the surgeon and the comfort of the patient,"
says Mr. Landess. "With staff advocacy, the
patient wins."
4. Skin and nerve injury
in Trendelenburg position
A 65-year-old man underwent a robotic prostatectomy. The
man was placed into lithotomy position and then tilted
back into Trendelenburg position with his arms tucked to
the side and hands insulated with foam pads. The surgery
unexpectedly lasted for 6 hours. In PACU, his head and
face were swollen. His arms had marks and blisters from
the straps securing him and from the blood pressure cuff.
He experienced long-term numbness and tingling in his
arms and hands.
While Trendelenburg is a useful position,
since it gives the surgeon better visualization
and exposure, it is "very tricky," says Ms. Van
Wicklin. The most common problem is
patient sliding, she says, which can cause
shearing or put undue pressure on extremi-
ties.
To help avoid this, positioning devices and
tables can make a big difference. Mr. Klev's
facility recently invested in a special
Trendelenburg positioner "which has stopped
all sliding issues." Look for new positioners
made of material that molds to patients' bod-
ies, helping them stay secure while reducing
pressure on pressure points. If not using a
special positioner, Ms. Van Wicklin says staff
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