The ability to evenly distribute the body pressure to prevent circulatory disturbances and pressure ulcers at the bony prominences is one of the most important OR safety factors, the Association of Surgical Technologists stresses. “When the patient has been administered anesthetic agents, the ability for that patient to communicate pain and pressure to the surgical team has been eliminated, AST adds; therefore the team now becomes responsible for the patient.

A pressure ulcer [now referred to as a pressure injury] is localized injury to the skin and/or underlying tissue, usually over a bony prominence, AST emphasizes, and usually as a result of pressure in combination with shear and/or friction.”  Duration of surgery is an important risk factor for potential injury development. Surgical team members should follow ergonomic principles, being alert to body mechanics that can lead to neck, shoulder, back, and knee injuries. 

AST offers some important reminders: 

  • Pressure points and bony prominences must be identified and properly padded.
  • A pillow should be placed under the posterior of the knees to relive pressure on the lumbar region of the back. [We suggest a dome positioner made for this purpose-pillows are OK, but do not give consistent support. It may bottom out with large patients and not conform correctly with a small one.]
  • The surgery strap should be placed 2” above the knees, in a way that is not restrictive.
  • Table breaks should be underneath the lumbar-sacral area and knee joints.
  • Padding should be placed under each patella of the knee joints.
dome positioner and positioning strap

Positioners are devices that keep bony prominences such as knees and ankles from:

  • Direct contact with one another
  • Direct contact with the operating table or bed

In addition, the devices are meant to:

  • Position limbs to prevent foot contractures and hip rotation
  • Prevent pressure injuries
  • Raise knees and heels to prevent foot contractures and hip rotation

AST cautions OR staff that, with morbidly obese patients, the use of additional foam positioning devices may actually contribute to the development of pressure ulcers, due to the weight of the patient compressing the devices. For that very reason, Action Products’ Akton® polymer gel positioners, which distribute weight and never bottom out, are preferred in the operating room. The Akton® polymer gel dome-shaped positioners come in two sizes.

The point of Action Products’ unique fabrication and design? Position patients to prevent knee breakdown.