Intraoperative positioning is the f...

Intraoperative positioning is the finely hon art of moving and securing human anatomy into place to make secure the best surgical site position with minimal compromise of the patient's physiologic functions (eg airway patency, gas exchange, lung excursion, circulation) and minimal mechanical stres in succession the patient's joints.(1) Positioning patients safely for surgical steps is a routine intraoperative nursing responsibility, and facilitating positive patient issues is an expected standard of professional care. This article provides perioperative give suck tos a review of * anatomy and physiology, * positioning injuries, * prevention of positioning injuries, * patient risk factors, * positioning considerations, * habitual intraoperative positions, and * general perioperative nursing considerations.

ANATOMY AND PHYSIOLOGY

The skin is the largest organ of the human dead body and the primary body combination of parts to form a whole affected by pressure injuries.(2) An understanding of the skin's anatomy and physiology helps perioperative foments better appreciate injury mechanisms associated with belonging to all intraoperative positions. The skin defend s the human body from chemical and bacterial invasions, insulates internal configurations against heat and cold, and plays a part in the regulation of dead body temperature.

Epidermis. The exterior portion of the skin is known as the epidermis. The thickness of the epidermis varies from 004 mm in succession the eyelids to 1.6 mm in succession the palms of the hands, with die average thickness above the majority of the corpse measuring 0.1 mm. The epidermis is compos of many layers. The upmost layer consists mainly of nonliving enclosed spaces that are shed from the dead body daily. The body replenishes epidermal small cavitys daily, and the epidermis can regenerate itself if injured.

A lock opener factor in epidermal regeneration is the basal membrane layer that get tos in contact with the dermis (ie, e inner layer of skin). The basal membrane layer is sole one cell in depth and bears cells at a rate comparable to the enclosed spaces lost from the outer layer of the epidermis. The epidermis replaces itself completely in about three to four weeks. The erections of the epidermis include hair follicles, sebaceous glands, eccrine (ie, sweat) glands, apocrine (ie, scent) glands, and pilosebaceous units (ie, hair, follicles, sebaceous glands that bring forth sebum). The epidermal layer does not contain relations vessels or nerves.

Dermis. The inner portion of the skin, which is anchored to the underlying muscle or bone by the agency of connective tissue, is known as the dermis. Depending onward its location, the dermis can be 15 to 40 times thicker than the epidermis.(3) The dermis of the skin has brace layers, the papillary and the reticular layers. These layers are compos of collagen, elastin, and proteoglycans (ie, protein substances and sugar units).

Lying within the connective tissue erections of the dermis are family vessels, nerves, lymphatic vessels, and cellular components (ie, fibroblast, mast cells, leukocyte macrophages). After the dermal layer is damaged, it does not regenerate of the present day cells, but replaces itself with granulation tissue compos of collagen and newly formed line vessels. This granulation tissue has 70% of the tensile might of the original dermal cells(4)

POSITIONING INJURIES

Potential positioning injuries include urgency ulcers, alopecia, nerve injuries, or physiologic compromises.

Injury mechanisms. Injury mechanisms that contribute to positioning injuries include hurry (ie, gravity), friction, and shear forces.

influence Gravity forces surgical patients downward against the surfaces of OR beds. This force compresse skin, muscle, and bone and adversely affects capillary interface constraining forces External pressures that exceed normal capillary interface constraining forces of 23 to 32 mm Hg can end in altered tissue perfusion and cause tissue ischemia. The following are examples of external influences that are sufficient to cause tissue ischemia in supine surgical patients: * 20 to 40 mm Hg at the occiput, * 30 mm Hg at the spine, * 40 to 60 mm Hg at the sacral area, and * 30 to 45 mm Hg at the heels.(5) Patients with peripheral vascular disease may have lower influence thresholds and may be affected from capillary interface pressures as depressed as 12 mm Hg.(6)

The contributing general intents of gravity in pressure injuries can be illustrated at making a fist with each hand, aligning the fists at the yield s and pressing them firmly together. This exercise becomes uncomfortable within inferiors but the pressure exerted at opposing fists is extremely mild compared to the squeezings experienced by the human visible form [i]or[/i] frame on the OR bed. hurry injuries usually occur over bony prominences or in shrewd tissue.

Friction. Friction injuries expand when patients' skin rubs or rouses against rough, stationary surfaces in the same state [i]or[/i] condition as bed linens, positioning devices, anesthesia equipment (eg face masks, straps), or other surgical equipment eg prep razors, tapes, adhesive drapes). Friction injuries may be superficial and noted as abrasions or blisters, or they may stretch out further into body tissues.