Position of arms

yoga,

in an ideal setting, i would like to pad the elbows w/ gel pads and place them in a thumbs up position - but i find that the OR nurses in an attempt to help and expedite often tuck the arms prior to my inspection....

according to your references - what is the best way??

I grab 2 packs of ulnar pads, place one against the body and one on the outside of the arm against the elbow ... pronate my hands for lithotomy (always checking my fingers!), thumbs up for supine. If I know my arms will be tucked for a supine case (and I can get to the holding area in time), I'll start my large gauge IV in the cephalic vein - keeps excellent flow and is less likely to kink.

What literature do you have to support the way you position, yoga? And who in their right mind is arguing with you?

I'm going to try to keep this clinical idea afloat with a question.

How do all of you position the arms when the patient's arms are tucked at the side, not on armboards? This is when the patient is under general anesthesia.

Are the arms pronated or supinated and how are they padded? Even though I have some excellent references to prove my point, there has been a recent argument in my operating room about how the arms are positioned in other facilities.

Yoga CRNA

We kinda do a "tweener" (thumbs more or less at 10 and 2 (left thumb at 10 oclock and right at 2) with the plexiglass arm holders, egg crate, gel pads. Many times we just tuck them close with just sheets (under and through arm and then tucked under patient). Armboards come out.

Never had any problems (of course constant checking avoids the problems). If I had to say...... I guess the arm is in more of a supinated position. I leave the mid forearm down uncovered but tucked with sheets in case I have to restart a line (IV, A-line, etc.).

(I agree Yogi, who is debating you?)

Mike

We kinda do a "tweener" (thumbs more or less at 10 and 2 (left thumb at 10 oclock and right at 2) with the plexiglass arm holders, egg crate, gel pads. Many times we just tuck them close with just sheets (under and through arm and then tucked under patient). Armboards come out.

Never had any problems (of course constant checking avoids the problems). If I had to say...... I guess the arm is in more of a supinated position. I leave the mid forearm down uncovered but tucked with sheets in case I have to restart a line (IV, A-line, etc.).

(I agree Yogi, who is debating you?)

Mike

Also, I guess you would call it more or less a neutral position (with slight supination).

Mike

I usually tuck with gel pads wrapped around the elbow, hands in neutral position with thumbs up. When tucking the sheet, I make sure to include the elbow and not just the forarm. If the tuck before the patient goes to sleep, I make sure they are in a comfortable position after tucking.

The site I am at currently does not have elbow pads or egg crate, so I am just more careful with the sheet.

We have 1 GYN doc who wants us to make hand protectors out of NSS bottles and surgical towels. This works great for protecting the fingers, but I do not do it all the time.

I do it like mwbeah. The arms are in a neutral position left thumb at ten, rt thumb at 2 0 clock. Draw sheet rolled over arms and directly under pt. No problems so far.

From previous posts describing your position...I guess the argument is coming from the surgeons??

Where I am, tucking is kinda first-come-first-serve (might be done by anesth. pros, anesth. techs, or circulator). I know when someone else does it I, as circulator, check, and I'm sure everyone else checks when I tuck.

We tuck in a thumbs up position, too, as mentioned and now I'm noticing that that is the position promoted in Alexander's. We use armboards with ulnar protectors as needed, usually just a sheet on litter cases.

I do think the "neutral" 10 an 2 o'clock position sounds comfy, too...curious to hear more.

BTW- our arms are always supinated on armboards, but according to Alexanders (it must be years since I read this page) that is contoversial and some people prefer to pronate?

another by-the-way... I'm not a anesth provider, nor aspire to be one but spending so much time at the foot of the OR bed I like to know as much as possible what's happening at the head...glad to see the clinical topics!