1. Prevention of Perioperative Pressure Ulcers Tool Kit The Basics of Positioning Patients in Surgery

2. Funded in part by grants from Sage Products, LLC and Medtronic through the AORN Foundation.

3. Objectives 1.Describe the most commonly used surgical positions. 2.State techniques for preventing injury to surgical patients.

4. Goals of Positioning

5. General/Regional anesthesia – Physiologic changes – Reduced movement/sensation Positioning Injuries

14. Bracheal plexus – Shoulder – Arm – Hand Positioning Injuries

15. Bracheal plexus injury – Armboards extended beyond 90° – Armboards higher or lower than OR bed – Lateral rotation of patient’s head – Leaning against shoulder or arm – Shoulder braces Positioning Injuries

16. Common peroneal – Lower leg – Foot – Toes Sciatic Common Peroneal Tibial

17. Common peroneal injury – Direct compression – Patients who are thin – Hyperextension of knees – Pressure behind knee – Graduated compression stockings too tight – Foot drop/Lower extremity paresthesia Positioning Injuries

21. Positioning Process Collaborative process – Selection of equipment – Preoperative assessment – Positioning – Documentation – Postoperative evaluation

22. Selection of Equipment

23. Pressure relieving surface – Disperses weight – Prevents “bottoming out” – Relieves shear and friction

24. Preoperative Assessment Age/Height/Weight/Body mass index (BMI) Nutritional status Blood pressure Skin integrity ROM/Physical limitations Internal/External devices Preexisting conditions Medical history Diagnostic studies Psychological/Cultural considerations

25. Selection of Position

26. Supine

29. Trendelenburg

30. Reverse Trendelenburg

31. Sitting/Modified-Sitting

32. Lithotomy Low Standard Hemi High Exaggerated

33. Lithotomy

34. Common peroneal Femoral Obturator

35. Lithotomy

36. Prone

38. Jackknife

39. Lateral Right = Left

40. Lateral

41. Obese Patients

48. Documentation Preoperative assessment Names/titles participants Patient position Upper extremities Lower extremities Equipment/Padding Specific actions Repositioning Postoperative assessment

49. Nerve injury Pressure injury Reposition Transfer of care Postoperative Assessment

50. 1.Guideline for positioning the patient. In: Guidelines for Perioperative Practice. Denver, CO: AORN; 2015. References

51. Thank you Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNC Senior Perioperative Practice Specialist Association of periOperative Registered Nurses (AORN) Denver, CO. for preparing the content of this educational slide deck.

52. Prevention of Perioperative Pressure Ulcers Tool Kit The End