perioperative nurse educator at Temple University Hospital in
Philadelphia, Pa. "But it can also cause a lot of pressure on the coccyx
and ischial tuberosities, so make sure patients are properly supported
and that their buttocks is padded."
When choosing shoulder positioning devices, look for models that
stabilize the joint and provide enough distraction for the surgeon to
work on the front, back, side and top of the shoulder, says Dr.
Lubowitz. "We want wide access — 270 degrees in 2 different planes,"
he explains.
Some positioners hold the operative arm in place and let the surgeon
apply and adjust traction without assistance. That's a nice feature and
frees up nurses in the room to focus on other responsibilities.
Accessing the knee
During knee arthroscopy, when patients are supine, place them as
close to the side of the bed as possible so surgeons can distract the
knee enough to gain optimal access to the joint's various compart-
ments. Also place a support under patients' legs, so the heels aren't
touching the table surface. Also slide a pillow underneath the knees to
prevent stretching of the peroneal nerve.
Placing a lateral leg holder against the outside of the patient's leg
holds the knee in place and gives surgeons better access to the inside
of the joint. Make sure the holder's post is properly positioned. If it's
placed too close to the hip, for example, it won't be as effective as a
counter force, meaning the surgeon won't have enough leverage to
open up the tight medial aspect of the joint.
Almost all arthroscopic knee procedures are done anteriorly, says
Dr. Lubowitz. "We can now use advanced arthroscopic techniques to
work in the posterior aspect of the knee from the front of the joint."
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