2 6 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 7
Your surgical team may not think they need a
refresher on pressure injury prevention, but there's
always time for a look at best practices in patient
positioning. Here's a review, based on AORN's stan-
dard (osmag.net/2AsQSf).
• Supine. Place gel or foam pads under the ankles
so the heels don't touch the bed and under the
elbows to avoid skin breakdown. Elevate and offload
the heel completely to distribute the weight of the leg
along the calf without placing pressure on the Achilles
tendon area.
• Lateral. Make sure the shoulder and hips are turned simultaneously to
prevent torsion of the spine and great vessels. Flex the lower leg at the hip;
have the upper leg straight and make sure the head is in cervical alignment.
Pad the lower leg and put a pillow lengthwise between the legs so they do not
rest on each other. Place an axillary roll under the lower arm to protect the
brachial plexus. Most importantly: Stabilize patient with at least 2 points of
restraint.
• Prone. Ensure female patients' breasts and male patients' testicles are not
compromised. Pad underneath the knees and ensure the tops of the feet aren't
touching the bed surface. Position the patient's head in a headrest that places
no external pressure on the eyes or nose. A mirror placed below the headrest
lets the surgical team monitor the patient and endotracheal tube. Use addition-
al support surfaces such as facial pads to reduce stress on pressure points on
the face and body.
• Trendelenburg. Consider the use of an underbody pad that prevents slippage
to ensure patients remain safely on the surface. Use sheets or "sleds" to keep the
BACK TO BASICS
Patient Positioning Pointers
ADDED PRESSURE Make sure table
attachments offer support without
causing skin-related harm.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
