O C T O B E R 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 3 5
A patient in Trendelenburg can roll off the table during prepping, she cautions.
Designate an employee to monitor who removes and replaces the straps, espe-
cially during repositioning.
5. Use pads wisely
Proper padding is essential, too, says Dr. Capino. For example, in cervical sur-
geries (both supine and prone), place pads between the elbow pit and wrist,
making sure not to compress them or hyperextend them during positioning, she
says. An obese patient placed in a prone position requires more padding on his
belly, chest and knees (which must be slightly flexed). In long surgeries requir-
ing the lumbar position, a pressure ulcer may develop if you neglect to pad a
woman's breasts or a man's pelvis.
Nurse managers may differ in their preferences for memory foam or gel foam
content in mattresses on OR tables. Whichever product you choose, it's impor-
tant to follow the manufacturer's recommendations. For surgeries lasting more
than 3 hours, Mr. Bowers's staff uses memory foam mattresses. He's working
toward outfitting all the OR beds with these costly mattresses. "It's what should
be done for all patients," he says, "so we're trying to get there."
No matter which OR bed is in use, preventive dressings on pressure points
provide some cushioning. "You want to make sure you're protecting those
areas," says Mr. Bowers. For a patient in the supine position, the dressings
should be placed on the buttocks, heels, elbows, and the back of the head.
Gel cushioning has advantages over foam, says Mary Grace Hensell, RN, BSN,
MSN, CNOR, director of surgical services at Allegheny General Hospital in
Pittsburgh, Pa. She has found that gel offers higher density than foam for better
patient positioning and skin protection in most cases.
Ms. Hensell also has seen personnel roll up a blanket or a sheet as a means of
hyperextending a patient's leg or neck, allowing optimal visualization of the sur-
gical site. She cautions against using any product for a purpose other than the
