Wednesday, June 18, 2008

Basic body positions

Different surgical positions:

There are various type of positions in which the patient may be positioned during surgery include supine, prone, trendelenburg, reverse trendelenburg, lithotomy, sitting, lateral, and Jacknife position.

supine position:

The supine position is the most common position used

The most common complication of supine position is that pressure sores which can develop on any area that bears weight, such as heels and sacrum. Moreover, any unconscious patient lying in the supine position is at risk of aspirating gastric contents. The acidic nature of the gastric contents will severely burn the lung tissue and is a life threatening hazards, which is the major cause of morbidity and mortality.

trendelenburg position:

The trendelenburg position is a variation of the supine position in which the bed is flat, but the patient's head and body are lower than the heart. The patient is held in position by padded shoulder braces to prevent the patient from sliding on the OR table. This position is very useful in surgical procedures of lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen.

The Trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for Cesarean section.

Myth: The Trendelenburg position improves circulation in cases of shock

modified trendelenburg position(shock position):

only legs elevated position,to treat hypotension

reverse trendelenburg position:

  • variation of the supine position in which the bed is flat, but the head is higher than the heart level.
  • This position is used almost exclusively for head and neck procedures and laparoscopic procedures.
  • The main complication to look for in this position is peripheral pooling of the blood in the lower extremities.

Sims or lateral recumbent position:

  • used for orthopedic, kidney, and some thoracic surgeries in which the patient is placed on the non operative site in the right or left side with an air pillow 12-15 cm thick under the loin, or a table with a kidney or back lifts .
  • it may be used for administering rectal suppositories and enemas

Potential complications include, decrease in chest expansion and circulation. Blood can pool in dependent limbs causing pressure sores at the hip and ankle. Moreover damage to the brachial plexus also may occur if the patient is not positioned correctly.

prone position:

used for dorsal approach required in spinal cord procedures such as a laminectomy in which the patient is placed face down.

Jackknife position(kraske position):

variation of the prone position, with the patient flexed at the waist.

The complications associated include airway inaccessibility; potential for facial skin breakdown; tissue damage to knees, ankle, and chest. Potential exists for corneal abrasions, decreased blood pressure, decreased chest movement and femoral artery occlusion

lithotomy position:

patient is flat on the back facing upward with the legs and thighs flexed at right angles, and the feet are carefully positioned in stirrups

  • often used for gynecological or genitourinary surgeries
  • The patient is at risk for strained lumbosacral muscles, saphenous vessel and nerve damage, and perineal nerve damage. The potential for severe hypotension also exists, therefore both legs need to be raised and lowered together.

fowler's position:

semi-sitting position.

three variations are common-

  1. low fowlers position:head & torso elevated to 30 degrees.
  2. mid-fowlers /semi-fowlers position:head & torso elevated to 45 degrees.
  3. high fowlers position:head & torso elevated to 60 to 90 degrees.

knees may not be elevated,but doing so relieves strain on spine.

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