Correct Positioning of the Clients During the Intraoperative Stage

Figure 1: Practitioners during an Intraoperative Phase (Source: Nurse Labs, 2017)

Worth pointing out is that correct positioning of the clients during the intraoperative stage is an essential undertaking in the operative department. Placing a patient in an appropriate position is essential because it ensures that there is ample access to the operative site. The surgeons can, therefore, reach the region to be operated with ease (Carris & Franczek, 1999). Whenever the area is open, and the medical professionals have an extended view, then it becomes easy to conduct precise tissue opening and separation. Significant cases of operation complication have emanated from the inability of the surgeons to have a clear view or access to the specific site. Such occurrences impact the quality of patient outcomes. It is essential to recognize how correct positioning is a vital component of the intraoperative stage because of two significant reasons. Achieving the best position ensures that the patient is not subjected to inadvertent movement during operation (Nurse Labs, 2017). Correct positioning also ensures that the patient does not acquire injuries when the surgical process is being undertaken.

Correct positioning is also important because it reduces the risks emanating from the nature of the operational position. Cases of surgeons determining the positioning of the patient are typical; however, experienced nurses are mandated with the process based on their perioperative skills and expertise. However, errors may occur prompting the development of complications. Several factors contribute and determine the magnitude of the risk exposure based on the accuracy of the positioning. The nature of the surgery and the length of the time define the position that a patient is subjected to before any operation. The anesthesia that has been used during the preoperative preparations also dictate the type of position. On the other hand, other factors such as the height, age, weight, and the nutritional status are part of the considerations required for the position decision (Carris & Franczek, 1999; Dybec, 2004). The health status of the patient also affects the choice of the position where the objective is to achieve comfort as well as accessibility. Each of these elements is associated with the different level of implication but are part of the prepositioning assessment carried out before surgery. Therefore, the experience of the perioperative nurses is a critical factor at this stage.

During operation, several physiological changes occur, and the patient is supposed to be shielded from responding to pain. Feeling the pain could make the patient change the position and this could escalate surgery complications. Therefore, the use anesthetics and in some cases regional blocks is vital to ensure that the patient does not respond to pain. However, this presents the easy identification of complex stretches, twists, or compressions (OConnell, 2006). Such a scenario indicates that tissue damages such as nerve and capillary raptures as well as respiratory of circulatory deregulations could occur without any tactic response from the patient. In such a case, it is not easy to note potential changes that could affect patient outcomes. Based on this possibility and the need to limit the risks, correct positioning becomes the precise preventive mechanism during the intraoperative stage. Moreover, correct positioning guarantees intact skin, which free from abrasions, shear, and blisters. Whenever the surgical positioning is correct, then the cardiovascular status will adjust to the normal condition within a short time. The same scenario is witnessed when the neuromuscular recovery is evaluated (Richardson, 2004). Compromising the cardiovascular orientation or the neuromuscular alignment affects the recovery process, which could lead to hospital-acquired conditions after the operation.

Furthermore, diverse knowledge and skill are needed to achieve the best position. Perioperative nurses are required to have extensive knowledge of how the body works. The anatomy and physiology orientations determine how the surgery process is impacted. The decision to position the patient will, therefore, include how the surgery will affect the body anatomy and physiology. On the other hand, anesthesia affects body physiology, and perioperative nurses and surgeons are expected to understand this transformation and its impact on positioning as well as circulatory system pressure and immobility (Cluver et al., 2010). Being aware of the procedure to be performed and the positioning techniques enhance the patient outcome by guaranteeing a successful operation. Nurses who are in a position to incorporate optimal airway accessibility to present a significant surface for surgery also use body anatomical positioning to reduce risks of possible complications. In fact, this approach is essential because it reduces the exposure of the body of patients. The dignity of a patient is an integral part of the treatment process (Rothrock, 2003). In surgery, achieving limited exposure as well as maximum surface accessibility is a responsibility of the perioperative professionals. Therefore, nurses and surgeons should be aware that correct positioning is central to achieving safety, efficiency, dignity, and quality outcomes.

3.0 Different OR Table Positions

Different positions have been adopted to enhnace the surgical outcome and expereince. The supine position is when the patient lies flat with the back along bed. The position is recommended for abdominal surgeries requiring an anterior entry or access. Invasie, neck, and head operations are carried put at this position. The trendelenburg position resebles supine; however, in trendelenburg, the lgs are positoned higher than the rest of the body. The position is important when seeking easy access to pelvic organs such as in cases involviing abdominal or genitourinary system (Frey, Price, & Ross, 2008). The reseve version of trendelenburg involves setting the upper part of the body raised. The fructure table position is another an approach used when seeking to address hip fractures. In this position, the patient is set in a supine but upper torso position with the unaffected leg raised with straps. The lithotomy position is aplied in erological opertaions as well as gynaecology-based or anal surgery (Lopes & Galvao, 2010). Lithotomy involves an upper torso and supine position where the arms are extended while the legs are raised and supported. Another important positioning is the Fowlers position where the upper torso is set at an angle of about 90 degree. The angle may varry depending on the surgical needs, which leads to standard, high, low, and semi Fowlers positions.

Moreover, the prone position involves the patient lieying with the stomach. It is used when posterior access is needed. Therefore, the patient is transfered from the supine to the prone position where possible twists should be avoided and the spine alignment guaranteed (Lopes & Galvao, 2010). At this position, supporting the ankle and using supportive straps enhnace the safety and comfort. The jackknife position is also used in patient positioning where the abdomen is set flat in line with the bed but the hip remains lifted and legs lowered. In jackknife position the head is oriented away from the opertaive region (Frey, Price, & Ross, 2008). Furthermore, In jackknife position, when the legs are further bent at an angle of 90 degrees at the knee then it is called the knee-chest position.

On the other, hand, another approach is the lateral position, which resembles the jackknife positioning; however, the patient is set to rest on side. The alignment of the spine as well as the transfer of the patient to this position should be considered on the basis of comfort and safety. The other intraoperative position is the Llyod-Davis, which is used for pelvic and lower abdominal surgeries. The position involves setting the patient in the trendelenburg positio but the legs are set apart at 30 degress with the hip position adjusted to 15 degrees (Lopes & Galvao, 2010). When the patient is set to a lateral position with the abdomen placed over a lift then the kidney is easily accessible. Such a position is called the kidney position. Another notable opertaive positioning is the Sims position where the a variation of the left lateral position is carried out to improve sugical accessiblity. The left leg remains straight but the hip is moved slightly backwards (Frey, Price, & Ross, 2008). The right leg is bent and suported by a pillow between the legs to allow visible access to the anus.

Figure 2: Different OR Table Positions (Source: Geeky Medics, 2010)

4.0 Effects of Improper Positioning

It is essent...