Visit surgicaltechie.com Positioning of patient during surgery. In this presentation focused in Perineal surgery.

1. POSITIONING OF PATIENTS
IN PERINEAL SURGERY
By
RANGANATHAN D
www.Surgicaltechie.com

2. LITHOTOMY POSITION
Lithotomy Position
The patient lies supine on the operating table.
The thighs and knees are flexed and supported
on stirrups . Additional padding should
be placed under the posterior compartment
muscles
of the legs to reduce the risk of pressure
ulceration.

3. SAFETY PRECAUTIONS
The legs are secured onto the stirrups
with crepe bandaging. This position is routinely
used for cystoscopy, as it provides good exposure
of the perineum.
• Both the legs must elevated simultaneously by two
peoples .
• Rising both legs at the same time keeps the body in
the alignment and prevents twisting of lumbar spine.
• Both the arms are tucked at the sides of the body &
care must be taken to ensure that patient fingers do
not become impinged as lower table portion is flexed
or raised.

4. •When the legs are placed in the stirrups the
knee must be flexed first keeping them in the
middle position, then the thigh’s are abducted
while the knees are flexed after
anaesthesiologists gives permission.
Secure the compression area joints with cotton
pads, use the soft bandages or belts to secure
the legs.
The side edge of the both hands must be
secured and kept abducted within 90degree.

5. ❖ Nerve compression like popiteal nerve,
femoral nerve, ulnar nerve& radial nerve.
❖ Damage of achilles tendons.
❖ Post operative discomfort to the patient.
Complications

8. JACKKNIFE POSITION
It’s a modification of prone position.
■ General safety measures for Kraske
(jackknife) position:
■ (1) All general safety measures for the prone
position apply to the Kraske position.
■ (2) The hip joints should be over the middle
break of the OR table.
■ (3) The head should be turned towards the
non-affected or nonoperative side.

9. Acheivements of position
■ (4) The OR table should be moved into the Kraske
position slowly. The patient should be closely
observed to ensure the body maintains position, and
the hip joints remain over the middle break.
■ (5) The safety strap should not be placed until after
the position has been achieved. If the safety strap is
placed prior to positioning, such as during movement
of the OR table, the safety strap could cause
shearing and friction injuries. The safety strap should
be placed above the knees.
■ (6) The patient should be returned to the horizontal
prone position as soon as possible.

10. • Spine must be kept in a neutral position
during the positioning.
• A sufficient clearance must be allow deep
lung inflation.
• In female patient the breast must be
protected.
• Forcing the breast laterally during position
can cause bleeding & tearing of deep tissue
at the margins.
SAFETY PRECAUTIONS

11. COMPLICATIONS
■ Damage of subclavian & brachial plexus
causes thoracic outlet syndrome, risk of sever
injury to the cervical spine.
■ Corneal abrasion causes blindness.

14. PRONE POSITION
INDICATIONS
This position is mainly used to allow access to spine,
cranium& perineal regions.
Prone Position
The patient is placed flat, face downwards on
the operating table, with their arms at their side.The face
is supported with a head ring and the endotracheal
tube position is safely secured.
This position may be used for closure of
myelomeningocele and excision of sacrococcygeal
teratoma.

15. POSITIONING OF PATIENTS
▪ Align the stretcher with the operating table
▪ Perform the catheterization and secure it,
before positioning the patient.
▪ Before positioning inform to
anaesthesiologists, (by way they secure the
IV lines. Disconnect the patient ventillation
circuit temporarily).
▪ Head is hold by anaesthesia care provider,
two peoples are ready to receive the patient
to the OT table.
▪ One people hold the patient legs.

16. Contd.,
Keep cotton pads in eyes, elbow joints,ankles,
knees, male genital area.
Keep a chest roll at the edge of 10th intercoastal
rib.and a axillary roll.
Keep a gel pad or roll at the level of iliac
spines, leaving abdomen free.
The hand must be abducted 90degree /less
than 90 degree.

17. COMPLICATIONS
✓ Postoperative discomfort to the patient.
✓ Damage of popiteal nerve, radial& ulnar
nerve, brachial plexus.
✓ Post operative pain to the patient.
✓ Damage of cervical spine.
✓ Discomfort to the patient.
✓ Uneasy to handled by anaesthesia care
provider.
✓ Chances of airway obstruction.

18. Complication of prone position
➢Unintentional extubation
➢Eye complications: corneal abrasions,
conjunctival and periorbital
➢edema of the dependent eye, retinal
ischemia, post-operative
➢lymphatic obstruction).
➢Macroglossia.
➢Possibility of venous air embolism

19. Complication of prone position
➢visual loss due to ischemic optic neuropathy.
➢Entangling of cables.
➢ Abdominal compression (leading to impaired
ventilation, increased
➢bleeding, and decreased cardiac output).
➢Improper head and neck positioning (leading
to venous and

21. Needful for Positioning
■ Minimum 4 members without
anaesthesiologists
■ Proper and instruction must be discused by
technologists with chief surgeons and
anaesthesiologists
■ Follow each and every steps by the
technologist

22. The End