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Surgical Safety in Motion [Part 2]

Surgical Safety in Motion [Part 2]

Safe Patient Handling with Surgical Table Positioning

Clinician safely positioning patient's leg
Author photo of Heather Kooiker

By Heather Kooiker MSN, RN, CNL, CNOR, CRNFA

Senior Clinical Liaison
Perioperative Professor of Nursing, Davenport University

In the operating room, patient safety is a non-negotiable — and safe patient handling and positioning play major roles. Different positions can introduce certain risks for patients, ranging from physiologic changes to soft tissue injury (nerve damage, pressure injuries, etc.).1 That’s why leading organizations like AORN publish research and guidelines to help surgical teams balance surgical access with patient safety.1

As you expand your capabilities and add new specialties, are you equipping your team with the tools they need to ensure safe patient handling in any position? With the right surgical tables and accessories, you can safely use the most effective positions, help prevent injuries and help improve patient outcomes.

What Goes Into Safe Patient Handling in the OR?

Support the positions and procedures you need — safely and efficiently. Here are some key considerations for commonly used positions:

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Trendelenburg Position

In this position, the patient’s head is positioned below their feet at an angle of 15-30°.2 Commonly used for lower abdominal surgeries, it allows gravity to shift abdominal organs closer to the head, giving the surgeon better access to the pelvic organs.3

What Are the Risks?

Among others, the Trendelenburg position can increase the risk of:1

  • Injury to peripheral nerves, bony prominences and blood vessels
  • Blood pressure changes
  • Cerebral edema
  • Intraocular pressure increase
  • Respiratory distress
  • Decreased lung capacity
  • Diminished tidal volume
  • Sliding on OR table

How Can You Support Safe Patient Handling in the Trendelenburg Position?

Given the risks associated with this useful position, there are several practices surgical teams should consider when using the Trendelenburg or Reverse Trendelenburg positions — especially when using the steep Trendelenburg position (30-40°):

  • Minimize the degree as much as possible8
  • If possible, reposition patients into supine or reverse Trendelenburg positions at set intervals8
  • Check airway maintenance device after positioning, and make corrections as needed8
  • Prevent unintended movement and shearing with positioners that securely cradle the patient’s body — especially at steep angles
  • Choose surgical tables with collision control when using steep Trendelenberg positions
Relative Importance of the Predictor Variables

Fowler’s Position (Beach Chair)

In this position (sometimes referred to as the Beach Chair position) the patient is in a semi-seated position at an angle of 45-60° with their legs straight or slightly bent.4 Commonly used for neurology and orthopedic surgeries, Fowler’s position can help prevent respiratory distress by allowing for greater chest and lung expansion.5

What Are the Risks?

Among others, Fowler’s position can increase the risk of:1,6

  • Pressure injuries in the buttocks and abdomen
  • Decreased venous return, which may contribute to deep vein thrombosis
  • Nerve injuries due to neck flexion or pressure on the buttocks

How Can You Support Safe Patient Handling in Fowler’s Position (Beach Chair)?

Proper surgical table positioning equipment can help you protect patient safety and comfort when using Fowler’s position. For example:

  • Maintain a neutral head position, avoiding excessive flexion, extension or rotation8
  • Flex and secure the arms, or nonoperative arm, across the body8
  • Pad the buttocks and flex the knees 30°8
  • Keep abdominal pannus from resting on the thighs, and verify the safety restraint is securely positioned across the thighs8
  • Use a dedicated beach chair support surface to help you:
  • Reposition the patient more easily
  • Increase surgical site access
  • If a beach chair support surface is not available, place the surgical table in the sitting or reclined position and support the patient’s head and extremities with accessories
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Lithotomy Position

In the lithotomy position, the patient’s feet are positioned at or above hip level, with their knees flexed and thighs separated.7 The patient may lie flat or in the Trendelenburg position. The lithotomy position is popular for urology, gynecology and gastrointestinal procedures.

What are the Risks?

Among others, the lithotomy position can increase the risk of:8

  • Injury to peripheral nerves, bony prominences and blood vessels
  • Circulatory compromise
  • Hypotension (if legs are lowered too quickly)
  • Musculoskeletal injury
  • Nerve damage
  • Worsening of pre-existing back aches (if buttocks and lower back are not adequately supported)
  • Skin breakdown

How Can You Support Safe Patient Handling in the Lithotomy Position?

With the right positioning techniques and specialized accessories, you can make the lithotomy position safer and more comfortable for your patients. For example:

  • Do not place safety restraints over the chest or abdomen8
  • Position the buttocks even with the lower break of the table8
  • Avoid excessive flexion, rotation or abduction when positioning hips8
  • Place leg holders at an even height and support legs over the largest surface area of the legs8
  • Ensure proper use of leg holders like boots, knee crutches, or “candy canes"
  • Be sure to place the patient’s legs in the leg holders carefully and simultaneously — and remove them the same way9
  • Choose a pressure-redistributing OR surface or tabletop pad to help avoid pressure injuries
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Lateral Position

In the lateral position — commonly used for chest, lung, kidney and hip surgeries — the patient lies on their left or right side. Patients are typically placed in a supine position first, then rotated into the lateral position.10

What are the Risks?

Among others, the lateral position can increase the risk of:10

  • Nerve injury
  • Skin breakdown
  • Reduced respiration

How Can You Support Safe Patient Handling in the Lateral Position?

In order to safely rotate the patient into the lateral position and protect them throughout the procedure, surgical teams can:

  • Place a head positioner or pillow under the head8
  • Maintain physiologic spinal alignment8
  • Properly support and secure arms with arm boards8
  • Avoid compressing breasts or abdomen, and do not allow them to hang over the edge of the surface8
  • Use proper support pads and body positioners to reduce shear while flexing
  • Consider specialized accessories to help safely rotate the patient between lateral and prone positions

With proper safe patient handling and positioning, you can gain the surgical site access you need without sacrificing patient safety. Contact us today to find the right surgical tables and precision positioning table accessories for you.

References
  1. AORN. Guidelines for Perioperative Practice. 2021:645-718.
  2. Ostrow, CL (May 1997). "Use of the Trendelenburg position by critical care nurses: Trendelenburg survey". American Journal of Critical Care. 6 (3): 172–6. doi:10.4037/ajcc1997.6.3.172PMID 9131195.
  3. Ghomi A, Kramer C, Askari R, Chavan NR, Einarsson JI. Trendelenburg position in gynecologic robotic-assisted surgery. J Minim Invasive Gynecol. 2012;19(4):485-489. doi:10.1016/j.jmig.2012.03.019
  4. LaFleur Brooks, Myrna and Danielle (2018). Exploring Medical Language: A Student Directed Approach (10th Ed). Elsevier. p. 68.
  5. https://nurseslabs.com/patient-positioning/#fowlers_position
  6. Cogan A et al. Orthop Traumatol Surg Res. 2011;97(3):345–348.
  7. https://nurseslabs.com/patient-positioning/#lithotomy_position
  8. Association of PeriOperative Registered Nurses. Guideline for safe patient handling and movement. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2020:705-714.
  9. Bennicoff  G. Perioperative care of the morbidly obese patient in the lithotomy position. AORN J. 2010;92(3):297–309. [VB] [PubMed: 20816103]
  10. https://journals.lww.com/nursingmanagement/fulltext/2006/07001/preventing_intraoperative_positioning_injuries.4.aspx