prevention of perioperative pressure ulcers tool kit the basics of positioning patients in surgery
TRANSCRIPT
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Prevention of Perioperative Pressure Ulcers Tool Kit
The Basics of Positioning Patients in Surgery
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Funded in part by grants from Sage Products, LLC and Medtronic through the AORN Foundation.
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Objectives
1. Describe the most commonly used surgical positions.
2. State techniques for preventing injury to surgical patients.
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Goals of PositioningProviding adequate exposure
Maintaining patient dignity
Allowing for optimum ventilation
Providing adequate access
Avoiding poor perfusion
Protecting fingers, toes, genitals
Protecting muscles, nerves, bony prominences
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•General/Regional anesthesia–Physiologic changes–Reduced movement/sensation
Positioning Injuries
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Positioning Injuries
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Positioning Injuries
• Force placed on underlying tissuePressure
• Folding of underlying tissueShear
• Force of two surfaces rubbing against one another
Friction
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Positioning Injuries
Moisture Heat
Cold Negativity
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Positioning Injuries
MoistureProduces maceration
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Positioning Injuries
HeatIncreases metabolism
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Positioning Injuries
ColdReduces O2 delivery
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Positioning Injuries
NegativityIncreases pressure
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Positioning Injuries
Nerves
• Stretching or compression• Transient or permanent damage
Most common sites• Brachial plexus• Peroneal• Facial
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•Bracheal plexus–Shoulder–Arm–Hand
Positioning Injuries
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•Bracheal plexus injury–Armboards extended beyond 90°–Armboards higher or lower than
OR bed–Lateral rotation of patient’s head–Leaning against shoulder or arm–Shoulder braces
Positioning Injuries
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Positioning Injuries
•Common peroneal–Lower leg–Foot–Toes
Sciatic
Common Peroneal
Tibial
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•Common peroneal injury–Direct compression–Patients who are thin–Hyperextension of knees–Pressure behind knee–Graduated compression stockings too tight–Foot drop/Lower extremity paresthesia
Positioning Injuries
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Positioning Injuries
Pulmonary
• Hypoxia• Respiratory compromise• Decreased 02 saturation• Pulmonary edema• Congestion• Atelectasis
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Positioning Injuries
Ocular
• Corneal abrasion• Central retinal artery occlusion
Risk factors• Prone• Length of procedure• Blood loss
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Positioning InjuriesObese or underweight
Poor nutritional status
Advanced age
Preexisting conditions
History of skin breakdown/pressure ulcers
Smoking
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Positioning Process
•Collaborative process–Selection of equipment–Preoperative assessment–Positioning–Documentation–Postoperative
evaluation
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Selection of Equipment
Inspected and
maintained
Checked prior to
procedure
Competent surgical
personnel
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Selection of Equipment
•Pressure relieving surface–Disperses weight–Prevents “bottoming out”–Relieves shear and
friction
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Preoperative Assessment
• Age/Height/Weight/Body mass index (BMI)• Nutritional status• Blood pressure• Skin integrity• ROM/Physical limitations• Internal/External devices• Preexisting conditions• Medical history• Diagnostic studies• Psychological/Cultural considerations
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Selection of Position
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Supine
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Supine
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Supine
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Trendelenburg
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Reverse Trendelenburg
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Sitting/Modified-Sitting
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Lithotomy
Low
Sta
nd
ard
Hem
i
Hig
hExag
gera
ted
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Lithotomy
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Lithotomy
Common peroneal
Femoral
Obturator
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Lithotomy
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Prone
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Prone
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Jackknife
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Lateral
• Right = Left
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Lateral
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Obese Patients
Obese• BMI greater than 40
kg/m2
• More than 100 lbs overweight
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Obese Patients
Health conditions
• Type II diabetes• Hypertension• Atherosclerosis• Arthritis• Sleep apnea• Alveolar hypoventilation• Urinary stress incontinence• Gastroesophageal reflux
(GERD)
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Obese Patients
Respiratory issues
• Airway compromise• Difficult intubation• Aspiration• Hypoxia• Intra-abdominal pressure
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Obese Patients
Circulatory issues
• Increased cardiac output• Increased pressure on
pulmonary artery• Risk of inferior vena cava
compression
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Obese Patients
Skin issues• Difficult assessments• Skin breakdown• Moisture
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Obese Patients
Special equipment
• Procedure beds• Extra-wide/long safety
straps• Side attachments/Stirrups• Pressure relieving
surfaces
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Obese Patients
Position• Sitting/Modified-sitting• Lateral• Supine with wedge under
right side
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Documentation
• Preoperative assessment• Names/titles participants• Patient position• Upper extremities• Lower extremities• Equipment/Padding• Specific actions• Repositioning• Postoperative assessment
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• Nerve injury• Pressure injury• Reposition• Transfer of care
Postoperative Assessment
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1. Guideline for positioning the patient. In: Guidelines for Perioperative Practice. Denver, CO: AORN; 2015.
References
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Thank youSharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNCSenior Perioperative Practice SpecialistAssociation of periOperative Registered Nurses (AORN)Denver, CO.
for preparing the content of this educational slide deck.
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Prevention of Perioperative Pressure Ulcers Tool Kit
The End