should check
that straps or
tape used to
secure the
patient, as
well as BP
cuffs, are
tight enough
to do their
job without
cutting into
the patient's
skin. "It's a fine balance," she says. Additionally, shoulder braces
should not be used to secure patients, since they can cause brachial
plexus injuries.
Mr. Landess notes that there are other complications with
Trendelenburg besides sliding. Cardiovascular and pulmonary prob-
lems are common with the position, as well as perioperative vision
loss. To help prevent these complications, consider regularly "flat-
tening" the patient, or slowly elevating his head. This should be done
as frequently as the surgeon and procedure allow, says Mr. Landess.
5. Beach chair position complications
A North Carolina man underwent a right shoulder arthroscopy and right open rotator cuff
repair and was placed in the beach chair position. After surgery, he woke up and reported
pain in his left arm, elbow and fingers believed to be from improper positioning and
inadequate padding of the non-operative arm. He was eventually diagnosed with ulnar
nerve neuropathy, which left him with permanent daily pain.
Positioning non-operative extremities is as important as the opera-
tive ones, says Mr. Klev. To prevent nerve injury, it's important that
the patient's arms are secured in a neutral position, he says, and that
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A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T
z HEADREST Use tape to position the head firmly against the gel pad in the headrest.
Pamela
Bevelhymer,
RN,
BSN
