After administration of Anesthesia Best possible access Best possible visualization

1. PATIENT POSITIONING • After administration of Anesthesia • Best possible access • Best possible visualization • Causes the least compromise in function POSITIONING CONCEPTS • Access must be provided • --surgical site • --airway • --I V’s • --monitoring devices COMPROMISE TO BODY SYSTEMS MUST BE PREVENTED --Integumentary system --Nervous system --respiratory system --musculoskeletal system

2. BASIC POSITIONS • SUPINE- Is the most basic position • ---Flat on back • ---Arms secured at sides/palms inward • ---Elbows protected (eggshell crate) • ---Legs straight and parallel • ---Safety belt 2 inches proximal to knees • ---Arm-boards no more than 90 degree angle (if used) • to prevent hyperextension of shoulder • ---Heels must be protected • Body regions that may be accessed in the supine position • Anterior lower extremity, Pelvis, Abdomen, Chest/breast • Shoulder head and neck and upper extremity

3. Arm Boards SEAT BELT

4. TRENDELENBURG --- Is a modification of the supine position. It is used to displace the abdominopelvic organs cephalad to provide better visualization. (laparoscopic cholecystectomy) -- Apply safety strap proximal to knees - -Another benefit from this position, is that blood flow to the lower body is reduced and venous drainage is pro- moted. This position may be used to increase blood flow to the upper body. (treatment of shock or for dis- tention of blood vessels to be cannulated)

5. REVERSE TRENDELENBURG -- Modification of the supine position. It is used to displace the abdominal organs caudad to provide better visual- ization of the surgical site. Other benefits include, blood flow to the upper body is reduced, venous drainage is promoted, and respiration is facilitated. -- Apply safety strap snugly approximately 2 inches distal to the knees.

6. FOWLER’S POSITION AND SITTING POSITION -- Fowler’s position is a modification of the supine position provides improved access to the surgical site and reduces blood flow to the upper body, promotes venous drainage, and facilitates respirations. Air embolisms are a concern when in this position. -- Patients arms may be secured on arm-boards or across the abdomen. -- Apply safety strap 2 inches proximal to the knees

7. SITTING POSITIONS -- The sitting position is a modification of Fowler’s position. The torso is in an upright position. The flexed arms rest either on a lap pillow or on an adjustable table in front of the patient. -- A body strap should support the shoulders, pad for sciatic nerve damage. Head will be in a cranial head rest.

8. LITHOTOMY POSITION --The lithotomy position is a modification of the supine position. Variety of positioning devices. --Candy cane stirrups --Low lithotomy stirrups/built-in padding --Not usually safety strap used Body regions that may be accessed in this position are --Perineum --Anus/rectum --Vagina --Urethra

9. Table accessories for Lithotomy Position CANDY CANE STIRRUPS

10. PRONE POSITION -- Prior to placement into the prone position, the pt is anesthetized on the gurney first and then moved to the operating table. -- Placement of catheters and all pre-operative procedures need to be preformed before moving the pt into prone position. BODY REGIONS ACCESSED --posterior lower extremities --dorsal body surface

11. KRASKE POSITION -- Kraske is a modification of the prone position. BODY REGIONS ACCESSED -anus -pilonidal area

12. LATERAL POSITION ( Right lateral) -- The lateral position is also referred to as the recumbent or lateral decubitus position. Rt lateral position, pt is placed on the operating room table with the right side down. Exposing the left side of the body. Left lateral left side downward so right side is exposed for surgery.

13. Bean Bag for Lateral Position

14. RIGHT KIDNEY POSITION -- The kidney position is a modification of the lateral position. Regions accessed: Retroperitoneal space. -- Kidney rests -- Flex in table SIMS POSITION -- Sims position is a modification of the left lateral position this is the preferred position for endoscopy performed via the anus. (not used very often in surgery more so in office procedures)

15. DRAPES/DRAPING • -- Surgical drapes are used by the surgical team to isolate • and protect the operative site from contaminants that • can cause SSI’s. • Serve as barriers to eliminate the migration of micro- • organisms from non-sterile areas to the sterile field. • EFFECTIVE DRAPE MATERIALS SHOULD BE • Lint free • Fluid resistant • Antistatic • Tear and puncture resistant • Free of toxic residue • Porous escape of body heat • Finished with a color that does not reflect OR lights • Flame retardant DRAPE MATERIALS • Non-woven fabrics (disposable, made from compressed • synthetic fibers) Nylon or polyester. • light, but strong. • Disposable drapes have reinforced layers of material • Surrounding the fenestration (opening) extremity drape.

16. WOVEN TEXTILE FABRICS- reusable drapes are • Becoming popular with hospitals: • Cheaper • Impermeable to liquids • Treated with Fluor chemical finish increases fluid repellant • Have to be laundered • Folded • Inspected for wear • Sterilized after each use PLASTIC ADHESIVE DRAPES- Made of thin, clear, Plastic material that has an adhesive backing, can be Applied with out blocking view INCISE DRAPES- Made of thin, clear, plastic material That has adhesive backing that may be impregnated With an antimicrobial iodine agent. APERTURE DRAPES- Are small, clear plastic drapes With openings that are surrounded by an adhesive backing. They are commonly used to drape eyes. DRAPE TYPES Fenestrated: openings for exposure of area incised Nonfenestrated: ¾ sheet; ½ sheet

17. Fenestrated drape example: • Lap sheet • Pediatric lap sheet • Thyroid sheet • Nonfenestrated drape example • Leggings • Under-buttocks • Abdominal drape?? • Split sheets/u-drape/tails STOCKINETTES -- Stretchable tubes to cover extremities, one end is closed, some are covered with plastic, rolled-up (shoulder surgery) (total knees, total hips)