Positioning, skin prep, incision & draping

D. Positioning, skin preparation and Abdominal incisionE. Draping

Positioning

Putting patient in proper body alignment to expose the

operative site or area

EQUIPMENT FOR POSITIONING

POSITIONING EQUIPMENT1. Operating table

POSITIONING EQUIPMENTOperating table

POSITIONING EQUIPMENTOperating table

POSITIONING EQUIPMENT

2.1 Safety belt

2. Special bed equipment and Bed attachment


2.2 Anesthesia screen



2.3 Armboard



2.4 Double armboard



2.5 Wrist or arm strap



2.6 Upper extremity table (hand table)



2.7 (thyroid elevator)- Shoulder bridge towel roll



2.8 Body rests and braces-support maintain a lateral position


POSITIONING EQUIPMENT2.9 Lateral positioner (kidney rests)



2.10 Adhesive tape-for anal procedures



2.11 Stirrups



2.12 headrests



2.13 Clamps and sockets



2.14 Leg Prepper


Factors to consider when positioning a client

1. Site of operation2. Age and size of the

patient3. Type of anesthetic

used regional – position

patient first general – position

patient last

Factors to consider when positioning a client

4. Pain normally experienced by the patient upon movement

5.Must not hinder respiration and circulation

Procedure and General considerations in positioning a

client1. IDENTIFY2. Explain purpose of position.3. Mobility4. Precaution in transferring

the pt fr. One bed to another.▪ 2: Conscious▪ 4: unconscious, anesthetized,

weak and obese.

General considerations in positioning a client

5. OR bed is securely locked6. The anesthesia provider guards

the HEAD7. Operative site must be

adequately exposed.8. Avoid undue exposure.9. Strap the person to prevent falls.10. Maintain adequate respiratory

function.

General considerations in positioning a client:

11. Maintain good body alignment.

12. Do not allow the persons extremity dangle over the sides of the table

13. Avoid excessive muscle strain.

General considerations in positioning a client

14. Avoid person resting on hands which may impede circulation.

15. Precautions for patient’s safety must be observed, particularly with thin, elderly or obese patients.

16. Don’t cross ankles (cause DVT)

Different Positions assumed by the patient during surgery

Pre-operative

Supine position – most natural position of the body at rest

face neck shoulder induction of general anesthesia

Dorsal recumbent – lies on his back

HeadAbdome

n

Clamshell side view Clamshell top view

USED FOR:

- surgeries that involve unrestricted access to both sides of abdomen as in laparoscopic surgery

Supine frog leg

USED TO:- increase surgical exposure to both the vagina, perineum and abdomen.

Supine may fields tongs

USED FOR: Procedures of the anterior body such as: Neurosurgical Procedures Posterior Cervical Spine Procedures

Trendelenburg position – permits displacement of the intestines into upper abdomen

Surgery of lower abdomen or pelvis

USED FOR: Procedures of the anterior body such as:- laparoscopic surgery- abdominal - gynecologic surgery

trendelenberg

Reverse trendelenberg

USED FOR: Procedures of the anterior body such as:

laparoscopic surgery abdominal thoracic facial anterior upper and lower extremity

procedures

Prone position

For: neurological

procedure

Jacknife position / Kraske Position

rectal surger

y

Modified Jacknife

Lateral position (right or left)

For: surgical procedures of the kidneys

Sim’s position

For rectal

examination in an obese

patient

Lateral jacknife jack

Lithotomy position

For: vaginal, perineal like

D&C and rectal procedures like

hemorrhoidectomy

High-Lithotomy

DESCRIPTION: The patient is positioned so that the hips and knees are flexed and elevated to facilitate surgical access to the perineum and abdomen.


gynecologic procedures perineal perirectal/anal

Tilted Lithotomy

DESCRIPTION: The patient is positioned so that the hips and knees are flexed and elevated to facilitate surgical access to the perineum and abdomen. This is the most physiologically compromising of any position, especially if the patient is obese.


gynecologic procedures perineal perirectal/anal

Fowler’s / Sitting Position

bone section is raised 45 degrees

For: cranial procedure

Sitting may fields

Sitting may fields

Sitting may fields

Beach chair arm crossedBeach chair

Sitting

Exercises: Abdominal surgeries

Supine Bladder surgery

Slightly trendelenburg Perineal surgery

Lithotomy Brain surgery

Semi-fowler’s Spinal cord surgeries

Prone mostly Lumbar puncture

Side lying, flexed body

POSITIONING POST-OP

Abdominal Aneurysm Surgery: Fowlers

Cataract Surgery:Semi fowlersCraniotomy

Supratentorial:semi fowlers Infratentorial:flat

POSITIONING POST-OP

Gastrectomy - supine

Femoropopliteal by-pass graft – affected extremity (extended)

Hemorrhoidectomy – side lyingHip surgery – keep legs in

abductionHypophysectomy – elevate headLaminectomy – keep back

straight

POSITIONING POST-OP

Laryngectomy – semi fowler’s

Liver biopsy – right side lying Lobectomy – semi fowler’sLumbar Puncture –

lateral side lying: during procedure

Flat: post-op

POSITIONING POST-OP

Mastectomy – elevate on pillow (affected extremity)

Thyroidectomy – semi fowler’s

Tonsillectomy – side lying or prone

Vein Stripping & Ligation - keep legs elevated.

SKIN PREPARATION The removal

of as many bacteria as

possible from the patient’s skin through

shaving, mechanical,

washing, and chemical

disinfection

PURPOSE:

Prevention

of infection

Nursing Consideration

1. Determine the area to be shaved and its extent; know the operation to be done; the organ involved and its location and the proposed incision.

THORACIC SURGERY

KIDNEY SURGERY

Lower extremities

Upper extremities

Cranial surgery – depends upon surgeon Thyroid or neck surgery – chin to nipple plus

shoulder and axilla Eye surgery – cut eyelashes of affected eye Nasal surgery – no shaving unless with mustache Ear surgery – 2 ½ inches around ear Chest surgery – base of neck to waist, axilla and

inner arm Abdominal and pelvic surgery – nipple to

symphysis pubis, vulva, perineum, thigh Kidney – anterior – nipple to perineum, side to

side; supra scapular region to buttocks Vaginal, scrotal, rectal – waist to perineum plus

anterior and inner aspect of thigh and 6 inches from groin; posterior – entire buttocks and anus

Lower extremities – digits 2 inches above knee, entire extremity and groin

Upper extremities – distal arm 2 inches above elbow; elbow up to axilla


2. Practice modesty

and provide privacy


3.Ask the patient’s

permission in cutting

the eyelashes and hair.


4. Examine the area to be shaved for

any signs of irritation or

any abnormal condition.

Report this to your head

nurse


5. Do not cut the patient’s skin.

6. In abdominal operations, pay particular attention to the umbilicus.


7. Shave the operative site the day or the night before the operation

8. Discard soiled sponges in your kidney basin.


9. In shaving, follow the direction of the growth of the hair while the free hand exerts an opposite force by pulling the skin to the opposite direction.

10. If a wound is present on the area to be shaved, start from the clean area to the dirty area

Surgical incision

Sternal split

Subcostal (Kocher)

thoracoabdominal

Draping

Draping

Definition: Is the procedure of covering patient and

surrounding areas with a sterile barrier to create

and maintain an adequate sterile field during

operation

Nursing consideration in draping

1.Allow sufficient time to permit careful application

2.Allow sufficient space to observe sterile technique

3.Handle the drape as little as possible

4. If a drape becomes contaminated, do not handle it further.


5. If in doubt as to its sterility, consider it contaminated.

6. If end of sheet falls below waist level, discard it.

7.Never reach across the operating room table to drape the opposite side; go around the table


8. Take the towel clips to the side of the table from which the surgeon is going to apply them before handling them to him

9. Carry the folded drapes to the operating room table, watch the front of the sterile gown; it may bulge and touch the nonsterile table or blanket of the patient...Stand well back from the nonsterile table.


10. Hold drapes high enough to avoid touching them on the blanket but avoid touching the light.

11. Do not let your gloved hand touch the skin of the patient.

12. Hold the linen high until it is directly over the proper area then lay it down where it is to remain.


13. If a drape is incorrectly placed, the circulating nurse discards it from the table without contaminating other drapes or site.

14. In unfolding the sheet on the operative site, toward the foot or the end of the table, protect the gloved hand by enclosing it in the turned back cuff of the sheet provided for that purpose.


15. A towel clip that has been fastened through a drape has its point contaminated. Removed it only if absolutely necessary then discard it.

16. Place a drape on a dry area.

Criteria for effective drape material

1.Blood and fluid resistant to keep the drape dry and prevent migration of microorganism.

2.Lint free to prevent airborne contaminants and shedding into the surgical site.


3. Antistatic to eliminate risk of spark from static electricity.

4.Sufficiently porous to eliminate heat build-up so as to maintain an isothermic environment appropriate for pt body temp.


5.Drapable to fit around contours of the patient, furniture, and equipment

6.Dull, nonglaring to minimize color distortion from reflected light.

7.Free of toxic ingredient, such as laundry residues, and nonfast dye.


8.Flame resistant to self-extinguish rapidly on removal of an ignition source

Health & Medicine

Positioning, skin prep, incision & draping