7 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 A U G U S T 2 0 1 7
Positioning pointers
Proper patient positioning is critical during
every procedure, from routine knee scopes to
complex joint replacements, says Dr. Tucker.
"During a 30-minute surgery, patients are lying
motionless during prepping and draping, the pre-
op time out and during anesthesia induction and
emergence," he points out. "They're really posi-
tioned for longer than you think."
Here are a few positioning pointers for common orthopedic cases.
• Knees. With the patient in the supine position, use a gel donut pad to make
sure the head and neck are neutral. "I've had patients wake up after a lengthy
surgery complaining of pain on the back of their head, where a pressure sore has
started to form," says Dr. Tucker.
Place the patient's arms at his side at less than 90 degrees of abduction to
limit tension on the rotator cuff. The palms and elbows should be facing up
toward the ceiling to take pressure off the ulnar nerve. "You know that tingling
sensation in your hand when you get hit square on the funny bone?" asks Dr.
Tucker. "That's your ulnar nerve. Even if it's sitting on a soft cushion for extend-
ed periods, patients can wake up with a numb hand."
The pressure on the peroneal nerve is minimal when the patient is in the
supine position. Sequential compression sleeves placed on the lower legs to pre-
vent DVT also help relieve pressure in this area. As sleeves fill with air and con-
strict around the calves to help keep blood flowing, they lift the legs slightly off
the surgical table. Make sure the sleeves are placed equidistant from the ankle
and knee, so they're not pressing on any bony prominences. If a sleeve is placed
too high on the leg, for example, it could put pressure on the popliteal space.
Also, place the foot in a candy cane leg holder to allow access for prepping and
draping the entire leg.
Proper patient
positioning is critical
during every
procedure, from
routine knee scopes
to complex joint
replacements.
— Bradford Tucker, MD
