3 2 S U P P L E M E N T T O 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 C T O B E R 2 0 1 6
vers. In examining a patient's
skin for signs of frailty, it's also
prudent to inquire about limita-
tions in mobility. "I can't empha-
size enough to my nurses how
important it is to not cut corners on positioning," says Brent Klev, MBA, BSN,
RN, nursing manager at the University of Utah Health Care's South Jordan
Health Center in South Jordan, Utah.
Sometimes positioning concerns force you to consider an alternative surgical
approach. Hyperextending the arms upright for 2 or 3 hours poses a risk of injury
to the brachial plexus — the nerve network that controls movement of the shoul-
der, arm and hand, says Marichi Capino, MD, MSN, RN, quality and safety manag-
er for the John Hopkins Home Care Group and Pediatrics at Home Support.
Because an injury can occur with either overextension or compression of these
nerves, surgical protocols have evolved accordingly. Take thyroid surgery, for
example. In transaxillary robotic thyroidectomies, there've been reports of neu-
ropraxias when the patient straightens and extends the arm that's on the same
side as the target thyroid lobe above his head. To avoid such injuries, some sur-
geons have revisited the more conventional incision through the neck, wherein
the patient lies supine with both arms at his sides, says Dr. Capino. Others have
modified the positioning for the robotic procedure so that the patient flexes his
extended arm about 90° at the elbow with the forearm resting over the forehead.
Still other facilities no longer perform the procedure.
3. Transfer with care
It pays to be extra careful when you transfer or position a patient. Pulling a
patient across a stationary surface can cause shearing or friction. "Anytime you
move somebody, always do it with the natural range of motion of the patient,"
says Mr. Klev, "so you're not overextending an arm or leg that doesn't rotate that
way naturally."
Collaboration among surgeons, nurses and anesthesiologists is vital in pre-
"I can't emphasize enough to my
nurses how important it is to not
cut corners on positioning."
Brent Klev, MBA, BSN, RN
