THE PATIENT IN THE O.R. SHOULD IN THE O.R. SHOULDNEVER BE LEFT ALONE!!!

THE OPERATING TABLE

flexible in three sections to permit variations on the supine position

THE OPERATING TABLE "break the table" refers to bending the table in the middle section

THE OPERATING TABLE the table may be tilted up or down

THE OPERATING TABLE the table may be tilted side-to-side

THE OPERATING TABLE the table may be raised or lowered

THE OPERATING TABLE the headboard section may be removed or folded down out of the way

THE OPERATING TABLE the foot board section may be folded down out of the way

THE OPERATING TABLE the table must be locked while transferring patients or when the table is not being moved

GUIDELINES FOR POSITIONING AN ANESTHETIZED PATIENT

GUIDELINES Always ask the anesthetist/ anesthesiologist permission to move the patient

GUIDELINES Respect the patient's dignity by avoiding unnecessary exposure

GUIDELINES Assemble the necessary accessories and positioning aides before anesthesia induction

GUIDELINES Provide enough help for safe patient moving

GUIDELINES Teamwork - move on the count of "three”

GUIDELINES Align the neck and spine at all times

GUIDELINES Move slowly and deliberately

GUIDELINES Be gentle when manipulating joints

GUIDELINES Do not abduct arms at greater than a 90 degree angle

GUIDELINES Protect arms and fingers by using a lift sheet for transfers

GUIDELINES Protect IV lines, catheters, and airways from tension

GUIDELINES Tape all IV lines, catheters, and pt's eyes closed

GUIDELINES Use good body mechanics to prevent self injury

GUIDELINES Use good body mechanics bend your knees bend your knees use large muscle groups use large muscle groups keep back straight keep back straight

GUIDELINES Pad all bony prominences and delicate areas with toweling, sheets, or foam to prevent nerve and skin damage

GUIDELINES Prevent nerve damage brachial nerve -  head and arm extension ulna nerve -  pressure on the arm/elbow due to inadequate padding

GUIDELINES prevent nerve damage femoral nerve -  excessive pressure from abdominal or inguinal retractors peroneal nerve -  use of stirrups can create pressure on the back of the leg

EQUIPMENT

EQUIPMENT safety strap –thigh - 2" above the knee –arms - prevent sliding off the armboards

EQUIPMENT footboard –to avoid foot drop –prevent patient from sliding off the bed in reverse Trendelenburg –reduce pressure on the heel and back of ankle

EQUIPMENT footboard –bed extension for tall patients

EQUIPMENT footboard –table for lithotomy position work

EQUIPMENT armboards –positioning arms laterally –avoid hyperextension of the arm

EQUIPMENT Stirrups - application concepts –equal height and distance on both sides –patients legs lifted together, slowly and placed in stirrups together to prevent back strain –padded well to prevent nerve damage

EQUIPMENT stirrups –types knee crutch

EQUIPMENT stirrups –types string or candy cane

EQUIPMENT stirrups –types leg/ankle support//boots

EQUIPMENT pillows towel/blanket rolls sand bag

EQUIPMENT kidney rests and bar

EQUIPMENT anesthesia screen –applied after the pt is anesthetized –used to lift and hold drapes off patient's face - access for anesthesia

EQUIPMENT head extension/foot board

EQUIPMENT thyroid bar/shoulder bridge

EQUIPMENT shoulder braces

EQUIPMENT positioning systems –pneumatic beanbags

EQUIPMENT positioning systems –McGuire Pelvic Positioner

CRITERIA FOR POSITIONING

no interference with respiration no interference with circulation

CRITERIA FOR POSITIONING no pressure on any nerves minimal skin pressure

CRITERIA FOR POSITIONING accessibility of operative site accessibility of anesthetic administration

CRITERIA FOR POSITIONING no undue post-operative discomfort

CRITERIA FOR POSITIONING meets individual patient requirements –obesity –pregnancy –cardiac compromise –respiratory compromise

POSITIONS

POSITIONS  SUPINE  LATERAL  PRONE

POSITIONS  SUPINE –DORSAL RECUMBENT –TRENDELENBURG/ REVERSE TRENDELENBURG –SEMI-FOWLER’S/FOWLER’S –LITHOTOMY

POSITIONS supine/dorsal recumbent –most common position –head/neck kept in proper alignment with rest of the body

POSITIONS supine/dorsal recumbent –arms at sides under lift sheet or on armboards prevents respiratory embarrassment –pillow under knees prevents hyperextension

POSITIONS supine/dorsal recumbent –safety strap above knees snug –feet fully on table, not over edge –ankle support used to decrease heel pressure

POSITIONS supine/Trendelenberg –same as supine with head down –table broken at the knees to 30 degrees –used to: visualize pelvic organs increase venous return from the lower extremities

POSITIONS supine/Reverse Trendelenberg –same as supine with feet down, head up –use footboard and blanket padding –used for upper abdominal surgery

POSITIONS supine/semi-Fowler’s//Fowler’s –a modification of the supine position –back section of the table elevated –base of table in Trendelenberg

POSITIONS supine/semi-Fowler’s//Fowler’s –knees flexed –arms on pillow on lap or at sides –footboard with padding for full Fowler's –used for procedures of: head and neck shoulderNeurosurgical

POSITIONS supine/lithotomy –a modification of the supine position –patient's buttocks at the edge of the foot section to prevent lumbosacral (lower back) strain

POSITIONS supine/lithotomy –stirrups hold each leg should be at equal heights and well padded check for neurovascular compromise secure with safety straps

POSITIONS supine/lithotomy –lift legs together by the ankle and thigh, rotate slowly outward, lift slowly –lower legs slowly after procedure, especially with long procedures, to prevent hypotension

POSITIONS supine/lithotomy –arms at sides or armboards WATCH FINGERS/HANDS WHEN RAISING/LOWERING THE FOOTSECTION!!! DANGER FROM HAND/FINGER INJURY IS VERY HIGH!! –patient should be positioned preoperatively (if possible) for safety and comfort

POSITIONS supine/lithotomy –keep patient covered and offer verbal and physical support –used for vaginal and rectal procedures

POSITIONS  LATERAL/SIMMS

POSITIONS lateral/Simms –state which side down for orientation –patient on side with flank area over the middle break in the table arms are supported at a 90 degree angle double armboard pillows/blankets sling armboard padded Mayo stand

POSITIONS lateral/Simms –top leg may be straight –lower leg bent 30 degrees at knee 15 degrees at hip pillow padding between legs

POSITIONS lateral/Simms –secured in place tape and padding positioning device –kidney rests –pneumatic bean bag

POSITIONS lateral/Simms –safety strap over thigh area –axillary roll for lower arm

POSITIONS lateral/Simms –kidney rests with kidney bar elevated will increase the space between the chest and iliac crest NOTE: lower the kidney bar and unflex the table when closing to facilitate tissue approximation

POSITIONS lateral/Simms –used for kidney and chest surgery –Colonoscopy in less formal position

POSITIONS  PRONE –PRONE –JACKKNIFE –KNEE-CHEST

POSITIONS Prone –face down –head turned to the side and supported by pillows, towels, headrest –chest is elevated with blanket rolls along the sides permits adequate respiration

POSITIONS Prone –axillary rolls used to pad the vascular/nerve complex of the shoulder area –pillow under ankles to elevate feet and prevent pressure to the toes safety strap above the level of the knees

POSITIONS Prone –arms at sides rotated onto armboards –check and pad: female breasts male genitalia –used for back surgery

POSITIONS Kraske (Jackknife) –same as prone with the table “broken” –sometimes the foot section is slightly elevated –pillow under hips for padding

POSITIONS Kraske (Jackknife) –pillow under ankles for padding –check and protect male genitalia

POSITIONS Kraske (Jackknife) –used for: pilonidal surgery hemorrhoidectomy anal surgery

POSITIONS Knee-Chest –patient kneels in fetal position –patient kneels on footboard with table bent in middle section –used for Culdoscopy or Proctoscopy

SURGICAL POSITIONING