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You have successfully created a MyAccess Profile for alertsuccessName. Home Books Anesthesiology, 3e. Previous Chapter. Next Chapter. Surgical Positioning: Physiology and Perioperative Implications. Longnecker D. David E. Longnecker, et al. Anesthesiology, 3e. McGraw Hill; Accessed November 11, The adopted research method was an integrative literature review. This method includes systemized analysis and synthesis of research results on the same theme, contributes to deepen the research theme, supports decision making and, consequently, the improvement of clinical practice, based on preexisting research results The following steps were followed to elaborate this integrative review: identification of theme or formulation of guiding question; sampling or literature search for studies; assessment of studies included in the review; discussion and interpretation of results and synthesis of knowledge evidenced in analyzed articles or presentation of integrative review results 5,7.
The guiding question to elaborate the integrative review was: what is the nursing care related to surgical positioning of adult patients in the intra-operative period? Keywords related to the theme were selected and it was checked in the databases whether these were controlled descriptors according to each specific database indexation. Table 1 displays the descriptors used to conduct the integrative review. With a view to a broad article search, all possible combinations among the descriptors were searched in each database.
The following inclusion criteria were adopted: article on nursing care to adult patients in surgical positioning in the intraoperative period; published in English, Spanish and Portuguese between July and July and articles without distinguishing the adopted research design.
The articles were selected by their title and abstract, in line with the study goal and in compliance with the inclusion criteria. To extract the data, a previously published and validated data collection instrument was used 8.
To analyze the evidence level and research design of the studies included in the review, the concepts proposed by nursing researchers were used 3,9. The articles were analyzed and summarized descriptively, allowing readers to assess the quality of evidence evidence level available in literature on the research theme, support decision making in daily intraoperative nursing and identifying knowledge gaps with a view to future research.
With regard to the evidence level, only one study showed a strong evidence level level II with an experimental design, i. In the same sense, the other ten studies narrative literature reviews are not classified according to the adopted hierarchical system.
Tables 2 , 3 , 4 and 5 show the synthesis of the analyzed articles. All identified risk factors should be documented, as well as orientations patients received Using drugs like muscle relaxants and pain medication can mask and delay the diagnosis of intraoperative injuries ;. Abrir menu Brasil. Revista Latino-Americana de Enfermagem. Abrir menu. Perioperative Nursing; Nursing Care; Research.
E-mail: camila. Purpose This research aimed to search for and assess evidence available in literature about nursing care related to surgical positioning of adult patients in the intraoperative period. Methodological procedure The adopted research method was an integrative literature review. St-Arnaud D, Paquin M. Safe positioning for neurosurgical patients.
AORN J. Intrinsic factors can include the overall health of the patient, and preexisting conditions such as respiratory or circulatory disorders, diabetes mellitus, anemia, malnutrition, advanced age, and body size.
When anesthetics and muscle relaxants depress pain, pressure receptors and muscle tone, the normal defense mechanisms cannot guard against joint damage or muscle stretch and strain. One of the main goals of proper patient positioning is to keep the patient's body as naturally aligned as possible while providing the surgical staff access to the surgical site, and quick, jerky movements should be avoided. Of the common patient positions, there are variations of different patient positions which play a key role in minimizing the risk of positioning related issues, such as: respiratory problems, circulatory problems, nerve or muscle injuries, and soft tissue injuries.
Fowler's position, also known as sitting position, is typically used for neurosurgery and shoulder surgeries. The beach chair position is often used for nasal surgeries, abdominoplasty, and breast reduction surgeries. When positioning a patient in Fowler's position, the surgical staff should minimize the degree of the patient's head elevation as much as possible and always maintain the head in a neutral position.
The patient's arms should be flexed and secured across the body, the buttocks should be padded, and the knees flexed 30 degrees.
In Fowler's position, the patient is at an increased risk for air embolism, skin injury from shearing and sliding, and DVT forming in the patient's lower extremities. In this type of position, a patient has an increased pressure risk in their scapulae, sacrum, coccyx, ischium, back of knees, and heels. In High Fowler's position, the patient is usually seated Fowler's position at the head end of the operating table. The upper half of the patient's body is between 60 degrees and 90 degrees in relation to the lower half of their body.
The legs of the patient may be straight or bent. Supine position, also known as Dorsal Decubitus, is the most frequently used position for procedures.
In this reclining position, the patient is face-up. The patient's arms should be tucked at the patient's sides with a bedsheet, secured with arm guards to sleds. The arms may be flexed and secured across the body or extended and secured on padded armboards.
In Supine position, the patient may risk pressure ulcers and nerve damage. This position causes extra pressure on the skin and bony prominences over the occiput, scapulae, elbows, sacrum, coccyx and heels. Jackknife position, also known as Kraske, is similar to Knee-Chest or Kneeling positions and is often used for colorectal surgeries. This type of position places extreme pressure on the knees. While positioning, surgical staff should place extra padding for the knee area.
The kidney position resembles lateral position, except the patient's abdomen is placed over a lift in the operating table that bends the body to allow access to the retroperitoneal space. A kidney rest is placed under the patient at the location of the lift. In Prone position, the patient is face-down with their head in a neutral position without excessive flexion, extension or rotation. A face positioner is used when the patient's head is in midline.
Prone position is often used for spine and neck surgeries, neurosurgery, colorectal surgeries, vascular surgeries, and tendon repairs. Foam or gel positioners may also be used for spinal procedures. When a patient is in Prone, pressure should be kept off of the eyes, cheeks, ears, and breast.
At a minimum, four members of the surgical staff should be available when turning a patient prone. Risks associated with Prone position include increased abdominal pressures, bleeding, compartment syndrome, nerve injuries, cardiovascular compromise, ocular injuries, and venous air embolism.
In Lithotomy position, the patient can be placed in either a boot-style leg holder or stirrup-style position. Modifications to this type of position include low, standard, high, exaggerated or hemi.
This position is typically used for gynecology, colorectal, urology, perineal, or pelvis procedures. The risks posed to a patient in a Lithotomy position for a procedure include fractures, nerve injuries, hip dislocation, muscle injuries, pressure injuries, and diminished lung capacity.
While positioning a patient in this position, surgical staff should avoid hyperabduction of the patient's hips and leaning against their inner thighs. Stirrups used on a patient in this position should disperse support and pressure over wide areas.
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