inconsistency," says Ms. Digneo, the facility's nurse director. "Multiple
surgeons and different circulators were using different positioning
practices. Of course we also wanted to decrease the potential for hav-
ing pressure ulcers develop during surgery." It wasn't something her
staff had been having a problem with, and she wanted to keep it that
way.
A team made up of RNs, surgical techs, nursing aides and a CRNA
ended up recommending several changes to protect bony promi-
nences and vulnerable pressure points:
• Provide ankle support. The team realized that patients on their
backs were vulnerable to pressure ulcers, because their ankles were
being allowed to rest on OR tables and beds and weren't being elevat-
ed. "That was a change in practice," says Ms. Digneo. "We now have
gel supports that we place under patients' ankles to take their feet off
the bed."
• Look out for lithotomy. Patients positioned in stirrups are poten-
tially vulnerable in a couple of ways, the team found. One solution
was to equip tables with larger boots that accommodate, support and
protect the ankles and calves of larger patients placed in the stirrups,
eliminating the potential for spillover that could result in pressure
sores. Staff members were also reminded about the dangers of hyper-
extension and nerve injuries.
• Prevent slippage. The team also noted that patient warming
sometimes caused patients to perspire, which made them more likely
to slide when in the Trendelenburg position and potentially experi-
ence shearing. Plenty of pads, restraints and bolsters are designed to
secure patients in Trendelenburg, including an underbody pad that
Ms. Digneo says helps absorb perspiration and keep patients from
slipping and sliding.
• Avoid friction injuries. The team also decided against using foam
J U L Y 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 6 1
