Positioning And Nerve Injuries Flashcards
What is the most common peripheral nerve injuries?
- ulnar 21%
- brachial plexus 20%
Advantages of supine position
- easy access of airway/IV’s
- preservation of HD stability
Describe proper placement of arms in supine position:
- arms abducted <90 degrees
- elbows padded
- arm supinated
- safety strap
Describe proper positioning for arms that are tucked in:
-tucked in with palms facing patient, thumbs facing up. “Pencil” style
How to avoid brachial plexus injury:
- avoid abducting arms greater than 90 degrees
- avoid direct compression on shoulders (no shoulder pads—if you must use them-place on acromion process)
How can you avoid ulnar injury?
- supinate arms and hands
- pad elbows
Trendelenburg
-feet up head down
Describe the HD effects of trendelenburg.
- increase VR, CVP, C.O
- cerebral vascular congestion
- ocular vascular congestion
- risk of poor cerebral perfusion pressure
- facial edema and orbital, laryngeal, angioedema
- *not good for patients with head injuries or glaucoma
Describe respiratory effects during Trendelenburg:
-abdominal contents move cephalad lowering FRC, increasing atelectasis, shunting blood, and inducing hypoxemia
Describe Trendelenburg peripheral nerve injuries:
- brachial plexus - shoulder pad; poor arm abduction
- ulnar - supinate hands and padded elbows
What are ways to reduce risk of complications in Trendelenburg:
- anti skid pads, egg crates
- conservation of IVF
- change positions slowly
- OGT
- low insufflation of abdomen
Reverse Trendelenburg
-head up feet down
Describe the HD effects of reverse Trendelenburg
- decreased venous return, decreased CVP, venous pooling and stasis
Describe respiratory effects during Trendelenburg:
- abdominal contents move cauded and allow for greater lung expansion and higher FRC
- ** venous air embolism
PNI for Reverse Trendelenburg
- brachial plexus
- ulnar
Lithotomy
- hips flexed 90 degrees
- legs 30-45 degrees
- lower legs parallel to abdomen
Describe the HD effects of Lithotomy
- increase venous return, increase CVP, increase C.O
Describe the respiratory effects of Lithotomy
-abdominal contents move cephalad, pushing abdominal contents upward, reducing FRC, increased atelectasis, shunting blood, and creating hypoxemia
PNI for Lithotomy
- common perineal
- sciatic
- obturator
- femoral
What are ways to reduce complications in Lithotomy Position
- pay attention to fingers that they are not crushed in the knee gatch
- raising the legs should be done in synchrony
- try to use boots that distribute pressure evenly
Compartment Syndrome
- perfusion reduced, ischemia, edema, rhabdo
- occurs most frequently 2-3 into case
Lateral Decubitus Position
-side for “lung” surgery
Describe the respiratory effects of the Lateral Decubitus
-V/Q mismatch
What are ways to reduce complications in Lateral Decubitus?
- head neck neutral position
- dependent eye, ear
- “axilla” bean bag caudate to axilla under chest
- concern for vascular compression: NIBP, pulse on dependent arm
- compartment syndrome on dependent leg from upper leg and inguinal ischemia
