Positioning the patient for a surgical procedure is a shared responsibility among the surgeon, the anesthesiologist, and the nurses in the operating room. The optimal position may require a compromise between the best position for surgical access and the position the patient can tolerate. [1]One of the four basic patient positions during surgery is the prone position.
What is the Prone Position?
The Prone position is a common position used during surgical procedures that provide surgical access to the dorsal aspects of the patient’s body.1 In the prone position, the patient is positioned face-down with their head in a neutral position without excessive flexion, extension, or rotation. The patient’s arms should be abducted less than 90 degrees with the elbows flexed and palms down to maintain a neutral alignment of the arms and wrists. Some common procedures that are performed while the patient is in the prone position include spine and neck surgeries, neuro surgeries, colorectal surgeries, vascular surgeries, and tendon repairs.[2,3]
When to use the prone position?
The prone position is used during surgeries that require access to the back of your body. Some common examples include:
* Brain or brainstem surgeries
* Spinal surgeries
* Rectal or buttock surgeries
* Surgical procedures on the back of your arms or legs
How to decrease the risk of injury in this position?
Medical staff will assist the patient in slowly and carefully laying on his stomach if he needs to be in a prone position for surgery. The patient will generally receive anesthesia first and will be hooked up to any needed monitors, IVs, or other medical equipment before being placed in the prone position. There will be supportive cushioning to prevent injury to the face, breasts, and pelvic region.
● A minimum of four personnel is required to safely turn the patient into the prone position when transferring them from the stretcher to the OR table.
● All movements are carried out slowly and gently to allow the patient’s body time to adjust to the change from the original supine position.
● The anesthesia provider assists by supporting and managing the head and airway, one team member supports and rotates the torso while another team member on the other side of the bed positions the patient on the padded laminectomy frame or chest rolls.
● Pads and rolls are positioned lengthwise and lift the patient’s chest off the OR table to allow sufficient respiratory expansion.
● The fourth team member is responsible for supporting and moving the lower part of the patient’s body. During rotation, the patient’s arms should be placed at their side and their body should be maintained in an anatomically aligned manner. Caution should be taken to avoid unnecessary compression of the breasts and genitalia.
● The patient’s arms are brought down and forward in a normal range of motion and placed on arm boards near the head. The arms are flexed at the elbows with palms down and the elbows padded.[4]
Complications associated with prone position
Complications include hemodynamic changes resulting in hypoperfusion, a range of ophthalmologic conditions, central nervous system lesions, peripheral nerve compression injuries, compartment syndrome, and pressure ulcers. Other complications include airway swelling and peripheral arterial compression. Though most of these complications are rare, familiarity with the spectrum of potential complications and strategies for prevention can limit morbidity in prone spine surgery.
Prone position supporting devices
The followings are the devices or apparatus that can be used to help position the patient properly.
- Prone Positioner
- Flat-Bottom Chest Roll
Related Resources
Reference
1.https://www.uptodate.com/contents/patient-positioning-for-surgery-and-anesthesia-in-adults
2.Guideline for positioning the patient. (2017). AORN Journal, 105(4), P8-P10. doi:10.1016/s0001-2092(17)30237-5
3.Rothrock, J. C. (2011). Alexander's care of the patient in surgery (14th ed.). St. Louis, MO: Mosby.
4.Beckett AE. Are we doing enough to prevent patient injury caused by positioning for surgery? J Perioper Pract. 2010;20(1):26. PMID: 20225718.
