1. Is the patient a risk?
When doing a risk assessment with regards to positioning of a patient, the follow factors must considered:
- How old the patient is
- How long the surgery will take
- What the overall condition of the patient is
- Does the patient smoke
- How will be patient need to be positioned in order to access the surgical site
- What positioning devices will be required
- Does the patient have any underlying conditions that would increase his/her risk, for example diabetes, obesity, malnutrition, vascular disorders
- Has the patient had previous surgery, if so what surgery was done
- Has the patient had a joint replacement
- Is the patient pregnant
2. What are the AORN Recommendations
The AORN recommends the following practices when positioning a patient in the peri-operative setting:
- The patients positioning needs should be assessed before the patient is transferred onto the operating table
- Positioning devices should be checked to ensure that they are available, clean, and in proper working order before the patient is transferred onto the operating table
- The theatre nurse should actively be involved in the positioning of the patient by monitoring the patient’s body alignment and tissue integrity
- After positioning and before skin prep, the theatre nurse should check the patients body alignment and tissue integrity
- Patient positioning must be well documented
3. Do I need to use Protective Devices and Table Accessories
The operating table accessories help to secure the patient in the required position. The table accessories must be appropriately padded. A variety of accessories are available and this includes arm boards, lateral supports, head rests, foot boards, knee arthroscopy immobilizer, split leg positioner’s and stirrups for lithotomy positioning.
In addition to table accessories there are a variety devices that can be used to help protect the patients’ skin integrity and to maintain correct anatomical alignment. These include: gel pads, head rings, heel protectors, prone positioner’s, lateral positioner’s, chest rolls and wedges. These devices can be made out of a variety of materials. Pressure relieving support surfaces like gel pads for example have developed and become more sophisticated in recent years. The goal of these devices is to redistribute pressure over a wider area thereby reducing pressure on a particular point. Many of the latest designs dampen shear forces, and feature anatomical specific contouring. Approximately 95% of all pressure ulcers are avoidable.
4. Which operating table will I use
Operating tables are designed to provide a safe effective way of positioning a patient for surgery. The design of the table must take into account the needs of the patient and the needs of the surgeon. The theatre nurse has a responsibility to ensure that she / he is familiar with all the operating tables and accessories in her / his theatre complex. Some theatre complexes use a variety of makes and models of operating tables. Standardization on one make of theatre table would make it easier for staff training and could also have cost benefits.
In general operating tables can be tilted left or right and be raised or lowered. They can be tilted horizontally (head up or head down) and some can shift / slide to provide access for an imaging (normally a C arm).
Operating tables tend to be divided into four sections that support the major body parts (head, back, seat and leg). The head section is normally removable. There are a number of attachments available for safe patient positioning. The latest designs in general allow one table to be adapted for many different disciplines, where as previously specific tables had to be moved in and out of theatre. An operating table with battery back up and a manual override facility would be beneficial as it would ensure continuous operation even in the event of power failure or a faulty hand control.