BROAD SCOPE With the right attachments, a general OR table can be used for the increasingly wide range of procedures being performed in outpatient settings.

As more types of procedures migrate to outpatient settings, you might find your tables are limited in their abilities. Ever wish yours could do more? Surgical table attachments can bring versatility to your OR, letting your table host new procedures and adapt to new approaches. Here's a look at some innovative accessories to consider.

No more arm tucks
Adjustable arm supports might not seem like an essential, but they can help to prevent minor inconveniences and major complications.

To get as close as possible to patients during procedures, surgeons have traditionally taken the patient's arm off of the armboard once the IV's been started and tucked it beneath the drawsheet in order to improve accessibility. This practice, however, can lead to problems — potentially serious ones — if complications arise and anesthesia providers have to crawl under the sheet and find the IV. Depending on the patient's positioning, tucking the arm might also result in pressure injuries to skin or musculoskeletal structure. As a result, AORN and other authorities are recommending an end to the practice of tucking arms beside the table.

One solution: Trumpf's universal arm supports can be clamped onto the side rails of virtually any table. Once attached, it can be adjusted quickly and easily into almost any position by releasing 2 ball joints with a hand wheel. You can then shift it to support arms in prone, supine and lateral positions, as well as over and under a patient's head.

SECURE HOLD

STAY PUT The Hug-U-Vac (above) conforms to the contours of the body, supporting patients up to 500 pounds. Universal arm supports (below) can support arms in many positions.

Uphill battles
The advent of robotics in outpatient surgery, along with the prevalence of gynecological, urological, colorectal and cholecystectomy surgeries, means patients are spending more time in the Trendelenburg position, which can present a range of positioning challenges and hazards.

You'll want to avoid, for example, discharging your patients with — or having them discover later — the "burns" that result from sliding skin and the shear force created when patients are pulled up or down with sheets. Not only do they look as bad as electrocautery burns, but also they can increase and prolong post-op pain.

Robotics presents some ghastly technological hazards. As one manufacturer puts it, "the robot is not programmed to compensate for changes in patient location on the OR table. When a patient slides 'just a little bit,' the arms/trocars of the robot will begin to assume the primary role for restraining the patient."

To prevent sliding, Medicus Surgical offers a system that uses the concavities of the anatomy to hold patients in place. Along with a head-stabilizing speed bump, the company's attachments include lateral torso-stabilizing pillows that prevent the torso from shifting. The combination of patient weight and gravity keep the thoracic spine in direct contact with the foam bolster, so the steeper the tilt, the more firmly patients are held, even those who weigh up to 450 pounds.

As an adjunct, foam guards can also be used to hold arms in place, providing cushioning that protects against pressure and nerve injuries and provides anesthesia access via a zipper-like closure.

Another option for safely and comfortably holding patients in Trendelenburg (as well as in reverse Trendelenburg and the lateral oblique position) is the Allen Hug-U-Vac. It's an inflatable bean bag that's secured to the rails of the OR table with 3 straps. Its soft micro-beads allow it to inflate and deflate evenly without continuous suction. After patients are positioned, the device is deflated, causing it to conform to the contours of the patient's body. Used with shoulder supports, it can handle patients of up to 500 pounds.

JOINT EFFORT The right attachments turn a general OR table into a hip and knee arthroplasty table.

Joints and structures
With the right attachments, you can turn a general OR table into a hip and knee arthroplasty table. Attachments and extensions can bring a HANA table's hip and knee arthroplasty capabilities to your OR, without your having to purchase a specialty table, and without having to find the space to store it and the manpower to routinely move it in and out of your rooms.

It's a similar situation with spinal surgery's specific positioning and access needs. There are tables specially designed for spine surgery. But what if you're not running a spine or neurosurgery center even as you ambitiously court spine cases to your mix? You may be better served by attachments that can convert conventional tables into spinal analogues. Most are made from radiolucent materials, enabling clear visualization for the C-arm the cases will require.

These types of specialty attachments usually involve assembly and disassembly to convert your tables. Many models of OR tables are made up of 3 heavy segments: the head, the middle and the bottom. Taking down the bottom piece in order to add leg attachments for gynecology or urology cases can be some serious labor.

Here's some good news, though. Some attachment manufacturers use aircraft-grade aluminum instead of stainless steel for their components. This creates an equally strong, but lighter weight, attachment. Keep an eye out for this advance if you're in the market for surgical table attachments. Some of these aluminum attachments can also be hung on the wall, saving floor and storage room space and making them conveniently retrievable.

It's always a good idea to evaluate the accessories you're considering with the help of staff and physicians who'll actually be using them. Whenever you can, take advantage of the opportunity to trial before making a purchase.

Don't put cost before safety, though. It's true that tables and their accessories are large budget items. And the carts that some vendors offer to hold and transport table attachments often get value-engineered out of the deal by the time it's inked. They're not inexpensive. But neither are the workers' comp costs for employees who get hurt hefting the attachments from storage and back. And they may also save your staff time in locating the attachments when they're needed. Devices that can organize your process into efficiency are always a good idea.