happening. The 4-inch wide metal braces clamp onto the edge of the
bed near your patient's head and secure the tops of their shoulders
from sliding off that edge, says Dr. Sinha. Thick padding between the
brace and the shoulder are intended to prevent dermal injury and
soreness after the surgery.
Protection like the braces are necessary to use during a long proce-
dure, but also when the patient has a higher BMI, says Dr. Sinha. The
weight of a larger patient can cause them to slide more easily.
However, recently, studies have suggested that the shoulder braces
are linked to higher rates of soreness and brachial plexus injuries.
Some doctors have chosen instead to opt for a "speed bump" method
in which 4 pieces of foam are affixed to a frame at the head of the
table, according to a poster on patient sliding by Jan Barber, BSN, RN,
service educator for gynecology/urology at the University of Michigan
Health System. One of the pieces fits like a roll — or a speed bump —
underneath the neck, butting up against the trapezius muscle; another
goes around the head in a half cylinder; and 2 final pieces of foam sit
in a 45-degree angle from the shoulders for stabilization.
A study using the speed bump method for stabilization in 503
laparoscopic and robotic gynecological cases with a steep
Trendelenburg position of 30 to 40-degrees produced amazing results,
the poster said. None of the patients slid, suffered skin shearing or
developed brachial plexus injuries.
• Fitted restraints. Deep Trendelenburg positions — which are
classified as 30-40 degrees — might require more in the way of sup-
port and restraint to keep your patient from shifting or sliding on the
table. In these cases, beanbag restraints can help. The restraint is a
bag that's placed under the patient, between their upper back and the
table, and it's affixed to the table with straps. It holds your patient's
upper body in a firm position throughout the course of the surgery.
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