Positioning Patients for Surgery

Positioning patients for surgery

Positioning patients for surgery Chris Servant, BSc(Hons), MB, BS, FRCS Orthopaedic Specialist Registrar Royal United Hospital Bath, UK

Shaun Purkiss, MS, FRCS(Gen) Senior Lecturer Royal London Hospital Whitechapel London, UK

With contributions from

John Hughes Senior Operating Department Assistant Royal United Hospital Bath, UK

CAMBRIDGE UNIVERSITY PRESS

CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo, Delhi Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521741453 © Greenwich Medical Media Ltd 2002 The rights of Chris Servant, Shaun Perkiss and John Hughes to be identified as editors of this work has been asserted by them in accordance with the Copyright Designs and Patents Act 1988. This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2002 Digitally reprinted by Cambridge University Press 2009 A catalogue recordfor this publication is available from the British Library ISBN 978-0-521-74145-3 paperback Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Contents Acknowledgements

Kidney

vii

30

Lateral kidney

Introduction

1 Vascular

32

Neck and thyroid

Aims of good patient positioning 2

Supine Supine (knee flexed) Supine (arm table)

Medicolegal considerations

3

Trendelenburg

General considerations Responsibility

Head and neck

Patient comfort

Neck and thyroid

37

Patient dignity

Breast

Patient safety

38

Supine (arm board)

Other considerations

6

Operating tables

Thorax

Patient transfer

Supine

Securing the patient

Lateral

39

Effect of patient position on the circulation and respiration

Orthopaedics

Protection of important structures

43

Anaesthetic access

Upper Limb

Surgical access

45

Ancillary theatre equipment Theatre staff

Shoulder

Thromboembolic prophylaxis

Beach-chair

46

Tourniquets

Supine (intramedullary nailing)

Diathermy

Lateral

Arm (humerus and elbow)

General surgery Abdomen

24

23

Prone Lateral Supine (arm table) Supine (arm over chest)

Dorsal recumbent

Forearm Perineum

25

Lithotomy

55

Supine (arm table) Supine (arm over chest)

Lloyd Davies Jack-knife

Wrist and hand

Knee-chest (lateral or prone)

Supine (arm table)

57

49

Lower limb

59

Ankle

86

Supine

Pelvis

60

Lateral

Supine

Hip

Prone

61

Foot

Supine (medial approach)

90

Supine

Supine (anterior and lateral

approaches)

Spine

93

Lateral

Thigh (femur)

Cervical spine Pine

64

Supine (with traction)

Prone

Supine (without traction)

Thoracic spine

Lateral (with traction)

98

Prone

Lateral (without traction)

Knee

95

Su

Lateral

74

Lumbar spine

Supine (anterior and lateral

100

Prone

approaches) Supine (medial approach)

Lateral

Supine (arthroscopy)

Semi-lateral Supine

Leg (tibia and fibula) Supine (with traction)

80

Appendix

105

Supine (without traction) Lateral

VI

Surgical approaches

Acknowledgements The authors would like to thank the following for their help in the preparation of this book: John Hughes, Senior Operating Department Assistant, Royal United Hospital, Bath

§• 3

• • • •

Supine position Knee flexed Hip slightly flexed and externally rotated Position is usually obtained by the surgeon after the patient has been prepared and surgically draped.

Considerations • Surgeon may stand or sit on either side of the distal operative site. • Hip and knee movements should be performed gently.

Surgical approaches Femoro-popliteal bypass

FIG. 28 Position for femoropopliteal bypass

34

Vascular

£

Supine position (arm table)

£

(Figure 29)

5-; 2.