened with suction for stability.
The pegboard is used similarly without suction, involving pegs inserted to hold the patient in place while also ensuring additional positioning aids are utilized to avoid pressure on the pegs.
Supine Position
Definition: The supine position is defined as when the patient lies flat on their back, arms extended on armboards with palms facing upward.
Positioning Guidelines:
Arm boards should not exceed 90 degrees relative to the operating table to avoid hyperextension and potential nerve damage.
Alternate positioning may require arms to be alongside the body, bent at the elbows with palms inward—patients are advised to think of putting their hands in their pockets.
A draw sheet is placed over the arms, tucked between the body and mattress, extending two inches above the elbows and secured without being too tight (to prevent circulation issues).
A sled may be used to prevent the arms from slipping and to manage pressure.
Head stabilization is accomplished using a small pad or donut to avoid extreme head rotation, which can lead to vertebral artery occlusion or nerve injury.
Additional pillows may be used for lumbar curvature and knee support.
Leg Positioning:
Legs should be straight and aligned with head and spine.
Avoid prolonged plantar flexion to prevent stretch injuries, using a pillow or footboard for foot support.
Ensure that the feet do not extend beyond the operating table to prevent perineal nerve injuries (e.g., foot drop).
Use a safety belt positioned approximately two inches above the knee.
Pressure Points:
Areas at risk during surgery: occipital region, scapula, sacrum, ischial tuberosity, and others. Soft padding like egg crate and gel pads can minimize pressure.
Timing:
Patients are often placed in a supine position before anesthesia administration and may remain in this position during the surgery or be repositioned subsequently (with necessary approval from anesthesia).
Access Points:
Supine positioning allows for access to the head, neck, anterior upper extremities, chest, abdomen, pelvis, and anterior lower extremities.
Potential Hazards:
Includes brachial plexus injuries, ulnar nerve injuries, pressure injuries to skin, blood vessels, and nerves, back/necks pain, corneal drying or abrasion, foot drop, etc.
Positioning Aids for Supine:
Egg crate, donuts, arm boards, sleds, pillows, especially for patients with chronic pain conditions.
Trendelenburg Position
Definition: A modified supine position where the patient’s head is lower than their feet to facilitate surgical access to the pelvis and lower abdomen, and to assist in displaced abdominal pelvic organs.
Benefits:
Increases venous drainage and may assist in treating shock by boosting blood flow to the upper body.
Body regions accessible include the pelvis and lower abdomen.
Potential Hazards:
May cause cardiovascular and respiratory compromise, movement towards the head of the table, blood pressure changes, and venous stasis.
Positioning Aids:
Use of shoulder braces to prevent slipping towards the head; may utilize stirrups.
Avoid using pillows under the patient’s back but can use them for knee support.
Reverse Trendelenburg Position
Definition: The opposite of Trendelenburg, where the head is elevated above the feet, used for better visualization during procedures.
Benefits:
Displaces abdominal organs caudad, facilitating access while promoting respiration.
Body Regions Accessible:
Upper abdomen, head, and neck.
Potential Hazards:
Includes movement towards the foot of the table, blood pressure changes, and venous stasis.
Positioning Aids:
Significant use of a footboard, and sometimes pillows or egg crates for padding; donuts may support the head but keep it stable without rolling forward.
Fowler's Position
Definition: A modification of supine with the torso elevated, promoting venous drainage and facilitating respiration.
Access Points:
Body regions include head, neck, shoulders, and breast.
Potential Hazards:
Blood pressure fluctuations, respiratory compromise, pressure injuries, and puncturing from improperly secured arm positions.
Positioning Aids:
May include a small pillow or thin blanket for lumbar support, donuts for head stabilization, and unique head holders for certain surgeries (like craniotomies).
Lithotomy Position
Definition: A variation of the supine position, primarily used during gynecological surgeries, requiring stirrups for leg elevation.
Stirrup Varieties:
Boot style and candy cane stirrups, noting that candy cane stirrups are generally more rigid and cannot adjust.
Access Points:
Vaginal, urethral, perineal, and rectal access.
Potential Hazards:
Crushing or shearing of the hands, pressure injuries to skin or vessels; also back, knee, and hip pain due to stirrup use.
Positioning Guidelines:
Ensure hands are secured away from moving parts of the table to avoid getting caught. Lowering or raising legs must be performed slowly to prevent strain or blood pressure discrepancies.
Prone Position
Definition: Position where the patient lays flat on their stomach, used for access to the posterior side of the body.
Preoperative Care:
Patient must be anesthetized and have undergone all other procedures such as Foley insertion before flipping.
Access Points:
Posterior cranium, dorsal body surface, spine, posterior lower extremities, and anus.
Safety Considerations:
Risks include abdominal content pressure, thoracic compression, and potential for venous stasis and shoulder injuries.
Positioning Aids:
Requires face padding to prevent pressure injuries and maintain airway patency; may be designed to provide a view of the face for monitoring.
Requires multiple staff for safe flipping due to the complexity of managing positioning and airway safety.
Jackknife (Krasby) Position
Definition: A variation of the prone position used for accessing the anus and pilonidal area.
Potential Hazards:
Similar to prone but primarily focused on monitoring blood pressure fluctuations during elevation changes.
Positioning Aids:
Pillows and shoulder braces may be necessary; careful attention is required when moving arms.
Lateral Position
Definition: Patient lies on their side (either right or left), exposure varies based on the side down.
Access Points:
Retroperitoneal space, hip, hemithorax.
Safety Considerations:
Risks include respiratory and circulatory compromise, movement on the operating table, pressure injuries, and foot drop.
Positioning Guidelines:
The bottom leg is bent while the top leg is straight, separated by pillows. The arm on the bottom can be placed on an armboard, positioned to avoid respiratory complications.
Sims Position:
A modification where the bottom leg remains straight with the top leg bent, typically for endoscopies with awake patients.
Kidney Position
Definition: A modification of the lateral position, designed for accessing the retroperitoneal space.
Positioning Guidelines:
Involves table flexion and kidney lifts for surgical exposure.
Potential Hazards:
Risks include abdominal compression, circulatory issues, and blood pressure changes.
Positioning Aids:
Similar aids as lateral positioning will be required, including blankets and pillows but less concern for footboards due to leg positioning.
Conclusion
Regular review of all positioning aids and associated potential risks is essential for the safety and well-being of patients throughout surgical procedures.