limitations."
Knees
Knee replacement patients
are typically placed in the
supine position, with arms
on armboards and the
operative knee propped or
flexed. Be sure these areas
are padded and protected
when patients are in
supine position:
• Occiput. Many anesthesia providers prefer to use a foam "donut"
to stabilize the head. However, during prolonged procedures involving
patients who have sustained low mean arterial pressures (MAPs),
these devices have caused deep tissue injuries at the back of the head.
It's better to use the foam donut during intubation before switching to
an air-filled pressure redistributing pad or fluidized positioner pillow.
• Sacrum. Sacral deep-tissue injuries occur often on patients in the
supine position because it's difficult to reposition or offload pressure
from the sacrum during surgery. To protect the sacral area, use an
atraumatic foam silicone dressing that covers the entire bony promi-
nence in conjunction with an air-filled pressure redistributing pad.
The air-filled pad distributes pressure and the foam dressing protects
the skin from shearing forces.
• Arms. Place the arms on armboards with palms facing up. Make
sure the arms are abducted at less than a 90-degree angle.
Hyperextending the arm can cause brachial plexus nerve injuries.
Secure arms to armboards and pad elbows with gel, foam or air-filled
pressure redistributing pads.
5 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
FROM
ALL
ANGLES
Placing
hip
replacement
patients
on
their
side
gives
surgeons
posterior
or
lateral
access
to
the
joint.
