Safety: Are You Using the Right Positioning Aids?

Protect vulnerable patients from unnecessary skin injuries and shearing.

We perform roughly 40 procedures a day at our busy orthopedic surgery center, and we expect every patient to leave the operating room without a pressure injury.

In a previous role, I witnessed some serious pressure injuries go untreated in patients who were in one position for a long period of time, causing skin and tissue damage so deep you could see the bone.

To prevent disastrous outcomes like that, you must take the procedure, the position and the positioning aids needed for that procedure into consideration. You must also consider length of the surgery, patient comorbidities — such as diabetes, healing disorders, respiratory disorders and circulatory disorders — the patient’s weight and common pressure points (toes, heels, knees, coccyx, sacrum, hips, elbows, ears and eyes).

Procedure-specific positioning

Here’s how we prevent pressure injuries and keep our various surgical patients safe and satisfied:

• Total knees. We utilize a right-angle bar, a common positioning device for knee surgeries. When these right-angle bars are purchased, they are sent with reusable pads. These pads can be cleaned and reused; however, we found after multiple uses, they start breaking down. We felt this could easily turn into an infection risk and went on the hunt for a better way. That’s when we started using single-use disposable pads. Of course, there’s a higher cost associated with using single-use disposables, but we feel that the benefit outweighs the potential risk to our patients.

• Total hips. When placing the patient in a lateral position, we allow the patient to position themselves and ask if they are comfortable. If the patient is undergoing general anesthesia, this is not an option, and we must rely on our knowledge and training to ensure the patient is comfortable. Also, when positioning the patient in the lateral position, all bony prominences must be protected and supported; therefore, we utilize a single-use foam and headrest. In addition, an axillary roll is placed in the patient’s axilla region to help support the shoulder and ensure all the weight of the patient is not on their shoulder.

• Shoulder arthroscopies. One type of surgical position we use during shoulder arthroscopies is called the beach chair position. When choosing a positioning device, all bony prominences need to be supported, and the patient must be in correct anatomical alignment. We use a headrest, which fully supports the head and cervical area. The gel headrest is curved and takes the ears into consideration. In order to prevent pressure injuries, the ears should never have pressure on them. Patients wear goggles to protect the eyes from abrasion or harm. Yellow foam supports the bony prominences of the arm and heels, and the backs of the knees are supported with a pillow. We want the patient to feel as comfortable as they would in a reclining chair with support. The yellow foam and eye goggles are single-use and discarded after each patient.

• Spine. For spine surgeries, we use the prone position on a Wilson frame. We utilize all single-use positioning aids to diminish the risk of patient infection. Positioning a patient in the prone position requires extra care when moving the head and neck. The prone head pillow has a cut-out for the eyes, nose and mouth. The extra-long foam for the arms helps protect and support the entirety of the arm. We also utilize pillows under the knees.

• The supine position. This is a common position for many surgical procedures. When positioning the patient in a supine position, if at all possible, have the patient help. Allow them to lay their arms out on the padded arm boards and ask, “Are you comfortable?” By utilizing foam (or another positioning device), you protect the ulnar nerve and the bony prominence of the elbows. You should also support the heels of the patients. Operating room tables have pads that are cushioned and support the patient; however, this extra layer of protection is never a bad thing.

By utilizing single-use patient positioning aids, you decrease the potential for patient infections by cross-contamination. When researching aids, you must find what works for your facility. While single-use positioning aids may cost more, one must never sacrifice patient safety and care because of cost.

Put yourself in the patient’s shoes

One thing many of our surgical techs commonly do is test out the positioning aids. You can never know just how comfortable — or uncomfortable — your patient may be unless you test out different surgical positions and the positioning aids you use for them. Have staff of different heights and weights test out your positioning aids and report back to you, because some aids might feel great for a patient who is five feet tall and weighs 100 pounds but wouldn’t prevent pressure injuries for a patient who is six feet tall and weighs over 200 pounds. Even if your facility has been successful at preventing pressure injuries, make sure to take the time to educate your patients beforehand. They should know what signs to look for, such as discomfort, red areas, numbness or tingling. Even if they’re unsure, we tell them to call the doctor and get checked out just to be safe. You’ll never regret being overprepared or overvigilant — especially when it comes to your patients’ health and safety. OSM