being up in the stir-
rups that puts pres-
sure on the lateral side
of the legs and per-
oneal nerve. Check to
see that the stirrups
are in the right place
and that the patient is
positioned at the bot-
tom of the bed.
"I make sure that the
articulating aspect of the stirrup that's attached to the bed is at the
level of the hip joint of the patient," says Taylor Brueseke, MD, of St.
Joseph Health in Orange, Calif. "So, when I move the foot up, the leg
is rotating from that same point of rotation."
When positioning patients, Dr. Brueseke thinks about the skeleton
rather than the skin. He uses the ischial tuberosity — the bony part of
the buttocks — as a guide to make sure it's supported and located at
the edge of the table so that the lower back will stay neutral and not
hyperextend, which can cause back pain after surgery. Also, keeping
the legs in an ergonomically appropriate position while in the stirrups
helps prevent injuries.
"As we move the legs, from high lithotomy to low lithotomy, we're
not damaging any nerves and we're keeping the patient in the appro-
priate physiological position," says Mini "Dr. Mini" Somasundaram,
MD, of Comprehensive Women's Care in Columbus, Ohio.
When adjusting or re-positioning one side of the patient, be sure to
check the opposite side for potential problems.
"When the patient position has been adjusted, whether this is due to
table, patient or purposeful staff movement, always check the con-
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 9
• VIEW FROM THE BOTTOM There are several important steps to take to ensure
patients are safe when in the Trendelenburg position.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
