Archive April 2015 XVI, No. 4

Avoid These 5 Patient Positioning Disasters

From pressure ulcers to vision loss, don't let positioning problems happen on your watch.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


prone position patient PRONE TO INJURY Prone position carries with it several potential complications, including perioperative vision loss.

Poor patient positioning can lead to devastating consequences. While some complications are unavoidable, there are plenty of ways to reduce your risk. Check out these 5 real-life patient positioning disasters and experts' advice on how to prevent them.

1. Pressure ulcers
A 78-year-old man — who was 6-foot-2 and 250 lbs. — with Parkinson's disease was placed in supine position for a cholecystectomy. His Parkinson's, along with his large and heavy legs, made movement difficult. After surgery, he developed blisters on his heels that progressed to full-thickness wounds. After a delayed discharge from the hospital, the man was sent to a wound care center for 4 months until the pressure ulcers healed.

heels in supine position AVOID DISASTERS Be sure to float a patient's heels in supine position to avoid pressure ulcers.

"The simple answer is his heels should have been elevated," says Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN-R, PLNC, a perioperative nursing specialist for AORN. But it often takes more than that to prevent pressure ulcers. Prevention requires a multi-factor approach, she says, including a skin assessment and proper use of positioning devices to prevent skin breakdown.

Brent Klev, MBA, BSN, RN, surgical services nurse manager for South Jordan Health Center at the University of Utah, says every patient at your facility — even those undergoing short procedures — should have a pre-op skin assessment. The assessment should use the Braden Scale and look at such risk factors as an age older than 70, vascular disease or diabetes, an operation longer than 4 hours, or a patient who is thin or malnourished.

If a patient is found to be at risk, Mr. Klev says staff should pad all bony surfaces, including floating the patient's heels. For those deemed high-risk, Mr. Klev suggests using a fluid mattress overlay on the OR bed and placing a foam sacral dressing on patients. Ms. Van Wicklin recommends using gel positioning devices, which distribute pressure better.

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