Positioning of Patient

 

Positioning of Patient in Surgical Operation

§ A proper and careful correct positioning of patient is very important for operation.

 Why Proper Position is important:

It is essential to:

 ·        To provide good anatomical exposure/access for surgery.

·        To maintain proper body alignment, circulatory and respiratory functions.

·        For patient safety.

·        It allows anesthesia person to monitor airway, administer anesthetic drugs and I/V fluids.

·        It protects the patient from nerve injury, protects from circulatory collapse/ shock.

 Common Positions:

1) Supine or Dorsal Recumbent position

2) Trendelenburg (Head Down position)

3) Gall bladder and liver position

4) Lithotomy position

5) Breast and axilla position

6) Neck position

7) Supine Hip position

8) Lateral position f extension

9) Prone cranial position

10) Sitting cranial position.

1) Supine or Dorsal Recumbent position

 §This is most common position, in which patient is lying flat on back.

 § Uses: it is used for many operations, including those on the Eye, Ear, face, Chest, abdomen, Legs or feet, and with modification is suitable for operations on breast and arms or hands.

 § Patient lies flat over back and with face upwards and arms at the side. Small pillows may be placed down under the head and lumbar curvature to maintain alignment and prevent muscle strain.

 § Side effects: decrease B.P and Respiratory rate risk of venous thrombosis, radial, Median and ulnar nerve damage.

 2) Trendelenburg Position (Head Down Position)

 § This is modified Supine position; in which patient is lying flat on the back with the table is tilted downward at 45 degree angle at the head.

 § The knees are flexed at the brick of the bed to prevent pressure on the perineal nerves.

 § Uses: it is used for intrapelvic and lower abdominal operations i.e. for operations on intestines, pelvic organs, for operation of varicose veins, gynecological operations.

§ Disadvantages= decrease BP, risk of Brachial plexus damage.

 3) Reverse Trendelenburg Position:

§ It is opposite of Trendelenburg position. 

§The patient lies flat on the back with table tilted upwards.

§ In this position, the bed is tilted upwards so that the patient head is higher than the feet.

Uses=It is used for procedures on head, neck, upper abdomen.

 4) Gall Bladder and Liver Position

§ This is another modified supine position.

§ It is used for operations on gall bladder and liver.

§ The patient is positioned over the back elevator which is raised to produce extension, and thereby push the gall bladder towards the anterior abdominal wall.

 

5) Lithotomy Position ( Leg- up Position)

 § The buttocks project over the edge of the table and the junction of the centre and foot section which is lowered or removes. The legs are flexed at the hips and knees, and raised with the feet supported in webbling slings suspended from the lithotomy poles.

 § A douching funnel may be fitted below the perineal area to collect the blood.

 § Uses: This is used for operations on the external genital organs, Perineum, rectal, anal, and vaginal/ gynae region.

 §Disadvantages= Risk of thrombosis, ulnar nerve damage, decrease vital capacity

 6)    Breast and Axilla Position

§ It is used for the operations on the breast and axilla.

§ It is modifies supine position, either with both arms extended and secured on arm tables, or one arm secured by the side of the patient and other on the affected side abducted and supported by nurse.

 

7) Neck Extension Position

§ This position is used for operations on the neck, especially thyroidectomy and tracheostomy.

§ The patient is placed in the supine position with a pillow or sandbag under the shoulder blades, and the head is held by a nurse or assistant with the neck well extended; a padded horse-shoe provides a good support from the head in such operations.

 8) Supine Hip Position

§ This is mainly used for nailing a femoral neck fracture but is also suitable for osteotomy, slipped femoral epiphysis etc.

§ The patient is in supine position, with his pelvis supported by a supplementary table top which is translucent to X-rays and incorporates a slot for introducing anterior position film cassettes under the pelvis.

 

9) Lateral Position of Extension (Kidney Position)

§This is used for operations on the kidneys, hips and chest but may be modified slightly for operations on hips.

§ Patient is positioned over the kidney bridge which is raised to extend this region.

 

9) Prone Cranial Position

§ This position is used for cerebellar operations and high cervical laminectomy.

 10) Sitting Cranial Position

 §This is alternative for prone cranial position. It is used for cerebellar cranial operations and high cervical laminectomy.

 

 11) Prone Position

 § It is opposite of supine position.

§ Patient is lying on the abdomen with rolls or padded frames to allow the diaphragm to move freely and permit the lungs to expand, the arms are positioned either on the patient’s side or on the padded arm board with arms extended outwards and upwards.

 § Uses: it is used for operations on the back, for spinal surgery and in general surgery for pilonidal sinus.

 

12) Genu-Pectoral Position/Knee Chest Position

§ Patient lies with chest downward on pillow while thigh and knees are flexed with buttock high up in air.

§ Uses: it is used for vaginal, cervix and rectal examinations.

§ It is used for introduction of proctoscope and sigmoisoscope.

 13) Sim’s Position

§ It is same as prone position but patient lies more prone, chest and head resting on one pillow, left arm lying behind back or hanging over edge of bed or table, both knees drawn up, more flexed than left.

§Uses: Vaginal examination 

14) Left lateral Position

§ Patient lies on left side, buttocks to edge of bed, head forward on one pillow, thigh and knees flexed.

§ Uses: it is used for Rectal, vaginal and perineal examinations, giving enema and suppositories.

 15)  Surgical position for Nephrectomy:

 § The patient is placed on his sound side with the loin overlying the bridge of the table, which is screwed up in order to increase the space costal margins and the iliac crest. To maintain the stability of this position the lower hip and knees are fully flexed and the upper leg is extended.

 § The lower arm is pulled forward so that the patient does not lie on it. The upper arm is supported on an arm rest so that the chest may not be compressed by the weight of arm.

 § Uses: - Used for operations on Kidneys.