1. THE PATIENT IN THE O.R. SHOULD IN THE O.R. SHOULDNEVER BE LEFT ALONE!!!

2. THE OPERATING TABLE

3. flexible in three sections to permit variations on the supine position

4. THE OPERATING TABLE "break the table" refers to bending the table in the middle section

5. THE OPERATING TABLE the table may be tilted up or down

6. THE OPERATING TABLE the table may be tilted side-to-side

7. THE OPERATING TABLE the table may be raised or lowered

8. THE OPERATING TABLE the headboard section may be removed or folded down out of the way

9. THE OPERATING TABLE the foot board section may be folded down out of the way

10. THE OPERATING TABLE the table must be locked while transferring patients or when the table is not being moved

11. GUIDELINES FOR POSITIONING AN ANESTHETIZED PATIENT

12. GUIDELINES Always ask the anesthetist/ anesthesiologist permission to move the patient

13. GUIDELINES Respect the patient's dignity by avoiding unnecessary exposure

14. GUIDELINES Assemble the necessary accessories and positioning aides before anesthesia induction

15. GUIDELINES Provide enough help for safe patient moving

16. GUIDELINES Teamwork - move on the count of "three”

17. GUIDELINES Align the neck and spine at all times

18. GUIDELINES Move slowly and deliberately

19. GUIDELINES Be gentle when manipulating joints

20. GUIDELINES Do not abduct arms at greater than a 90 degree angle

21. GUIDELINES Protect arms and fingers by using a lift sheet for transfers

22. GUIDELINES Protect IV lines, catheters, and airways from tension

23. GUIDELINES Tape all IV lines, catheters, and pt's eyes closed

24. GUIDELINES Use good body mechanics to prevent self injury

25. GUIDELINES Use good body mechanics bend your knees bend your knees use large muscle groups use large muscle groups keep back straight keep back straight

26. GUIDELINES Pad all bony prominences and delicate areas with toweling, sheets, or foam to prevent nerve and skin damage

27. GUIDELINES Prevent nerve damage brachial nerve -  head and arm extension ulna nerve -  pressure on the arm/elbow due to inadequate padding

28. GUIDELINES prevent nerve damage femoral nerve -  excessive pressure from abdominal or inguinal retractors peroneal nerve -  use of stirrups can create pressure on the back of the leg

29. EQUIPMENT

30. EQUIPMENT safety strap –thigh - 2" above the knee –arms - prevent sliding off the armboards

31. EQUIPMENT footboard –to avoid foot drop –prevent patient from sliding off the bed in reverse Trendelenburg –reduce pressure on the heel and back of ankle

32. EQUIPMENT footboard –bed extension for tall patients

33. EQUIPMENT footboard –table for lithotomy position work

34. EQUIPMENT armboards –positioning arms laterally –avoid hyperextension of the arm

35. EQUIPMENT Stirrups - application concepts –equal height and distance on both sides –patients legs lifted together, slowly and placed in stirrups together to prevent back strain –padded well to prevent nerve damage

36. EQUIPMENT stirrups –types knee crutch

37. EQUIPMENT stirrups –types string or candy cane

38. EQUIPMENT stirrups –types leg/ankle support//boots

39. EQUIPMENT pillows towel/blanket rolls sand bag

40. EQUIPMENT kidney rests and bar

41. EQUIPMENT anesthesia screen –applied after the pt is anesthetized –used to lift and hold drapes off patient's face - access for anesthesia

42. EQUIPMENT head extension/foot board

43. EQUIPMENT thyroid bar/shoulder bridge

44. EQUIPMENT shoulder braces

45. EQUIPMENT positioning systems –pneumatic beanbags

46. EQUIPMENT positioning systems –McGuire Pelvic Positioner

47. CRITERIA FOR POSITIONING

48. no interference with respiration no interference with circulation

49. CRITERIA FOR POSITIONING no pressure on any nerves minimal skin pressure

50. CRITERIA FOR POSITIONING accessibility of operative site accessibility of anesthetic administration

51. CRITERIA FOR POSITIONING no undue post-operative discomfort

52. CRITERIA FOR POSITIONING meets individual patient requirements –obesity –pregnancy –cardiac compromise –respiratory compromise

53. POSITIONS

54. POSITIONS  SUPINE  LATERAL  PRONE

55. POSITIONS  SUPINE –DORSAL RECUMBENT –TRENDELENBURG/ REVERSE TRENDELENBURG –SEMI-FOWLER’S/FOWLER’S –LITHOTOMY

56. POSITIONS supine/dorsal recumbent –most common position –head/neck kept in proper alignment with rest of the body

57. POSITIONS supine/dorsal recumbent –arms at sides under lift sheet or on armboards prevents respiratory embarrassment –pillow under knees prevents hyperextension

58. POSITIONS supine/dorsal recumbent –safety strap above knees snug –feet fully on table, not over edge –ankle support used to decrease heel pressure

59. POSITIONS supine/Trendelenberg –same as supine with head down –table broken at the knees to 30 degrees –used to: visualize pelvic organs increase venous return from the lower extremities

60. POSITIONS supine/Reverse Trendelenberg –same as supine with feet down, head up –use footboard and blanket padding –used for upper abdominal surgery

61. POSITIONS supine/semi-Fowler’s//Fowler’s –a modification of the supine position –back section of the table elevated –base of table in Trendelenberg

62. POSITIONS supine/semi-Fowler’s//Fowler’s –knees flexed –arms on pillow on lap or at sides –footboard with padding for full Fowler's –used for procedures of: head and neck shoulderNeurosurgical

63. POSITIONS supine/lithotomy –a modification of the supine position –patient's buttocks at the edge of the foot section to prevent lumbosacral (lower back) strain

64. POSITIONS supine/lithotomy –stirrups hold each leg should be at equal heights and well padded check for neurovascular compromise secure with safety straps

65. POSITIONS supine/lithotomy –lift legs together by the ankle and thigh, rotate slowly outward, lift slowly –lower legs slowly after procedure, especially with long procedures, to prevent hypotension

66. POSITIONS supine/lithotomy –arms at sides or armboards WATCH FINGERS/HANDS WHEN RAISING/LOWERING THE FOOTSECTION!!! DANGER FROM HAND/FINGER INJURY IS VERY HIGH!! –patient should be positioned preoperatively (if possible) for safety and comfort

67. POSITIONS supine/lithotomy –keep patient covered and offer verbal and physical support –used for vaginal and rectal procedures

68. POSITIONS  LATERAL/SIMMS

69. POSITIONS lateral/Simms –state which side down for orientation –patient on side with flank area over the middle break in the table arms are supported at a 90 degree angle double armboard pillows/blankets sling armboard padded Mayo stand

70. POSITIONS lateral/Simms –top leg may be straight –lower leg bent 30 degrees at knee 15 degrees at hip pillow padding between legs

71. POSITIONS lateral/Simms –secured in place tape and padding positioning device –kidney rests –pneumatic bean bag

72. POSITIONS lateral/Simms –safety strap over thigh area –axillary roll for lower arm

73. POSITIONS lateral/Simms –kidney rests with kidney bar elevated will increase the space between the chest and iliac crest NOTE: lower the kidney bar and unflex the table when closing to facilitate tissue approximation

74. POSITIONS lateral/Simms –used for kidney and chest surgery –Colonoscopy in less formal position

75. POSITIONS  PRONE –PRONE –JACKKNIFE –KNEE-CHEST

76. POSITIONS Prone –face down –head turned to the side and supported by pillows, towels, headrest –chest is elevated with blanket rolls along the sides permits adequate respiration

77. POSITIONS Prone –axillary rolls used to pad the vascular/nerve complex of the shoulder area –pillow under ankles to elevate feet and prevent pressure to the toes safety strap above the level of the knees

78. POSITIONS Prone –arms at sides rotated onto armboards –check and pad: female breasts male genitalia –used for back surgery

79. POSITIONS Kraske (Jackknife) –same as prone with the table “broken” –sometimes the foot section is slightly elevated –pillow under hips for padding

80. POSITIONS Kraske (Jackknife) –pillow under ankles for padding –check and protect male genitalia

81. POSITIONS Kraske (Jackknife) –used for: pilonidal surgery hemorrhoidectomy anal surgery

82. POSITIONS Knee-Chest –patient kneels in fetal position –patient kneels on footboard with table bent in middle section –used for Culdoscopy or Proctoscopy

83. SURGICAL POSITIONING