resulting in
the so-called
V/Q mis-
match.
• And then
there's "meat
hooking," the
new risk
brought on by
robotic-assist-
ed
laparoscopy.
When a patient slides on the table while robotic arms are buried deep
inside the trocars, the trocar sites act as meat hooks, restraining the
patient by the abdominal wall against gravity's pull. This can cause
painful incisional tears, hernias and necrosis at the camera port.
Fortunately, there are plenty of pads, restraints and bolsters out
there designed to secure patients in Trendelenburg — from half-moon
shaped shoulder bumps and stabilizing pillows to bean bag position-
ers with rail straps and foam pads that mold and conform to the
patient's body. Here are 5 tips for safe patient positioning in
Trendelenburg.
1. Shoulder bumps, not braces. Shoulder braces used to be the size
of cinder blocks — and as unyielding. They were effective at keeping
patients from sliding, but they'd often cause brachial plexus injuries
because they'd force so much weight and pressure on the clavicle. Now
they're called shoulder bumps. They're shorter and shaped like half
moons, meant to stabilize the patient, not completely stop him and
stretch out the brachial plexus. Bumps don't come all the way over the
shoulders; you just tuck them under the shoulders. Another raised half-
6 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J a n u a r y 2 0 1 7
• ARM POSITIONING If you need to abduct the patient's arm for the case, do not exceed 90 degrees.
Brent
Klev,
MBA,
BSN,
RN
