Archive April 2019 XX, No. 4

Keep Patients Safe in Steep Trendelenburg

Here's a heads-up on what to do when patients are heads-down.

Mike Morsch

Mike Morsch, Associate Editor


Pamela Bevelhymer, RN, BSN, CNOR
NO SLIP SLIDING AWAY Make sure the patient is secure and doesn't slide on the table when put into the Trendelenburg position.

From speed bumps and sticky pads to arm tucks and tilt tests, you pull out all the stops to protect patients when you place them in the Trendelenburg position. Here are 6 tips to keep their bodies from sliding and their skin from shearing.

1. Lithotomy-Trendelenburg. Anytime you go into a lithotomy-Trendelenburg position — supine with the legs separated, flexed and supported in raised stirrups — you need to worry about positioning injuries. Most of the time it's a peroneal nerve injury, caused by being up in the stirrups that puts pressure on the lateral side of the legs and peroneal nerve. Check to see that the stirrups are in the right place and that the patient is positioned at the bottom of the bed.

"I make sure that the articulating aspect of the stirrup that's attached to the bed is at the level of the hip joint of the patient," says Taylor Brueseke, MD, of St. Joseph Hospital in Orange, Calif. "So, when I move the foot up, the leg is rotating from that same point of rotation."

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