2. AIMS AND OBJECTIVES
To provide knowledge on common surgical position of
patient in during surgery
To identify and develop awareness of potential
complication in patient positioning
To practice measure to avoid injuries and others
complication to patient during surgery
To promote safety and safeguarding patient well-being
during intra-operative period
3. ASSOCIATED RISK PATIENT FACTOR
• ADVANCED AGE
• NUTRITIONAL STATUS
• RESPIRATORY DISORDER
• CIRCULATORY DISEASE
• OBESE PATIENT
• CHRONIC IMMOBILITY
• PRESCRIBED MEDICATIONS
• UNDERLYING MEDICAL PROBLEMS
• NATURE OF SURGERY
4. GOAL OF PATIENT POSITIONING
Promote proper physiological alignment
Minimal interference with circulation
Protection of skeletal and neuromuscular structures
Optimum exposure to operative and anaesthetist site
Provide patient’s comfort and safety
Maintenance of patient’s dignity
Stability and security in position
5. OPERATIVE NURSING ROLES
Be knowledgeable on table mechanism
Prepare table attachments and accessories
Familiar with various patient position for optimum surgery
access
Placement of patient to comfortable position
Correct position placement when a table break is needed
intra-operatively
Prevent interference with respiration whilst moving.
Ensure patient is fully anaesthetized before positioning
Never reposition without anaesthetist supervision
Table fitting must be placed without obstruction to
incision site
All fitting and attachments must be secure completely
Ergonomic care whilst positioning
Applying diathermy plate
6. INTRAOPERATIVE NURSING
CONSIDERATIONS
Maintenance of unimpaired respiratory action
Maintenance of physiological alignment from pressure
Maintenance of adequate circulation avoiding
impaired venous return
Maintenance of body temperature by limiting
exposure
Avoiding metal contact
Sufficient staffs and equipments for positioning
Pressure over the patient
7. POSITION DEVICES
Patient-positioning devices can be divided into two
categories:
One which are primarily geared toward pressure-relief
Ones which are designed to provide better access to the
surgical site
10. Guidelines for Patient Positioning
Proper execution is needed during patient positioning to prevent injury for both the patient and the
nurse. Remember these principles and guidelines when positioning clients:
Explain the procedure. Explain to the client why their position is being changed and how it will be
done. Rapport with the patient will make them more likely to maintain the new position.
Encourage the client to assist as much as possible. Determine if the client can fully or partially
assist. Clients that can assist will save strain on the nurse. It will also be a form of exercise, increasing
the client’s independence and self-esteem.
Get adequate help. When planning to move or reposition the client, ask for help from other
caregivers. Positioning may not be a one-person task.
Use mechanical aids. Bed boards, slide boards, pillows, patient lifts, and slings can facilitate the ease
of changing positions.
Raise the client’s bed. Adjust or reposition the client’s bed so that the weight is at the nurse’s center of
gravity level.
Frequent position changes. Note that any correct or incorrect position can be detrimental to the
patient if maintained for a long time. Repositioning the patient every two hours helps prevent
complications like pressure ulcers and skin breakdown.
Avoid friction and shearing. When moving patients, lift rather than slide to prevent friction that can
abrade the skin making it more prone to skin breakdown.
Proper body mechanics. Observe good body mechanics for your and your patient’s safety.
Position yourself close to the client.
Avoid twisting your back, neck, and pelvis by keeping them aligned.
Flex your knees and keep your feet wide apart.
Use your arms and legs and not your back.
Tighten abdominal muscles and gluteal muscles in preparation for the move.
A person with the heaviest load coordinates the efforts of the nurse and initiates the count to 3.
11. Support Devices for Patient
Positioning
The following are the devices or apparatus that can be used to help position the
patient properly.
Bed Boards. Bed boards are plywood boards placed under the mattress’s entire
surface area and are useful for increasing back support and body alignment.
Foot Boots. Foot boots are rigid plastic or heavy foam shoes that keep the foot
flexed at the proper angle. It is recommended that they should be removed 2 to
3 times a day to assess the skin integrity and joint mobility.
Hand Rolls. Hand rolls maintain the fingers in a slightly flexed and functional
position and keep the thumb slightly adducted in opposition to the fingers.
Hand-Wrist Splints. These splints are individually molded for the client to
maintain proper alignment of the thumb in slight adduction and the wrist in
slight dorsiflexion.
Pillows. Pillows provide support, elevate body parts and splint incision areas,
and reduce postoperative pain during activity, coughing, or deep breathing.
They should be of the appropriate size for the body to be positioned.
12. Contd..
Sandbags. Sandbags are soft devices filled with substances that
can be used to shape or contour the body’s shape and provide
support. They immobilize extremities and maintain specific
body alignment.
Side Rails. Side rails are bars along the sides of the length of the
bed. They ensure client safety and are useful for increased
mobility. They also assist in rolling from side to side or sitting in
bed. Check with your agency’s policies regarding the use of side
rails as they vary from state to state.
Trochanter Rolls. These rolls prevent the external rotation of
the legs when the client is in the supine position. To form a roll,
use a cotton bath blanket or a sheet folded lengthwise to a width
extending from the greater trochanter of the femur to the lowest
border of the popliteal space.
Wedge Pillows. Are triangular pillows made of heavy foam and
are used to maintain legs in abduction following total hip
replacement surgery.
13. POSITION DURING INDUCTION OF
ANAESTHESIA
• SUPINE POSITION
• HEAD EXTENDED
• NECK FLEXED
• AIM – to visualized Oral, Pharyngeal and Tracheal
spaces
• POSSIBLE COMPLICATIONS – Trauma to lips and
teeth, Jaw dislocations, laryngeal or vocal cords
injury, epistaxis and trauma to pharyngeal wall
15. SUPINE OR DORSAL POSITION
• The patient lies flat on his back
• The arms may be placed beside the body, on an
armboard or supported across the chest by lifting
up the gown which acts as sling
• Most common Operative position, such as in
Laparotomy, certain Gynecological and
Orthopedic cases
18. PRONE POSITION
• The patient lying with abdomen on table
surface
• Arms are placed above the head
• Pillows are placed under the shoulders,
hips and feet
• Access for all surgeries involving posterior
back
(cervical spine, back, rectal area and dorsal
extremities)
21. TRENDELENBURG POSITION
Patient lying in supine position
with knees over lower
break of the table
Head tilted down to 15° or according to the
surgeon preferences
Arms may placed on the chest or armboard
Common position for laparoscopic surgeries
in pelvic or lower abdominal region
Using of shoulder or knee braces may
benefit patient from sliding
22.
23. REVERSE
TRENDELEBURG
POSITION
Patient in supine position with arms by sides or on arm
board
Table tilted to 5-10° raising the head
A sand bag may used below the neck and the shoulder
blade for extension of neck (RUSS TECHNIQUE)
The head stabilized by head ring
Position often used for head and neck surgery to
reduce venous congestion
To prevent stomach regurgitation during induction of
anaesthesia
26. LITHOTOMY
POSITION
Patient lies in supine position with buttocks at the
lower break of the table
Lithotomy stirrups placedin position level with patient
ischial spine
Arms placed over the chest or on an armboard
Legs are lifted together upwards and outwards and feet
placed in knee crutch or candy cane
Common position for Urology, Gynecology, perineal or
rectal operations
29. TYPES OF STIRRUPS AND IT’S
HAZARDS
• KNEE CRUTCH
– Pressure on peroneal nerve
resulting footdrop and
neuropathies
• CANDY CANE
– Pressure on distalsural and
plantar nerves which can
cause neuropathies of the
foot
– Hyperabduction may
exaggerated flexion and
stretch sciatic nerve
• BOOTH TYPE
– May produce support more
evenly and reduce localized
pressure
30. LATERAL & KIDNEY
POSITION
In lateral or side-lying position, the patient lies on one side of
the body with the top leg in front of the bottom leg and the hip
and knee flexed. Flexing the top hip and knee and placing this
leg in front of the body creates a wider, triangular base of
support and achieves greater stability. An increase in flexion of
the top hip and knee provides greater stability and balance. This
flexion reduces lordosis and promotes good back alignment.
Patient lying with one side facing operative side uppermost
The legs flexed to 90° and a pillow is placed in between
Upper arm rested on elevated arm rest and the other remains
flexed on the table or armboard
A roll bags may used below the hip/kidney to increased exposure
of iliac region
Position is maintained by use of sandbags or braces attached to
the side of bed
Head supported on a pillow
32. KIDNEY POSITION
n the kidney position, the patient assumes a modified lateral position
wherein the abdomen is placed over a lift in the operating table that
bends the body. The patient is turned on their contralateral side with
their back placed on the edge of the table. The contralateral kidney is
placed over the break in the table or over the kidney body elevator (if
an attachment is available). The uppermost arm is placed in a gutter
rest at no more than 90º abduction or flexion.
Access to the retroperitoneal area. The kidney position allows
access and visualization of the retroperitoneal area. A kidney rest or a
small pillow is placed under the patient at the location of the lift.
Risk for falls. The patient may fall off the table at any time until the
position is secured.
Padding and stabilization support is given. The contralateral arm
underneath the body is protected with padding. The contralateral knee
is flexed, and the uppermost leg is left straight to improve stability. A
large soft pillow is placed in between the legs. A kidney strap and tape
are placed over the hip to stabilize the patient.
35. SIM’s Position
Sims’ position or semi-prone position is when the
patient assumes a posture halfway between the lateral
and the prone positions. The lower arm is positioned
behind the client, and the upper arm is flexed at the
shoulder and the elbow. The upper leg is more acutely
flexed at both the hip and the knee than is the lower
one.
36. Contd..
Prevents aspiration of fluids. Sims’ may be used for
unconscious clients because it facilitates drainage from the
mouth and prevents aspiration of fluids.
Reduces lower body pressure. It is also used for paralyzed
clients because it reduces pressure over the sacrum and greater
trochanter of the hip.
Perineal area visualization and treatment. It is often used for
clients receiving enemas and occasionally for clients undergoing
examinations or treatments of the perineal area.
Pregnant women comfort. Pregnant women may find the Sims
position comfortable for sleeping.
Promote body alignment with pillows. Support proper body
alignment in Sims’ position by placing a pillow underneath the
patient’s head and under the upper arm to prevent internal
rotation. Place another pillow between the legs.
37. KNEE-CHEST POSITION
Patient lying into prone position
Both legs are abducted and flexed together at right
angles
Knees flexed and hip elevated
Head, shoulders and chest rest directly on the table
Arms are placed above the head
Primary position for sigmoidoscopies and
laminectomy procedure
38.
39. SEMI-FOWLER’S AND
FOWLER’S
POSITION
Fowler’s position, also known as semi-sitting position, is a bed
position wherein the head of the bed is elevated 45 to 60 degrees.
Variations of Fowler’s position include low Fowler’s (15 to 30
degrees), semi-Fowler’s (30 to 45 degrees), and high Fowler’s (nearly
vertical).
The patient positioned in supine with the upper body part is flexed to
45° or 90° and the knees slightly flexed and legs lowered
Arms may be placed over the laps or armboard
A footrest is used to prevent footdrop and head spike to stabilized head
Useful position for craniotomies, shoulder or breast reconstruction and
ENTS’
42. JACKNIFE
POSITION
A modification of prone position
Patient hips are supported on a pillow and the table are
flexed at 90° angle, raising the hips and lowering head and
body
A straps used over the thigh to prevent shearing and sliding
The head, face, shoulders, chest and feet are supported by
soft pads or rolls to prevent bony pressure
Common position for hemorrhoidectomy or pilonidal sinus
procedures.
Jackknife position, also known as Kraske, is wherein the
patient’s abdomen lies flat on the bed. The bed is scissored,
so the hip is lifted, and the legs and head are low.
