Why supine position

Many will deem this as a good course of treatment. However, facts are that the pressure ulcer under the tuberosities ischia is caused by the seated position, while the pressure ulcer on the sacrum is caused by lying in bed. This clearly illustrates why it is important to do a positioning that relives the sacrum when the client is lying in bed. A pressure-relieving mattress cannot do this alone, especially not when the amount of time spent in bed is taken into consideration.

When incorporating positioning into the supine position, it also becomes possible to work preventatively with pressure ulcers, which can improve recovery and healing. You might also like: Obesity and Bariatrics. When working with positioning, it is possible to provide clients with stability and comfort, which will leave them calmer and more relaxed. No matter the situation, these factors play a huge part in recovery.

It is also possible to position clients in ways that make certain procedures easier for the caregivers, e. Good positioning can in some situations even result in the ability to do certain tasks alone, e.

Read the next article: What is good positioning? Mon-Wed: 8 a. Thursday: 8 a. Friday: 8 a. Then please contact us at vendlet vendlet. To prevent this, the hand table must be at the same level as the operating table.

The entire humerus including humeral head and elbow must be visible in two planes with the image intensifier. If cotton blankets are used, place a single drape over the hand table, followed by a larger drape on top which is wrapped around the limb as a shut off. Place the image intensifier display screen in full view of the surgical team and the radiographer.

Introduction All anterior, anterolateral, lateral and medial approaches may be performed with the patient supine. An additional arm table is recommended. Preoperative preparation Operating room personnel ORP need to know and confirm: Site and side of fracture Type of operation planned Ensure that operative site has been marked by the surgeon Condition of the soft tissues Implant to be used Patient positioning Details of the patient including a signed consent form and appropriate antibiotic and thromboprophylaxis Comorbidities, including allergies.

Anesthesia General anesthesia Local nerve block Combination of nerve block and light general anesthesia. All monitors, intravenous lines, and the endotracheal tube need to be carefully managed when moving a patient. The eyes should be taped to avoid corneal abrasion. With excellent communication, patients can be safely and successfully transferred within the operating room.

The supine or dorsal decubitus position is the most common position used in the operating room. Typically, the head is rested on a foam pillow, keeping the neck in a neutral position.

If the arms are tucked, a bed sheet is typically used to secure the arms. This sheet is placed under the body of the patient, brought above and around the arm, and then tucked under the body of the patient. All pressure points should be checked and padded. The arms should always be maintained in a neutral thumb-up or supinated position. The legs are often positioned with the knees slightly flexed resting on pillows to alleviate strain on the lumbar spine.

Ultimately, the proper position of the supine patient is a shared responsibility between the anesthesia, surgery, and intraoperative nursing teams. The supine position provides excellent surgical access for intracranial procedures, most otorhinolaryngology procedures, and surgery on the anterior cervical spine.

The supine position also is used during cardiac and abdominal surgery, as well as procedures on the lower extremity including hip, knee, ankle, and foot. Alterations of the supine position typically include tilting the patient in various planes. This includes the Trendelenburg, reverse Trendelenburg, and left or right tilt. This is often used for patient comfort during monitored anesthesia care MAC or awake procedures. The frog-leg position can be used for access to the perineum and for Foley catheter placement.

The plantar surface of each foot are placed together. When the patient is placed from the upright to the supine position, the intra-abdominal contents and diaphragm shift cephalad, compressing the adjacent lung tissue. This leads to a decrease in functional residual capacity FRC when going from standing to the supine position.

Anesthesia and neuromuscular blockade do not appear to be additive in decreasing FRC. Closing capacity is the lung capacity at which small airways begin to collapse. In a healthy, spontaneously breathing patient, normal tidal breathing is typically above closing capacity and thus small airways remain open.

This changes with age, as closing capacity increases and approaches FRC. By age 45, normal tidal breathing causes airway collapse in the supine position and by age 65 in the upright position. Closing capacity is minimally affected by posture or anesthesia.

However, in the anesthetized patient, the decrease in FRC seen in the supine position could place normal tidal breathing at or below closing capacity, allowing airway collapse with normal ventilation leading to atelectasis and intrapulmonary shunt. Placing a patient supine from an erect position increases venous return to the heart through redistribution of blood from the lower extremities. This leads to an increase in cardiac output via preload augmentation. Heart rate, stroke volume, and contractility are reflexively decreased through baroreceptors from the aorta via the vagus nerve and from the carotid sinus via the glossopharyngeal nerve to maintain a constant blood pressure.

Downstream alterations in sympathetic flow to splanchnic and renal vasculature continue to augment the circulatory system during postural changes, maintaining a strictly controlled systemic blood pressure. This synchronized and well-controlled system to maintain a relatively constant blood pressure is altered with the addition of general anesthesia, neuraxial anesthesia, neuromuscular blockade, and the initiation of positive pressure ventilation.

During anesthesia, systemic vascular resistance SVR and return of venous blood to the heart decrease. With derailed mechanisms to compensate for changes in position, the systemic blood pressure under anesthesia is more labile. Placing the patient in the Trendelenburg or reverse Trendelenburg position will have greater effects of systemic blood pressure in a supine patient under general anesthesia than an awake spontaneously breathing patient. In the parturient, the gravid uterus in the supine position can cause aortocaval compression leading to a supine hypotension syndrome and uteroplacental insufficiency.

The pregnant patient at term should rarely, if ever, be placed in a true supine position in order to maintain placental perfusion. Classic teaching for cesarean section mandates the maintenance of 15 degrees of left lateral tilt to offload the pressure of the gravid uterus on the inferior vena cava IVC to decrease venous obstruction.

However, recent reports suggest that a minimum of 30 degrees of left lateral tilt might be needed to improve IVC obstruction and truly improve placental perfusion. However, the ability to perform a cesarean section in 30 degrees of left lateral tilt does not seem optimal for the patient or surgeon and future research needs to evaluate the best intraoperative position for cesarean section.

When the left lateral tilt position is used, the pregnant patient must be secured to the table to prevent fall and injury. Nearly all anesthetic techniques are employed in the supine position. These range from awake techniques for carotid endarterectomy to general anesthesia with tracheal intubation for cardiac procedures. Regional and neuraxial anesthesia are readily used to provide anesthesia and analgesia in the supine position.

The supine position is related to several potential complications including peripheral nerve injury. The importance of perioperative nerve injuries is emphasized by the findings of the American Society of Anesthesiologists ASA closed claims database. Although the mechanism of nerve injury is not always clear, internal and external compression, stretch, ischemia, metabolic derangement, direct trauma, and direct nerve laceration can all lead to postoperative nerve injury.

In theory perioperative neuropathies are preventable through proper positioning and padding. In reality, nerve injuries will continue to rarely occur. Nerve injuries potentially related to patient positioning must be understood to mitigate any risk of injury and limit overall occurrence.

Historically, the ulnar nerve was the most common nerve injured in the perioperative setting, followed by the brachial plexus and lumbosacral roots. Symptoms of ulnar neuropathy include paresthesia and weakness of the fourth and fifth digits of the affected hand, and pain of the medial forearm and hand.