Risks to a patient in Lateral position include pressure to points on the dependent side of the body such as ears, shoulders, ribs, hips, knees and ankles, as well as brachial plexus injury, venous pooling, diminished lung capacity and DVT.
A pressure-reducing OR mattress or tabletop pad should be used as needed. Trendelenburg position is typically used for lower abdominal, colorectal, gynecology, and genitourinary surgeries, cardioversion, and central venous catheter placement. In this type of position, the patient's arms should be tucked at their sides, and the patient must be secured to avoid sliding on the surgical table.
The Trendelenburg position should be avoided for extremely obese patients. Risks to a patient while in this position include diminished lung capacity, diminished tidal volume and pulmonary compliance, venous pooling toward the patient's head, and sliding and shearing.
Reverse Trendelenburg position is typically used for laparoscopic, gallbladder, stomach, prostrate, gynecology, bariatric and head and neck surgeries.
Risks to a patient in this type of position include deep vein thrombosis, sliding and shearing, perineal nerve, and tibial nerve. Padded foot boards should be used to prevent the patient from sliding on the surgical table and reduce the potential for injury to the peroneal and tibial nerves from foot or ankle flexion. Explore our Surgical Tables. The different positioning of patients to be used also depends on the type of procedure, with the purpose to both provide optimal exposure and access to the surgical site and maintain patient comfort, among several other reasons.
The most common position used for cardiovascular procedures is the supine position. This type of position allows the best possible surgical access to the chest cavity. For coronary artery bypass grafting CABG , the anterior thorax is exposed with the patient in a supine position. A roll is placed in the interscapular region to improve access to the sternum by extending the neck and elevating the sternal notch. Fem-pop is used to bypass narrowed or blocked arteries above or below the knee.
The bypass restores blood flow to the leg. Typically, surgical table accessories such as the FEM POP Board will attach to the surgical table to increase lower body, intraoperative, fluoroscopic imaging coverage during the procedure. Variations of the lithotomy position are most commonly used in cystoscopy, urology or gynecology procedures.
Surgical table accessories such as stirrups, split-leg positioners and well leg-holders are commonly used to support patient legs during procedures. A variation of lateral position with kidney elevation flexion is most commonly used for kidney and thoracic procedures.
Lateral positioners , arm boards, headrests and restraint straps are used to safely position the patient for this procedure. A variety of positions may be used for orthopedic procedures depending on the specific type of procedure. Common positions include supine with additional attachments for traction of lower extremities.
Such procedures include hip arthroscopies and anterior hip replacements. Other common orthopedic procedures utilize Fowler's position beach chair for shoulder arthroscopy procedures. Fowler's position is commonly used for shoulder arthroscopy procedures. Surgical tables may be articulated to place patients in a seated position or shoulder chair beach chair accessories may be used as an alternative. The patient is placed supine on the operating table and general endotracheal anesthesia is induced.
The endotracheal tube should be taped to the contralateral side of the mouth to assure easy airway access during the procedure if needed. The patient is moved into the upright beach chair position in conjunction with the anesthesia staff to ensure that the patient does not become hypotensive during this positioning maneuver. Explore our Surgical Table Accessories. Safe Positioning for Neurosurgical Patients.
AORN Journal, 87 6 , Alexander's care of the patient in surgery 14th ed. Louis, MO: Mosby. Infection Prevention. Make sure an additional health care provider is available to help with the move. Explain to the patient what will happen and how the patient can help.
Doing this provides the patient with an opportunity to ask questions and help with the positioning. Raise bed to safe working height and ensure that brakes are applied. Health care providers stand on each side of the bed. Lay patient supine; place pillow at the head of the bed and against the headboard.
Stand between shoulders and hips of patient, feet shoulder width apart. Weight will be shifted from back foot to front foot. Ask patient to tilt head toward chest, fold arms across chest, and bend knees to assist with the movement. Let the patient know when the move will happen. Tighten your gluteal and abdominal muscles, bend your knees, and keep back straight and neutral. On the count of three by the lead person, gently slide not lift the patient up the bed, shifting your weight from the back foot to the front, keeping back straight with knees slightly bent.
Replace pillow under head, position patient in bed, and cover with sheets. Lower bed, raise side rails as required, and ensure call bell is within reach.
Perform hand hygiene. Hand hygiene reduces the spread of microorganisms. Data source: Perry et al. Prior to ambulating, repositioning, or transferring a patient from one surface to another e.
Checklist 26 describes how to safely move a patient to the side of the bed. Make sure you have as many additional health care providers as needed to help with the move. This provides the patient with an opportunity to ask questions and help with the positioning.
Lay patient supine. Safe working height is at waist level for the shortest health care provider. Stand on the side of the bed the patient is moving toward. One person stands at the shoulder area and the other person stands near the hip area, with feet shoulder width apart.
Have the health care provider at the head of the bed grasp the pillow with one hand and the draw sheet with the other hand. Place one foot in front of the other. The weight will shift from the front foot to the back during the move.
On the count of three by the lead person, with arms tight and shoulders down, shift your weight from the front foot to the back foot.
Use your large leg muscles to move the patient. Do not lift, but gently slide the patient. If the patient is bariatric, the move should be repeated to correctly position the patient, or use a mechanical lift. Once patient is positioned toward the side of the bed, ensure pillow is comfortable under the head, and straighten sheets.
Complete all other procedures related to safe patient handling. Name five body mechanic principles that should be used when moving a patient up in bed. A health care provider completes a risk assessment for a patient and determines the patient is unable to assist with repositioning. What should the health care provider do next? However, in the left lateral position, it is difficult to obtain fluoroscopic image of right hepatic duct and intrahepatic bile duct.
In cases of severe abdominal pain, severe abdominal distension, large amount of ascites, recent abdominal surgery or cervical spine surgery, intra-abdominal catheter insertion, severe obesity, it is difficult to position in prone or left lateral, therefore, ERCP may be performed in the supine position.
In supine position for ERCP, there has been documented increased risk of cardiopulmonary adverse event and decreased success rate of selective bile duct cannulation.
There have been reported the efficacy and safety between the prone position and supine position for ERCP in several studies. We aimed to evaluate the efficacy and safety between the prone position and left lateral position for ERCP in this prospective, randomized study. Procedure: Endoscopic retrograde cholangiopancreatography Endoscopic retrograde cholangiopancreatography is started using conventional duodenoscope TJF or V, Olympus Optical Co. Selective bile duct cannulation is performed using wire-guided cannulation.
In case of difficult cannulation, precut is performed using a needle-knife. Other Name: Endoscopic biliary drainge Active Comparator: Prone position Endoscopic retrograde cholangiopancreatography is performed in prone position in this group. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below.
For general information, Learn About Clinical Studies. Pancreas cancer, bile duct cancer, ampulla of Vater cancer. Hepatocellular carcinoma with bile duct invasion, metastatic lymphadenopathy with bile duct invasion from malignancy other than pancreaticobiliary malignancy.
Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information. Search for terms. Save this study. Warning You have reached the maximum number of saved studies Left Lateral Position and Prone Position for Endoscopic Retrograde Cholangiopancreatography The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Last Update Posted : April 7, Study Description. Detailed Description:. Methods Written informed consent for the endoscopic retrograde cholangiopancreatography is obtained from all patients.
Blood culture is performed, and intravenous 3rd generation cephalosporin is administered routinely. Before endoscopic procedure, patients are randomly assigned to left lateral position or prone position for the endoscopic retrograde cholangiopancreatography. Conscious sedation is performed by non-anesthesiologist-assisted method. Intravenous midazolam 0. Analgesics was administered intravenous meperidine 25mg in patients with older than 50 years and meperidine 50mg in patients with younger than 50 years.
To limit duodenal peristalsis hyoscine-N-butylbromide is administered intravenously.
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