Who positions the patient during surgery?
When patients and their families think about risks associated with their surgeries, they usually think about unexpected systemic failures, post-operative infections or other complications that may occur at the surgical site, and anesthesia problems. Fortunately, these risks generally are quite small, and improvements in analgesic medications and techniques have remarkably decreased the problems associated with significant post-operative pain. Show Patient positioning, an often overlooked risk, may cause immediate intraoperative problems as well as long-term disability and pain. Examples of positioning problems include:
Because sedated or anesthetized patients often can't shift their bodies during surgery, even short procedures can lead to post-operative soft tissue problems, peripheral neuropathies or painful localized myalgias if patients are positioned improperly. Some of these post-op problems are unavoidable in order to provide appropriate surgical access, especially for unexpectedly prolonged procedures. Others are problems that develop post-operatively and are not associated with intraoperative care. However, you can prevent or reduce the frequency of many of these injuries by using the right equipment and reasonable positioning techniques. Here are seven strategies to assist with intraoperative positioning.
1. Put a pre-op plan in place
Curiously enough, advanced age isn't an independent risk factor for positioning-related problems - an otherwise healthy 82-year-old may be less vulnerable than a diabetic, overweight 35-year-old. However, older people tend to have reduced flexibility and poorer peripheral circulation than younger people, factors that may them more susceptible. Note that some problems are unique to specific patient groups: Men who are 40-to-70 years old who undergo abdominal or pelvic procedures, for example, have a higher risk of developing post-op ulnar neuropathy. Women who are older than 60 years of age have an increased risk of developing obturator and lateral femoral cutaneous neuropathies after procedures performed while they are positioned in a lithotomy position (cystoscopies and gynecologic outpatient procedures, for example). Use the pre-op assessment to create a positioning plan before you enter the OR. All members of the team should know how to maintain patients in the required positions before, during and after surgery and how to shift them smoothly from one position to another, if needed. 2. Work as a team
Anesthesia providers are probably best suited to integrate all of the patient information, but the entire team needs to understand positioning. 3. Assemble the proper equipment The attachments you'll need will depend on the types of procedures performed. In general, attachments should help retain and support patients, especially the extremities and head, without placing point or band-like pressure on major nerves and vessels. Make sure they are padded, fully adjustable and stable. When possible, they should offer support of the full body part, thus dispersing pressure over a broad area. Practice attaching and removing them from the OR table so you can do this smoothly during procedures. There are many different types of pads and gels that disperse point pressure across a larger area or eliminate pressure on protuberances altogether. Some are composed of materials with elasticity and other mechanical attributes that theoretically may cushion protuberances better than other materials. I'm not aware, however, of any independent clinical studies that prove any specific cushioning material to be superior to another in reducing the frequency of positioning-related problems such as skin damage or peripheral neuropathies. Therefore, it appears to be just as effective to use towels and blankets for point pressure dispersion as more expensive commercial pads. There are times, however, when commercial pads provide better support and pressure dispersion than you might obtain with towels and blankets. I generally use whatever materials are readily available, as long as they meet my positioning goals. Remember that cushioning materials aren't always entirely effective. In many instances, patients who were apparently well padded subsequently developed pressure-associated injuries. Men, for instance, are particularly susceptible to ulnar nerve injury, even if the arm is kept on padded surfaces. Recent studies have found that some patients develop these problems post-operatively. Even medical (non-surgical) patients can develop these same problems. 4. Take time to reassess 5. Be
aware of ergonomics
Table attachments and other equipment, such as padded, adjustable surgical stools, may help alleviate these problems. Team members should also have a basic understanding of ergonomics so they know how to use the equipment optimally. 6. Perform a thorough post-op assessment Some injuries, especially those of the lower peripheral nerves, show up immediately. But patients do not note many upper extremity neuropathies until several days after their procedures. This suggests differences in etiologies of these nerve injuries, with lower extremity nerve injuries more likely to be associated with the intraoperative period and those of the upper extremities to evolve post-operatively. 7. Document everything Every case, every patient How are patients positioned for surgery?Supine position, also known as Dorsal Decubitus, is the most frequently used position for procedures. In this reclining position, the patient is face-up. The patient's arms should be tucked at the patient's sides with a bedsheet, secured with arm guards to sleds.
Who has joint responsibility for placing the patient in the correct surgical position?According to the interdisciplinary agreements, positioning and checks on position are the task of the surgeon, while the anaesthetist is responsible for the "infusion arm". This does not exclude the possibility that anaesthetist and surgeon may agree on a different division of labour in the operating room.
Is a position who perform surgery?The surgeon is responsible for the preoperative diagnosis of the patient, for performing the operation, and for providing the patient with postoperative surgical care and treatment.
Why is positioning important in surgery?The goals of positioning the surgical patient are ensuring patient comfort and dignity; maintaining homeostasis; protecting anatomical structures and avoiding complications and injuries; promoting access to the surgery site; promoting access for the administration of IV fluids and anesthetic agents; and promoting ...
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