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SURGICAL POSITIONS AND SKIN PREPARATION

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SUPINE (DORSAL) POSITION

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It is the most natural position for the body at rest. lies flat on the back with the arms secured at the sides with the lift sheet, and the palms extend along the side of the body. padding placed under patients head and neck and under knees.

Patient

Small

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Vulnerable If

pressure points should be padded. Ex. Heels, elbows, sacrum procedure will be longer than one hour or patient is particularly vulnerable to pressure, egg crate or flotation mattress should be used. safety belt is placed across the thighs 2 inches above the knees. head is turned to one side, doughnut or special head rest should be used to

A If

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Uses:
Used

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for procedures on the anterior surface of the body, such as abdominal, abdominothoracic, and some lower extremity procedures. of the supine position are used for specific body areas:

Modifications

Procedures on the face or neck or anterolateral procedures recumbent position

Shoulder Dorsal

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TRENDELENBURGS POSITION
The

patient lies on his or her back in the supine position with the knees over the lower break of the operating bed. The knees must bend with the break of the operating bed to prevent pressure on the peroneal nerves and veins in the legs. The entire operating bed is tilted approximately 40 degrees downward at the head, depending on the surgeons preference. The foot of the operating bed is lowered to the desired angle.

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Uses:
Trendelenburg

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position is used for procedures in the lower abdomen or pelvis.

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Advantages:
tilt

the abdominal viscera away from the pelvic area for better exposure volume is decreased and the heart is mechanically compressed by the pressure of the organs against the diaphragm. ICP is increased.

Disadvantages:
lung

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REVERSE TRENDELENBURGS POSITION

The

patient lies on his or her back in the supine position. The mattress is adjusted so the surgical area is over the elevator bridge on the operating bed. If the elevator bridge is not used, the surgical area may be hyperextended by a shoulder roll. The entire operating bed is tilted 30-40 degrees so the head is higher than the feet: a padded footboard Is used to prevent the patient from sliding toward

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Uses:
Used

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for upper abdominal, head and neck, facial surgery

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Advantages:
facilitates

breathing and decrease blood supply to the surgical site (blood will pool caudually) during thyroidectomy. the abdominal viscera to fall away from the epigastrium, giving access to the upper abdomen in laparoscopic gallbladder, biliary tract, or stomach procedures. stasis can cause complications and prevention of deep vein thrombosis is an important consideration.

allows

Disadvantages:
Venous

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FOWLERS POSITION
Sitting

position - Neuro surgery

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Sitting position pressure points

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Sitting position

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Uses:
This

position may be used for shoulder, nasopharyngeal, facial, and breast reconstruction procedures.

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Advantages:
Better Less Less Less More

surgical exposure

tissue retraction & damage bleeding cranial nerve damage complete resection of lesion

Ready

access to airway, chest & extremities monitoring gives early warning of venous air-embolism

Modern

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Disadvantages:
At

risk for Venous air embolism

May

cause Hypotension (prevented by stockings) if not well supported cause brachial-plexus stretching

Arms

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Lithotomy position:
Exaggerated

variation of supine position; can be dangerous and uncomfortable to patient. is placed in supine position with buttocks near lower break in the table (sacrum area should be well padded) are placed in stirrups or knee rests attached to operating table on both sides

Patient

Feet

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Stirrup

height should not be excessively high or low, but even in both sides stirrups (knee brace) must not compress vascular structures or nerves in the popliteal space from the metal stirrups against the upper inner aspect of thigh/calf should be avoided should be raised and lowered

Padded

Pressure

Legs

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Lithotomy positioning - I

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Lithotomy positioning - II

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Final lithotomy position

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Lithotomy position with stirrups

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Lithotomy position

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Urology -- Lithotomy position

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Lithotomy position

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Various types of Lithotomy stirrups

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Nerve injuries in lithotomy

Peroneal

nerve injury nerve injury nerve injury nerve injury

Saphenous Femoral

Obturator

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Uses:
Perineal,

vaginal, rectal surgeries; combined abdominal-vaginal procedures

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Advantages:
Elevation

of legs promotes translocation of vascular volume centrally supporting weight of legs prone for nerve injury

Disadvantages:
Areas