air-filled pad distributes pressure and the foam dressing protects the
skin against shear forces.
• Knees and hips. Position the table so the hips are angled to 60
degrees and the knees are angled to 30 degrees. Use pillows to
support under the knees.
• Heels. Place gel, foam or air-filled or fluidized pressure redistribut-
ing pads under the feet to lift the heels off the table surface.
When positioning patients laterally with a bean bag positioner, make
sure the device is clean, in good working order and free from leaks,
suggests Ms. DiNobile. She recommends having a designated team
member check for excessive pressure on male genitals and female
breasts at regular intervals during surgery. Additionally, says Ms.
DiNobile, make sure a staff member is assigned to hold the patient's
head while securing the positioning aid.
Post-op precautions
Recheck patients' skin in recovery, looking for redness or signs of
neurological injuries, and educate patients on how to self-assess for
pressure-related complications when they return home, says Ms.
Prevatt.
Improving your patient positioning protocols should start outside of
the OR, with your facility developing and implementing guidelines
with input from your surgical team and PACU nurses, says Ms.
DiNobile. "Don't wait for a poor outcome," she adds. "For the continu-
ing safety of your patients, all surgical team members must be
instructed on patient positioning risks and follow best practice on
every patient, every day."
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