1. COMPROMISE TO BODY SYSTEMS MUST BE PREVENTED
PATIENT POSITIONING
After administration of Anesthesia
Best possible access
Best possible visualization
Causes the least compromise in function
POSITIONING CONCEPTS
Access must be provided
--surgical site
--airway
--I V’s
--monitoring devices
COMPROMISE TO BODY SYSTEMS MUST
BE PREVENTED
--Integumentary system
--Nervous system
--respiratory system
--musculoskeletal system

2. BASIC POSITIONS SUPINE- Is the most basic position ---Flat on back
---Arms secured at sides/palms inward
---Elbows protected (eggshell crate)
---Legs straight and parallel
---Safety belt 2 inches proximal to knees
---Arm-boards no more than 90 degree angle (if used)
to prevent hyperextension of shoulder
---Heels must be protected
Body regions that may be accessed in the supine position
Anterior lower extremity, Pelvis, Abdomen, Chest/breast
Shoulder head and neck and upper extremity

3. Arm Boards
SEAT
BELT

4. TRENDELENBURG
--- Is a modification of the supine position. It is used to
displace the abdominopelvic organs cephalad
to provide better visualization.
(laparoscopic cholecystectomy)
-- Apply safety strap proximal to knees
- -Another benefit from this position, is that blood flow to
the lower body is reduced and venous drainage is pro-
moted. This position may be used to increase blood
flow to the upper body. (treatment of shock or for dis-
tention of blood vessels to be cannulated)

5. REVERSE TRENDELENBURG
-- Modification of the supine position. It is used to displace
the abdominal organs caudad to provide better visual-
ization of the surgical site. Other benefits include, blood
flow to the upper body is reduced, venous drainage is
promoted, and respiration is facilitated.
-- Apply safety strap snugly approximately 2 inches distal
to the knees.

6. FOWLER’S POSITION AND SITTING POSITION
-- Fowler’s position is a modification of the supine
position provides improved access to the surgical site
and reduces blood flow to the upper body, promotes
venous drainage, and facilitates respirations. Air
embolisms are a concern when in this position.
-- Patients arms may be secured on arm-boards or
across the abdomen.
-- Apply safety strap 2 inches proximal to the knees

7. SITTING POSITIONS
-- The sitting position is a modification of Fowler’s
position. The torso is in an upright position. The
flexed arms rest either on a lap pillow or on an
adjustable table in front of the patient.
-- A body strap should support the shoulders, pad for
sciatic nerve damage. Head will be in a cranial
head rest.

8. LITHOTOMY POSITION
--The lithotomy position is a modification of the supine
position. Variety of positioning devices.
--Candy cane stirrups
--Low lithotomy stirrups/built-in padding
--Not usually safety strap used
Body regions that may be accessed in this position are
--Perineum
--Anus/rectum
--Vagina
--Urethra

9. Table accessories for Lithotomy Position
CANDY CANE STIRRUPS

10. PRONE POSITION
-- Prior to placement into the prone position, the pt is
anesthetized on the gurney first and then moved to
the operating table.
-- Placement of catheters and all pre-operative procedures
need to be preformed before moving the pt into prone
position.
BODY REGIONS ACCESSED
--posterior lower extremities
--dorsal body surface

11. KRASKE POSITION -- Kraske is a modification of the prone position.
BODY REGIONS ACCESSED
-anus
-pilonidal area

12. LATERAL POSITION ( Right lateral)
-- The lateral position is also referred to as the recumbent
or lateral decubitus position. Rt lateral position, pt is
placed on the operating room table with the right side
down. Exposing the left side of the body. Left lateral
left side downward so right side is exposed for surgery.

13. Bean Bag for Lateral Position

14. RIGHT KIDNEY POSITION SIMS POSITION
-- The kidney position is a modification of the lateral
position. Regions accessed: Retroperitoneal space.
-- Kidney rests
-- Flex in table
SIMS POSITION
-- Sims position is a modification of the left lateral position
this is the preferred position for endoscopy performed
via the anus. (not used very often in surgery more so
in office procedures)

15. DRAPES/DRAPING DRAPE MATERIALS
-- Surgical drapes are used by the surgical team to isolate
and protect the operative site from contaminants that
can cause SSI’s.
Serve as barriers to eliminate the migration of micro-
organisms from non-sterile areas to the sterile field.
EFFECTIVE DRAPE MATERIALS SHOULD BE
Lint free
Fluid resistant
Antistatic
Tear and puncture resistant
Free of toxic residue
Porous escape of body heat
Finished with a color that does not reflect OR lights
Flame retardant
DRAPE MATERIALS
Non-woven fabrics (disposable, made from compressed
synthetic fibers) Nylon or polyester.
light, but strong.
Disposable drapes have reinforced layers of material
Surrounding the fenestration (opening) extremity drape.

16. DRAPE TYPES WOVEN TEXTILE FABRICS- reusable drapes are
Becoming popular with hospitals:
Cheaper
Impermeable to liquids
Treated with Fluor chemical finish increases fluid repellant
Have to be laundered
Folded
Inspected for wear
Sterilized after each use
PLASTIC ADHESIVE DRAPES- Made of thin, clear,
Plastic material that has an adhesive backing, can be
Applied with out blocking view
INCISE DRAPES- Made of thin, clear, plastic material
That has adhesive backing that may be impregnated
With an antimicrobial iodine agent.
APERTURE DRAPES- Are small, clear plastic drapes
With openings that are surrounded by an adhesive
backing. They are commonly used to drape eyes.
DRAPE TYPES
Fenestrated: openings for exposure of area incised
Nonfenestrated: ¾ sheet; ½ sheet

17. STOCKINETTES Fenestrated drape example: Lap sheet Pediatric lap sheet
Thyroid sheet
Nonfenestrated drape example
Leggings
Under-buttocks
Abdominal drape??
Split sheets/u-drape/tails
STOCKINETTES
-- Stretchable tubes to cover extremities, one end is
closed, some are covered with plastic, rolled-up
(shoulder surgery) (total knees, total hips)