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    Positioning Patients in Bed

    Uploaded by

    Aldo BGaman
    Thank you for the detailed presentation on patient positioning. Let me know if you need any assistance in the future.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Positioning Patients in Bed

    Uploaded by

    Aldo BGaman
    97 views27 pages
    Thank you for the detailed presentation on patient positioning. Let me know if you need any assistance in the future.

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    © © All Rights Reserved

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    PPTX, PDF, TXT or read online from Scribd

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    Thank you for the detailed presentation on patient positioning. Let me know if you need any assistance in the future.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    97 views27 pages

    Positioning Patients in Bed

    Uploaded by

    Aldo BGaman
    Thank you for the detailed presentation on patient positioning. Let me know if you need any assistance in the future.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    POSITIONING

    PATIENTS IN
    DR MARSEL
    BED
    POSITIONING A PATIENT IN BED IS IMPORTANT FOR MAINTAINING ALIGNMENT
    AND FOR PREVENTING BED SORES (PRESSURE ULCERS), FOOT DROP, AND
    CONTRACTURES (PERRY ET AL., 2014).
    PROPER POSITIONING IS ALSO VITAL FOR PROVIDING COMFORT FOR PATIENTS
    WHO ARE BEDRIDDEN OR HAVE DECREASED MOBILITY RELATED TO A MEDICAL
    CONDITION OR TREATMENT. WHEN POSITIONING A PATIENT IN BED, SUPPORTIVE
    DEVICES SUCH AS PILLOWS, ROLLS, AND BLANKETS, ALONG WITH
    REPOSITIONING, CAN AID IN PROVIDING COMFORT AND SAFETY (PERRY ET AL.,
    2014).
    POSITIONING A PATIENT IN BED IS A
    COMMON PROCEDURE IN THE
    HOSPITAL. THERE ARE VARIOUS
    POSITIONS POSSIBLE FOR PATIENTS
    IN BED, WHICH MAY BE
    DETERMINED BY THEIR
    CONDITION, PREFERENCE, OR
    TREATMENT RELATED TO AN
    ILLNESS
    Provides optimal
    Airway management and Provide physiologic
    exposure of the surgical
    ventilation (FRC) safety (BP)
    site

    Maintenance of the
    Maintain body alignment
    patient’s temperature and
    & prevent nerve, vessel & Minimise risk VTE
    dignity by controlling
    soft tissue injury
    unnecessary exposure.

    THE IMPORTANCE OF PROPER


    POSITIONING
    PATIENT TRANSFER FROM BED TO
    OPERATING TABLE
    Avoid Friction burns when moving,

    Avoid Pressure on soft tissues, vessels & nerves and ears with appropriate padding

    Avoid Contact with metal

    Avoid Leaning on patient

    Protect Eyes from extra-ocular pressure and close lids to prevent corneal abrasions

    Note Pt position relative to table “breaks”

    Consider Any physical abnormalities & avoid hyperextension of joints

    Consider Pt tolerance to position (including length of op & type of anaesthesia)


    Patient lies flat
    on back.
    Additional
    Supine
    position
    supportive
    devices may be
    added for
    comfort.
     Hips & spine aligned, legs parallel & ankles uncrossed.
     Head in a neutral position
     Arm boards at <90 degrees
     Pressure relief required for occiput, sacrum, ankles, heels & elbows

    Issues:
     Reduces ventilation by ↓ FRC
     Most common neuropathy

    SUPINE- FOR MAJORITY OF


    PROCEDURES
    SPECIFIC PROBLEM OR
    SUPINE POSITIONINGS
     Pregnant Patient
     Leg Traction

    • Counter traction provided by a perineal


    post.
    • Must be well broad & well padded & rest
    against the pubic ramus
    • It should not press against the external
    genitalia, ischium or the pudendal nerve
    Prone
    position Patient lies on stomach with head
    turned to the side.
    PRONE
     Intracranial & spinal surgery; achilles tendon
    repair

     General Issues
     Airway difficult to access
     needs to be secured without damaging face
     Recheck tube after turn
     Keep anaesthetised until turned back over
     Keep head neutral (nerve & vessel injury) Staffing needed to roll
     Variable effects on ventilation (so avoid Patient???
    abdominal compression)
     Venous access difficult (avoid antecubital fossa) CPR difficult
     Many pressure points
    Lateral Patient lies on the side of the body
    position with the top leg over the bottom leg.
    This position helps relieve pressure on
    the coccyx.
    Lateral position
    Sims Patient lies between supine and prone
    position with legs flexed in front of the
    patient. Arms should be comfortably
    placed beside the patient, not
    underneath.
    Fowler’s Patient’s head of bed is placed at a 45-
    position degree angle. Hips may or may not be
    flexed. This is a common position to
    provide patient comfort and care.
    Fowler’s position
    Semi- Patient’s head of bed is placed at a 30-
    degree angle. This position is used for
    Fowler’s
    patients who have cardiac or respiratory
    position conditions, and for patients with a
    nasogastric tube.
    Patient sits at the side of the bed
    with head resting on an over-
    Orthopneic
    bed table on top of several
    or tripod
    pillows. This position is used for
    position
    patients with breathing
    difficulties.
    Trendelenbu Place the head of the bed lower than the
    rg position feet. This position is used in situations such
    as hypotension and medical emergencies. It
    helps promote venous return to major
    organs such as the head and heart.
    TRENDELENBURG (HEAD DOWN-
    APPROX. ????O)
     Ideal for some abdominal, laparoscopic & gynaecological surgery.
     Can allow better access to organs located in the pelvis or for hernia repair.
     May be useful in hypotension 
     Issues- ↑intracranial pressure; risk of vomiting; restriction of lung
    movements due to pressure on diaphragm, facial and eye swelling
     Need a secure non-slip mattress
    REVERSE TRENDELENBURG (HEAD
    UP 15-20O)

    1 2 3
    Useful for H&N surgery In obese patients Patient must be well
    (? less bleeding) Good laryngeal exposure secured and
    normovolaemic
    + Upper GI surgery ↑pulmonary compliance
    Supine position with legs separated, flexed and supported in raised stirrups.
    LITHOTOMY Issues/Risks- esp
    with prolonged
    surgery
    > 2hrs

    Increased central
    Obstruction to
    venous return on leg
    Compartment venous drainage-
    Nerve injury elevation &
    Syndrome need DVT
    hypotension when
    prophylaxis
    put back down

    Note any
    consider resting
    Note time of suggestive signs
    legs for 10 mins
    surgery starting and Sx post
    every 2 hrs
    operatively
    LLOYD DAVIES POSITION (??HEAD DOWN LITHOTOMY
    OR LEGS APART TRENDELENBURG??)

     For pelvic and rectal surgery where access is


    required from both abdominal and perineal aspects
    ie anterior resection; laparoscopic surgery
     Key difference from lithotomy is lesser degree of
    hip & knee flexion- allows longer surgery
     Position legs first and then tilt
     The patient’s hands should be padded and tucked in
    to avoid table attachments
     Risks- as for Lithotomy & Trendelenburg
    LATERAL POSITION For thoracic, hip & shoulder surgery
     Issues
     Airway
     V/Q mismatch → hypoxia
     BP cuff ideally on upper arm
     Nerve injuries ????
     Lower ear
    SITTING/ BEACH CHAIR

     Shoulder surgery; breast reconstruction; intracranial


    surgery
     Issues
     Access to airway (secure well)
     Hypotension ( sit slowly; keep filled)
     Monitor BP (keep MAP >70mmHg) on non-
    operated arm
     Complications
     Cerebral ischaemia
     Venous air embolism
     Excessive neck flexion-quadriplegia
     Table height
     Sitting vs standing
     Lighting
     Assistants

    SURGEONS POSITION
    ANY QUESTIONS?

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