References:
1. https://doi.org/10.1016/j.juro.2016.11.030.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838256/)
3. Burlingame B, Davidson J, Denholm B. Guideline for positioning the patient.
Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017.
DOI:10.6015/ psrp.17.01.e1.
4. HC.Fletcher Preventing skin injury in the OR. OR Nurse. 2014; 8(3):29–34.
5. https://doi.org/10.1016/j.jclinane.2014.01.012.
6. Aronovitch S. Intraoperatively acquired pressure ulcers: are there common
risk factors? Ostomy Wound Manage. 2007;53(2):57–69.
7. Black J, Fawcett D, Scott S. Ten top tips: preventing pressure ulcers in the
surgical patient. Wounds Int. 2014; 54(4):14–18.
8. https://www.mnhospitals.org/Portals/0/Documents/ptsafety/
skin/OR-pressure-ulcer-recommendations.pdf. Accessed February 2, 2018.
9. https://doi.org/10.1016/j.jmig.2010.02.010.
Positioning best practices
have been performed in
the United States in the
last 14 years.
2
million+
robotic procedures
1.75
Only use evidence-based
positioning products. Off-label
use of items can put the patient
at a higher risk for injury.
7,8
Apply adequate padding at
all pressure points to minimize
neuromuscular injuries and
avoid extreme flexion, extension
and abduction.
Use foam padding under
the patient's head to maintain
head alignment.
Tuck and secure the patient's
arms at their sides.
Avoid crisscrossed chest straps.
This technique can place pressure
on the shoulder area and result in
significant skin and nerve injury.
9
Do not allow tape to come into
direct contact with the patient's
skin by using a barrier if tape
must be used.
Use positioning aides to help
maintain the patient's position
and prevent them from sliding,
such as a padded chest strap or
foot board.
Adjust the robot console
settings to allow for maximum
ergonomic comfort prior to
starting the procedure.
Reassess the patient's position
frequently during the procedure
to ensure that the patient is still
positioned correctly and to make
necessary adjustments.
Do not move the OR table or
patient intraoperatively without
undocking the patient and
releasing and removing the
instruments and robotic camera
to avoid serious patient injury.
Use disposable positioning
products to minimize the risk
of cross contamination.
1
2
12
11
10
9
8
7
6
5
4
3
Best practices
Conduct a preoperative assessment
to identify risks, develop a plan of care
and implement interventions to
prevent injury.
The assessment should include:
Procedure type
Procedure length
Patient tolerance level in
required position
Required surgical exposure
Ability of the anesthesia
provider to access
the patient
4,5,6
Patient history
Current skin condition
12
Patient positioning risks
Robotic surgery
Pressure and compression injuries
Physiological effects
Nerve injuries
Increased intraocular pressures
Skin tears and punctures
Robot-assisted surgery procedures have become a dominant surgical method.
1
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