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INTRODUCTION

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Positioning a patient for surgery is much more intricate than you might think (Figures 14.14,14.15,14.16,14.17). The following series of steps must occur.

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STEP 1: TRANSFERRING THE PATIENT TO THE OR TABLE

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In order to transfer the patient from their bed to the OR table, both beds are pushed together and locked in place. The surgical team works together to safely transfer the patient, usually with a basic roller board. The surgeon and/or resident and the circulator verify the safety of the patient. The patient is NEVER left unattended through this process, particularly once anesthesia has been induced.

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STEP 2: PLACING SEQUENTIAL COMPRESSION DEVICES (SCDS) TO THE PATIENT’S LEGS

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These leg-warmer-like wraps are wound around the patient’s legs, secured, and connected to a machine that creates a squeezing action on each leg. The squeezing action of the SCDs assists with blood flow and prevents blood clots. This is a priority action for patient safety and they must be on prior to anesthesia induction.

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STEP 3: POSITIONING OF THE ASLEEP PATIENT

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Many basic positions exist for patient positioning for operative cases. Some of the most common are supine, prone, low lithotomy, and lateral decubitus. Correct positioning of the patient is one of the basic essential functions of every case. It can be done well when the OR team works together to ensure the safety of the patient. The patient is positioned in the most anatomically appropriate position for the surgery, safety straps are applied, pressure points are padded, and genitals are checked. Padding and positioning can be enhanced by the use of gel pads, pillows, foam pads, blanket rolls … there are numerous options. Anesthesia verifies that the head and neck are in correct alignment and that there are no pressure points on the face or neck. The patient’s ultimate position depends on what needs to be done, but access to the surgical site and comfort/safety of the patient are paramount. Because the patient is unable to move during surgery, it is critical that we check for potential circulatory, musculoskeletal, and neurological injuries that could occur. The ultimate goal is to have no postoperative injuries or complications due to positioning.

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STEP 4: MOVING THE FURNITURE AROUND

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During surgery the OR table height is often changed. When the height of the table goes up, the mayo stand needs to go up so it doesn’t place pressure on the patient’s feet. Anesthesia communicates this to the team and the scrub tech will adjust the mayo. They might ask you to move your arms so they can move the tray. Please remember that while you may rest your hands on the patient if you are scrubbed, you must be mindful of leaning on the patient—particularly if they are a very small ...

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