Positioning Techniques in Surgical Applications - part 8 pot

4 Arm positioning devices 4 Remove Gilchrist bandage 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent de

4 Arm positioning devices

4 Remove Gilchrist bandage

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Tilt the operating table in the Trendelenburg position, raise the back plate

by 20–30°, lower the leg plates and the head section by hand

4 Position the head on a gel ring, possibly slightly turned to the other side and reclined

4 Position the infusion arm on an arm positioning device

4 Pad the shoulder with a positioning aid, thus raising the operating site or joint being operated

4 Cover the arm on the side being operated while leaving it free to move and position it at the body with arm protection or place it on the arm posi-tioning device

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.1 Supine position with arms

posi-tioned at the body (arm protection with padding)

. Fig 17.2 Supine position on special

shoul-der plate with the advantage of scanning and the head on a one-piece horseshoe-shaped headrest

17.1 · Shoulder

4 Arm positioning devices

4 Remove Gilchrist bandage

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 The patient’s shoulders end at the upper edge of the operating table

4 Bring the operating table gradually to the half-sitting (beach-chair) position

4 Raise the back plate and alternately lower the head of the complete ting table until the final position is reached

opera-4 Change the Bowden cable over and lower the legs to the horizontal po sition (system 1120)

4 Position the head on a gel ring and fix with transparent plaster right across the forehead or use a head support for shoulder operation (U-shaped helmet)

4 Position the infusion arm on an arm positioning device

4 Cover the arm on the side being operated while leaving it free to move and position it at the body with arm protection or place it on the arm positio-ning device

4 Apply the neutral electrode and connect to the HF surgery device

4 Fit the thorax support to the side rail of the shoulder plate

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

. Fig 17.7 Thorax support

. Fig 17.6 A segment is removed to leave free access to the rear

shoulder

. Fig 17.5 The universal operating table with special shoulder plate

is adapted to the body

. Fig 17.3 Beach-chair positioning on special shoulder plate with

helmet for safe positioning of the head

. Fig 17.4 The thorax support offers additional safety 17.1 · Shoulder

17.1.3 Prone position

Figs 17.8, 17.9.

Indications

Dorsal and transacromial access to the shoulder joint and access to the

scapu-la for luxation, fractures, posttraumatic misalignment, instability, tumours, rotator cuff lesions

Preparations

4 Arm positioning devices

4 Special head positioning cushion for prone position

4 Thorax, pelvic and wedge cushion, padded roll

4 Shaving in the area of the incision and preoperative skin cleansing

4 Transfer to the prepared operating table in the induction room

4 Position both tables next to each other, with the prepared table lowered

4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Position the head on the special head positioning cushion

4 Position both arms on the arm positioning devices

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.8 Prone position with small arm

plate/upper arm plate

. Fig 17.9 The distal joint is positioned

lower than the proximal joint

17.1 · Shoulder

4 Arm positioning devices

4 Remove Gilchrist bandage

4 Shaving in the area of the incision and preoperative skin cleansing

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Standard supine position, infusion arm is spread out

4 Remove the arm positioning device and fasten the large arm table to the side rail of the back plate

4 Position the patient near to the edge of the table

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.10 Arm positioning on large arm

table

. Fig 17.11 360° fluoroscopy possibility

. Fig 17.13 Arms positioned with maximum approx 50° abduction

. Fig 17.12 Arms positioned with maximum 90° abduction in

17.2 · Upper arm

4 Arm positioning devices

4 Special head positioning cushion for prone position

4 Thorax, pelvic and wedge cushion, padded roll

4 Small arm rest, X-ray protection, C-arm (poss G-arm) in the theatre

4 Remove Gilchrist bandage

4 Shaving in the area of the incision and preoperative skin cleansing

4 Transfer to the prepared operating table in the induction room

4 Position both tables next to each other, with the prepared table lowered

4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Position the head on the special head positioning cushion

4 Position the infusion arm on the arm positioning device

4 Position the patient near to the edge of the table, until the injured/fractured arm hangs at the elbow over the edge of the small arm rest with the lower arm in a vertical position

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.14 Prone position with small arm

plate/upper arm plate

. Fig 17.15 The distal joint is positioned lower than the

proximal joint

. Fig 17.16 Use of the image intensifier on the head side (here in 17.2 · Upper arm

4 Arm positioning devices

4 Remove Gilchrist bandage

4 Large arm table

4 Shaving in the area of the incision and preoperative skin cleansing

4 Apply a tourniquet in position

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Standard supine position, infusion arm is in abduction

4 1st arm table: remove the arm positioning device and fasten the large arm table to the rail of the back plate

4 Position the patient near to the edge of the table

4 Apply the neutral electrode and connect to the HF surgery device

4 Connect the compressed air device to the tourniquet

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.17 Arm positioning on large arm

table

. Fig 17.18 360° fluoroscopy possibility

. Fig 17.20 Arms positioned with maximum approx 50° abduction

. Fig 17.19 Arms positioned with maximum 90° abduction in

17.3 · Elbow

4 Arm positioning devices

4 Special head positioning cushion for prone position, thorax, pelvic and wedge cushion, padded roll

4 Small arm rest, X-ray protection, C-arm (poss G-arm) in the theatre

4 Remove Gilchrist bandage

4 Shaving in the area of the incision and preoperative skin cleansing

4 Apply a tourniquet in position

4 Transfer to the prepared operating table in the induction room

4 Position both tables next to each other, with the prepared table lowered

4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Position the head on the special head positioning cushion

4 Position the infusion arm on the arm positioning device

4 Position the patient near to the edge of the table, until the injured/fractured arm hangs at the elbow over the edge of the small arm rest with the lower arm in a vertical position

4 Apply the neutral electrode and connect to the HF surgery device

4 Connect the compressed air device to the tourniquet

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.21 Prone position with small arm

plate/upper arm plate

. Fig 17.23 The small arm plate/upper arm plate should have a

nar-. Fig 17.22 The distal joint is positioned lower than the proximal

17.3 · Elbow

17.4 Forearm and hand

17.4.1 Supine position

Figs 17.24–17.29.

Indications

Ventral, dorsal and dorsolateral access to the forearm, dorsal and palm access

to the wrist and to the hand, access to the thumb and first finger for fractures, posttraumatic misalignment, pseudarthrosis, luxation, inflammation, arthro-sis, soft tissue lesions, nerve lesions, contractures, tumours, operations to ten-dons, synovial sheaths and carpal tunnel

Preparations

4 Arm positioning devices

4 Remove splints from extremity

4 Large arm table

4 Shaving in the area of the incision and preoperative skin cleansing

4 Apply a tourniquet in position

4 Crosswise positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Standard supine position, infusion arm is spread out

4 Remove the arm positioning device and fit the large arm table to the side rail of the back plate

4 Position the patient near to the edge of the table

4 Apply the neutral electrode and connect to the HF surgery device

4 Connect the compressed air device to the tourniquet

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

. Fig 17.24 Arm positioning on large arm

table

. Fig 17.25 360° fluoroscopy possibility

. Fig 17.29 Operation scene

. Fig 17.28 The image intensifier is ready for use on the side opposite

. Fig 17.27 Arms positioned with maximum approx 50° abduction

4 Arm positioning devices

4 Shaving in the area of the incision and preoperative skin cleansing

4 Normal positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Position both arms on the arm positioning device in abduction position

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

Risks

4 Secondary dislocation

. Fig 18.1 Supine position on universal

operating table with CRP back plate 1150.45 and supported extension plate

. Fig 18.2 Supine position on CRP

operat-ing table 1150.16 for 360° use of the image intensifier

. Fig 18.4 Masking the extremity for

preoperative skin disinfection and additional moisture protection also during the operation ( 7 see Fig 18.15 on p 243)

. Fig 18.5 Good covering techniques

allow for movement of the extremity ( 7 see Fig 18.17 on p 243)

. Fig 18.3 Supine position on operating

extension table (1150.20) with special leg plates for optimum fluoroscopy of the hips

18.1 · Hips

4 Arm positioning devices

4 Shaving in the area of the incision and preoperative skin cleansing

4 Gel ring, gel cushion, Goepel leg holder, side supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions or tunnel cushions, body belts

4 Normal positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Fit the radial adjusting clamp to the side rail of the head plate, position the Goepel leg holder and place a gel padded mat on the operating table

4 Spread out the arm on the side not being operated

4 Move the patient over onto the healthy side

4 Move the lower arm forwards so that the weight of the upper body does not lie directly on the shoulder

4 Fit the body supports to the rails and brace on the level of the sacrum and symphysis

4 1st possibility: position the legs with the padded cushions (normal and flat) and possibly wedge cushions

4 Fix the lower leg and the positioning aids with the body belts

4 2nd possibility: position the legs with the tunnel cushion

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

Risks

4 Secondary dislocation

. Fig 18.6 Lateral position on CRP operating

table 1150.16 with 2 CRP accessory adapters and lateral positioning cushion for anatomic positioning of the lower arm

. Fig 18.8 Lateral position on universal

operating table with lateral positioning cushion and operating table in flex position

18.1 · Hips

. Fig 18.7 Lateral position on universal

operating table with vacuum mat

4 Arm positioning devices

4 Shaving in the area of the incision and preoperative skin cleansing

4 Normal positioning of the operating table in the theatre

4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4 Position both arms on the arm positioning device in abduction position

4 Apply the neutral electrode and connect to the HF surgery device

4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

Risks

4 Secondary dislocation

. Fig 18.9 Supine position on universal

operating table with CRP back plate 1150.45 and supported extension plate

. Fig 18.10 Supine position on CRP

oper-ating table 1150.16 for 360° use of the image intensifier

18.2 · Thigh

. Fig 18.12 Masking the extremity for

preoperative skin disinfection and additional moisture protection also during the operati-

on ( 7 see Fig 18.15 on p 243)

. Fig 18.13 Good covering techniques allow

for movement of the extremity ( 7 see Fig 18.17 on p 243)

. Fig 18.11 Supine position on operating

extension table (1150.20) with special leg tes for optimum fluoroscopy