As a circulating nurse, I'm very conscientious about how I position my patients. After they go to sleep, I am their protector and their voice. It is my job to make sure not only that the surgeon has unobstructed access to the surgical site, but also that the patient remains positioned correctly and comfortably throughout the surgery. Patients are in jeopardy if we give more thought to access than to safety when we position them. Plus, we know that many medical negligence cases are pursued as a result of patient positioning injuries, such as nerve damage, palsy, skin breakdown and pressure ulcers. We can easily avoid these injuries if we take appropriate precautions, such as those you'll see in the photos illustrating proper technique over the following pages. OSM
OVERLOOKED DANGERS There are so many different things to hook up and get going before the drapes go on that it's easy to rush through and overlook positioning dangers. Note the forced-air warming tube resting between the patient's legs. Had the tube been resting on the patient's foot for a couple hours, it could have prevented blood from perfusing to the toe and caused post-op numbness and tingling and possibly nerve damage. Similarly, you wouldn't want an upper-body warming tube to rest against a patient's arm (in that situation, we'd suspend the tube from a clamp on the IV pole). Also note the egg crate under the patient's heels to prevent skin breakdown. Because he's sitting up, blood is flowing down toward his feet.
LITHOTOMY POSITION For this urological procedure, the patient is going into the lithotomy position. When suspending the patient's legs in the stirrups, raise the legs slowly and pay extra attention to the hip joints. The knees should be of equal height and angle to prevent back strain. Don't flex the hips more than 90 degrees; you could dislocate them or put extra tension on the hip joints and nerves. The patient's lumbar area should not hang over the table. You want the patient's leg to only touch the cushioned part of the stirrups.
LATERAL POSITION The bean bag positioner molds to the patient's shape to keep her safely and securely on her side for a lateral shoulder repair. Ensure there's a draw sheet between the patient and the bean bag so her skin isn't right up against the plastic bean bag. Plus, you can use the draw sheet to help turn the patient over on her side. Once a patient is on his or her side, ensure that the scrotum or breasts are in a neutral position so they aren't squished. The blue foam axillary role puts the shoulder the patient is lying on in a more neutral position. The pillow is folded to keep the head and neck aligned.
HANDOFF This patient's hand is well padded and supported, so her skin is not pushing up against a plastic and metal bar. Also note that the hand is in a neutral position, resting comfortably down at her side on the foam donut. A safety strap keeps her arm from falling off the bed.