Patient Positioning

Question 1

Physiological considerations?

Answer 1

Support for head and limbs
Eyes taped to avoid corneal abrasion, dehydration an irritating fluids eg prep fluid
No excessive pressure to bony prominences or nerves . nerves at risk of injuring from traction, pressure or joint extension.
No overflexion or extension of ligaments or joints. Can result in injuries caused by stretching, twisting compression of tendons, ligaments and muscles

Question 2

Reasons why anaesthesia can place a patient at greater risk of injury

Answer 2

*Muscle relaxants administered - allow for over stretching of muscles, tendons and joints

• Under GA patients pain and pressure receptors blocked
• patient unable to object to discomfort or pain

Nerves and vessels can be compressed or stretched causing injury

Unnatural positioning can lead to muscle fatigue, inefficiency of muscle pumps and vasomotor systems and compression of the respiratory muscles and organs leading to hypoxia and hypercapnia

Additionally CVS changes may include peripheral dilation, decreased CO and hypotension. Hypotension reduces tissue perfusion and increases risk of tissue injury.

Question 3

Principles involved in patient positioning

Answer 3

Assess patient/care plan involving surgeon anaesthetist and theatre staff
Anaesthetist should lead supporting the head
Consider no of staff needed to safely move
Patients body should be in physiological alignment
Moving and handling equipment
Padding for extremeties
Gel pads

Question 4

what should you consider when positioning patient

Answer 4

Optimal exposure of operation site
stable position
Anaesthetic interventions i.e airway maintenance, ventilation, IV access
Dignity of patient
Physiological considerations

Question 5

Hazards of positioning

Answer 5

• Circulatory (anaesthetic agents inhibit normal compensatory mechanisms, vasodilation and hypotension, decreased CO. Lithotomy and Trendelenbeg can cause redistribution and congestion
• Respiratory. function reduced due to mechanical restriction of rib cage (prone, lateral and lithotomy)
• Neurologic : stretching or compression, extensive external rotation head hyperflexed/extended. Nerve damage: short term/long term pain, decreased function

Musculoskeletal : Muscles overstretched, pressure on joints,

Integumentary: unrelieved pressure, duration and location > 2hrs