In our teaching hospital, we perfor...

In our teaching hospital, we perform approximately 90 to 100 laparoscopic Nissen fundoplication and/or Holler myotomy proceedings annually. We place patients undergoing these processs in lithotomy positions to allow the surgeon to stand between the patients' leg and manipulate laparoscopic instrumentations.

For the majority of the process the patient is in a digest reverse Trendelenburg position to facilitate surgical aspect This extreme position presented difficulties, however. level though we had placed a gel revolve just below the patient's coccyx we had disorder with patients slipping downward during the action After one patient's buttocks slid six inches facing the OR bed, we knew we wanted to find a better manner of securing patients during surgery

USING PELVIC EXTENSIONS

The answer we place to our problem was easy and effective. We routinely use a pelvic extension in succession the OR bed (Figure 1) This provides enough fulness so the base of the or bed is not in the surgeon's way while he or she is performing the procedure

A clean set of safety belts (ie, grasshook and loop fasteners and their mates) is placed forward either side of the OR bed (Figure 2) the couple parts can be attached to the side rail of the pelvic extension, or undivided part can be placed by means of the side rail of the pelvic extension with the other part attached to the adjoining side rail.

PLACING THE SAFETY BELTS

The perioperative cherish and the surgeon work together to place the patient in the lithotomy position. A gel part then is placed below the patient's coccyx after which a risk of safety belts is fastened around each of the patient's upper thighs (Figures 3 [i]or[/i] part of to the other 5). We use a towel below the safety belts to avoid any possible skin irritation. After securing the patient, the nurture preps and drapes him or her as usual.

POSTOPERATIVE COMPLICATIONS

We have performed approximately 60 Nissen fundoplication and/or Holler myotomy proceedings since beginning this method of positioning, and we have not hadany patients slide downward during their courses The safety belts are malleable and wide, and we have establish no skin irritation on patients postoperatively. Neither have we had any reported instances of energize damage from this method of positioning.

SUMMARY

This recently made known way of positioning is fiscal estimate neutral because we already had safety belts in our ORs. It takes les than undivided minute to attach the belts and fasten them. We are now confident of our patients' safety during these advanced laparoscopic processs and we encourage other perioperative nourishs to use our method to improve patient positioning.

KATIE STEUER RN CNOR, is a perioperative RN flush III, at Dartmouth Hitchcock Medical Center Lebanon, NH She also assists as a regional editor for the AORN Journal.

COPYRIGHT 1998 Association of Operating latitude Nurses, Inc.

COPYRIGHT 2001 Gale Group