Surgical positioning refers to the placement of the patient in a particular position during surgery. When selecting a surgical position, the main goals are allowing the surgeon adequate access to the surgical site while maintaining the patient’s comfort and safety. Other considerations include maintaining the patient’s airway, avoiding constriction or pressure on the chest cavity, maintaining proper circulation and preventing nerve damage.
Positioning is the responsibility of the surgical team and usually occurs after the anesthesia is administered.
The most optimal position for each surgical procedure is determined by the surgical team according to several factors. These include the location of the surgical site, body alignment, circulation and respiratory issues.
The patient’s physical traits, such as height, weight, body type, musculature, age, general physical health, and allergies are also factored into the decision, as is the type of anesthesia that will be used.
Basic Surgical Positions
The four basic surgical positions (with variations) are:
- Supine (on the back)
- Prone (face down)
- Lateral (on either side)
- Lithotomy (on back with legs elevated and sometimes placed in stirrups, depending on the degree of elevation required)
Variations of these positions include:
- Trendelenburg (supine position where the bed is modified so the head is lower than the pelvis)
- Reverse Trendelenburg (supine position where bed is tilted so the feet are higher than the head)
- Fowler’s (seated)
- Jackknife (prone position with hips elevated at an angle higher than the rest of the body)
- High and Low Lithotomy
Common Surgical Positioning Mistakes
While most surgical teams make every effort to ensure the comfort and safety of their patients, mistakes happen. These errors are caused by a variety of factors that include:
- Inadequate training in safe positioning techniques
- Understaffing in the operating room
- Failure to thoroughly read a patient’s chart and consider all relevant factors before determining the correct position for a procedure
- Incorrect or lack of assessment of extremities for signs of circulatory compromise
- Insufficient padding or positioning aids
- Lack of attention to vulnerable pressure points
- Failure to protect vulnerable blood vessels such as the carotid, aorta, vena cava or saphenous
- Failure to take additional precautions for obese patients, who may be more at-risk for compromised blood flow and decreased lung capacity in certain positions
- Neglecting to protect loose skin, especially in the lithotomy position
- Failure to lock the bed or stretcher before transferring or positioning a patient
- Carelessness when securing a patient to the operating table
- Failure to maintain proper head, neck and spinal alignment during the procedure
- Neglecting to shift a patient to avoid pressure ulcers (bed sores) during longer surgeries
- Failure to take proper precautions during delicate neurosurgical procedures
Consequences of Surgical Positioning Errors
Positioning errors can result in significant injuries to a patient, some of which can be debilitating or life-threatening. Here are some of the most common conditions that can be caused by surgical positioning mistakes:
- Nerve Damage
- Joint Injuries
- Vascular congestion
- Impeded blood flow and reduced lung capacity, especially with obese patients or when certain positions are used
- Injury to vulnerable bony prominences such as the temporal lobe, shoulder blade, elbows or knees
If you or a loved one has experienced any of the above conditions or has been otherwise harmed as a result of a surgical procedure, contact us immediately for a free consultation.
Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265668/
http://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard%20Surgical%20Positioning.pdf
www2.tulane.edu/som/departments/surgery/…/PATIENT-POSITIONING-2.ppt