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the 'T' to prevent pressure on the eyes. Additionally, Mr. Klev notes you should limit the use of foam eye protector "goggles," which can shift during surgery in the prone posi- tion and place pressure on eyes. Your best bet, says Mr. Klev, is a headrest that uses a mirror attachment, so your anesthesia provider can conduct and record eye checks every 15 to 20 minutes. 3. Brachial plexus injury After undergoing an open-heart procedure that lasted 5 hours, a man woke up to find his right hand and arm numb. Nurses documented that his right arm was bruised and swollen, and he was eventually diagnosed with a brachial plexus injury. While the hos- pital argued in court the injuries were caused internally during the procedure, experts believed the injuries occurred from improper or inadequate padding, or someone lean- ing against the patient's arm during surgery. Brachial plexus injuries are some of the most common injuries asso- ciated with patient positioning, says Mr. Landess. The injury is com- mon in nearly all positions, he says, but is especially "notorious" in supine and prone position. It's often caused by a stretching of the brachial plexus, a network of nerves that runs from the spine to the shoulders, arms and hands. One of the best ways to prevent the injury is to avoid stretching the arms in order to place them on arm boards flexed beyond 90 degrees away from the body, says Ms. Van Wicklin. She also says that during positioning, staff should avoid extreme rotation of the head and should ensure that all pressure points are properly padded, especially around the head, shoulders and elbows, to avoid a nerve injury. Additionally, as may have been the case above, a staff member lean- ing on a patient can cause injury. That's more common than you think, says Mr. Landess, and can be easily prevented. Encourage OR staff to remain alert and speak up if they see something that's putting undue pressure on the patient. "Often it is a battle between the comfort of 1 1 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 O N L I N E | A P R I L 2 0 1 5