Patient positioning

Supine positioning is common for many surgical disciplines. Special attention should be given to leg positioning, ensuring that the knees and joints are not overstretched. The head and cervical spine should be relaxed. Careful arm placement can prevent nerve damage.

Used during spine surgery, the thorax must be placed on a pad with a large opening; this allows the stomach and breast to follow the breath, and reduces intra-abdominal pressure. It is important to ensure that the blood vessels in the groin are not compressed. Knees should be bent slightly and well-padded. The head should be positioned so that the cervical spine is in a neutral position. Pillows with lateral cut-outs enable easy access for anesthesia tubes.

In lateral positioning, the patient must be secured to prevent rolling. Good padding for the legs and heels is recommended to relieve stress. The patient can be positioned on the motorized joints of the table top to give optimum access to the thorax or kidney area. Best practice recommends using a pillow that offers space for the ear.

Ideal positioning for gynecology and urology surgery requires that the pelvis is positioned to prevent a hollow back (lordosis) and to provide the largest possible supporting surface of the calf in the knee crutch. The popliteal fossa and heels should be freely positioned. The foot and knee should be positioned in line with the opposite shoulder.

For gynecological or rectal surgery, patients are anesthetized in supine position, and then repositioned into a Trendelenburg position for surgery to prevent sliding. Positioning aids play an important role in this position. The thorax must be placed on a pad with a large opening to reduce intra-abdominal pressure and aid breathing. Protect the patella with a gel pad, and use additional padding at the hip.

The legs and knees should be relaxed and not overstretched. Raise the front and back stepwise, alternating between the two to reduce shear and friction forces. Once the patient has been placed into the sitting position, again assess the patient’s position to eliminate any forces that might have arisen during the positioning process.