4. The Operating table used in theatre.pptx

notes

1. Operating Table

2. INTRODUCTION Room where surgery is performed is called an Operating Room ( OR ) or Operation Theatre OR is different from other rooms in the hospital because The environment is controlled Special electrical wiring is done It is clean Different emergency equipment Inside the OR, the ambient temperature is set to between 20-21 ◦ C The humidity is regulated to 50% . These are achieved by air conditioners. Also incorporated into the inlet path of the air to the OR are HEPA (High Efficiency Particle Absorbers ) filters which minimize the dust entering into the OR

3. INTRODUCTION patient is positioned The op e rat i on table on whi c h the f or s u rge r y is fully adjustable for: Height , Degree of tilt in all directions, Orientation in the room, Articular breaks and lengths Th i s allo w s mani p ulat i on of the patient in any p o s it i on whi l e maintaining proper body allignment. The surface is covered with a firm pad that can be removed for cleaning

4. ACCESSORIES Removable arm boards : allow extension of the patients arms and hands for IV lines . This surgical arm board is wider and provides a broader surface on which to place the hand Leg holder : provide access to the knee when it must be held up away from the table surface . A special table top cassette attachment accepts X-ray cassettes when the operative procedure requires radiographs Back table : is a large table on which all instruments are placed during surgery . Before surgery, a sterile linen pack is opened on to the table and sterile supplies are placed. After donning gloves, the nurse arranges these in an orderly fashion Mayo stand : is a tray supported by 2 legs that is placed adjacent and very near to the operative site . Instruments that are used frequently are placed here where it is immediately accessible. This stand is adjustable and may be placed over(above) the table, but never in contact with the patient.

5. ACCESSORIES Gerhardth (overhead) table : is a combination of Mayo stand and backtable . The overhead table is positioned over, but not touching the patient. The large surface of table provides access to numerous instruments and supplies without the use of a back table. The sizes and contours of the table along with all the other accessories are standardized to accommodate all patients irrespective of their size. The table is also made to withstand various weights. The table is powered by electromechanical or electro-pneumatic methods. The table can be operated by a hand control placed on the side. Hand control is a membrane type, feather touch to adjust all electro-hydraulic movements . It is shock free, operating on DC 12V with a flexible cable . Most of the tables give a foot switch control enabling the surgeon to manipulate it to his comfort. The table is made up of stainless steel with smooth contours . It can be cleaned easily with spray disinfectants and blood removing agents. Since it is electrically operated, the leakage current should be tested periodically .

6. SPECIAL FEATURES Operation table is used for general surgery and other certain procedures. It provides smooth, easy and accurate positioning. It is fully maneuverable by finger tip operated feather touch keys on a remote control hand switch . Unique, sensor controlled leveling for Lateral and Trendelenberg positions. Movement is controlled by high pressure electro-hydraulic system to achieve smooth and efficient operation, without the slightest jerk from start to the end. The manifold has flow control valves for adjusting the desired speed of the table movement to high accuracy. Hydraulic motor pump with long operating life is fitted with anti-vibration mountings and auto thermal cut-off .

7. SPECIAL FEATURES Remote control hand unit operates on extra safe 12V DC. Le g ible and ea s i l y identifi a ble symbo l s on sw i tches provide correct selection of table positions at any stage of operation. Full length cassette tunnel to move X-ray cassette . Special quick change clamp to hold cassette firmly at any position. Radio translucent top. Durable & hygienic base cover made of stainless steel.

8. MANUAL ADJUSTMENTS Head section can be moved mechanically. Detachable for fixing neuro hand rest Table is mounted on castor wheels , its movement in the operation theatre is smooth Mechanical pedal brakes for firm and rigid locking of table. When brake is released, the table is free to move on its castors

9. ATTACHMENTS Shoulder support Lateral support, Universal lateral support General purpose head support Knee rest Knee crutches Raised arm board Arm board Kidney elevator Anesthetic screen frame Cassette holder, lateral cassette hold Cassette tray with adjustable rod Douche tray, Douche tray with drain bucket

10. IMPORTANCE OF PROPER POSITIONING Why do we need proper positioning? To maintain patient’s airway and avoid constriction or pressure on the chest cavity To maintain circulation To prevent nerve damage To provide adequate exposure of the operative site To provide comfort and safety to the patient

11. BASIC SURGICAL POSITIONS Variations include :  Trendelenburg  Reverse Trendelenburg  Jackknife  Fowler’s  High Lithotomy  Low Lithotomy Four basic surgical positions Supine Prone Lateral Lithotomy

12. ONE LAST NOTE… Positioning problems can result in significant injuries and successful lawsuits.

13. SUPINE Most common with the least amount of harm Placed on back with legs extended and uncrossed at the ankles Arms either on arm boards abducted <90* with palms up or tucked (not touching metal or constricted) Spinal column should be in alignment with legs parallel to the OR bed Head in line with the spine and the face is upward Hips are parallel to the spine Padding is placed under the head, arms, and heels with a pillow placed under the knees Safety belt placed 2” above the knees while not impeding circulation

14. P R ONE Anesthetized supine, usually on the stretcher, prior to turning Turning is synchronized and supported Face down, resting on the abdomen and chest Chest rolls x2 placed lengthwise under the axilla and along the sides of the chest from the clavicle to iliac crests (to raise the weight of the body off of the abdomen and thorax) One roll is placed at the iliac or pelvic level Arms lie at the sides or over head on arm boards (must lower arms slowly to the ground then bring them up in an arc to place on arm boards) Head is face down and turned to one side with accessible airway Forehead, eyes and chin are protected Padding to bilateral arms and under Knees Pillow placed under bilateral feet (for maintenance of foot extension) Female breasts and male genitalia must be free from pressure and torsion Safety strap placed 2” above knees

15. L A TERAL Anesthetized supine prior to turning Shoulder & hips turned simultaneously to prevent torsion of the spine & great vessels Lower leg is flexed at the hip; upper leg is straight Head must be in cervical alignment with the spine Breasts and genitalia to be free from torsion and pressure Axillary roll placed to the axillary area of the downside arm (to protect brachial plexus) Padding placed under lower leg, to ankle and foot of upper leg, and to lower arm (palm up) and upper arm Pillow placed lengthwise between legs and between arms (if lateral arm holder is not used) Stabilize patient with safety strap and silk tape, if needed

16. TRENDELENBURG The patient is placed in the supine position while the OR bed is modified to a head-down tilt of 35 to 45 degrees resulting in the head being lower than the pelvis Arms are in a comfortable position – either at the side or on bilateral arm boards The foot of the OR bed is lowered to a desired angle Velcro adhesive MUST be checked prior to placing the patient on the table padding Surgical tape may be indicated to assure the table padding is fixed to the table to prevent pad slippage In addition to a safety strap, strips of 3” tape may be used to assist with holding the patient in the proper position Used for procedures in the lower abdomen or pelvis Enables the abdominal viscera to be moved away from the pelvic area for better exposure

17. REVERSE TRENDELENBURG  The entire OR bed is tilted so the head is higher than the feet  Used for head and neck procedures  Facilitates exposure, aids in breathing and decreases blood supply to the area  A padded footboard is used to prevent the patient from sliding toward the foot

18. FOWLER’S POSITION  Patient begins in the supine position  Foot of the OR bed is lowered slightly, flexing the knees, while the body section is raised to 35 – 45 degrees, thereby becoming a backrest  The entire OR bed is tilted slightly with the head end downward (preventing the patient from sliding)  Feet rest against a padded footboard  Arms are crossed loosely over the abdomen and taped or placed on a pillow on the patient’s lap  A pillow is placed under the knees.  For cranial procedures, the head is supported in a head rest and/or with sterile tongs  This position can be used for shoulder or breast reconstruction procedures

19. JACKKNIFE  Modification of the prone position  The patient is placed in the prone position on the OR bed and then inverted in a V position  The hips are over the center break of the OR bed between the body and leg sections  Chest rolls are placed to raise the chest  Arms are extended on angled arm boards with the elbows flexed and the palms down  A pillow is placed under the ankles to free the feet and toes of pressure  The OR bed leg section is lowered, and the OR bed is flexed at a 90 degree angle so that the hips are elevated above the rest of the body  Used in gluteal and anorectal procedures

20. LITHOTOMY sides, or placed across the abdomen The legs and feet are placed in stirrups that support the lower extremities Stirrups should be placed at an even height The legs are raised, positioned, and lowered slowly and simultaneously, with the permission of the anesthesia care provider Adequate padding and support for the legs/feet should eliminate pressure on joints and nervus plexus With the patient in the supine position, the legs are raised and abducted to expose the perineal region The patient’s buttocks are even with the lower break in the OR bed (to prevent lumbosacral strain) The arms are placed on padded arm boards, tucked at the High Lithotomy Low Lithotomy