“Positioning the patient for a surgical procedure is a shared responsibility among the surgeon, the anesthesiologist, and the nurses in the operating room,” Dr. Marnie Welch writes in uptodate.com. The challenge, Welch explains is that a compromise may be required between what is best for surgical access and the position the patient can tolerate.

In Pressure Ulcer Prevalence and Risk Factors among Prolonged Surgical Procedures in the OR, the authors describe a cohort study tasked with identifying risk factors associated with pressure injury development. While the researchers concluded that certain intrinsic factors (including patient age, weight, co-morbidities, and nutritional status) were often factors in the injury, extrinsic factors such as temperature, moisture, and friction or shearing forces played a significant role as well. The findings indicated that positioning and table surfaces are two key components that influence pressure ulcer development.

The compromise:

  • Tilting the operating table can improve surgeon access, but can cause changes in ventilation and perfusion, and compress vascular structures.
  • The positioning of surgical equipment (microscope, laser, robot) for ease of use by the operating team can create injury to the patient’s skin, digits, or spine.
  • Regarding patient positioning, the head and neck must be in a neutral position; “however, the only surgical personnel that should maintain control of the head and neck is the anesthesia care provider.”
  • Safety straps are designed to protect the patient, yet can cause shearing and friction injuries.
  • Intravascular lines, endotracheal tubes and urinary catheters must be free to move, yet adequately secured before any movement.
  • In the prone position, the patient’s head may move significantly during the procedure, resulting in direct pressure on the eye.

“The goal of the surgical position is to provide optimal visualization of, and access to, the surgical site that causes the least physiological compromise of the patient, while also protecting the skin and joints”, caution the authors of “Lateral position…beware!” in the Journal of Anaesthesiology

Is positioning in the O.R. a problem?  Definitely.  “All surgical patients should be considered at risk for pressure ulcer development, AORN states. And, according to the American Society of Anesthesiologist Closed Claims Project database, perioperative nerve injury is the second most common class of injury next to death!

At Action Products, our concern is the creation of pressure relieving and redistributing devices as a method of preventing the development of pressure ulcers. Devices used include different types of mattresses, overlays, cushions, and seating. These devices work by reducing or redistributing pressure, friction or shearing forces. When creating products for use in the operating room, that translates into pressure injury prevention through the right-sizing of each product to optimize patient positioning and the prevention of friction and shear. In fact, as pioneers in reusable pads and positioning products, Action Products has been named a leader due to the clinical performance of its products in the O.R., including their effectiveness in preventing friction and shear.

At Action Products, we are all aware that bridging the “compromise gap” in the O.R. must remain a major goal in all facets of perioperative care.