POSITIONING OF PATIENT

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POSITIONING OF PATIENT

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The patient's position should provide optimum exposure for the procedure access to IV lines and monitoring devices patient comfort Safety to circulatory, respiratory, musculoskeletal, and neurologic structure The procedure, surgeon preference, and patient condition determine equipment used for positioning.

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Preoperative assessment for positioning needs should be made before transferring the patient to the procedure bed. preoperative interview should include questions to determine patient tolerance to the planned position Assessment includes both patient and intraoperative factors . Patient factors include * age, * height and weight, * skin condition, * nutritional status, * preexisting conditions (eg, vascular, respiratory, circulatory, neurologic, immunocompromise), and * physical/mobility limits (eg, prostheses, implants, range of motion). Intraoperative factors include, but are not limited to, * anesthesia, * length of surgery, and * position required.

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Documentation should include, but not be limited to, * Preoperative assessment, * Type and location of positioning and/or padding devices, * Names and titles of persons positioning the patient, and * Postoperative outcome evaluation.

PRONE POSITION : 

PRONE POSITION

KRASKE/JACKNIFE POSITION : 

KRASKE/JACKNIFE POSITION

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the patient is placed face down on the OR bed The arms are placed at the patient's side, palms up or extended outward and upward on padded arm boards palms down, with elbows flexed to prevent overextension of the shoulders The patient's spinal column should be straight and in parallel alignment to the sides of the OR bed.

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Possible injuries The patient's face (ie, eyes, nose, ears, cheeks), clavicles, elbows, breasts, iliac crests, male genitalia, knees, and toes at risk for pressure injuries Neural injuries result from neck hyperextension, foot drop, and brachial plexus insults Potential injuries are facial, head, neck, and conjunctival edema; alopecia; corneal abrasion; and retinal ischemia

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Physiologic responses. Decreased cardiac index and stroke volume, increased systemic and pulmonary vascular resistance Respiratory excursion can be limited severely

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Safety considerations Maintain cervical neck alignment. Protection for forehead, eyes, and chin. Padded headrest to provide airway access. Chest rolls (clavicle to iliac crest) to allow chest movement and decrease abdominal pressure. Breasts and male genitalia free from torsion. Knees padded with pillow to feet. Padded footboard.

LATERAL POSITION : 

LATERAL POSITION

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Used for surgical procedures involving the upper chest, kidney, or upper areas of the ureter. Used for thoracotomy (eg, resection, lobectomy, repair of aortic aneurysms), gastroesophageal, orthopedic, neurosurgery, renal (eg, nephrectomy, pyelostomy, pyelolithotomy, adrenalectomy), and retroperitoneal procedures

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Safety considerations Axillary role for dependent axilla. Lower leg flexed at hip. Upper leg straight with pillow between legs. Padding between knees,ankles,and feet. Maintain spinal alignment during turning. Padded support to prevent lateral neck flexion. Using a head rest or placing a pillow under the patient's head to keep the cervical and thoracic vertebrae aligned Ensuring that the patient's dependent ear is not folded and is well padded.

SUPINE POSITION : 

SUPINE POSITION

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Patient is placed on his or her back on the OR bed. The patient's spinal column should be in a straight line with his or her legs parallel to the OR bed Used for abdominal, cardiac, peripheral vascular, and some orthopedic extremity procedures. Variations include Trendelenburg's position (ie, patient supine with head lowered, feet up), Reverse Trendelenburg's position (ie, patient Supine with head up, feet lowered), and Modified supine position on the fracture table (ie, Patient supine with one leg extended in traction

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Possible injuries Pressure points vulnerable to skin include the occiput, scapulae, thoracic vertebrae, olecranon (ie, elbow), sacrum, coccyx, and calcaneous (ie, heel) Neural injuries common with prolonged supine positioning involve the extremities (eg, brachial plexus injury, wrist drop, ulnar neuropathy, foot drop, pudendal nerve injury).

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Physiologic responses Patient's respiratory efforts, however, may be impeded by decreased diaphragmatic movements secondary to pressure from abdominal contents Adversely affect the patient's cardiac output because of mechanical compression of the heart and increased venous return from the lower extremities.

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Safety considerations Padding to heels,elbows, knees, spinal column, and occiput Alignment with hips, legs Parallel and uncrossed ankles. Arm boards at less than 90-degree angle and level with floor. Head in neutral position. Arm board pads level with table pads.

LITHOTOMY POSITION : 

LITHOTOMY POSITION

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Possible injuries Hip and knee joint injury Lumbar and sacral pressure Vascular congestion Neuropathy of obturator nerves, saphenous nerves, femoral nerves,common peroneal nerves, and ulnar nerves. Restricted diaphragmatic movement

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Safety considerations Place stirrups at even height. Elevate and lower legs slowly and simultaneously from stirrups. Maintain minimal external rotation of hips. Pad lateral or posterior knees and ankles to prevent pressure and contact with metal surface. Keep arms away from chest to facilitate respiration. Arms on arm boards at less than 90-degree angle or over abdomen.

Sitting position : 

Sitting position

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Possible injuries Pressure injuries include the patient's occiput (ie, in a semisitting position), scapulae, back of the knee, coccyx, ischial tuberosities, and calcaneous. Injuries can occur to the patient's supra-scapular, ulnar, sciatic, peroneal, and anterior tibial nerves. Increased likelihood of air embolism due to negative venous pressure in the patient's head and neck.

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Outcomes of safe and appropriate positioning may include * optimal exposure of the surgical site; * airway management, ventilation, and monitoring access for the anesthesia care provider; * physiologic safety for the patient; and * maintenance of patient dignity by controlling unnecessary exposure *Studies suggest that positioning devices should maintain normal capillary interface pressure of 32 mm Hg or less

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