Positioning Ideas: Lithotomy

[nursinadream]

Any good hints for lithotomy positioning? We do lots of laparoscopic cases; supracervical hysts, LAVH, sacral colpopexy, etc. Both arms are tucked and wrapped with foam. During steep Trendelenburg the patient slips/slides toward the head. Couple surgeons want us to put egg crate padding under patient to prevent the slipping. Anybody have luck with that, or something else? We did it that way a couple times but when you move down "south" to place in yellow fins the foam wants to slide right with the patient.

Deb

[jwk]

You're wrong. There is very little weight on the top of the shoulders. You act as if the patient is doing a headstand. It takes very little pressure to prevent a patient from sliding during trendelenburg. If there were a lot of weight, your eggcrate idea would not work. Furthermore, your eggcrate idea is unsafe because the patient can still slide if the angle is too steep

Apparently you don't do the types of cases we do. We use the eggcrate precisely because the patient is in max trendelenburg position, which approaches 45deg on our OR tables. The egg crate is secured to the table with wide adhesive tape. We don't use a sheet on top of the egg crate, and of course it is discarded after the procedure. The ridges in the eggcrate provide enough friction/resistance to keep the patient from sliding down the table. Leaving the patient on a regular table, putting something in place to block the shoulders, and then putting the patient in max trendelenburg WILL put significant pressure on the shoulders. If there were no cephalad force on the shoulders, there would be no reason to try the shoulder blocks as you have suggested, would there?

We use the same technique for some bariatric procedures and lap nissens as well to help keep them from sliding during steep reverse trendelenburg cases.

[nursinadream]

jwk,

I understand what you are saying, but explain in even more detail if you can. You are using the egg crate (ours is yellow) only, no devices for any body parts to rest on. And up to 45 degrees T-berg - maybe more (we do for sacral colpopexy, for 3 hours or more). Please tell me anything else, you said no sheet, how do you slide them up or down? or off the table? Which side to patient? You say it stays in place? great.

Tell me more. We are quite challenged by this. I think we are way outside of suggested guidelines for positioning in lithotomy. Our uro-gyne docs really like the buttocks off the bed, ouch, I'm amazed the women ever walk after this.

Thanks Deb

[linda2097]

If the sliding pressure is were heavy enough to put dangerous levels of pressure on the shoulders, then eggcrate would not work either. Eggcrate works precisely because the sliding pressure is mild.

For very heavy patients, eggcrate is risky. If the angle-to-weight ratio gets too dangerous, there is nothing to stop the patient from sliding off the table. And the head will hit the ground first. It's your license.

If you truly want to protect the patient, then go ahead and use the eggcrate, but put shoulder braces on as well. Then, you're safe.

[fracturenurse]

I agree, if you could give more detail on the eggcrate. I have to agree with Linda, I would be worried about heavy patients sliding right off the table.

Thanks...