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Positioning patients in

the Operating Room


Prone positioning safety and
assessment measures.

6/22/09

Mary Jean Croft, RN, BSN,


CNOR

Objectives

Summarize the physiologic effects of prone


positioning on patients major body systems.
Identify areas of potential injury from positioning
patients in the prone position.
Describe the use of intraoperative positioning
devices.
Discuss potential complications from
intraoperative positioning of surgical patients.
Describe perioperative nursing interventions to
prevent surgical patient injuries from
intraoperative positioning.
2
Understand intraoperative documentation
for the

Preoperative interview

Questions to determine patients tolerance


to planned procedure
patient factors
Age, hgt, wgt
Skin condition
Nutritional status
PMI
Physical/mobility limitations
Intraoperative factors
Anesthesia
Length of surgery/position required
3

Preplanning

Ensure that positioning devices are available


Adequate number of staff to assist in the
positioning
Requires teamwork
Ensures
Optimal exposure of surgical site
Airway management
Safety for the patient
Maintain patient dignity and body
temperature by controlling unnecessary
exposure.
4

Positioning Devices

Studies suggest that positioning devices


should maintain capillary interface pressure
of 32mm Hg or less.
Foam pads are not effective: they quickly
compress
Gel pads redistribute pressures over a larger
surface and are more effective.
Pillows, blankets and molded foam devices
produce a minimum of pressure reduction
and are suitable for short procedures.
5

Positioning/protective
devices
Chest rolls
Gel pads
Pillows
Arm boards
Slotted head rests
Eye shields
Tape
Safety straps

Positioning/protective
devices

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McEwen,D.R. (1996). Intraoperative positioning of surgical patients. AORN, 63(6), 1058-1079.

Positioning help
Four is the
Minimum
number
For positioning
A patient in
The prone
Position.

9
McEwen,D.R. (1996). Intraoperative positioning of surgical patients. AORN, 63(6), 1058-1079.

10
Walton-Geer, P.S. (2009). Prevention of pressure ulcers in the surgical patient. AORN, 89(3), 538-548.

11
Walton-Geer, P.S. (2009). Prevention of pressure ulcers in the surgical patient. AORN, 89(3), 538-548.

12
McEwen,D.R. (1996). Intraoperative positioning of surgical patients. AORN, 63(6), 1058-1079.

Physiologic effects

Cardiovascular system

Decrease in Cardiac output

Increase pressure on IVC

Decreased preload
Respiratory system
Broad positive effect on resp.
FRC and oxygen tension both increase
Loss of airway (extubation, kinked tube.)
Ineffective chest expansion
Neuro/vascular/musculo-skeletal injuries
Peripheral nerve injury
Occlusion of pulses
Muscle/spinal injuries.
13

Potential sources of
injury

Pressure injuries

Eyes
Nose
Forehead
Chest
Arms
Breasts
Genitalia
Pelvis
Knees
Feet
14

Intraoperative
assessment

Radial and pedal pulses


Femoral pulses
Breath sounds
Alignment of the cervical, thoracic, lumbar vertebrae
Ensure proper placement of chest rolls/abdomen not
compressed
Make sure breasts and male genitals in correct anatomical
position.
Check all pressure areas for proper padding
Knees
Iliac crests
Feet
Toes off the bed
Shoulders and arms in proper alignment and
15 padded.
Face (particularly eyes, nose, ET tube)

16

Documentation
Preoperative assessment
Type of positioning
Padding devices used
Names and titles of persons
positioning the patient
Postoperative outcome evaluation

17

???? Questions ???

18

References
AORN Journal. Recommended practices for positioning the
patient in the perioperative practice setting. AORN, 73(1),
231-238.
Edgecombe, H., Carter, K., & Yarrow S. (2008). Anaesthesia in
the prone position. British Journal of Anaesthesia, 100(2),
165-183.
McEwen,D.R. (1996). Intraoperative positioning of surgical
patients. AORN, 63(6), 1058-1079. 27
Phillips,N. (2007). Berry & Kohns Operating room technique
(11th ed.). St. Louis: Elsevier. (Original work published 1955)
Rothrock, J.C. & Tighe, S.M. (2007). Alexanders care of the
patient in surgery (13th ed.). Elsevier Health Sciences.
Walton-Geer, P.S. (2009). Prevention of pressure ulcers in the
surgical patient. AORN, 89(3), 538-548.
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