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Pads

The clever use of suitable positioning aids, such as pads with viscoelastic foam core or gel pads, together with the right positioning technique, can effectively reduce and even prevent the risk of positioning damage. Positioning the patient correctly for the operation makes assistance during the operation much easier or at all possible. The following sections list some frequently used positioning aids together with the corresponding operating positi-

□ Fig. 7.35. Body patient board with large longitudinal displacement and 4-section special leg plates

4 Test for deformation (2.2X safety = 135 kg x 2.2), 4 Test for failure (4X safety = 135 kg x 4).

Detailed information can be found for example in the following standards:

4 IEC 60 601-1: 1998 + Ai: 1991 + A2: 1995 4 IEC 60 601-2-46: 1998 4 IEC 60 601-1-2: 1993 and IEC 60 601-2-46

The German version of the MPG also makes reference to the Ordinance for erecting, operating and using medical products (medical product owner ordinance - MPBetreibV). This ordinance contains detailed rules which the owner of the product has to observe, for example: 4 Using the device according to the manufacturer's instructions

4 Keeping the user manual available on site 4 Keeping records of corresponding instructions issued to the staff

7.2.1.1 Pads with viscoelastic foam core

Cushions. In various sizes (e.g. 40x15x10 cm) to support the heads of adult patients in the supine position in the pre-, peri- and postoperative phase.

Head rings. In various sizes to hold the head firmly in child and adult patients in the supine and lateral position. Particularly for goitre positioning and secure positioning for operations to the face or head.

Special cushions. In various sizes for firm positioning of the head in the lateral and prone position. The cushion has cut-outs for the patient's nose and eyes and lateral cutouts for the respiratory tube (O Fig. 7.36).

□ Fig. 7.36. Cushions for positioning the head in the supine, lateral and prone position

ons.

Fig. 7.38. Rolls and semi-rolls

Fig. 7.37. Wedge cushions

Fig. 7.38. Rolls and semi-rolls

Wedge cushions. In various sizes (e.g. 45x35x8 cm). Placing a wedge cushion under the pelvis with the patient in the supine position means that the leg lies in inner rotation on this side. This gives easier surgical access to the ankle joint. Another possible use is to pad the knee and foot region for patients in the prone position (O Fig. 7.37).

Rolls and semi-rolls. In various sizes to relieve the brachial plexus; they are placed under the patient's knees to achieve a relaxed, almost physiological positioning in the patient's hips and knees (O Fig. 7.38).

Double wedge cushions. In wedge shape, with cut-outs for the cervical spine and V-shaped cut-outs for the head. Firm positioning of the head and shoulders with the patient in the supine position. The shoulders are raised slightly to relieve the plexus (O Fig. 7.39).

Padded cushions. For prone positioning of the patient. With abdominal cut-out and radiolucent, thermo-modulating special foam. Removable padding elements for individualised adjustments to suit the patient's body (O Fig. 7.40).

Bolsters (MHH). For prone positioning of the patient. Fitted with clamps to the lateral rails of the patient board (O Fig. 7.41).

Tunnel cushion. Special U-shaped padding, positioned between the patient's legs in the lateral position to avoid pressure sores. The weight of the upper leg does not rest on the lower leg. The pressure on the fibular head of the lower leg is thus reduced to a minimum (O Fig. 7.42).

Special knee positioning cushion. Positioning the healthy leg for arthroscopy of the knee, operations to the lower legs suspended on both sides. The cushion achieves a neutral position of the leg in the hip area (no hyperextension in the hip joint) and thus also relieves the lumbar spine.

Fig. 7.39. Double wedge cushions

Fig. 7.40. Padded cushions for slipped disc operations

Fig. 7.40. Padded cushions for slipped disc operations

Fig. 7.41. Bolsters fitted with clamps

Fig. 7.42. Tunnel cushion

Fig. 7.42. Tunnel cushion

Fig. 7.45. Head cushion for prone position

Fig. 7.45. Head cushion for prone position

Fig. 7.43. Special knee positioning cushion (MHH)

Fig. 7.46. Head cushion for supine position

Fig. 7.43. Special knee positioning cushion (MHH)

□ Fig. 7.44. View of the operating table mats, universal positioning aids and head rings

Fig. 7.47. Lateral positioning padding

□ Fig. 7.44. View of the operating table mats, universal positioning aids and head rings

The raised sides provide adequate lateral stability (□ Fig. 7.43).

Various positioning aids of special gel in a flat or specially shaped design offer good pressure distributing properties and thus help to prevent pressure sores. They can be heated to approx. 50°C.

Patient board mats. These mats cover the full length of the patient board and help to distribute weight evenly. They are ideal for universal use because they can be folded together or rolled up easily.

Fig. 7.47. Lateral positioning padding

Universal positioning aids. Used as heel supports, shoulder supports and axilla rolls in various sizes.

Head rings. Available in closed and open design. Protect the head, face, neck and ears in all kinds of procedures (□ Fig. 7.44).

Cushion for prone position. Supports the head in an anatomically correct position and provides tube access on both sides (□ Fig. 7.45).

Cushion for supine position. For better fixing and positioning of the head with the patient in the supine position (□ Fig. 7.46).

Lateral position pads. Wedge-shaped positioning aids with a cut-out to relieve the lower arm specially for the lateral position, e.g. total hip replacement surgery or kidney operations (□ Fig. 7.47).

Heel protection. Provides support and maximum heel protection even during long operations with optimum pressure distribution.

The positioning aids described here should be available in an adequate quantity to ensure that every patient is positioned correctly, regardless of the patient's size (O Fig. 7.48).

7.2.2 Operating table accessories

Fig. 7.50. One-piece horseshoe headrest

The positioning aids described here should be available in an adequate quantity to ensure that every patient is positioned correctly, regardless of the patient's size (O Fig. 7.48).

7.2.2 Operating table accessories

Fastening piece for head positioning elements. With star handles for adjustment in 3 joints with rail piece to take various head positioning elements, e.g. horseshoe headrest, headrest or skull clamp. Optimum adjustment thanks to the fine indentation of the joints (O Fig. 7.49).

Horseshoe headrests. As adapters for fastening pieces (O Figs. 7.50, 7.51).

Arm positioning device. Supports the arms in any position to give the best possible access for the anaesthetist. Maximum adjustments in all levels to prevent plexus damage when adjusted to the right height. The arm support is padded to avoid paralysis (ulnar nerve). A belt prevents the arm from being moved unintentionally (O Fig. 7.52).

Arm protection. For positioning the arm firmly to the body with L-pad and 2 belts. The patient's arm is protected from the operating team standing at the side of the operating table and from unintentional movement when adjusting the position of the operating table during the operation (O Fig. 7.53).

Fig. 7.50. One-piece horseshoe headrest

Fig. 7.51. Two-piece horseshoe headrest

Fig. 7.54. Radial adjusting clamp

Fig. 7.52. Arm positioning device

Fig. 7.54. Radial adjusting clamp

Fig. 7.53. Arm protection

Fig. 7.55. Radial adjusting clamp with one-hand control

Fig. 7.53. Arm protection

Fig. 7.55. Radial adjusting clamp with one-hand control

Anaesthesia screen. For screening the sterile area. Adjustable height fitted with a radial adjustment clamp on a rail.

Arm restraint straps for anaesthesia screen The arm restraint straps are fastened to the anaesthesia screen for suspending the patient's arm (supine position).

Radial adjustment clamp. Fastening element for accommodating and safely fastening accessories to the rails of the operating table. A radial adjustment mechanism facilitates optimum placement of the accessories (O Figs. 7.54, 7.55).

Upper arm positioning plate. Fitted to the lateral rail of the operating table. For treating humerus fractures in the prone and supine position; radiolucent (O Fig. 7.56).

Fig. 7.56. Upper arm positioning plate

Hand operating table. Fitted to the lateral rail of the operating table. For surgery to the arm and hand. Radiolucent

Fig. 7.57. Hand operating table

Fig. 7.58. Back plate for shoulder operations

Fig. 7.59. Thorax support
Fig. 7.60. Fastening piece for body supports

Fig. 7.58. Back plate for shoulder operations and with many varied adjustments for anatomically correct positioning of the patient also with raised back plate (O Fig. 7.57).

Fig. 7.61. Back/buttocks support

Back plate for shoulder operations. Back plate with two laterally removable pads for exposing the shoulder being operated and free anteroposterior scanning with the image intensifier, with adapter at the head end for head positioning accessories (O Fig. 7.58).

Thorax support. For supporting the body when positioning the patient in the sitting position (beach-chair positioning), fitted to the lateral rail of the lower motor-driven back plates (O Fig. 7.59).

Fastening piece and body supports. Fitted to the lateral rails of the operating table to fix the patient's body in any position. Various pads are available for anatomically correct positioning, e.g. back/buttock support, pubis/sacrum/ sternum support and lateral support (O Figs. 7.60-7.63).

Fig. 7.62. Pubis/sacrum/sternum support

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