under pressure. Intraoperative neuromonitoring will alert the team if
there is a problem in real-time so they can adjust the patient as neces-
sary.
Say your surgical team is performing a procedure that requires the
patient to have his shoulder held down or his arm tucked so the sur-
geon has access to a site. The recommended method to tuck a patient's
arm involves running a sheet over the arm and under the patient above
the mattress. The sheet can then be pulled tight — keeping his arm in
position. The patient is under anesthesia during positioning, so he can't
tell you if there is too much pressure on his shoulder or if the sheet
used to tuck his arm is pulled too tight. In a 2013 study published in
Otolayngol-Head and Neck Surgery, researchers found that attaching
an automated somatosensory evoked potential (SSEP) device to the
brachial plexus during crainial surgery alerted the team to positioning
problems by showing a decreased signal within the first hour of posi-
tioning the patient. After loos-
ening the sheet and reposi-
tioining the arm, the signal
reappeared, which showed a
loss of signal due to pressure
on the nerve.
4. Take a positioning
time out.
In the situation
described above, the surgical
F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 6 7
Somerset, N.J., developed a "perioperative pressure ulcer proto-
col," which included guidelines on how to assess patients' skin at
every phase of surgery. After its implementation, there have been
no identifiable pressure ulcers from the OR. osmag.net/5PCmzB
• POSITION BREAK Pausing a procedure to assess positioning creates
opportunities for intervention.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
