SAFE POSITIONING FOR NEUROSURGICAL PATIENTS

Authors

  • Danielle St. Arnaud
  • Marie-Josée Paquin

Abstract

Positioning the patient for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage.

The objectives of perioperative positioning activities are to balance optimal surgical exposure with the prevention of any injury related to position and to maintain normal body alignment without excess flexion, extension, or rotation.

After providing general principles of positioning, specific considerations with surgical rationale are presented for each of the commonly used neurosurgical positions (eg. supine, knee-chest, prone, lateral, park-bench, sitting).

Author Biographies

Danielle St. Arnaud

Danielle St-Arnaud, RN, BSc, CPN(C), is a Nursing Professional Development Educator for the Operating Room at Montreal Neurological Hospital, Montreal, Quebec, Canada. Ms. St-Arnaud has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.

Marie-Josée Paquin

Marie-Josée Paquin, RN, BScN, is a Staff Nurse in the Operating Room at Montreal Neurological Hospital, Montreal, Quebec, Canada. Ms. Paquin has no declared affiliation that could be perceived as a potential conflict of interest in publishing this article.

References

Goodman T. Pressure damage in surgery. July 14,

http://nursing.advanceweb. com/common/

Editorial/Search/AViewer.aspx? AN=NW_ 05jul14_

n2p33.html&AD=07-04-2005. Accessed April

, 2008.

Rithalia S, Kenney L. The art and science of

evaluating patient support surfaces. World Wide

Wounds. http://worldwidewounds.com/2001/

september/Rithalia-and-Kenney/Evaluating-

Support-Surfaces.html. Accessed April 14, 2008.

Periop 101: A Core Curriculum. Denver, CO;

AORN, Inc; 2007.

Recommended practices for positioning the

patient in the perioperative practice setting. In:

Perioperative Standards, and Recommended

Practices. Denver, CO: AORN, Inc; 2008: 497-520.

AORN guidelines for prevention of venous

stasis. AORN J. 2007;85(3):607-624.

O’Connell P. Positioning impact on the surgical

patient. Nurs Clin North Am. 2006;41(3):173-192.

Heizenroth PA. Positioning the patient for

surgery. In: Rothrock JC, Mc Ewen DR, eds.

Alexander’s Care of the Patient in Surgery. 13th

ed. St Louis, MO: Mosby; 2007:130-157.

Ferrara DL. Neurosurgery. In: Rothrock JC,

McEwen DR, eds. Alexander’s Care of the Patient

in Surgery. 13th ed. St Louis, MO: Mosby; 2007:

-862.

Winfree CJ, Kline DG. Intraoperative positioning

nerve injuries. Surg Neurol. 2005;63:5-18.

Schonauer C, Bochetti A, Maraci A,

Barbagallo G, Albanese V. Positioning on surgery

table. In: Haemostasis in Spine Surgery.

Heidelberg, Germany: Springer Berlin; 2005:50-

http://www.springerlink.com/content/j68237

u754074j3/?p=ibd64. Accessed April 23, 2008.

Graftieaux JP, Littré F, Gomis P, Malinovsky

JM. Interest and feasibility of a modified supine

position for posterior cranial fossa surgical

procedures [in French]. Ann Fr Anesth Reanim.

;23(7):751-754.

Kamming D, Clarke S. Postoperative visual

loss following prone spinal surgery. Br J Anaesth.

; 95(2):257-260.

Roth S, Tung A, Ksiazek S. Visual loss in a

prone-positioned spine surgery patient with the

head on a foam headrest and goggles covering the

eyes: an old complication with a new mechanism.

Anesth Analg. 2007;104(5):1185-1187.

Woodruff C, Hemmerling T, English M.

Postoperative visual loss after plastic surgery in

the prone position: a case report. Can J Anesth.

; 54:1230-1400.

Daley MD. Positioning and the geriatric surgical

patient. Today’s Surg Nurse. 1997;19(5):13-18.

Bambakidis NC, Gonzalez LF, Amin-

Hanjani S, et al. Combined skull base

approaches to the posterior fossa. Neurosurg

Focus. 2005;19(2):1-9. http://www.aams.org

/education/journal/neurosurgical/aug05/19-2-

pdf. Accessed April 14, 2008.

Kim LJ, Klopfenstein JD, Feiz-Erfan I,

Zubay GP, Spetzler RF. Postoperative acute

sialadenitis after skull base surgery. Skull Base.

;18:129-134. http://www .thieme-connect.

com/ejournals/abstract/sbs/doi/ 10.1055/s-

-991110. Accessed February 20, 2008.

Guarnieri J, Derlon JM, Houtteville JP. The

ventrolateral position [in French]. Neurochirurgie.

; 50(2-3 Pt 1):105-110.

Engelhardt M, Folkers W, Brenke C, et al.

Neurosurgical operations with the patient in

sitting position: analysis of risk factors using

transcranial Doppler sonography. Br J Anaesth.

;96(4):467-472.

Gale T, Leslie K. Anaesthesia for

neurosurgery in the sitting position. J Clin

Neurosci. 2004;11(7):693-696.

Butler VM, Dean LS, Little JR. Positioning

the neurosurgical patient in the operating

room: “a team effort.” J Neurosurg Nurs.

;16(2):89-95.

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Published

2009-12-01

How to Cite

St. Arnaud, D., & Paquin, M.-J. (2009). SAFE POSITIONING FOR NEUROSURGICAL PATIENTS. Operating Room Nurses Association of Canada Journal, 27(4). Retrieved from https://ornacjournal.ca/index.php/ornac/article/view/12393

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Section

Feature Articles