Each of the clinical papers listed here should be 3-5 pages long (some will be longer), typed, double-spaced, and referenced. Do not cite references that are more than 5 years old, unless you are doing so for historical purposes. When you cite the Guidelines for Perioperative Practice- formerly known as Perioperative Standards and Recommended Practices [AORN], you must use the most current version. The 2021 edition can be ordered from AORN.
Paper Description: Review and critique the institution’s plan of care for a surgical position you have used. Discuss the RNFA’s role during the preoperative briefing and during actual patient positioning. What are critical patient assessment parameters, and how does the RNFA evaluate the achievement of desired outcomes of safe surgical positioning? Be sure to include any relevant nursing interventions related to DVT prevention.
I choose the Lithotomy position for the paper
My Hospital’s policy:
Lithotomy:
Patients are first anesthetized in the supine position. In select cases, the attending surgeon may choose to position the patient in the stirrups while awake to ensure patient comfort.
Knee Stirrups
Yellow Fin stirrups
The stirrups support the patient’s legs at the calf and are used on all lithotomy procedures.
Grasping the sole of the foot in one hand and supporting the leg near the knee in the other hand raise the legs slowly and simultaneously. Raising one leg at a time may cause injury to the hip or hip structures.
The knees are bent slightly, and the foot and calves are made to rest in the boot of each stirrup.
Toe, knee and opposing shoulder are anatomic landmarks for alignment.
The legs are padded and secured.
The surgeon may make any necessary adjustments.
The pressure points for consideration in the lithotomy position are the occiput, the shoulder, blades, the sacrum, and the heels. These areas may be protected with a foam dressing if the procedure is expected to exceed three hours or if the patient’s BMI is 19 or below. If the patient has a low BMI, below 19, foam dressings to protect the spinal processes will be considered.
Care is taken while lowering the foot end of the table to not entrap the patient’s fingers.
Note: Whenever in a lithotomy position regardless of positioning device:
The patient’s position is symmetrical.
The perineum is in line with the longitudinal axis of the table
Arms are placed on arm boards as previously described.
After the procedure, the legs are brought down simultaneously and slowly to prevent strain on the lumbar-sacral muscles and to allow gradual adjustments to position change (I.e blood pressure).
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