Positioning the Surgical Pt Pt. II

1. Positioning the Surgical PtPt. II • Source: Phippen, M.L. & Wells, M.P. (1995). Perioperative nursing handbook. (p. 165-167).

2. Lateral Decubitus Position

3. Lateral Decubitus Position • Staffing Requirments • The Perioperative nurse and three asst are the minimum nursing staff needed. • Supplies and Equipment • Pillows • Headrest • Padding for bony prominences (foam, sheepskin, blankets, pillows) • Arm boards • Safety strap • beanbag

4. Lateral Decubitus Position • Transfer the pt to the OR bed • Transfer the pt to the OR bed. • Prepare the asst.’s • Ensure that the asst.’s understand their individual roles. • The circulating nurse and one asst stand on the right side of the OR bed if the pt’s left side with be facing down. If the pt.’s right side will be facing down, the circulating nurse and asst stand on the left side of the OR bed. The other two asst.’s stand on the opposite side of the OR bed, one across from the circulating nurse and the other near the foot of the OR bed.

5. Lateral Decubitus Position • Turn and Position the Pt. • The anesthetist controls the head and neck and initiates movement. • After the pt’s arms are placed at his or her sides, the circulating nurse and asst reach under the pt’s shoulders and hips, lift slightly, and draw the pt’s far shoulder and hip toward the middle of the OR bed. Next they concurrently rotate the pt to the lateral position. • The asst. across from the circulating nurse helps rotate the pt. The asst near the foot of the OR bed controls the pt’s legs. • Support the pt until after the anesthetist has reestablished ventilation. Place a rolled towel or other type of padding (axillary roll) under the pt below the axilla, not in the axilla. • Secure the pt with tape, beanbags, rolls or other type support. Flex the downside legs at the knee to add stability. • Place a pillow or padding between the pt’s legs. After positioning the pt, ensure that the pt’s head, neck, and spine are in proper alignment and that the axillary roll is in proper position below the axilla, the genitalia and breast are free from pressure, the legs and knees are padded, no part of the pt’s anatomy is resting on an unpadded surface, and the other extremities are secured away form the OR bed joints (breaks) and attachments. • Stabilize and secure the pt’s body to the OR bed.

6. Prone Position

7. Prone Position • Typically, the pt is placed under general anesthesia on the gurney before being transferred to the OR bed. However, the pt may be anesthetized on the OR bed and then rotated into the prone position. • Staffing Requirements • The perioperative nurse and three assistants are the minimal nursing staff needed. Supplies and Equipment • Pillows • Headrest • Chest rolls or a supporting frame • Padding for bony prominences and the dorsa of the feet (foam, sheepskin, blankets, pillows), arm boards • Arm restrains • Safety strap • Face rest (horseshoe, Mayfield, etc.) • Padded knee rest • Table extension

8. Prone Position • Procedure • Transfer the pt to the OR Bed • Transfer and prepare the pt for anesthesia administration in the supine pos. • Turn the pt on the OR bed • Prepare the asst. by ensuring that they understand their individual roles. The circulating nurse and one asst stand on one side of the OR bed. • The anesthetist controls the head and neck and initiates the movement. After the pt’s arms are placed at his sides, the circulating nurse and asst. reach under the pt’s shoulders and hips, lift slightly, and draw the pt’s far shoulder and hip toward the middle of the OR bed. • The nurse and the asst concurrently rotate the pt to the lateral position. The asst. across form the circulating nurse helps rotate the pt. The asst near the foot of the bed should control the legs. Continue rotating the pt while centerine the trunk on the OR bed. • Support the pt until after the anesthetist has reestablished ventilaiton. Place the positioning devices under the pt.

9. Prone Position • Place the pt in position • After turning the pt, ensure that the chest rolls extend from the acromioclavicular joint to the iliac crest and do not impinge on the chest expansion. • Ensure that the breasts are displaced medially on the chest rolls. • Check that the head neck, spine and legs are in proper alignment. • Ensure that the legs are uncrossed and slightly apart. • Check and free genitalia from pressure. • Pad iliac crests and knees. Support the dorsum of the foot with a pillow to prevent pressure on the toes. • Ensure that no part of the pt’s anatomy is resting on an unpadded surface. Ensure that the extremities are secured away from the OR bed joints (breaks) and attachments. Secure the body to the bed. • Position the arms. • If arm boards are used, the pt’s arms “should be rotated cephalad in a plane roughly parallel to the sagital plane of the body. • The arms are positioned above the pt’s head with the elbows flexed and secured to the arm boards.

10. Prone Position • If the arms are placed at the pt’s side, the palms should be turned toward the body or the bed, and the full length of the arms needs to be secured by a draw sheet or a padded toboggan. • Reassess the Pt • Reassess the pt before draping. • Ensure that the chest rolls extend from the clavicle to the iliac crest and do not impinge on the chest expansion. • Check that the female breasts are displaced medially and the chest rolls. • The body should be properly aligned and the safety strap in place. • The arms should be properly secured and placed on the arm boards or at the pt’s side. • Check that there is no pressure on the genitalia. • The dorsum of the foot should be supported to prevent pressure on the toes.

11. Jackknife (Kraske) Position

12. Jackknife (Kraske) Position • Staffing Requirements • The perioperative nurse and three assistants are the minimal nursing staff needed. Supplies and Equipment • Pillows • Headrest • Chest rolls or a supporting frame • Padding for bony prominences and the dorsa of the feet (foam, sheepskin, blankets, pillows) • arm boards • Arm restrains • Safety strap • Face rest (horseshoe, Mayfield, etc.) • Padded knee rest • Table extension

13. Jackknife (Kraske) Position • Procedure • Transfer the pt to the OR Bed • Transfer and prepare the pt for anesthesia administration in the supine pos. • Turn the pt on the OR bed • Prepare the asst. by ensuring that they understand their individual roles. The circulating nurse and one asst stand on one side of the OR bed and the other two asst.’s stand on the other side of the OR bed. • Position the pt as described for the prone position. • Adjust the OR Bed • Ensure that the pt’s hips are positioned over the OR bed break. • Check that there is no pressure on the pt’s genitalia. • Reverse flex the OR bed until the pt is in an inverted ‘V” position. • Reassess the Pt. • Reassess the pt before draping for any potential discrepancies as described for in the prone position.

14. Sitting Position

15. Sitting Position • Staffing Requirements • The perioperative nurse is the minimal staff needed. • Additional staffing requirements need to be noted on the perioperative Nsg care plan. • Supplies and Equipment • Arm boards • Arm restraints • Head holder (skull clamp, Mayfield, etc. • Padding for bony prominences (foam, sheepskin, blankets, pillows) • Padded fottboard • Saftety strap • Antigravity suit • Medical antishock trousers • Elastic bandages • Table extension • Toboggans

16. Sitting Position • Transfer the pt to the operating rm. • Transfer and prepare the pt for administration of anesthesia in the supine position. • Prepare the pt • Before placing the pt in the sitting position, wrap both legs of the pt to the groin with antiembolic stockings. • The surgeon may request that an antigravity suit or medical antishock trousers be applied. • Generously pad the pt under the buttocks and place padding under ea heel. • A padded footboard should be attached to the end of the OR bed. • Modify the OR bed to the sitting position • Elevate the pt’s back, flex the bed, lower the foot piece. • After the pt is in position, place the pt’s arms on a pillow that has been set on her or his lap and secure with 3-inch adhesive tape attached to the OR bed frame. Pad ea elbow with rubber. • If available, place the pt’s arms in arm holders. • Attach the accessories for the skull clamp. • Reassess the pt • Check for proper alignment • If pt is male, check to ensure that the scrotum and penis are not twisted or compressed between the legs.