Lithotomy position ppt

Lithotomy position ppt


  • Patient Positioning and Injury (Anesthesia Text)
  • Patient Positioning: Complete Guide for Nurses
  • Labour and Birthing Positions
  • Likelihood of instrumental delivery forceps , vacuum ; Length of the second stage; or Requirement for strong pain relief medicines. Women who go through the first stage in an upright position are less likely to require an epidural.

    Some studies have found that for women without epidurals, walking around or being seated upright e. Spending at least 30 minutes during labour in four-point kneeling, possibly with pillows under the knees and hands, has been found to reduce persistent back pain during labour.

    Nevertheless, most women find it an acceptable position for labouring. Moving around, sitting in a chair or on a ball, showering and baths may also reduce discomfort during contractions.

    Being seated in an upright position during cervical dilation from 6 to 8 centimetres results in less back pain than lying on the back. Walking around has not been found to alter the need for augmentation, use of painkillers, or requirement for assisted or caesarean delivery. The appropriateness of such activities varies depending on factors such as the need to monitor the mother and baby, personal preference, and epidural anaesthesia.

    As there is no significant effect of posture on labour progress, women will be encouraged to assume the position in which they are most comfortable, and as long as there are no complications, women should be free to walk around if they so wish.

    Once labour is well established, the strength of contractions may be such that moving around becomes more difficult. The midwife and birth attendant will help the woman find a position in which she feels comfortable.

    The woman should be supported by attendants, pillows, furniture and the like, in order to allow her to relax as much as possible.

    Non-upright positions Side-lying, supine lying on the back or semi-reclining positions are often preferred by medical staff, as it is more convenient for the staff and allows easier monitoring of the progression of labour and the status of the woman and baby. However, some centres have portable monitors that allow the woman to move around.

    Attachments such as epidurals and IV fluid therapy may also limit movement. When a pregnant woman is lying on her back, the weight of the baby and uterus presses on the large blood vessels in the abdomen, which may reduce the blood supply to the baby and uterus, and decrease the strength of the contractions.

    Putting a wedge under one hip can help reduce this effect. Little is known about the effect of upright versus lying down positions during the first stage on outcomes for babies or satisfaction for mothers. Although some women with epidural anaesthesia are able to walk around safely, if a woman has an epidural or spinal anaesthetic that has resulted in muscle weakness or problems with blood pressure , she will not be able to move around until it wears off.

    If the epidural has partly blocked feeling, but not movement, the woman may still be able to remain mobile and upright. Side-lying or a half-lying positioning with pillows or a wedge under one hip will improve blood supply to the baby. During the transition phase, standing or sitting in the shower with water directed towards the back or the abdomen may help with pain control. Two-point or four-point kneeling, with the woman well supported on a beanbag or pillows, may also assist with this stage.

    If a premature urge to push occurs, the knee—chest position has been suggested. This is where the woman kneels with her forehead and arms on the floor and her bottom in the air, in order to reduce pressure on her cervix. Water immersion Being immersed in water such as a bath or birth pool during the first stage of labour significantly reduces perception of pain and use of epidural analgesia. It does not have any negative effects on length of labour, operative delivery rates, or wellbeing of the baby.

    Positions for first stage Common options for positions to try during the first stage of labour include: Upright positions Standing: Leaning onto a benchtop or similar surface, or the back of a chair, or leaning on a partner with hands around their neck or waist for contractions may be helpful. Some women find asymmetrical positions reduce discomfort, such as having one leg bent with the foot on a stool; Sitting, usually with the legs wide apart, leaning forward with elbows on thighs.

    Alternatively, straddling a chair, resting forward on pillows on the backrest, may be helpful, especially to relieve back pain. Again, asymmetrical positions may be helpful, with one leg up on the lounge and the other on the floor. Rocking chairs, or swaying with the bottom on a large ball, may provide comfort; Kneeling, possibly with a pillow between the bottom and the feet, and leaning forwards onto a bed hospital beds may have the head raised to lean against , beanbag or chair seat; Walking around, although it is important that the woman conserves her energy, so taking rests regularly are encouraged.

    Non-upright positions Four-point kneeling, in which the abdomen is hanging freely, and the hips are over the shoulders. Weight may be taken alternately between the hands and the forearms resting on a raised surface. This position has been found to be appropriate for most women with epidural anaesthesia; Side-lying for rest, with pillows between the legs for comfort; and Recumbent or semi-recumbent, though the impact on blood supply to the baby needs to be taken into account.

    Second stage of labour There are a wide variety of positions that may be used by a woman during labour and delivery.

    No one position for the second stage of labour is superior to others in terms of outcomes for the mother and baby. They tend to have support in an upright position through devices such as slings, birthing stools, rope and attendants. They are encouraged to rock or circle their pelvis, or shift weight between their feet. If required, they may briefly spend time in a side-lying position.

    Prior to the s, women in Western countries also tended to deliver in upright positions. Over the past years or so, women in Western society have been encouraged to deliver in lying down positions, largely for the convenience of the doctor or midwife delivering the baby.

    Upright versus non-upright positions for delivery Many women continue to deliver in a non-upright position, although there is increasing support for consideration of delivering in an upright position. Studies comparing different birth positions are not of good quality. A study carried out in a country where women commonly use a deep squatting position for work, rest and toileting found no difference in use of episiotomies.

    However, there was a greater occurrence of perineal tears and use of instrumental delivery when women delivered in the lithotomy position lying on the back with the legs in stirrups versus in squatting. There was no difference in the health of the babies between the groups. Although the squatting position may assist delivery, Western women tend to be unaccustomed to maintaining a deep squatting position, so only a very small proportion of women are able to maintain this position for any meaningful length of time, or for delivery itself.

    A large study showed the best position for avoiding perineal tears is in the lateral position. This is when the woman is lying on her side with the top leg supported by an attendant Birthing chairs have been used in several studies, and have been found to have no advantage in terms of length of the second stage, need for instrumental delivery or the degree of perineal trauma; however, they are associated with increased blood loss from the mother. As long as there are no medical concerns about the mother or baby, women benefit from making their own decisions about which position to give birth in.

    There is a large range of choices of position and experience of pain in relation to position type. Women are most familiar with the supine position lying on their backs , regardless of their ethnic background, which emphasises the importance of women learning about different positions during pregnancy and labour in order to increase their range of choices. The best place for a woman to learn about different options for labour is from her midwife or obstetrician, who will have suggestions and preferences that will help women prepare before birth.

    A Dutch study found that highly educated and older women were more likely to use birthing positions other than supine lying on their back. In all positions, the chin should be tucked in and the back rounded in order to maximise the efficiency of pushing.

    The midwife or obstetrician may encourage the woman to change position during the second stage, as this can help prevent injuries caused by long periods of pushing down in the one posture. There is limited information about the effect of position on outcomes for mothers and babies when the mother has an epidural. If there is an increased risk of complications with a delivery multiple births, large baby, etc , it may be most appropriate for delivery to take place in the lithotomy position, which is where the woman is lying on her back with her legs raised in stirrups, so that the attendant can easily see the perineum and access it if required.

    Otherwise, the mother may deliver the baby in almost any position she finds comfortable. In general, positions where the legs are wide apart and the hips are flexed maximise the width of the pelvis and assist passage of the baby. When delivery is very rapid, adopting a gravity-neutral position four-point kneeling, sidelining may help slow the stretch of the perineum and reduce the risk of tears. Pillows may be behind the knees, arms and back. During contractions, the woman may brace by holding her knees and pulling up.

    The partner may sit behind the woman to assist with pulling her knees up. The benefit of the semi-sitting position is that the perineum can be easily visualised and is accessible if necessary, though in one study this position was associated with an increased risk of perineal tears; Sitting, such as on a toilet or birth stool, with the legs wide apart and leaning forwards with the arms supported on the thighs, or by a partner; Kneeling, on the bed or floor, leaning against a large pile of pillows, or supported by a partner.

    Some women may feel more comfortable with one knee up; or Squatting, supported by partner behind, or holding onto a bar. The woman should stand to rest between contractions. This may not be appropriate for women who have had epidurals. This is a good position when delivery is rapid, as it is gravity-neutral; Four-point kneeling, which may reduce the effect of gravity on delivery as the head is crowning, reducing the risk of perineal tears, and be more comfortable for women who are experiencing significant back pain.

    More information For more information on birth, including information about the stages of birth, birthing types, and helpful videos, see Birth. For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy. Maternal posture in labour.

    Promoting, Promoting, protecting, and supporting normal birth: A look at the evidence. J Obstet Gynecol Neonatal Nurs. Nonpharmacologic relief of pain during labor: Systematic reviews of five methods.

    Am J Obstet Gynecol. Evidence-based labor and delivery management. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. Lack of effect of walking on labor and delivery. N Engl J Med. Impact of first-stage ambulation on mode of delivery among women with epidural analgesia.

    Overcoming the challenges: Maternal movement and positioning to facilitate labor progress. Am J Maternal Child Nurs. Hands and knees posture in late pregnancy or labour for fetal malposition lateral or posterior.

    Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Immersion in water in labour and birth. Nurs Res. The effect of maternal posture on fetal cerebral oxygenation during labour. Br J Obstet Gynaecol. Hands-and-knees positioning during labor with epidural analgesia. Position in the second stage of labour for women without epidural anaesthesia. Morris R. History of Childbirth: Fertility, pregnancy and birth in early modern Europe. Cambridge: Polity Press; Korejo R.

    Compared to other surgical positions, the supine position produces the least amount of hemodynamic and ventilatory changes. The lawn chair position relaxes the abdominal musculature and thus improves closing conditions, and also enhances venous return from the legs [Miller] Complications Complications of the supine position include pressure alopecia for long procedures , backache, and tissue ischemia [Warner MA.

    Positioning in Anesthesia and Surgery, 3rd ed: , ] Trendelenburg If a patient is placed in Trendelenburg position, shoulder braces should not be used as the risk of compressive injury to the brachial plexus is significant. FRC and pulmonary compliance are reduced by the dislocated viscera. Trendelenburg Physiology The effects of the Trendelenburg TREND position and passive straight leg raising PLR on cardiopulmonary performance in 18 anesthetized patients undergoing myocardial revascularization were studied with a two-dimensional transesophageal echocardiography probe and a thermodilution right ventricular ejection fraction RVEF pulmonary artery catheter.

    CVP and left ventricular areas did not change significantly. CCM 17 4 , ]. Lithotomy Hips are flexed degrees and legs abducted degrees. Knees are flexed until parallel with the torso Complications Movement of abdominal contents in particular when patients have an abdominal mass can obstruct venous return to the heart. Loss of lordosis can lead to back pain [Martin JT. Positioning in Anesthesia and Surgery, 3rd ed: , ].

    Arm boards are recommended to keep the fingers away from the break in the table, which has in the past caused significant crush injuries. Anesthesiology , ]. Compartment syndrome risk is approximately In another, the incidence of motor deficit was only [Warner et.

    Anesthesiology , ] Lateral Decubitus Lateral decubitus is associated with pulmonary compromise due to movement of abdominal contents as well as the mediastinum, which enhance airway movement to the non-dependent lung while increasing blood flow to the dependent lung, thereby adversely affecting ventilation-perfusion matching Placing someone in lateral decubitus may require additional support for the head.

    The dependent eye should be checked for external compression and both eyes should be taped prior to positioning. A kidney rest placed under the dependent iliac crest and prevent compression of the vena cava. Sitting Advantages include excellent surgical exposure, decreased blood loss, superior access the airway, reduced facial swelling, and improved ventilation especially in obese patients.

    Sitting patients are, however, prone to hypotension — consider alternating between other positions. In neurosurgical patients p-fossa , excessive neck flexion can impede both arterial and venous blood flow, kink the ETT, and put significant pressure on the tongue which could potentially require tracheostomy.

    Always leave at least two fingerbreadths distance between the chin and the sternum. Sitting patients especially neurosurgical are also at risk for venous air embolisms, which cause arrhythmias, desaturation, pulmonary hypertension, arrest, and even stroke or MI in PFO patients. Ultrasound may help in detection Prone Mandates frequent eye checking just like the lateral position.

    Keep in mind that in certain patients, lateral rotation of the neck can compromise arterial flow to the brain. Horseshoe headrests are ideal in that they allow reasonable access to the airway in these patients. Breasts should be placed medial to the bolsters. Prone positioning is not ideal for obese patients, whose pulmonary function is reduced and who cannot be easily repositioned if needed — consider alternative positions if possible For prone patients, Backofen and Schauble found that even after careful positioning, being prone caused an increase in SVR and PVR as well as a decrease in SV and CI MAP stayed the same , and recommended that patients in precarious cardiovascular states receive invasive monitoring before being placed prone [Backofen et al Anesth Analg , abstract ].

    Kaneko et. J Applied Physio , ]. Nerve Injuries Introduction Overall incidence of peripheral nerve injury is 0. APSF 9: 17 ]. Ulnar Neuropathy Note that ulnar neuropathies develop in medical and surgical patients [Warner et. Anesth , ]. Furthermore, many patients who develop postoperative ulnar neuropathies are found to have contralateral nerve dysfunction as well [Alvine et. J Bone Joint Surg Am , ], suggesting that these patients may actually be predisposed to injury. Lastly, many patients who develop an ulnar neuropathy do not complain about symptoms until 48 hours after their surgical procedure [Warner et.

    Anesth , ; Alvine et. J Bone Joint Surg Am , ]. Interestingly, a prospective study of ulnar injuries showed that none occurred in the first two postoperative days [Warner et. Anesth 54, ] For nerve deficits in general — if the deficit is sensory, assure the patient that the deficit will almost certainly resolve within 5 days and follow up with them by phone if function abnormal, obtain formal neurologic consultation. A motor deficit is more important, less common, and requires immediate neurologic consultation.

    In non-cardiac surgery, the incidence is only 0. Clin Orth Relat Res 33, ]. Treatment of Nerve Injuries Always seek neurologic consultation. Reversible motor nerve injuries usually take months to recover and require physical therapy to prevent atrophy and contractures in the interim Compartment Syndromes Pulses and capillary refill are unreliable indicators of CS i.

    Overall risk is and is no different in the lithotomy legs and lateral arms positions. Additionally, the dead tissue from CS is predisposed to infection and can lead to lung injury and possibly acute lung injury. Corneal abrasions are the most common and should be treated with antibiotic ointment — a prospective study of patients suggested that vision worsens in 4. Ann Thor Surg 34, ; Roth et. Anesthesiology , ; Roth et. Anesthesiology , ; Warner ME et. Anesth Analg , ; Nuttall GA et.

    Anesth Analg , ]. Etiology is usually ischemic optic neuropathy, which is caused by prolonged hypotension, duration of surgery, blood loss, anemia, and pressure secondary to prone positioning.

    In supine position, legs may be extended or slightly bent with arms up or down. It provides comfort in general for patients under recovery after some types of surgery. Most commonly used position. Supine position is used for general examination or physical assessment. Watch out for skin breakdown. Supine position may put patients at risk for pressure ulcers and nerve damage. Assess for skin breakdown and pad bony prominences. Support for supine position.

    Small pillows may be placed under the head to and lumbar curvature.

    Patient Positioning and Injury (Anesthesia Text)

    Heels must be protected from pressure by using a pillow or ankle roll. Prevent prolonged plantar flexion and stretch injury of the feet by placing a padded footboard. Supine position in surgery. Supine is frequently used on procedures involving the anterior surface of the body e. A small pillow or donut should be used to stabilize the head, as extreme rotation of the head during surgery can lead to occlusion of the vertebral artery. Promotes lung expansion. Useful for NGT.

    Prepare for walking. Nurses should watch out for dizziness or faintness during change of position. Poor neck alignment. Encourage patient to rest without pillows for a few hours each day to extend the neck fully.

    Used in some surgeries. Orthopneic or Tripod Position Orthopneic or tripod position places the patient in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on. Orthopneic or tripod position is useful for maximum lung expansion. Maximum lung expansion. Patients who are having difficulty breathing are often placed in this position because it allows maximum expansion of the chest.

    Helps in exhaling. Orthopneic position is particularly helpful to patients who have problems exhaling because they can press the lower part of the chest against the edge of the overbed table. Prone Position In prone position, the patient lies on the abdomen with head turned to one side and the hips are not flexed. Prone position is comfortable movieskiduniya bollywood 2019 some patients.

    Extension of hips and knee joints. Prone position is the only bed position that allows full extension of the hip and knee joints. It also helps to prevent flexion contractures of the hips and knees. Contraindicated for spine problems. The pull of gravity on the trunk when the patient lies prone produces marked lordosis or forward curvature of the spine thus contraindicated for patients with spinal problems.

    Drainage of secretions. Prone position also promotes drainage from the mouth and useful for clients who are unconscious or those recover from surgery of the mouth or throat. Placing support in prone. To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen. In surgery. Prone position is often used for neurosurgery, in most neck and spine surgeries. Lateral Position In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed.

    Patient Positioning: Complete Guide for Nurses

    Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability. Increase in flexion of the top hip and knee provides greater stability and balance. This flexion reduces lordosis and promotes good back alignment.

    Lateral position. Relieves pressure on the sacrum and heels. Body weight distribution. In this position, most of the body weight is distributed to the lateral aspect of the lower scapula, the lateral aspect of the ilium, and the greater trochanter of the femur. Support pillows needed. To correctly position the patient in lateral position, use of support pillows are needed.

    The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.

    Reduces lower body pressure. It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip. Perineal area visualization and treatment. It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area.

    Pregnant women comfort.

    As long as there are no medical concerns about the mother or baby, women benefit from making their own decisions about which position to give birth in. There is a large range of choices of position and experience of pain in relation to position type.

    Women are most familiar with the supine position lying on their backsregardless of their ethnic background, which emphasises the importance of women learning about different positions during pregnancy and labour in order to increase their range of choices. The best place for a woman to learn about different options for labour is from her midwife or obstetrician, who will have suggestions and preferences that will help women prepare before birth.

    A Dutch study found that highly educated and older women were more likely to use birthing positions other than supine lying on their back. In all Finale v26 crack mac, the chin should be tucked in and the back rounded in order to maximise the efficiency of pushing.

    The midwife or obstetrician may encourage the woman to change position during the second stage, as this can help prevent injuries caused by long periods of pushing down in the one posture. There is limited information about the effect of position on outcomes for mothers and babies when the mother has an epidural.

    If there is an increased risk of complications with a delivery multiple births, large baby, etcit may be most appropriate for delivery to take place in the lithotomy position, which is where the woman is lying on her back with her legs raised in stirrups, so that the attendant can easily see the perineum and access it if required. Otherwise, the mother may deliver the baby in almost any position she finds comfortable.

    In general, positions where the legs are wide apart and the hips are flexed maximise the width of the pelvis and assist passage of the baby. When delivery is very rapid, adopting a gravity-neutral position four-point kneeling, sidelining may help slow the stretch of the perineum and reduce the risk of tears.

    Pillows may be behind the knees, arms and back. During contractions, the woman may brace by holding her knees and pulling up. The partner may sit behind the woman to assist with pulling her knees up. The benefit of the semi-sitting position is that the perineum can be easily visualised and is accessible if necessary, though in one study this position was associated with an increased risk of perineal tears; Sitting, such as on a toilet or birth stool, with the legs wide apart and leaning forwards with the arms supported on the thighs, or by a partner; Kneeling, on the bed or floor, leaning against a large pile of pillows, or supported by a partner.

    Some women may feel more comfortable with one knee up; or Squatting, supported by partner behind, or holding onto a bar. The woman should stand to rest between contractions. This may not be appropriate for women who have had epidurals. This is a good position when delivery is rapid, as it is gravity-neutral; Four-point kneeling, which may reduce the effect of gravity on delivery as the head is crowning, reducing the risk of perineal tears, and be more comfortable for women who are experiencing significant back pain.

    More information For more information on birth, including information about the stages of birth, birthing types, and helpful videos, see Birth. For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy. Maternal posture in labour. Promoting, Promoting, protecting, and supporting normal birth: A look at the evidence. J Obstet Gynecol Neonatal Nurs. Nonpharmacologic relief of pain during labor: Systematic reviews of five methods.

    Am J Obstet Gynecol. Evidence-based labor and delivery management. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. Lack of effect of walking on labor and delivery.

    N Engl J Med. Impact of first-stage ambulation on mode of delivery among women with epidural analgesia. Overcoming the challenges: Maternal movement and positioning to facilitate labor progress. Am J Maternal Child Nurs. Hands and knees posture in late pregnancy or labour for fetal malposition lateral or posterior.

    Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Immersion in water in labour and birth. Nurs Res. In neurosurgical patients p-fossaexcessive neck flexion can impede both arterial and venous blood flow, kink the ETT, and put significant pressure on the tongue which could potentially require tracheostomy. Always leave at least two fingerbreadths distance between the chin and the sternum. Sitting patients especially neurosurgical are also at risk for venous air embolisms, which cause arrhythmias, desaturation, pulmonary hypertension, arrest, and even stroke or MI in PFO patients.

    Ultrasound may help in detection Prone Mandates frequent eye checking just like the lateral position. Keep in mind that in certain patients, lateral rotation of the neck can compromise arterial flow to the brain.

    Labour and Birthing Positions

    Horseshoe headrests are ideal in that they allow reasonable access to the airway in these patients. Breasts should be placed medial to the bolsters. Prone positioning is not ideal for obese patients, whose pulmonary function is reduced and who cannot be easily repositioned if needed — consider alternative positions if possible For prone patients, Backofen and Schauble found that even after careful positioning, being prone caused an increase in SVR and PVR as well as a decrease in SV and CI MAP stayed the sameand recommended that patients in precarious cardiovascular states receive invasive monitoring before being placed prone [Backofen et al Anesth Analgabstract ].

    Kaneko et. J Applied Physio]. Nerve Injuries Introduction Overall incidence of peripheral nerve injury is 0. APSF 9: 17 ]. Ulnar Neuropathy Note that ulnar neuropathies develop in medical and surgical patients [Warner et.

    Anesth]. Furthermore, many patients who develop postoperative ulnar neuropathies are found to have contralateral nerve dysfunction as well [Alvine et.

    J Bone Joint Surg Am], suggesting that these patients may actually be predisposed to injury. Lastly, many patients who develop an ulnar neuropathy do not complain about symptoms until 48 hours after their surgical procedure [Warner et. Anesth; Alvine et.


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