POSITIONS FOR SURGERY ("Good order is the foundation of best out come".): POSITIONS FOR SURGERY ("Good order is the foundation of best out come".) CONDUCTED BY: Ms.Monika Clinical instructor Army college of nursing ,jal cantt Introduction : I ntroduction Many positions are used for various surgical procedures Correct positioning of the pt during surgery is of very important. Careful & secure positioning provides appropriate access to the surgical site. Proper & safe positioning prevents harm to the pt which may be caused by prolonged pressure on the bony prominences & Nerves The pt’s position during surgery is determined mainly by the site of operation. Criteria for good positioning : C riteria for good positioning Pt should be transferred from the stretcher to a well padded operation table very gently. While transferring the pt ,his head ,body & lower parts are to be adequately supported. Pt should be secured on the operation table with the help of restraints or straps. These restraints should be firm but soft & should provide gentle but adequate support. Thus is going to ensure maximum safely for pt. Pt’s body must be placed in proper anatomical alignment. The arms & legs are to be supported properly &adequately. Cont…..d: C ont …..d Pt should be made as comfortable as possible. the position should allow normal respiration as far as possible. The position should not interfere with pt’s circulation. Care should be taken to ensure that there is no undue pressure on any parts of the body because it may cause obstruction to free blood flow. Pt’s position should not provide any pressure on the peripheral nerves which may otherwise causes nerve injury. Pt’s position should ensure that there is no pressure on the skin surface &pressure points. Cont……..d: C ont ……..d Pt’s position should provide easy accessibility to the anesthesiologist for administering anesthesia. The position should provide easy accessibility to the operation site for the operating surgeon to perform the surgery. Pt’s body should not be in contact with any metal at any point. Various positions for surgery : V arious positions for surgery Pt’s position for surgery are determined by mainly two factors. The first is the site of the operation or the organ to be operated upon the other determinant is the operation surgeon’s decision or choice. Following are the vatious position in which pt are placed during surgery: Following are the vatious position in which pt are placed during surgery Supine or dorsal recumbent position. Prone position Trendelenburg position Reverse trendelenburg position Lateral position Fowlers position Sitting position Knee chest position Jackknife (Kraske) position Kidney surgery position Lithiotomy position Endoscopy position Supine or dorsal recumbent position: Supine or dorsal recumbent position This position is the natural position for the body when a pt is at rest. The pt lies flat on back. Pt’s arms are placed on either side of the body & are secured by arm straps Cont……..d: C ont ……..d The arm is supported on an arm board & well strapped. The arm board can be locked with the operation table to make them fixed & secured. Pt’s legs are put straight & parallel. The legs remain in the same alignment with the head & spine. A safety strap is placed across the thighs 2 inches above the knees. A small pillow is placed under pt’s head. The heels are protected by a small pillow or ankle roll If the operation is of long duration pt’s feet are supported by a padded foot board to prevent foot drops. Cont…….d: C ont …….d If necessary eyes are to be kept closed by the eye pads to protect eyes. Uses of this position: This position is used for surgical procedures on eyes ,ear ,chest ( heart & lung surgery) ,upper & lower abdomen ,breasts ,arm ,hands ,legs ,knee joints ,feet etc. Cont………..d: C ont ………..d This supine position is slightly modified when surgery is to be done on the neck or on the face. The neck is slightly hyper extended by lowering the head section of the operation table. The position is used for tracheotomy or throidectomy. The supine or dorsal recumbent position is also modified for any surgical procedures on the shoulders. A small bag or small pillow is placed under the shoulder to elevate it off the operation table. Cont…..d: C ont …..d This position is further modified when there is any surgical procedures on the groin ,perineum & vagina. The pt is placed in supine position ,knees are slightly flexed upward. The thighs are slightly rotated externally separating the legs. Cont………..d: Cont………..d For any operation on the axilla ,on the breast ,on the upper or the forearm or the hand ,the pt is placed in supine position. The arm on the affected side is placed on the arm board which is locked with the operation table. For an operation on the breast the armboard on the affected side is hyper extended to 120 ° angle to provide easy access to the breast. 2)Prone position : 2)Prone position Pt is first anaesthetized in supine position . Then the pt is slowly & gently turned to lie on the abdomen. Two long chest rolls are placed along the sides of the chest which extend from the axillae to the iliac crests. These helps to raise the body from the chest & abdomen & relieves body pressure. This facilitates proper chest expansion & adequate respiration. Cont……….d: Cont……….d In a female pt breasts are to be moved laterally to relieve pressure from them. The arms are placed on the sides of the body & supported & strapped by arm straps. The head is turned to one side & rest on a padded donut to prevent pressure on the face ,eyes ,nose & ear. A small pillow is placed under the ankle joint to prevent pressure on the toes. This position is used for operation on the back of the scapula & on the cervical ,thoracic or lumber spine. Cont……..d: Cont……..d This position is further modified as kneeling position. The buttocks remain at the right angle to the thighs. The lower legs remain at the right angle to the knees which rest on leg board. This position is used for the surgeries on spine. 3) Trendelenberg position : 3) Trendelenberg position In this position pt lies on the back. in the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head The entire body from the knee joint onwards is tilted to 45° angle downward. This position is used for surgery in the lower abdomen & pelvic organs. 4)Reverse trendlenberg position : 4)Reverse trendlenberg position In this position pt lies in supine position. The entire OT table tilted downward so that the head is higher than the feet. A padded foot board is used to prevent the pt from sliding downward. Small pillow Is placed under the head ,neck the lumber curvature. Uses of trendlenberg position : Uses of trendlenberg position This position is used for surgery on the gall bladder & biliary tract. The abdominal organs are displaced downwards which provides easy access to the upper abdomen. This position is also used for surgery on the thyroid glands such as thyroidectomy. 5)Lateral position : 5)Lateral position Pt is anaesthetized in supine position. Then the pt is slowly & gently move to the unaffected side. For surgery on the right side pt is placed on the left lateral position. For surgery on the left side the pt is placed on the right lateral position. The knee joint of the upper leg is flexed & supported on a large soft pillow. Cont………..d: Cont………..d Pt’s arms are supported on the armboard & are secured with arm straps. The pt head & neck is supported on small pillow. Use of position: this position is used for surgery on either the lungs ,the kidneys or the gall bladder. This position is also called side lying position. 6) Fowlers position : 6) Fowlers position In this position pt lies on the back. The body section of the operation table is elevated at 45° angle. The leg section of the operation table is lowered at the level of the knee joint. A padded foot board is provided for keeping the feet on rest. Head is supported on the head rest. Cont………d: Cont………d This position is used for cranial surgery ,nasopharyngeal surgery ,surgery of shoulder ,plastic surgery on the face & nose etc. The pt instead of being placed on the OT table can also be placed on a modified armchair. 7) Sitting position : 7) Sitting position In this position the body is in upright position. The shoulders are gently supported with body straps. Arms are flexed at the elbow joint & rest on a large pillow which Is placed on the pt lap or the cardiac table in front. Head is supported on a padded head rest. Cont…..d: Cont…..d This position is used for surgery of skull such as craniotomy & neuro surgery procedures such as surgery on cerebellum. 8) Knee chest position : 8) Knee chest position In this position pt lies on prone position after the pt has been anaesthetized. Pt knees are flexed at the right angle to the body. Pt head rests on a small pillow , & it is tuned to one side. Pt chest is raised from both side of axillae. Cont………d: Cont………d Pt’s arm are flexed at the elbow & placed around the head & supported on a pillow. Pt’s hips & pelvis remain at the highest point. This position is used for sigmoidoscopy. 9) Jacknife (Kraske ) position : 9) Jacknife (Kraske ) position In this position pt remain in prone position. The operation table is flexed at the center break & the head & foot end of the OT table are lowered. The head is turned to one side & supported on a small pillow. The chest is elevated off the OT table Cont………….d: Cont………….d Pt’s thighs ,knees joints & legs are supported on the pillow. Body is strapped on the thighs to avoid slipping. Arms are placed on the arm boards on the side of the OT table. In this position pt’s buttocks remain at the highest point. This position is used for surgery in the rectal area or for haemorrhoidectomy. Kidney surgery position : Kidney surgery position This is modified lateral position. Pt is anaesthetized in supine position & then slowly & gently turned to the lateral position on unaffected side. OT table is flexed at the level of the iliac crest. The head end of the OT table is tilted downward . Cont……….d: Cont……….d the knee joint of the lower e.g. is flexed & supported on a pillow. Pt’s head & neck are supported an a pillow. Pt’s arms are supported over the hip to stabilize the pt on the OT table. The body strap is placed over the hip to stabilize the pt on the OT table. This position is used for surgery on the kidney & ureters. 11) Lithotomy position : 11) Lithotomy position In this position the pt lies on her back ,the foot end of the OT bed is lowered. Pt’s buttocks are brought to the flexed edge of the lower segment. Patient’s legs from the thighs onward are supported by padded stirrups . Cont……..d: Cont……..d Which is suspended from lithiotomy poles on either side of the operation table. For a short procedure legs and thighs may be supported by canvas straps. Patient’s arms may rest on patient’s sides or over the abdomen or on the arm boards on either side secured with straps. This position is used for perineal,rectal and vaginal surgeries. ENDOSCOPY POSITION: ENDOSCOPY POSITION For pharyngoscopy,laryngoscopy,bronchoscopy and oesophagoscopy a modified supine position is given where the head section of the operation table is lowered to bring the oesophagus,pharynx and mouth in one straight line.