Patient Positioning in Surgery

Patient Position on the Operating Table

• Each patient position has specific uses and potential risks.
• Following best practices and guidelines is crucial for patient safety and optimal surgical outcomes.

Supine Position

• Description: Patient lies flat on their back.
• Benefits: Easy access to the anterior body (chest, abdomen, and pelvis).
• Indications: Abdominal surgeries, cardiac surgeries, and some orthopedic procedures.
• Hazards: Pressure sores, nerve damage (e.g., brachial plexus injury), and respiratory issues.
• Avoiding Complications: Use padding to protect pressure points, ensure proper alignment, and monitor for nerve compression signs.

Prone Position

• Description: Patient lies on their stomach.
• Benefits: Access to the posterior body (spine and back of legs).
• Indications: Spinal surgeries, rectal surgeries, and certain neurosurgical procedures.
• Hazards: Respiratory compromise, pressure sores, and eye injuries.
• Avoiding Complications: Use chest rolls for breathing, protect eyes with padding, and ensure proper head and neck support.

Lateral Position

• Description: Patient lies on their side.
• Benefits: Access to the lateral aspects of the body.
• Indications: Thoracic surgeries, kidney surgeries, and hip surgeries.
• Hazards: Nerve damage (e.g., peroneal nerve), pressure sores, and respiratory issues.
• Avoiding Complications: Use padding, ensure proper alignment, and monitor for nerve compression signs.

Lithotomy Position

• Description: Patient lies on their back with legs raised and supported in stirrups.
• Benefits: Access to the perineal and pelvic areas.
• Indications: Gynecological surgeries, urological surgeries, and colorectal surgeries.
• Hazards: Nerve damage (e.g., femoral nerve), pressure sores, and circulatory issues.
• Avoiding Complications: Ensure proper leg positioning to avoid nerve compression, use padding, and monitor circulation.

Trendelenburg Position

• Description: Patient lies on their back with the body tilted so the head is lower than the feet.
• Benefits: Improves venous return and provides better access to the lower abdomen.
• Indications: Lower abdominal surgeries and certain gynecological procedures.
• Hazards: Respiratory compromise, increased intracranial pressure, and pressure sores.
• Avoiding Complications: Limit the duration of the position, monitor respiratory status, and use padding.

Reverse Trendelenburg Position

• Description: Patient lies on their back with the body tilted so the head is higher than the feet.
• Benefits: Reduces blood flow to the upper body and provides better access to the upper abdomen.
• Indications: Upper abdominal surgeries and certain head and neck procedures.
• Hazards: Hypotension, pressure sores, and venous pooling in the legs.
• Avoiding Complications: Monitor blood pressure, use anti-embolism stockings, and ensure proper padding.

Sitting Position

• Description: Patient sits upright or semi-upright.
• Benefits: Access to the posterior and superior aspects of the body.
• Indications: Neurosurgical procedures, shoulder surgeries, and certain ENT procedures.
• Hazards: Air embolism, hypotension, and pressure sores.
• Avoiding Complications: Monitor for air embolism, ensure proper support and padding, and monitor blood pressure.

Jackknife Position

• Description: Patient prone (face down), with hips elevated and legs/head lowered.
• Indications: Rectal surgeries, perineal procedures, certain spinal surgeries.
• Hazards: Respiratory compromise, cardiovascular issues, nerve injuries, and pressure injuries.
• Avoiding Complications: Ensure proper padding, monitor respiratory and cardiovascular status, use arm boards, and employ sequential compression devices.

Kidney Position

• Description: Patient in lateral decubitus position (lying on their side) with the operating side up, elevated flank.
• Indications: Kidney surgeries, retroperitoneal procedures.
• Hazards: Respiratory compromise, cardiovascular issues, nerve injuries, pressure injuries, and compartment syndrome.
• Avoiding Complications: Ensure proper padding, monitor respiratory & cardiovascular status, maintain proper alignment, and employ sequential compression devices.

Benefits of Gel Positioning Pads

• Pressure Distribution: Even pressure distribution to reduce the risk of pressure sores.
• Comfort: Soft, cushioning surfaces for enhanced patient comfort.
• Stability: Help maintain proper positioning and prevent unwanted movement.
• Durability: Reusable and easy to clean.
• Crucial: In ensuring patient safety and comfort during surgical procedures.

Common Types of Gel Positioning Pads

• Gel Wedges: Triangular-shaped pads for limb elevation & support.
• Gel Donuts: Circular pads with a hole for bony prominences (heels, elbows, head).
• Gel Flat Pads: Rectangular pads for protecting various body parts from pressure sores.
• Gel Chest Rolls: Cylindrical pads for chest support.
• Gel Heel Pads: Small, contoured pads for heel protection.
• Gel Sacral Pads: Contoured pads for the sacral area (lower back).
• Gel Arm Cradles: Contoured pads to support the arms.
• Gel Headrests: Contoured pads to support the head.