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Prevention of Perioperative Pressure Injury Tool Kit

The Basics of Positioning Patients in Surgery. Prevention of Perioperative Pressure Injury Tool Kit. Objectives. Describe the most commonly used surgical positions. State techniques for preventing injury to surgical patients. Goals of Positioning. Positioning Injuries.

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Prevention of Perioperative Pressure Injury Tool Kit

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  1. The Basics of Positioning Patients in Surgery Prevention of Perioperative Pressure Injury Tool Kit

  2. Objectives • Describe the most commonly used surgical positions. • State techniques for preventing injury to surgical patients.

  3. Goals of Positioning

  4. Positioning Injuries • General/Regional anesthesia • Physiologic changes • Reduced movement/sensation

  5. Positioning Injuries

  6. Positioning Injuries

  7. Positioning Injuries

  8. Positioning Injuries

  9. Positioning Injuries

  10. Positioning Injuries

  11. Positioning Injuries

  12. Positioning Injuries

  13. Positioning Injuries • Brachial plexus • Shoulder • Arm • Hand

  14. Positioning Injuries • Brachial plexus injury • Arm boards extended beyond 90 degrees • Arm boards higher or lower than the OR bed • Lateral rotation of the patient’s head • Leaning against the shoulder or arm • Shoulder braces

  15. Positioning Injuries • Common peroneal • Lower leg • Foot • Toes Sciatic Common Peroneal Tibial

  16. Positioning Injuries • 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

  17. Positioning Injuries

  18. Positioning Injuries

  19. Positioning Injuries

  20. Positioning Process • Collaborative process • Selection of equipment • Preoperative assessment • Positioning • Documentation • Postoperative evaluation

  21. Selection of Equipment

  22. Selection of Equipment • Pressure relieving surface • Disperses weight • Prevents “bottoming out” • Relieves shear and friction

  23. 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

  24. Selection of Position

  25. Supine

  26. Supine

  27. Supine

  28. Trendelenburg

  29. Reverse Trendelenburg

  30. Sitting/Modified-Sitting

  31. Lithotomy Low High Standard Exaggerated Hemi

  32. Lithotomy

  33. Lithotomy Common peroneal Femoral Obturator

  34. Lithotomy

  35. Prone

  36. Prone

  37. Jackknife

  38. Lateral • Right = Left

  39. Lateral

  40. Obese Patients

  41. Obese Patients

  42. Obese Patients

  43. Obese Patients

  44. Obese Patients

  45. Obese Patients

  46. Obese Patients

  47. Documentation • Preoperative assessment • Names/titles of participants • Patient position • Upper extremities • Lower extremities • Equipment/Padding • Specific actions • Repositioning • Postoperative assessment

  48. Postoperative Assessment • Nerve injury • Pressure injury • Reposition • Transfer of care

  49. References • Guideline for positioning the patient. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017.

  50. Thank you Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNC Senior Perioperative Practice Specialist Association of periOperative Registered Nurses (AORN) Denver, CO for preparing the content of this educational slide deck.

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