Midterm Week 5 (Positioning) Flashcards
The overall goals of surgical positioning are to
- Maintain a physiologically and anatomically ____ _____
- Provide optimum _____ during the operative procedure
- Maintain the patient’s _____
- Allow access to (2)
- safe environment
- exposure
- airway
- monitoring devices, intravenous lines
Why is positioning important?
- Patient cannot do what?
- Enables IV lines and catheters to ->
- Enables monitors ->
- Facilitates the surgeon’s ->
- Patient safety (1)
- make clinician aware of compromising positions
- remain patent
- to function properly
- technical approach
- Don’t let them fall off table
Preop Assessment =
Risk Factors (5)
= Info about patient’s medical history and condition, and possible risk factors, needed to plan the necessary precautions and prevent positioning-related injuries
- Pre-existing DM
- PVD
- Renal Failure
- Neuropathy
- Obesity
Implementation
- Assessing the patient’s _____
- Developing a ___ _ ____
- ______ the necessary positioning devices
- The actual ->
- Reevaluating (2) intraoperatively
- Evaluating _____ _____ with respect to _____ related complications
- needs
- plan of care
- assembling
- positioning of patient
- body alignment and tissue integrity
- patient outcomes, position
Developing a plan of care
- After the preoperative assessment, next step is to develop a plan of care. Review the type of ______ to be administered, the planned surgical _____ the surgical _____ required, the _____ _____, the estimated ____ of the procedure and the patient’s ____ and ____ status
- Ensure that (2) are available to position the patient on the table
- anesthesia, procedure, position, surgeon’s preferences, length, physical/mental status
- appropriate positioning devices, adequate # of personnel
Positioning Devices
1) Procedure Tables (3)
2) Attachable equipment (6)
3) Pads to ->
4) Support devices for head, arms, chest
1) Urology, Orthopedic, Spinal Surgery tables
2) headrests/holders, overhead arm supports, stirrups, footboards, leg holders, shoulder supports, skull clamps, armboards, additional UE support, lateral positioning bars
3) to protect pressure points
4) Securing devices (e.g., safety belts, tapes, vacuum beanbags)
Urology Tables =
= are shorter than general surgery tables, with emphasis on leg elevation, perineal fluid drainage and compatibility with radiography
Orthopedic tables
= come with a wide variety of standard orthopedic accessories, such as removable leg supports, collapsible arm extension devices, foot traction units, a transfer board for moving the patient, a nailing support or hip rest and traction extensions.
Spinal Surgery Tables
= designed to facilitate imaging and placement of the patient in the kneeling position.
Table Attachments
1) Leg Attachments =
2) Shoulder Supports =
3) Skull Clamps =
4) Armboards =
5) Additional UE support =
6) Lateral positioning bars
1) which include hanging straps that suspend the ankles and padded foot and calf supports
2) may be necessary to secure patients in a steep head-down tilt position (trendelenburg)
3) provide maximum stability of the positioned head
4) which may be contoured to cradle the patient’s arm and protect the biceps, elbows and forearms
5) designed to support the upper arm, forearm, wrist and/or hand
Pads and Positioning Devices
- Any direct contact between pt and surface of table/positioning device has potential to?
- These devices help distribute pressure ->
- cause injury
- wider area
Pads and Positioning Devices (5)
1) Arm pads
2) Donuts
3) Rolls,
4) Heel cups
5) Egg-crate foam
6) Vacuum beanbags
7) Pillows and blankets
8) Table pads
1) Arm Pads =
2) Donuts =
3) Rolls =
1) Arm pads redistribute pressure from pressure points to a larger surface area. They include ulnar nerve protectors and a variety of larger pads that cushion the whole arm.
2) Donut-shaped head pads are designed to protect and cradle the patient’s head. Smaller donuts may be used to cradle other parts of the anatomy.
3) Full and half-round positioning devices are used to lift certain areas of the body off the mattress, restoring more physiological alignment and relieving down-side pressure points.
4) Heel Cups
5) Egg-crate foam
6) Vacuum beanbags
4) appropriate for any procedure that is lengthy and involves pressure at the patient’s heel area. Slit in back of the cup secures the patient’s Achilles tendon. Heel cups can be used in multiples to provide quick, easy protection of any bony prominence or potential high-pressure area
5) convoluted foam mattress overlay (egg-crate foam) is effective in reducing pressure only if it is made of thick, dense foam that resists compression.
6) contain tiny plastic pellets. They are molded to the shape of the positioned patient and then the contained air is evacuated, stiffening the bag to help hold the patient in place. A cloth covering placed over the bag prevents direct contact between the plastic surface of the bag and the skin.
7) Pillows and Blankets
8) Table Pads
7) produce only a minimum of pressure reduction. Towels and sheet rolls do not reduce pressure and may contribute to friction injuries.
8) Soft, segmented table pads that adhere to metal surfaces are standard parts of all procedure tables. A full-length table pad offers maximum protection and comfort for the patient.
Shearing =
= patient’s skin remaining stationary while underlying tissues shift or move, when pulled or dragged without support to the skeletal system or when a draw sheet is used
Friction =
= when skin rubs over a rough stationary surface. Maintaining the patient’s correct body alignment and supporting extremities and joints decreases the potential for injury during transfer and positioning
Physiological Compromises (4)
- Respiratory compromise
- Circulatory compromise
- Nerve and muscle trauma
- Intraoperative skin injury
Respiratory Compromise =
Often in what positions (3)
= decreased respiratory function by mechanical restriction of rib cage
- Prone, Lateral, Lithotomy
Circulatory Compromise =
= increased in positions such as lithotomy or head down that cause redistribution and congestion of blood supply
