Surgical positioning

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Positioning the head for a thyroid operation

Surgical positioning refers to the positioning of the patient on the operating table for a specific medical procedure. Operations and invasive examination procedures require a precise patient position in order to give the surgeon optimal access to the relevant anatomical operating area and to protect the patient from damage caused by positioning.

Basics

The most important aspect of positioning is protecting the patient from damage caused by positioning. Possible are:

  • Nerve damage due to pressure or tension on a peripheral nerve , for example peroneal palsy due to pressure on the head of the fibula when the leg is positioned in a leg shell, damage to the ulnar nerve when pressure is applied to the elbow, or tensile damage to the arm plexus when an arm is positioned extremely overhead.
  • Joint damage such as strained or torn capsules due to permanent overstretching up to shoulder dislocation due to improper prone positioning.
  • Pressure damage to the soft tissue with insufficient padding (pressure ulcers on the tailbone , under the shoulder blades , etc.)
  • Burns caused by the use of high-frequency electricity on parts of the body that are in contact with electrical conductors or electrically conductive liquids.

Storage damage is regarded as medical treatment error, with the consequence of claims for damages up to the accusation of negligent bodily harm, if proof of improper storage can be provided.

Storage types

The positioning should ensure the best possible access to the anatomical treatment area. It should be as stable as possible and thus protect against complications from unwanted movements. However, especially in operations on the extremities, the possibility of intraoperatively necessary changes in position must also be guaranteed. In addition, a short distance between surgeon and patient, freedom of movement for the surgical team and the sufficiently large prepared surgical field are important.

In addition, the requirements for the best possible anesthesia management must be met, as well as the high hygiene standards in the operating area.

The following types of storage are of practical importance:

  • The supine position is used in most abdominal and sternotomy thoracic surgery . If necessary, the table can be tilted in the transverse or longitudinal axis. The table height is adjusted to the size of the surgeon.
  • Prone positioning is used for operations on the back and buttocks. The patient is usually only turned after anesthesia has been induced . A variant of the prone position is the knee-elbow position in spinal surgery.
  • Side positioning is used, among other things, for thoracotomies , operations on the kidneys and in the context of endoprosthetics of the hip joint.
  • Half-seated position for operations on the shoulder joint (so-called beach chair position ) or on the thyroid gland ( goiter resection , thyroidectomy ).
  • Lithotomy position: supine position with legs apart and 90 ° flexion in the hip and knee joints for gynecological , urological and proctological interventions.
  • Storage on the extension table in trauma surgery and orthopedics for operations on the hip or thigh.

execution

In Germany, surgical positioning is a medical task that falls within the area of ​​responsibility of the surgeon and is usually delegated to and carried out by appropriately trained nursing staff. The doctor (surgeon, especially for the arms and head, also the anesthetist) is responsible for the execution and control. In Switzerland , surgical positioning is being carried out more and more by specially trained specialists for surgical positioning (formerly known as positioning nurses ).

literature

  • Horst Glauch, Ernst Haaf: Surgical instruments, surgical positioning, surgical procedures. 3. Edition. Thieme, Stuttgart 2002, ISBN 3135747034 .
  • Christian Krettek: Positioning techniques in the operating area. Springer, 2005, ISBN 354065948X .
  • Rudolf Sommer: OP bearings in trauma surgery and orthopedics. Springer, 1999, ISBN 379851139X .

Web links

Individual evidence

  1. ↑ Reinhard Larsen: Anesthesia. 8th (7th revised and expanded) edition. Urban & Fischer, Munich / Jena 2002, ISBN 3-437-22500-6 , pp. 619-625.