The lateral position

O Fig. 8.47. Arm positioning to protect the nerves and optimum shoulder position on the arm positioning device

Version without vacuum mat. The patient is placed under anaesthetic while still supine and rolled into the operating theatre still supine. The arm positioning device on the side not being operated is positioned at an angle of 90° to the operating table. A Goepel leg holder is fitted to the rail of the headrest using a radial adjustment clamp, this is for the upper arm. The patient is brought into the lateral position using kinesiology (O Fig. 8.50).

Version with vacuum mat. The vacuum mat is moulded to the body of the patient in the lateral position, then the air is withdrawn from the mat with a surgical suction unit or special pump. This means the patient is now lying in a bed fitted to his body shape. If before extracting the air a side support is fitted for safety reasons to either side on the level of the sacrum and symphysis if the operating table is expected to tilt to the side, as far as possible the support should not be in contact with the patient but support the vacuum mat (O Fig. 8.51).

Fig. 8.50. Lateral position

D Fig. 8.52. Positioning the patient on a special cushion for lateral position

Fig. 8.50. Lateral position

D Fig. 8.52. Positioning the patient on a special cushion for lateral position

Fig. 8.51. Lateral position with vacuum mat

Fig. 8.53. The left ear is kept free with a gel ring

8.7.1 Head

The operating table headrest is adjusted in such a way that the patient's head is positioned with the spinal column in a straight neutral position in the area of the lower cervical spine. Another version is to use a gel ring as additional padding for the head (D Figs. 8.52, 8.53).

8.7.2 Shoulders and arms

The lower arm is pulled forwards slightly and placed on the arm support device which stands at an angle of 90° to the operating table and reaches up to the table. The upper arm is abducted maximum 90° in the shoulder and positioned with the lower arm and slightly bent elbow on the Goepel leg holder. Both arms are padded with small gel mats (D Fig. 8.54).

D Fig. 8.54. Maximum 90° abduction of the arms with shoulders moved forwards

8.7.3 Thorax and pelvis

A foam or gel roll is pushed under the lower thorax side to relieve the shoulder. The special pad for the lateral position cushions the thorax to a large extent and supports the lower arm and shoulder with a padding effect (O Fig. 8.55).

The pelvis is supported with two side supports at the symphysis and sacrum. For operations to the lower extremities, the side supports are fitted to the rails of the lower back plate or seat plate from the head end, and for lateral thoracotomy, retroperitoneal access or procedures to the vertebral column, from the foot end, (O Fig. 8.56).

O Fig. 8.55. Padding under the thorax and positioning of the lower arm and shoulder so as to provide relief

8.7.4 Legs

A tunnel cushion is positioned between the legs to prevent pressure sores. By using the tunnel cushion, the weight of the upper leg does not impair the position of the lower leg. One or two body belts fix the positioning of the legs and pads (O Fig. 8.57).

O Fig. 8.55. Padding under the thorax and positioning of the lower arm and shoulder so as to provide relief

Fig. 8.57. Tunnel cushion, patient safeguarded with body belt

Fig. 8.59. The surgeon is leaning on the patient's left knee

Was this article helpful?

0 0

Post a comment