POSITION DURING INDUCTION C ANAESTHESIA

SUPINE POSITION

HEAD EXTENDED

NECK FLEXED

AIM- to visualized Oral, Pharyngeal and Tracheal spaces

POSSIBLE COMPLICATIONS - Trauma to lips and teeth, Jaw dislocations, laryngeal or vocal cords injury,
epistaxis and trauma to pharyngeal wall

SUPINE OR DORSAL POSITION

The patient lies flat on his back

The arms may be placed beside the body, on an armboard or supported across the chest by lifting up the
gown which acts as sling

Most common Operative position, such as in Laparotomy, certain Gynecological and Orthopedic cases

NURSING PRECAUTIONS

Head not Hyperextended

To ensure that arms are not abducted < 90°

Armboard is padded

Hand in prone position

Arms do not overlap or hang over table edge

Patient protected from metal contact

Bony prominences are protected (occiput, scapulae, thoracic vertebrae, olecranaon, sacrum and coccyx,
calcaneus)

POTENTIAL COMPLICATION

Backache resulted from unsupported lumbosacral curvature

Paralysis of arm and hand due to over abduction

Radial or Ulnar nerve palsy due to arm or elbow hanging or tight strapping

Continuous pressure on the calves may caused venous stasis resulting thrombosis which can lead to
Pulmonary Embolisms

PRONE POSITION

The patient lying with abdomen on table surface

Arms are placed above the head

Pillows are placed under the shoulders, hips and feet

Access for all surgeries involving posterior back (cervical spine, back, rectal area and dorsal extremities)

NURSING PRECAUTIONS

Pillow or towel under shoulders and hip facilitate chest expansion, reduce abdominal pressure and
venous oozing at operation site

Head not hyperextended, placed on side and kept supported

Pressure point are well protected with pad (cheek, ear, acromion process, breast, genitalia, patella,
dorsum of feet, toes)

POTENTIAL COMPLICATIONS

Lower neck and upper bac pain resulting from hyperextension of head

Hypotension resulted from pressure on inferior vena cava and pooling of blood in lower limbs

Radial and ulnar nerve palsy due to arm restrainer

Shoulder dislocation during arm positioning

Brachial plexus injury due to over extension of arm < 90

TRENDELENBURG POSITION

Patient lying in supine position with knees over lower break of the table

TRENDELENBURG POSITION

Head tilted down to 15° or according to the surgeon preferences

Arms may placed on the chest or armboard

Common position for laparoscopic surgeries in pelvic or lower abdominal region

Using of shoulder or knee braces may benefit patient from sliding

NURSING PRECAUTIONS

Head not hyperextended and arm not abducted beyond 90°

Hands on padded armboards are supinated

Arms not overlap the table edge or hang over

Patient is protected from metal contact

Bony prominences are well protected (occiput, scapulae, thoracic vertebrae, olecranon, sacrum and
coccyx and calcaneus)

Returning leg first to reverse venous stasis

POTENTIAL COMPLICATIONS

A 30° Trendelenbur position may caused

changes in blood pressure, cerebral edema, congestion of face and neck

A too steep position may result in cyanosis due to alteration on diaphragmatic extension and lung
expansion

Shearing of skin may occurred during positioning

REVERSE TRENDELEBURG POSITION

REVERSE TRENDELENBURG POSITION

Patient in supine position with arms, by sides or on armboard

Table tilted to 5-10°

raising the head A sand bag may used

below the neck and the shoulder blade for extension of neck (RUSS TECHNIQUE)

The head stabilized by head ring

Position often used for head and neck surgery to reduce venous congestion

To prevent stomach regurgitation during induction of anaesthesia

NURSING PRECAUTIONS

Head not hyperextended and arm not abducted beyond 90°

Hands on padded armboards are supinated

Arms not overlap the table edge or hang over

Patient is protected from metal contact

Bony prominences are well protected (occiput, scapulae, thoracic vertebrae, olecranon, sacrum and
coccyx and calcaneus)

Anti embolic stocking may be used to prevent blood pooling

Foot bracket may used to prevent sliding

POTENTIAL COMPLICATIONS

Backache may result unsupported lumbosa curvature

Paralysis may occurred due to over abduction of arm

Ulnar and radial palsy due to elbow or arm hanging over the table or tight restraint

Pulmonary embolisms as a result of venous stasis

Cardiovascular overloaded due to quick return

Skin shearing due to sliding down

LITHOTOMY POSITION

Patient lies in supine position with buttocks at the lower break the table

Lithotomy stirrups placed in position level with patient ischial spine

Arms placed over the chest or on an armboard

Legs are lifted together upwards and outwards and feet placed in knee crutch or candy cane
Common position for Urology, Gynecology, perineal or rectal operations

NURSING PRECAUTIONS

Two person required to raised the legs simultaneously by grasping the sole and other hand supporting
the calf

Stirrups bars must be checked and secure before use and it's height must be similar and not suspend
the patient weight

The buttock must be even with the edge of bed to prevent lumbosacral strain

Anti embolic stocking may used to promote venous return Bony prominences protected

POTENTIAL COMPLICATION

Severe backache caused high stirrups

Calf holder may resulted peroneal or femoral obturator nerve damage

Osteoarthritis or stiff hips due to rough handling

Too quick of lowering the legs may cause hypotension

Femoral nerve damage due to acutely flexed thighs

Hip dislocation or fracture as a result faulty stirrups

TYPES OF STIRRUPS AND IT'S HAZARDS

KNEE CRUTCH

Pressure on peroneal nerve resulting footdrop and neuropathies

CANDY CANE

Pressure on distalsural and plantar nerves which can cause neuropathies of the foot

Hyperabduction may exaggerated flexion and stretch sciatic nerve

BOOTH ΤΥΡΕ

May produce support more evenly and reduce localized pressure

LATERAL OR KIDNEY POSITION

Patient lying with one side facing operative side uppermost

The legs flexed to 90° and a pillow is placed

in between Upper arm rested on elevated arm rest and the other remains flexed on the table or
armboard

A roll bags may used below the hip/kidney to increased exposure of iliac region
Position is maintained by use of sandbags or braces attached to the side of bed

Head supported on a pillow

NURSING PRECAUTIONS

POTENTIAL COMPLICATIONS

If table break is used, it must be correctly level with iliac crest to prevent alteration in respiration and
severe post- operative backache

Ensure ear is not trapped when supporting the head

Arms are supported with adequate padding to prevent pressure necrosis

Bony prominences are fully protected (ribs, iliac crest, greater trochanter, medial and lateral femoral
epicondyles, Tibial condyles, Malleous

Nursing complications

If the kidney rest raised to much, the lungs will not e adequately which will result in cyanosis and
hypotension

Injuries to brachial plexus, median, radial and ulnar nerves can occur if upper arm is not supported

If the head is not supported adequately, brachial plexus can get stretched

Perineal nerve damage may resulted from compression on the down knee against hard surface
NEUROSURGICAL POSITION

NEUROSURGICAL POSITION

The patient may lang in a supine position prone or lateral

The head is positioned either on soft ring or a spiked head rest

The head of the table may be tilted a little to facilitate venous drainage and to reduce CSF pressure in
the brain

NURSING PRECAUTIONS

Ensure patient is fully anaesthetized before

positioning or insertion or head spike

Eye are well covered and fully protected by pads

Position of spike must not harm patient's ears and eyes

Face is protected from pressure when in prone position

Arms are in good anatomical alignments

Bony prominences is protected whilst in all position

POTENTIAL COMPLICATIONS

Similar complica as for prone and supine positions

Development of skin pressure over the ear, cheek or face if using head ring for several hours (supine)

Sciatic nerve damage may result due to long pressure on the dorsum of the foots

FRACTURE TABLE POSITION

Patient positioned in supine with the pelvis

stabilized against well padded vertical perineal post

FRACTURE TABLE POSITION

Traction of operative leg is achieved either by boot- shaped cuff or devices with restraining straps

Un affected leg may be rested on well padded, elevated leg holder

Common position for ORIF of hip or closed femoral nailing

NURSING PRECAUTIONS
Patient usually brought into theatre with hospital bed and traction applied

Ensure patient is anaesthetized before transfer onto OT table

Operating table are and attachments are ready according to surgeon preferences or standard manual

Cautions and extra care regarding shear force injuries, musculoskeletal and nervous system during
transfer

Bony prominences protected

POTENTIAL COMPLICATIONS

Pressure due to perir post may injured gen structure

Fecal incontinence and loss of perineal sensation may occurred as a result of pressure injury to
perineal and pudendal nerve

Tight strap may resulted peroneal or femoral obturator nerve damage resulting in foot drop

KNEE-CHEST POSITION

Patient lying into prone position

Both legs are abducted and flexed together at right angles

Knees flexed and hip elevated

Head, shoulders and chest rest directly on the table

Arms are placed above the head

Primary position for sigmoidoscopies and laminectomy procedure

NURSING PRECAUTIONS

Legs moved together to prevent back strain

Arms gently lift up to prevent dislocation

Head is not hyperextended and placed to the side on a pillow

Bony prominences are well protected (cheek, ear, forehead, nose, eyes, acromion process, breast
[women], genitalia, patella, dorsum of feet, toes)

POTENTIAL COMPLICATION

Lower neck and upper ba pain due to hyperextende

........

Ulnar or radial nerve palsies as a result tight arm restrainer

Hypotension due to pressure on inferior vena cava and pooling of blood at lower extremities

Shoulder dislocation or brachial plexus injury when placing the arms

Patient may fall from table if bracket are not secure and fail to support patient's weight

SEMI-FOWLER'S AND FOWLER'S POSITION

The patient positioned in supine with the upper bod part is flexed to 45° 901 and the knees slightly
flexed and legs lowered

SEMI-FOWLER'S AND FOWLER'S POSITION

Arms may be placed over the laps or armboard

A footrest is used to prevent footdrop and head spike to stabilized head

Useful position for craniotomies, shoulder or breast reconstruction and ENTS'

NURSING PRECAUTIONS

The cervical, thoracic and lumbar section of spine must be aligned once position established

Extra padding are requires over bony prominences (coccyx, ischial tuberosities, calcaneus, elbows,
knees and scapulae)
The use of anti-embolism stocking may necessary to assist venous return

Reposition after surgery must be done gently and slowly

POTENTIAL COMPLICATIONS

Orthostatic hypotensio to blood pooling at low extremities

Risk of venous thrombosis and embolisms as a result of impended venous return

High risk of development of skin pressure over affected bony prominences

Alteration on chest movement due to restriction from rested arms or tight straps

JACKNIFE POSITION

A modification of prone position

Patient hips are supported on a pillow and the table are flexed at 90° angle,

JACKKNIFE POSITION (KRASKE'S)

raising the hips and lowering head and body A straps used over the thigh to prevent shearing and
sliding
The head, face, shoulders, chest and feet are supported by soft pads or rolls to prevent bony pressure

Common position for hemorrhoidectomy or pilonidal sinus procedures

NURSING PRECAUTIONS

Pillow or towel under shoulders and hip facilitate chest expansion and reduced abdominal pressure

Anti-embolisms stocking aid venous return

Head not hyperextended, placed on side and kept supported

Pressure point are well protected with pad (cheek, ear, acromion process, breast, genitalia, patella,
dorsum of feet, toes)

Patient turn using log-roll technique end of procedure

POTENTIAL COMPLICATIONS

Lower neck and upper ba resulting from hyperexter of head

Injury to genitalia due to pressure

Radial and ulnar nerve palsy due to arm restrainer

Hypotension resulted from pooling of blood in lower limbs Shoulder dislocation during arm
positioning

Brachial plexus injury due to over extension of arm < 90°

POSITIONING OF ELDERLY PATIE

FRAGILE SKIN SURFACES

ARTHRITIC JOINTS

LIMITED RANGE OF MOTION

• PARALYSIS

• LIFTING RATHER THAN SLIDING OR DRAGGING

AVOID OF ADHESIVE TAPE FOR STRAPPING

ADEQUATE PADDING FOR BONY PROMINENCES

ALLOW PATIENT TO POSITIONING BEFORE ANAESTHETIZED