Strap yourself in for our guide to Patient Positioning

by Brie Eteson, Medical Communications, Digital Surgery

Are you sitting comfortably? A guide to Patient Positioning

It’s been a while since we’ve posted about new content on the Touch Surgery™ app, and we’re relaunching these blogs with our latest simulation that demonstrates how to ensure safe and effective patient positioning is adhered to. This simulation provides the key steps for positioning in supine, prone, lateral, lithotomy, sitting, Trendelenburg, and reverse Trendelenburg. As well as the management of position-associated risks, for example, the safety of at-risk soft tissue and neurovasculature.

Delivering safe patient positioning is essential to ensure effective surgical procedures.1 All members of the OR team share responsibility for the initial placement and maintenance of the patient perioperatively.2,3

Risk Factors

To ensure appropriate understanding of patient positioning, all members of the OR team should be aware of the common risks, particularly the pressure points associated with varying positions, and specific indications for bariatric patients.

Patient Transfer

Each member of the OR team needs to be aware of their role in patient transfer to the OR table.2,3,5 This includes the challenges of transferring anesthetized and bariatric patients.

Common Patient Positions

Supine

Supine is the most commonly used position for surgical procedures. In this position, the patient is face-up with their arm tucked by their sides or extended, secured on armboards. Variations to supine position may include abducted legs, neck extension or cranial fixation.

Prone

Also known as ventral decubitus, the patient is positioned face-down with the head in neutral in a prone view headrest, turned to one side, or secured in a skull clamp device. Common variations to prone can include a slight head-up position with cranial fixation for craniotomy, or specialized frames for spinal exposure.

Lateral

The lateral position is common in cardiothoracic surgery. The patient is placed on either side depending on the surgical site. Variations to this position have use in orthopedics, urology and neurosurgery. These variations include kidney flexion, park bench and Sim’s position.

Prone position

Prone position

Lithotomy position

Lithotomy position

Lithotomy

Lithotomy is also referred to as the dorsosacral position. Standard lithotomy position is common in gynecological, rectal and urological procedures. Variations to this position refer to the angle of elevation to the patient’s legs for differing surgical requirements. These variations are low, high, exaggerated and hemilithotomy.

Sitting

Also known as beach chair or semi-Fowler’s, this position is common to shoulder, neck, and cranial surgery. Variations to the sitting position include high-Fowler’s and low Fowler’s.

Trendelenburg

‘Head down’ position is commonly used in lower abdominal and colorectal surgery to displace abdominal viscera cranially, which improves exposure. This position may also be indicated short-term intraoperatively to improve blood pressure.

Reverse Trendelenburg

‘Head up’ position is commonly used for laparoscopic upper gastro-intestinal and bariatric surgery. In this position, the patient is secured and tilted head-up and a padded footplate is attached to the OR table.

Trendelenburg

Trendelenburg

Reverse Trendelenburg

Reverse Trendelenburg

If you’re keen to learn more about patient positioning and when it’s indicated, slide on over to the Touch Surgery™ app to begin these modules.

Launch in App

References

1. Winnipeg Regional Health Authority. Patient Positioning for Surgical Procedures: Evidence Informed Practice Tools; 2019.

2. Association of Perioperative Registered Nurses (AORN). Recommended Practices for Positioning the Patient in the Perioperative Practice Setting. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN; 2008:497-520.

3. Rothrock JC. Alexander’s Care of the Patient in Surgery. 16th ed. Elsevier Health Sciences; 2018.

4. Association of Surgical Technologists (AST). AST Standards of Practice for Surgical Positioning. 2006. Available from: https://www.ast.org/AboutUs/Surgical_Technologists_Responsibilities [Accessed 20 Nov. 2019].

5. Goodman T, Spry C. Chapter 5: Positioning the Patient for Surgery. In: Essentials of Perioperative Nursing. 6th ed. Jones & Bartlett Publishers; 2017.