prone positioning

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    I'm a nurse student, in my first years. When transfering a patient from the stretcher to the or table for surgery, wich steps and precautions you have to take?
    fully anesthesized? (general anesthesia)
    when to insert foley?
    how many people is needed to transfer?
    after surgery precautions?
    any recomendations will be very helpfull!!!!!!
    I don't have access to many literature (I live in Ecuador)
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    As with any transfer of a patient under general anesthesia, there should be at least 4 people transfering, more when the patient is heavy.
    Catheter goes in before you turn the patient, it is very hard to do after the patient is prone.
    As with all positioning in the OR you have to make sure all pressure points are padded. You can make padding out of any piece of foam, covered with a plastic bag, so it can be cleaned. Pillows are very good under the lower leg, so the feet are free from the OR table.
    Make sure when you move the arms you only rotate them in the way nature intended (you don't want any nerve damage). Also make sure the chest has space to move, so the patient can be adequately ventilated. Pillows under the shoulders will help with that.
    If you send me your address, I am sure I can find some material on this subject and send it to you.

    Marijke
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    Used to be we had to make chest rolls with rolled towels or blankets. These days, if you have access to it, you can put the patient on a Wilson frame. The newer Wilson frames don't require any more padding for the chest. I have seen one really good technique--if you have access to gel donuts (usually used to support the head) put one under each KNEE. You can put either a stack of blankets or (better) pillows to support lower legs and ankles. If a male--MAKE SURE SCROTUM AND PENIS are free-don't want them squashed. Make sure that abdomen hangs free, and that there is no pressure on the vena cava on either side; this can cause excessive bleeding. For the head, if you have access to it, a foam Shea or Richards headrest works well, and have slits cut for the ET tube. Make sure all pressure points are well-padded with gel pads (the best) rest-on foam or pieces of eggcrate mattress. Make sure Foley hangs to gravity without any kinks, and put it near the head of the bed so that the anesthesiologist can see it. Last, when you turn back supine, it is best to do it right onto the bed or gurney you are transporting on--DON'T forget to get the Foley up before you turn.
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    thank you!
  8. 0
    lindsey: all info is good info.i always try in any position to try to work from the pt.out.ask yourself why we need this postion in the first place and to what area of the body you need access to.pt. hx will determine what to be cautious about / limitations etc. in the prone position all tubes, lines need extra observations: where are they now and where are they going to be during and after to move ? let me back up, in the prone position under general anesthesia (local pts. is different considerations) allow for chest expansion is correct,the most important and what most nurses aren't aware is the pressure of the spine upon the ascending vena cava. this potential problem doesn't allow for adequate blood flow returning to heart.the chest rolls need to be the proper lenght and diameter for the most" correct " support. after just putting this much info i realise that i could go on and on. if you still have specific problems the others haven't answered maybe i can help some more.not to boast, but after doing neuro, spinal,ortho,and chest.i always ask the doc. u name the position and i'll get you there. all positioning starts with the patient.


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