Positioning for Da Vinci Robot Gyn cases

[bjsmsn]

I would like to know how other facilities position their women for Da Vinci robot gyn cases to keep them from sliding off the head of the bed when the bed was placed in extreme Trendelenberg position. We originally used the 'u'shaped shoulder supports that attached to the bed, but patients developed brachial plexis injuries secondary to the supports and the apparent pressure of their shoulders against the supports. So we went to the eggcrate foam across the chest and the tape over the eggcrate. The anesthesia provider stated that for this to be effective, the tape would have to be so tight that it would impede chest expansion during the case indicating that even this would not keep the patient on the bed. Another thing we do is to put the patient on a mattress sized gel pad with no sheet over it. The thought behind this was that the patient would "stick" to the gel pad and that and the tape over the eggcrate across the chest would keep her in place. My first concern was the possibility of shearing injury to the back and hips of the patient as gravity would 'pull' her body towards the head when she was put in Trendelenberg position, but that the skin that was stuck to the gel pad would remain in place causing a separation of tissue along the horizontal plane, thus the shearing effect. I would appreciate any thoughts and ideas out there and suggestions for alternative positioning techniques. Thanks

[Rose_Queen, BSN, MSN, RN]

Beanbag with a cutout at the neck and then the flaps wrapped around the shoulders. Haven't heard about any brachial plexus injuries, but I'm not a member of the robot team.