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The supine position is the most common surgical position with the patient lying on their back with the head, neck and spine in a neutral position.   This position is not without pressure injury risk as there is increased pressure and shear forces to the scapula, occiput, elbows, sacrum, coccyx, and heels. Today we are going to look at ways to mitigate the risk for pressure injuries (PI) to the heel, related to the supine position. When a patient lies supine, all the pressure of their lower legs and feet rest on the heel.  Heel PI represents approximately one third of pressure injuries acquired, and can result in increased morbidity and mortality. In some cases, heel pressure injuries can lead to amputation of the affected limb.

One of the highly common surgical positions is supine. This approach involves the surgical team’s watchful eyes to oversee a patient that will lie on their back with their arms either tucked or untucked to provide direct anatomical and surgical exposure to any area from the head and neck to the anterior aspects of the lower legs and feet. Supine position may be requested for a myriad of surgical procedures including everything from a thyroid, chest, cardiac, general, urology, orthopedic, or podiatry procedure to name a few. Given the wealth of clinical indications for the supine position, intentional time must be afforded for the perioperative team to consider all areas of required surgical access, as well as the areas not exposed during the surgical intervention.

 By: Amos Schonrock, MAN, RN, ST, PHN, CSSM, CNAMB, CNOR, NE-BC, Perioperative Patient Safety Specialist

As perioperative professionals, the operating room team has a constant dedication and calling to the creation and maintenance of an environment that keeps our patient free from harm. As a vigilant guardian, the perioperative nurse is often at the forefront of this action. For positioning the perioperative patient, the nurse must use their senses to assess the patient’s well-being and current integumentary status as part of the pressure injury prevention assessment during all phases of care.

Some surgical procedures require extreme positioning to ensure that the targeted surgical area is accessible to the surgeon and the surgical team. Extreme positioning requires extreme positioning devices which are manufactured to meet the need for surgical access first and foremost. Unfortunately, the devices and positions needed for optimal surgical access can increase the risk for an interoperative medical  device related pressure injury. The resultant pressure injury generally mirrors the pattern or shape of the device. One common position that fits the extreme high-risk description is the Lateral Decubitus Position. This position is commonly used during surgery requiring access to the thorax, retroperitoneum, or hip with a patient lying on the nonoperative side and careful positioning of the extremities. The following are some best practices to help when positioning the patient in a lateral position.

One of the biggest responsibilities of the operating room (OR) team is to ensure patient safety. There are many facets to patient safety in the OR. Safe patient positioning is a critical facet since the patient is unable to tell you if they are in pain or uncomfortable.  The first step to improved outcomes related to patient positioning is to look to the evidence for guidance when choosing your positioning device.  There are extrinsic and intrinsic factors that contribute to the development of pressure injuries (PI) in the OR; one of the extrinsic factors is prolonged surface interface pressure. In this week’s blog we will look at a scientific comparison between foam and gel used as positioning devices in order to determine best practice.