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Patient Positioning PowerPoint Presentation

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Description : Check out this medical presentation on Orthopedic Surgery, which is titled "Patient Positioning", to know about Patient Positioning in Peri-operative and Intra-operative Care.

Tags : Orthopedic Surgery, Patient Positioning, Peri-operative, Intra-operative, Care

Published on : Jul 20, 2021 | Views : 5313 | Downloads : 11

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Patient Positioning Rachel Bright-Thomas Consultant Surgeon WAHNHST r.bright-thomas@nhs.net
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Aims To cover the curriculum topics Peri-operative Care To assess & manage pre-operative risk To prepare patient for theatre To conduct safe surgery in the operating theatre environment Intra-operative Care To know the principles of positioning & pressure area care To have technical skills to be able to safely position a patient on the operating table General Principles Specific Positions Documentation
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The Importance of Proper Positioning
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Patient Transfer from Bed to Operating Table HAVE A PLAN Always under the leadership of 1 person (anaesthetist) with correct no. of TRAINED staff (?????) Generally best to anaesthetise the pt first Need brakes on, moving aids ready, and table attachments to hand Pt is supported in all areas All monitoring equipment is safeguarded Pressure care is given VTE prophylaxis Temp & Dignity is maintained
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Patient Transfer from Bed to Operating Table
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Supine- For Majority of Procedures Hips & spine aligned, legs parallel & ankles uncrossed. Head in a neutral position ????why??? Arm boards at <90 degrees ???Why??? Pressure relief required for occiput, sacrum, ankles, heels & elbows Issues: Reduces ventilation by ↓FRC Most common neuropathy ??????
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Specific Problems Pregnant Patient Leg Traction Counter traction provided by a perineal post. Must be well broad & well padded & rest against the pubic ramus It should not press against the external genitalia, ischium or the pudendal nerve
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Trendelenburg (Head down- approx. ????o) Ideal for some abdominal, laparoscopic & gynaecological surgery. Can allow better access to organs located in the pelvis or for hernia repair. May be useful in hypotension Issues- ↑intracranial pressure; risk of vomiting; restriction of lung movements due to pressure on diaphragm, facial and eye swelling Need a secure non-slip mattress
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Reverse Trendelenburg (Head Up 15-20o)
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Supine position with legs separated, flexed and supported in raised stirrups.
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Lithotomy Used in Urology(TURP/TURBT), gynaecology or AP excision rectum or proctology Patient is moved to the lower end of the table with the legs supported by an assistant. ASIS at the level of the break of the table & end removed Avoid overhanging buttocks at the end of the table. The lower back should be supported to maintain normal lumbar lordosis. Arms should be positioned on arm boards at less than 90 degrees or over the abdomen. Flex knees & hips <90 degrees (to protect the sciatic, femoral & obturator nerves) At the beginning and end of surgery the patient’s legs must be moved simultaneously and with care to prevent pelvic injury and sudden hypotension. Legs are placed outside of the lithotomy poles to avoid pressure on the common peroneal nerve. Stirrups should be placed at an even height. Knees & ankles should be padded to prevent pressure and contact with a metal surface. Pedal pulses should be checked and calves massaged
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Lithotomy
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Lloyd Davies Position (??Head Down LithotomyOr Legs Apart Trendelenburg??) For pelvic and rectal surgery where access is required from both abdominal and perineal aspects ie anterior resection; laparoscopic surgery Key difference from lithotomy is lesser degree of hip & knee flexion- allows longer surgery Position legs first and then tilt The patient’s hands should be padded and tucked in to avoid table attachments Risks- as for Lithotomy & Trendelenburg
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Prone Intracranial & spinal surgery; achilles tendon repair General Issues Airway difficult to access needs to be secured without damaging face Recheck tube after turn Keep anaesthetised until turned back over Keep head neutral (nerve & vessel injury) Variable effects on ventilation (so avoid abdominal compression) Venous access difficult (avoid antecubital fossa) Many pressure points Staffing needed to roll Pt??? CPR difficult
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Jack Knife (prone + bend & head down) Used for anorectal surgery Iliac crest just above table break Manual handling equipment needed e.g. slide sheet Pillows to support the body & reduce pressure on the pelvis, spine, neck and abdomen. Hands & arms supported by arm boards Operating table restraints should be used to avoid slipping
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Lateral Position For thoracic, hip & shoulder surgery Issues Airway V/Q mismatch → hypoxia BP cuff ideally on upper arm Nerve injuries ???? Lower ear
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Sitting/ Beach Chair Shoulder surgery; breast reconstruction; intracranial surgery Issues Access to airway (secure well) Hypotension ( sit slowly; keep filled) Monitor BP (keep MAP >70mmHg) on non-operated arm Complications Cerebral ischaemia Venous air embolism Excessive neck flexion-quadriplegia
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Documentation Preop Discuss patient’s positioning & specific requirements at team briefing Operating table & equipment checked for function, size & cleanliness Information to be recorded in the patient’s notes Position Pressure relieving padding used VTE equipment used Skin integrity before and after the procedure Names and designation of staff members positioning the patient
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Surgeons Position Table height Sitting vs standing Lighting Assistants
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Any Questions?