Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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roll section of foam (resembling a speed bump) fits in the contour of the patient's neck, bumping up against the trapezius muscle. 2. Protect patients' hands. Be careful how you tuck the arms of patients in Trendelenburg (see "Tuck the Draw Sheet to Safely Secure Arms" on page 10). You can easily injure your patient's hands and arms — and an anesthetized patient can't tell you his hand's being crushed or his wrist is being bent backwards. If you put the arms on arm boards and the patient slides, that can put a lot of pressure on the brachial plexus and lead to neuromuscular injuries. Use arm boards at less than 90 degrees when possible to avoid hand and arm injuries. When you tuck the arms, pad the hands and wrist and be sure to note the position of the hands under the drapes when you move the stirrups. If a patient is tilted to the right or left or starts to slide, his hands can become wedged between his outer thigh and the stirrup post, causing a crush injury. If sliding occurs in stirrups, be sure to alle- viate pressure on the peroneal nerve. 6 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J a n u a r y 2 0 1 7 a patient in Trendelenburg can inspire creative and curious posi- tioning ploys at the Or table. There's so-called gift wrapping, when you cover patients in layers of eggcrate foam and yards of tape. Some Ors use ace bandages to tie the patient's feet and lower leg into the stirrup boot. Others use belts, straps, bean bags and gel pads to secure patients — alone or in combination. Some say these efforts are only slightly better than the original method of keeping the patient in a tilted position: an assistant standing at the foot of the operating table with the patient's legs draped over his shoulders. — Brent Klev, MBA, BSN, RN TERRIBLE TILTS No Need to Go MacGyver