0. Surgical Positioning. Jeffrey Groom PhD, CRNA Nurse Anesthetist Program Florida International University. SURGICAL POSITIONING OBJECTIVES. Identify the role and responsibility of the anesthesia provider in patient positioning.
Jeffrey Groom PhD, CRNANurse Anesthetist ProgramFlorida International University
JackKnife - Kneeling
What happens when the anesthetized patient can’t care for themselves?
When you sleep, you reposition yourself to prevent pressure ischemia. Under anesthesia, the patient does not reposition (protect) them self so the responsibility falls to the surgical team to prevent pressure ischemia & positioning injuries.
Why is there a risk for injury ?
Preexisting patient attributes associated with increased incidence of perioperative neuropathies:
Ulnar nerve injury
Brachial Plexus Injury
Nurse anesthetists should “monitor and assess patient positioning and protective measures at frequent intervals.”
Failure to follow professional standards and guidelines may result in positioning injuries and liability.
55 y.o female w/fractured hip
2hr 20 min surgery
Developed peroneal palsy post-op
Protective and monitoring measures were not taken nor documented. No prior injury present. Conclusion at trial – injury would not have occurred had there not been negligence – res ipsa loquitur.
Protective and monitoring measures were taken and documented. Brachial plexus injury reported postop. No prior injury present. Conclusion at trial – injury was a risk of the procedure however personnel took precautions according to standards and were not negligent.
ASA Practice Advisory – Sets a legal standard of careLINK to Advisory in the Course Outline Page
6. Arms in physiological position and supported. - not to exceed 90 degree extension at shoulder - in flexion not hyperextension - upper arm not hanging over edge of table or rubbing on metal part of table - elbow area protected from ulnar pressure - hands free of pressure and compression - fingers in slight flexion or neutral extension - wrist restraints loose or padded - palms up on armboard - palms towards body when arms at side
During clinical this semester – spend time after cases learning the operation of the OR table and proper positioning. Practice on each other to appreciate “positioning” from patient’s perspective.