ROM intra-op for long cases

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Hi.... My first time on here! :typing Hope I'm doing this correctly! : P

I have a pressing question.... During long cases (>4 hrs), whether supine, or more specifically lithotomy position, do any of you practice patient ROM? If yes, could you include specifics as to how you do this and to what extent? Our policy currently states we should be doing this, but.....

Anxious to hear from you! Thankyou! :)

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Specializes in OR, Nursing Professional Development.

Not here. How would you be able to do that and not disturb the surgeon or sterile field? :confused:

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Specializes in 2 years school nurse, 15 in the OR!.

Not here...I'm with the earlier post, how in the world are you supposed to do that? I must not be understanding...:confused:

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It seems that the author of the policy has never actually done a long case. "OK, lets stop this 4 hour surgery now, time to stretch your legs!":confused:

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Specializes in US Army.

Because you do not do any ROM during surgical cases this is where it is important that you as the OR nurse have positioned the patient correctly, have maintained normal body alignment, and padded all pressure areas.

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Specializes in L&D, OR, travel.

ROM is recommended during long procedures in the AORN standards of care. I don't have the specific guidelines at hand, but it was addressed in a session I attended at the 2009 Congress. Of course those that wrote and researched the standards were not present to explain. Nevertheless the speaker, who was an expert in positioning, promoted this.

Good question from the OP. It is an expectation, but a reality?

Deb

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Specializes in 2 years school nurse, 15 in the OR!.

So, I am doing a spine case on a jackson frame with instrumentation. I am supposed to get under the drape, remove the seatbelt and start moving this patient's legs without contaminating anything? Or furthermore, causing the patient to fall off the frame? Talk about ROM! What are these people smoking?

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Specializes in OR scrub/circulator, hospice crisis care.

We just had a Grand Rounds presentation at work that mentioned this. The GYN MD presenting said that during long surgery using standard lithotomy position (as OP asked) that he wants the patient's legs lowered after 90-120 minutes to improve circulation. He didn't specify whether this was done within the sterile field or by breaking the drapes down and re-draping afterward.

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Specializes in CRNA, Finally retired.
We just had a Grand Rounds presentation at work that mentioned this. The GYN MD presenting said that during long surgery using standard lithotomy position (as OP asked) that he wants the patient's legs lowered after 90-120 minutes to improve circulation. He didn't specify whether this was done within the sterile field or by breaking the drapes down and re-draping afterward.

Gee - after 25 years, I don't believe I've ever seen a case with a patient in lithotomy for more than 60-70 minutes. I work with one surgeon who uses extreme lithotomy he's done in 45 minutes. No one should be in lithotomy for long periods but the new leg holders are much kinder to circulation than the old candy canes. I do massage patients elbows and scalps when the case permits - once an hour. But I'm anesthesia and would not take kindly to anyone else massaging the patient. Positioning is ulltimately our job and I believe that we are the ones usually sued for nerve injuries.

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Specializes in OR scrub/circulator, hospice crisis care.
Gee - after 25 years, I don't believe I've ever seen a case with a patient in lithotomy for more than 60-70 minutes. I work with one surgeon who uses extreme lithotomy he's done in 45 minutes. No one should be in lithotomy for long periods but the new leg holders are much kinder to circulation than the old candy canes. I do massage patients elbows and scalps when the case permits - once an hour. But I'm anesthesia and would not take kindly to anyone else massaging the patient. Positioning is ulltimately our job and I believe that we are the ones usually sued for nerve injuries.

Working in Neuro and Ortho Trauma for only a year, I've never seen anyone in lithotomy at all... but I'm teachable. And the MD didn't mention ROM, he only talked about lowering the legs. I have checked under the drapes to make sure heels, elbows etc haven't been shifted - I agree that initial positioning is key.

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