IMPORTANCE OF PATIENT POSITIONING IN SURGERY
Patient positioning is critical to a safe and effective surgical procedure. The appropriate patient position in the operating room depends on the type and length of the procedure, the accessibility of the patient’s anesthesia, the equipment needed, and other factors. Safely positioning the patient is a team effort. All members of the surgical team play an important role in the process and share responsibility for establishing and maintaining correct medical positions for the patient.1,2
The goals of appropriate patient positioning include:
- Maintain the patient’s airway and circulation throughout the procedure
- Prevent nerve damage
- Allows the surgeon access to the surgical area as well as the use of anesthesia
- Patient comfort and safety
- Prevention of soft tissue or skeletal muscle injury and other patients
INSTRUCTIONS FOR PATIENT LOCATION
Following standard patient positioning guidelines and practices helps ensure patient safety and physical well-being before, during, and after the procedure. There should always be a sufficient number of staff members during patient surgery to safely and efficiently locate the patient. General positioning practices include having an adequate number of staff, equipment, and instruments available in a process to ensure patient and staff safety. The patient should be kept in a balanced position, without excessive rotation or hypotension.
Make sure that the pressure is not concentrated in one spot to avoid pressure ulcers. Pressure ulcers, local trauma to the skin or underlying tissue, can result from pressure or force combined with shear and/or friction. It is not always possible for a patient to be sedated or anesthetized to communicate physical sensations such as numbness, tingling, tissue temperature, and other problems.2
RISKS IN PATTERN POSITIONING
Each of these factors plays a different role in creating risks during patient positioning. Internal and external factors can interact to contribute to the risk of developing pressure sores. External factors may include the intensity and duration of pressure and the overall effect of the anesthetic. Intrinsic factors may include the patient’s overall health and pre-existing conditions such as respiratory or circulatory disorders, diabetes, anemia, malnutrition, advanced age, and body size. 3 In addition, the patient’s musculoskeletal system may be stressed during postural positioning. When anesthetics and muscle relaxants relieve pain, pressure and tone receptors and normal defense mechanisms fail to protect against joint damage or muscle strain and tension.
POPULAR PATIENT PATTERNS IN SURGERY
Among the common patient positions, there are various patient positions that play an important role in minimizing the risk of posture-related problems, such as: breathing problems, circulatory problems, nerve or muscle injuries, and soft tissue injuries.
The Fowler position, also known as the sitting position, is commonly used for neurosurgery and shoulder surgery. The beach chair-like pose is commonly used for rhinoplasty, breast augmentation, and breast reduction surgery. When placing the patient in Fowler’s position, the surgical staff should minimize the patient’s head elevation as much as possible and maintain the head in a neutral position at all times.
The patient’s arms should be flexed and fixed above the body, the buttocks should be padded, and the knees should be flexed 30 degrees. In Fowler’s position, the patient is at increased risk for air embolism, shear and slip skin trauma, and deep vein thrombosis in the patient’s lower extremities. In this type of position, the patient is at risk of increased pressure in the spine, sacrum, coccyx, coccyx, backs of knees, and heels.
High Flower Pose
In the high Fowler position, the patient is usually seated at the top end of the operating table. The upper half of the patient’s body lies between 60 degrees and 90 degrees relative to their lower half. The patient’s leg may be straight or curved.
The supine position
The supine position
The supine position, also known as Dorsal Decubitus, is the position commonly used for procedures. In this reclining position, the patient lies supine. The patient’s arms should be placed on either side of the patient with a bed sheet, secured with arm guards. The arms can be bent and held in place on the body or stretched and fixed on the palm rest. The side-lying position is commonly used for the following procedures: intracranial, cardiac, abdominal, endovascular, endoscopic, lower extremity and ENT, neck and facial procedures. In the supine position, the patient may be at risk for pressure ulcers and nerve damage. This position puts extra pressure on the skin and highlights the bones on the occipitals, shoulder blades, elbows, sacrum, coccyx, and heels.
The Jackknife pose, also known as Kraske, is similar to the Knee-Chest or Kneeling pose and is commonly used for colorectal surgeries. This type of pose puts a lot of pressure on the knees. During positioning, the surgical staff should place additional padding for the knee area.
The renal position is similar to the lateral position, except that the patient’s abdomen is placed on a lift on the operating table that can flex the body to allow access to the retroperitoneal space. The remaining kidney is placed under the patient at the site of the nucleus accumbens.
Lie on your stomach
In the prone position, the patient lies face down, with the head in a neutral position without excessive flexion, extension, or rotation. Face locator is used when the patient’s head is centered. The prone position is commonly used for spine and neck surgeries, neurosurgery, colorectal surgery, vascular surgery, and tendon repair.
Foam or gel locators may also be used for spinal procedures. When the patient is in the prone position, pressure should be avoided on the eyes, cheeks, ears and breasts. A minimum of four members of the surgical staff should be present when turning the patient to the prone position. The risks associated with the prone position include increased intra-abdominal pressure, bleeding, compartment syndrome, nerve injury, cardiovascular damage, eye injury, and venous gas embolism.
In the Lithotomy position, the patient can be placed in a boot- or pedicure position. Variations for this position type include low, standard, high, magnified, or hemi. This position is commonly used for gynecological, colorectal, urological, perineal, or pelvic procedures. The risks posed to the patient in the Lithotomy position for a procedure include fracture, nerve injury, hip dislocation, muscle injury, pressure injury, and reduced lung capacity. While placing the patient in this position, the surgical staff should avoid flexing the patient’s hip and leaning on the patient’s inner thigh. Dual used for patients in this position must disperse support and pressure over large areas.
Sims’ pose is a variation of the side pose. The patient is usually awake and helps with positioning. The patient will roll to his left side. Body immobilizers are used to secure the patient to the operating table. Keeping the left leg straight, the patient will slide the left hip back and bend the right leg. This type of position allows anal access.
The patient may be placed in the lateral position during back, colorectal, kidney, and hip surgery. It is also commonly used in thoracic, ENT, and neurosurgery surgeries. Some variations of this pose include Side Kidney, Side Chest, and Side Jackknife. In the lateral position, the patient can be placed on their left or right side depending on the side of the surgical site. A pillow or head positioner should be placed under the patient’s head with the accessory ear evaluated after positioning. The patient’s physiological cervical and spine alignment should be maintained throughout surgery, and a seat belt should be secured at the patient’s hip.
Risks to the patient in the side-lying position include pressure on dependent points of the body such as the ears, shoulders, ribs, hips, knees, and ankles, as well as injury to the wing plexus arm, venous hematoma, decreased lung capacity, and deep vein thrombosis. A pressure relief cushion or table top pad should be used when necessary.
The Trendelenburg position is commonly used for lower abdominal, colorectal, gynecological and genital surgeries, cardioversion, and central venous catheterization. In this position, the patient’s arm must be placed on their side, and the patient must be immobilized to prevent slipping on the operating table.
The Trendelenburg position should be avoided in extremely obese patients. Risks to the patient in this position include decreased lung capacity, decreased lung volume and compliance, venous pooling toward the patient’s head, and slip and collapse.
Inverted Trendelenburg Pose
The inverted Trendelenburg position is commonly used for laparoscopic, gallbladder, stomach, prostate, gynecological, pelvic, and head and neck surgeries. Risks to patients in this type of position include deep vein thrombosis, slip and cut, perineal nerve, and tibial nerve. A foot pad should be used to prevent the patient from slipping on the operating table and to reduce the risk of damage to the tibial and tibial nerves from flexion of the foot or ankle.
MODEL SURGERY TABLE THAT MEETS ALL POSITIONS?
As you can see, there are many different types of patient positions that a quality operating table device must accommodate. Mediland is one of the few brands in the market that has different operating table product lines (14 lines) to meet all the needs of different patient operating positions. In addition to providing operating tables, we can also provide a wide range of good quality operating table accessories to support doctors and medical staff in complex surgical procedures.