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Just wondering what everyone here does for positioning patients that require steep trendelenberg. I do robot hysterectomies at two separate locations. At location #1, the patient is placed on the "non-slip" pad on the OR table and that's that.
At location #2, the nurses are in the habit of placing the shoulder braces at the head of the bed with some egg-crate padding to stop the patient from sliding down the table.
My issue: All the literature I've found recommends against using any shoulder braces or cross-straps to secure the patient in the event they slip down the table - citing an increased risk of brachial plexus injury.
I made a stink about not wanting shoulder braces at location #2 and the whale of a patient kept sliding down the table a few inches once I put her head down. The fatter patients are the ones I'm more concerned about with brachial plexus injuries since their weight can cause some stretching in their shoulders. I came up with a middle of the road solution and had the nurse place a bean bag under the patient and moulded it around their shoulders and upper arms in hopes that it would make a larger surface area for the pressure to evenly distribute (also using a lot of egg-crate padding).
My concerns stem from a patient I had wake up with a weak arm. Thankfully I was at location #1 and had not used any type of shoulder brace, thus the damage was rightfully attributed to the surgeon's 4 hour debacle of a case and not something I did with positioning. However this got me paranoid that if these things can happen to a patient while following all guidelines, it can certainly be blamed on a shoulder brace/strap.
Or is the real solution to just tell the surgeon their morbidly obese patient doesn't get full T-berg because they can't stay put on the table?
At location #2, the nurses are in the habit of placing the shoulder braces at the head of the bed with some egg-crate padding to stop the patient from sliding down the table.
My issue: All the literature I've found recommends against using any shoulder braces or cross-straps to secure the patient in the event they slip down the table - citing an increased risk of brachial plexus injury.
I made a stink about not wanting shoulder braces at location #2 and the whale of a patient kept sliding down the table a few inches once I put her head down. The fatter patients are the ones I'm more concerned about with brachial plexus injuries since their weight can cause some stretching in their shoulders. I came up with a middle of the road solution and had the nurse place a bean bag under the patient and moulded it around their shoulders and upper arms in hopes that it would make a larger surface area for the pressure to evenly distribute (also using a lot of egg-crate padding).
My concerns stem from a patient I had wake up with a weak arm. Thankfully I was at location #1 and had not used any type of shoulder brace, thus the damage was rightfully attributed to the surgeon's 4 hour debacle of a case and not something I did with positioning. However this got me paranoid that if these things can happen to a patient while following all guidelines, it can certainly be blamed on a shoulder brace/strap.
Or is the real solution to just tell the surgeon their morbidly obese patient doesn't get full T-berg because they can't stay put on the table?
