positions in OT . power point presentation

all the OT nurses and technicians should know the positions of patients in OT for surgery

1. Positions in operating theater

2. Lateral Care for spine alignment Suitable restraints are required Extra care to maintain for normal thermia Surgical procedures required this positions are: Hip surgery Neuro Renal Thoracic

3. Lloyd-Davies a similar position to lithotomy same Care to the buttocks care must be taken to support the Anterior superior iliac spine and the claves Care must be taken when positioning arms Used in Genito urinary procedures Procedures where access is required to both The abdominal and perineal areas in procedures such as an anterior resection

4. Lithotomy Pt in his /her spine legs supported with Lithotomy poles The lower end of the operating table Will be removed in order to gain surgical access Anterior superior iliac spine is positioned at break of the table Care is taken to ensure the buttocks are fully supported and not over hanging the table The pt legs should be raised simultaneously with care taken to ensure that the hips and knees are not flexed more than 90 degree

5. Lithotomy The legs are positioned on the out Side of the lithotomy poles in order to Prevent nerve damage Pts arm should be placed on suitable angled arm boards or folded across the abdomen and secured Procedures require this position are: Obstetrics and gynecology Urology Rectal surgery

6. Jackknife/knee-chest Similar to prone position require a dditional Positioning aids Care must be taken to ensure that minimal pressure is exerted on the abdomen, neck pelvis or spine with the careful use of pillows Arms to be placed on suitable arm boards and head should be fully supported Ensure suitable airway access for the anesthetist Pt should be maintained in agreed position with use the use of suitable operating table restraints and accessories Position used for adernal rectal spinal surgical procedures

7. Prone Care should be taken that cervical Alignment is maintain at all times chin , eyes , forehead are all adequately protected It is important that reinforced tracheal tube is used or alternatively if a laryngeal mask air way is used that the anesthetist is competent to manage airway in this position A padded horseshoe should be used to support the head and to prevent the neck being hyper extended

8. Prone Care should be taken to ensure that There is no torsion to the breasts or male genitalia when pts are in the prone position Pt legs are padded from the knee to the feet by pillow The pt arms will need to be brought forward simultaneously and placed on arms supports with no more than 90 degree flexion Position used for : surgery on buttocks or heels , varicose vein surgery, spinal surgery

9. Supine Most pt wil l remain in the supine position for their perioperative procedure Care must taken to ensure that the spine maintains alignment and legs and ankles are parallel The head should be maintained in a neutral position and the arms may be placed on suitable angled arm boards Pregnant pts will often require a 20 degree tilt to the left in order to prevent pressure on the inferior Vena cava and associated hypotension Care should be taken to ensure that an pressure areas are protected

10. Trendelenburg Involves the pt being in a head- Down position on the operating Table and this should not be greater than 20 degree of tilt The impact of gravity in this will allow the abdominal contents to more toward the diaphragm and will also minimize blood loss at the operating site due to elevation of legs. It is important that the operating table has a non- slip mattress and that restraints are appropriately

11. Trendelenburg Position used Insertion of a central line Lower abdominal, gynecological procedures Lower limb vascular procedure This position should be avoided if at all possible for morbidly obese pts as there is increased risk of respiratory and circulatory compromise

12. Reverse Trendelenburg This position involves the pt head elevated and body lowered thus providing maximum venous drainage from the operating site Operating table must have a non- slip mattress and the pt will need to be secured. Position used for Surgery on gall bladder and biliary tract The abdominal organs are displaced downward which provides easy access to the upper abdomen This position also used for surgery on thyroid glands

13. Sitting position In sitting position the body is in upright Position The shoulders are gently supported With body straps Arms are flexed at the elbow joints and rest on large pillow , which is placed on the pts lap or on the cardiac table in front Head supported on padded head rest Position used – skull surgery craniotomy - Surgery of cerebellum.