Patients are often at their most vulnerable when undergoing surgery in the operating room, with anaesthesia, and the prolonged immobility and loss of sensation it entails putting them at risk from skin, nerve and musculoskeletal injury. With its range of positioning products, Allen Medical is dedicated to ensuring the safety and comfort of patient and caregiver alike.

Allen Medical, a Hill-Rom company, has been a leader in patient positioning for the operating room for more than 15 years. Using its innovative R&D, the company is dedicated to providing solutions for all surgical requirements, and primarily for spine, orthopaedics, and procedures that require the patient to be in a lithotomy position either with or without Trendelenburg.

The goals of patient positioning

In all surgical situations, there is a permanent balancing act needed in order to deliver the best patient care while ensuring that the surgical team has access to perform the operation – procedures that are becoming more complex all the time. In addition, more attention has recently been given to the staff and caregivers in the OR so that they are protected from any work-related issues or injuries.

General or regional anaesthesia, and the resultant reduction in movement and sensation, mean patients are susceptible to injuries. Some of the key goals for patient positioning are therefore as follows:

  • maintaining patient dignity
  • providing adequate exposure and surgical access
  • allowing optimum ventilation
  • avoiding poor perfusion
  • protecting muscles, nerves and skin, as well as genitals and extremities.

The skin is susceptible to injuries in surgery; incorrect management of the patient can lead to various levels of skin damage, up to and including full-thickness skin ulcers. In the US, 23% of all hospital-acquired skin injuries originate in the OR. These injuries are created by direct pressure, shear or friction, and there are a number of factors that can diminish or heighten the potential risk of injury.

Vertical shear (direct) pressure is a result of soft tissue structures being pushed against firm structures – normally this means bony prominences. This is mitigated by protecting all obvious bony prominences with suitable positioning equipment and having a clear understanding of the underlying anatomy.

Horizontal shear pressure is the folding of underlying tissue caused by the skin sticking to a surface and the patient moving without the skin moving, ultimately causing the tissue underneath to fold over. The risk can be reduced by using appropriate pad covers that enable the skin to slide across.

Nerves are susceptible to damage from being overstretched and from direct pressure compression. Stretch and compression injuries can result in temporary or permanent damage. The most common sites for nerve injuries are the brachial plexus, and the peroneal and facial nerves.

The brachial plexus can be overstretched when positioning a patient if the arm is positioned too high or low on an arm board, or if the arm board itself is too high or low relative to the table. In addition, the position of the head may stretch the nerve bundle if it is either laterally rotated or leaning to one side.

The common peroneal nerve is vulnerable to compression. It may also be damaged from either hyperextension of the knee or pressure behind the knee

Into position

Allen Medical produces solutions for a wide range of surgical positioning requirements. Just one example of equipment that can mitigate the risks discussed in this article is the Allen Advance Table, which has numerous features specifically designed to counteract such issues.

The table’s pads are made up of a multilayered structure that offers stability while helping to minimise direct pressure on the patient. Attention has also been paid to the geometry and location of the pads to reduce the risk of pressure on nerve structures and the brachial plexus in particular. The pads also have comfort covers that reduce shear pressure while also wicking away moisture. The C-Flex head positioner enables the patient’s head to be positioned accurately for surgical needs and to manage pressure on facial structures.

The table also incorporates unique safety features to maximise patient safety and has numerous caregiver benefits, including a simple user interface, as well as features such as the central-locking castors.