PositioningChallenges of the Upper Extremity
Theoperating room (OR) team is responsible for ensuring appropriatepatient positioning. Proper surgical positioning is significant inpreventing patient injury, which range from organ damage as a resultof hypotension or hypoxia, and nerve injury as a result of tractionor compression (Warner, 2009). It is vital for the OR team to putinto consideration some patients who are at an amplified risk as aresult of disease. Patients suffering from obesity, diabetes,hereditary peripheral neuropathy, and peripheral vascular illnessamong others are at elevated risk of peripheral nerve injury (Warner,2009). Besides, skinny patients have a high likelihood of gettingperipheral nerve injury.
Supineposition is the major patient positioning used during upper extremitysurgical processes. Compared to other positions, it is believed to bethe safest positioning, and is not linked with catastrophic ordramatic injuries. Nevertheless, it has been evidenced that thispositioning is characterized by various challenges. For instance, itresults in nerve injuries such as postoperative ulnar neuropathy(Warner, 2009). About one third of nerve injuries are Ulnarneuropathy and is mostly found in men. This is due to the biggertubercle of the ulnar coronoid which makes the ulnar nervesusceptible to injury (Warner, 2009). Pressure is exerted on theulnar nerve by pronation, whilst supination reduces pressure. Varioussolutions have been provided to solve this challenge. To start with,padded arm boards should be employed, while arm abduction should belimited to less that or 90 degrees. The forearm should be kept in asupinated or neutral position. The positioning of the upper extremitymust be in such a way that reduces pressure on the ulnar groove.Extended pressure must be avoided on the radial nerve. Lastly,ensuring intervallic perioperative evaluation is vital in ensuringthe preferred position is maintained.
Patientssuffering from axillary burns should be positioned beyond 90 degreesof shoulder abduction (Warner,2009). Thisis believed to enhance motion of the shoulder besides reducingcontracture of the scar. Nevertheless, this position has been linkedwith the challenge of amplifying the risk of injury to brachialplexus nerves. In order to solve this problem, patients should bepositioned at 150 degrees of shoulder abduction. This is linked withmore safety and well tolerable by patients.
Anotherpositioning of the upper extremity is the beach chair position(Warner,2009). Thisposition is linked with various challenges including unconstructivepressure gradient exerted between the heart and surgical site. Theresult is venous air embolism due to air being entrained within thevenous circulation system. This leads to total cardiovascularcollapse. Upright positioning may also result in cerebral injury, asa result of hypotension. Inbeach chair positioning, hypotension results in reduced blood flow inthe cerebral area. This is linked with vision loss or ischemic damageof the brain. Whileusing this positioning, the OR team should make certain that theycarry out pressure measurements at the brain’s level. The reason isthat there subsists a big hydrostatic gradient between the area ofblood pressure determination and the brain.Accordingto research, a safe operative area can be obtained by ensuring that49 mm Hg is maintained between the subacromial space and systolicblood pressure (Warner,2009).Two methods can be used to attain this: inducing hypotension orincreasing the arthroscopicpump pressure (Warner, 2009).
Warner,M. A. (2009). Patientpositioning and related injuries(6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.