Positioning a patient for surgery is much more intricate than you might think (Figures 14.14,14.15,14.16,14.17). The following series of steps must occur.

In order to transfer the patient from their bed to the OR table, both beds are pushed together and locked in place. The surgical team works together to safely transfer the patient, usually with a basic roller board. The surgeon and/or resident and the circulator verify the safety of the patient. The patient is NEVER left unattended through this process, particularly once anesthesia has been induced.

These leg-warmer-like wraps are wound around the patient’s legs, secured, and connected to a machine that creates a squeezing action on each leg. The squeezing action of the SCDs assists with blood flow and prevents blood clots. This is a priority action for patient safety and they must be on prior to anesthesia induction.

Many basic positions exist for patient positioning for operative cases. Some of the most common are supine, prone, low lithotomy, and lateral decubitus. Correct positioning of the patient is one of the basic essential functions of every case. It can be done well when the OR team works together to ensure the safety of the patient. The patient is positioned in the most anatomically appropriate position for the surgery, safety straps are applied, pressure points are padded, and genitals are checked. Padding and positioning can be enhanced by the use of gel pads, pillows, foam pads, blanket rolls … there are numerous options. Anesthesia verifies that the head and neck are in correct alignment and that there are no pressure points on the face or neck. The patient’s ultimate position depends on what needs to be done, but access to the surgical site and comfort/safety of the patient are paramount. Because the patient is unable to move during surgery, it is critical that we check for potential circulatory, musculoskeletal, and neurological injuries that could occur. The ultimate goal is to have no postoperative injuries or complications due to positioning.

During surgery the OR table height is often changed. When the height of the table goes up, the mayo stand needs to go up so it doesn’t place pressure on the patient’s feet. Anesthesia communicates this to the team and the scrub tech will adjust the mayo. They might ask you to move your arms so they can move the tray. Please remember that while you may rest your hands on the patient if you are scrubbed, you must be mindful of leaning on the patient—particularly if they are a very small patient. A small amount of your weight can really impact a pediatric patient’s physiology.

Just as it took a village to get the patient properly positioned on the OR table, the same process must occur in reverse to get them back to their patient bed. The patient’s safety remains all of our responsibility during this transfer, particularly because they will often still be under general anesthesia. Also, we need to assess the condition of the patient’s skin and document this assessment. Hopefully other than the surgical site it is intact and in the same condition as when the patient came in. If not, the surgeon needs to be made aware, the condition should be passed along in report, and an incident report should be filed.

Think about your posture right now. How are your arms hanging? Are your palms facing out? No. Rotate them out and keep them there for a few moments. Is that comfortable for you? Probably not. How about after a 4-hour surgery? As a newcomer to the OR, now is the time to be paying attention and learning these basic skills. Think about finishing a long, complicated case. From a surgical standpoint it went smoothly. You don’t want the patient to develop a pressure sore due to lack of padding or a nerve injury because someone incorrectly positioned the patient’s hands. The preparations made for surgery can be just as important as the surgery itself.