Positioning Flashcards
Positioning is shared responsibility, but ultimately positioning is determined by?
surgeon
What is CRNA’s primary responsibility (3)?
protect aw, vascular access and promote homeostasis
Are all PNI preventable?
no
Which PNI most common? Second most common? Most common LE PNI?
ulnar nerve, brachial plexus close second, sciatic
Supine is also called?
dorsal decubitus
What is most common operative position?
supine/dorsal decubitus
Arms should never be abducted > ____ degrees?
90
Arms should always be supinated or pronated? Or?
supinated, palms up
at side, palms in
What can be injured if arms are abducted > 90 and pronated?
brachial plexus
How can the lumbar be supported in supine position? (3)
slight flexion hips/knees, pillows under knees, elastic compression stockings/SCDs
Why does the lumbar need to be supported in surgery and supine position?
ligaments of vertebral column relax w/ anesthesia
What can cause brachial plexus injuries in surgery? (4)
abduction of arms >90, compression of neck, shoulder braces/pads, cardiac surgery - instruments that open chest
What injury can result if arms are pronated and why?
ulnar injury, d/t compression of cubital tunnel
What are possible complications of supine position? (5)
pressure alopecia, backache, aortocaval compression syndrome, skin breakdown/ulcers, circulatory compromise
What is aortocaval syndrome?
compression of abd aorta and IVC in pregnant women from lying flat on back, causes hypotension and fetal compromise
What variation on supine can help alleviate low back pain?
lawn chair position
What are the effects of trendelenburg position? Increases, decreases, why?
increased venous return: increased preload, increased venous return increased ICP/decreased CPP - vascular congestion, increased intraocular pressure, increased PIP
abd contents/diaphragm moves cephalad, compresses lungs: decreased FRC, decreased pulmonary compliance, r/o endobronchial intubation
Fluid shifts in Trendelenburg can cause what complication? And it can cause what?
Edema: aw, tongue, pharanyx, face, sclera
Can cause aw patency issues.
If worried about effects of Trendelenburg position on aw patency what interventions can you perform? (2)
check for cuff leak, listen to lung sounds
What are the anesthetic concerns of Trendelenburg? (7)
sliding, alt. cardio/pulm function, PNI, aw edema, compartment syndrome, regurg/asp, ETT migration
How can you lower the risks of Trendelenburg? (8)
anti skid pads, appropriate padding - face, confirm ett, conservative use of fluids, post-op O2, OGT/suctioning, ensure patent IVs, vent modes (OC vs VC)
What surgeries are facilitated by reverse Trendelenburg? Why?
upper abd, head and neck, shoulder, intracranial
promotes venous drainage, decreases blood/bleeding, movings abd contents caudad
What surgeries are facilitated by lithotomy?
GYN, rectal, urology
What are some concerns of lithotomy position? (5)
watch for crush finger injuries, raising/lowering legs (do it at the same time, slowly), PNI, intubation difficulties, ask pt to position themselves by moving down