"It sits right in the small of the neck, and as the patient is put into
steep Trendelenburg, the speed bump is against the spine — the spine
is resting on it — and the whole load of the body is kept on the spinal
column," says Dr. Brueseke. "That's essentially what happens when
we're upright and walking. That's what the skeleton is built to do, to
hold the weight of the body."
The patient is upside down, but all the weight, pressure, tension and
heaviness are on the thing that's built to hold that kind of weight.
"It's remarkably effective. It's pretty impressive how you can put
that little speed bump right there underneath the neck and you put
the patient in steep Trendelenburg and she sits right on that spot,"
says Dr. Brueseke.
You can also keep Trendelenburg patients stable and pressure-ulcer
free with a combination of speed bumps and a pad that molds and
conforms to the patient's contour to prevent unwanted patient sliding.
A strap across the chest adds extra stability.
"My rule is if the patient weighs more than 250 pounds, I use the
sticky pad and the (speed bump) device because I want the security
of knowing for sure that if one device fails, the other is going to make
up for it," says Dr. Mini. "A lot of times, especially now that we're con-
scious of cost, people will say, 'Isn't that (using both the pad and the
speed bump device) more expensive?' Well, it's more expensive if you
injure your patient."
5. Chest strap or not?
Some surgeons like to use a chest strap
to help secure the patient to the table while in Trendelenburg. But this
can create a ventilation problem for larger patients.
"Not only are you pushing their abdomen contents toward their lungs
by tilting them on their head," says Mr. Klev, "but now you're strapping
their chest to the bed and potentially creating more problems."
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