Positioning Flashcards
What standard is related to positioning?
Standard 8
Which are the most common areas for positioning injuries?
ulnar nerve and brachial plexus
What are the 7 goals for positioning?
patient safety, optimize surgical exposure, preserve patient dignity, maintain hemodynamic stability, maintain cardiorespiratory function, no ischemia, injury or compression, joint commission safety goal to prevent pressure ulcers
Cardiovascular concerns with anesthetics
volatile anesthetics decrease CO/BP, NMBs decrease muscle tone/venous return, opioids decrease HR/CO
Prone position barrier to thoracic excursion
reduced capacity for chest expansion
Mechanisms associated with nerve injury
compression, transection, stretch, traction
Direct nerve sheath ischemia cause
compression
Indirect nerve sheath ischemia cause
compartment syndrome
Risk factors for integumentary issues/pressure ulcer
elderly, diabetes, PVD, surgical time (>4 hr), chronic hypotension, body habitus
Different types of surgical positions
supine, prone, lithotomy, lateral, sitting, trendelenburg, reverse T-burg, high lithotomy, low lithotomy, jack knife
What are different pressure points when lying supine?
occiput, thoracic vertebrae, humerous, elbow, sacrum, thighs, heel, toes, scapulae, coccyx
Arm positioning considerations for supine position
arms placed laterally with palms against sides or abducted <90 degrees on armboards with padding and straps supinated forearms (palms up)
Why should the forearms be supinated while in supine position?
to avoid brachial plexus injury
if placed in pronation there can be ulnar nerve compression
Leg positioning considerations for supine position
legs flat and uncrossed, knees slightly flexed, padding on heels
Why should the knees be slightly flexed in supine position?
to avoid sciatic nerve stretch/injury
How does flexion and extension of the neck effect ETT position?
remember the hose follows the nose!
Flexion and extension move the tube 1.9 cm and rotation of the head results in the tube moving 0.6 cm
Cardiopulmonary implications of supine position
reduced TLC and FRC, diaphragm shifts cephalad, BP stability
Prone positioning considerations
intubated on stretcher before positioning onto OR table, keep head/neck neutral, arms < 90 degrees
What is the first thing you should do after any position change?
check the tube!
What types of surgical cases would we use the prone position?
spine, buttocks, rectum or peri-rectal, ankle, intracranial
Prone cardiopulmonary considerations
pooling of blood in lower extremities and abdomen, compression of inferior vena cava, epidural engorgement, decreased compliance if chest not freely hanging, increased FRC
Which body parts should we be mindful of with prone positioning?
genitalia (penis), breasts, lower legs, face, eyes, nose
What causes an increased risk of postoperative vision loss?
prolonged surgical time, spine surgeries, prone position
How can we prevent POVL
surgical duration <6hr, 10-15 degree head up (reduce orbital edema), BP 20% of preop baseline (MAP >70 mmHg), maintain Hct >25
