Patient Positioning in operating rooms

Description

Surgical positioning is the procedure of placing a patient in a particular physical position for performing surgery. The goal in selecting and adjusting a particular physical position is to maintain the patient’s safety, while allowing access to the surgical site.

Purposes

1. To provide comfort and safety to patient
2. To maintain patient’s dignity and privacy
3. To allow maximum visibly and accessibility to the surgical site for the surgeon
4. To prevent soft tissue, musculoskeletal or nerve injury

Practices To Be Followed During Positioning

1.  Have adequate number of personnel, devices, and equipment available during positioning steps to ensure personnel safety.
2. Maintain patient in a natural neutral alignment. Keep the patient’s head and neck in a neutral position without extreme lateral rotation and avoid hyper flexing.
3. Ensure that the patient’s complete body is in physiologic alignment and that the hands, fingers, feet and toes are protected from surgical table articulations.
4. Operating room staff should always use safe “body mechanics’ during transfers and positioning.
5. Ensure that the patient is not in contact with any metal portions of the surgical table or positioning devices.
6. Never exceed the weight limits for the table
7. Maintain the patient’s airway and circulation throughout the procedure.
8. Prevent nerve damage.
9.  Allow access to surgical site as well as for anaesthetic administration.
10.  Prevent any soft tissue or musculoskeletal injury.

Patient positioning is an important aspect of patient care services in the operating room and an extremely important part of a nurse’s job as well. That is why, to be truly effective, nurses must know all about the different surgical positions of patients.

Goals of Proper Positioning

1. To maintain the patient’s airway and circulation
2. To prevent nerve damage.
3. To allow surgeon accessibility to surgical site as well as for anesthetic administration
4. To allow surgeon accessibility to surgical site as well as for anesthetic administration
5. To provide comfort and safety to the patient
6. To prevent soft tissue or musculoskeletal and other patient injury

Importance of Patient Position in OR                                                     

Proper positioning is vital to a safe and effective surgical procedure. Positioning in the operating room depends on the type and length of procedure (surgery), anesthesia access to patient, devices required and other factors. Safely positioning the patient, a team effort from all surgical team. Proper positioning is also important to maintain the patients’ airway and circulation throughout the procedure.

Factors To Be Considered

1. Physical condition of the patient such as size and weight
2. Type of anesthesia to be used
3. Respiratory constraints and circulation
4. Stress on muscular system
5. Body alignment. e.g., deformities

Guidelines For Patient Positioning

Proper execution is needed during patient positioning to prevent injury for both patient and staff members. patients are generally positioned for surgery on the table after anesthesia is administered.

1. Get adequate help
2. Use mechanical aids such as slide boards, pillows, patient lifts and slings
3. Raise the operating table and adjust according to the height of surgeons
4. Observe proper body mechanics.

Positions Commonly Used for Surgeries

1. Supine or Dorsal Recumbent Position

This is the most common position for surgery, with the patient lying on his or her back with hand, neck and spine in neutral positioning and arms either adducted alongside the patient or abducted to less than 90 degrees. Supine position is used for surgeries involving   the anterior surface of the body such as abdominal area, cardiac and thoracic surgeries. 

2. Fowler’s Position

Fowler’s position, also known as sitting position wherein the head is elevated 45-60 degrees. The legs of patient may be straight or slightly bent. Variations in Fowler’s position include low Fowler’s, semi-Fowler’s and high Fowler’s. Fowler’s position is used for head, chest and shoulder surgeries.

3. Knee-chest Position

For this position, the patient kneels on the table and lowers his/her shoulders on to the table, so that the chest and face rest on the table. This type of position places extreme pressure on the knees. Hence, while positioning, surgical staff should place extra padding for the knee area. For gynecological and rectal surgeries this position is used.

4. Kidney Position

The kidney position resembles lateral position, except the patient’s abdomen is placed over a lift in the operating table that bends the body to allow access to retroperitoneal space. Kidney wrest is placed under the patient at the location of the lift This position is used for surgical access to the thorax, kidney, retroperitoneal space and hip,

5. Prone Position

The patient is placed face-down with his/her head in a neutral position without excessive flexion or rotation. A face down position is used when the patient’s head is in the midline. Prone position is often used for spine and neck surgeries. neurosurgery, colorectal surgeries and vascular surgeries.                                                                                                      

6. Lithotomy Position

A position in which the patient is on her back with hips and knees flexed with thighs apart and legs on stirrups. The position is used for gynecology, colorectal, perineal or pelvic procedures and urology surgeries.

7. Sim’s position or Semi prone Position

This position is half-way between the lateral and the prone positions. The lower arm is positioned behind the client and the upper arm is flexed at the shoulder and below. The upper leg is more acutely flexed at the hip and knee, than is the lower leg.

8. Trendelenburg Position

This position involves lowering the head of the bed. The patient’s arms should be tucked at their sides. This position used for gynecological lower abdominal, rectal, and genitourinary surgeries.

9. Reverse Trendelenburg Position

A patient position where the head of the bed is elevated with the foot of the bed down. It is the opposite of Trendelenburg position and is used for gallbladder, stomach, prostate, bariatric and head and neck surgeries.

Support Devices for Patient Positioning

The following are the devices or apparatus that can be used to help position the patient properly.

• Bed boards
• Foot boards
• Hand rolls
• Hand-wrist splints
• Pillows
• Sandbags
• Side rails
• Trocar rolls
• Wedge pillows
• Anesthesia arm board

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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