Preventing Perioperative Positioning and Equipment Injuries

  • Lisa Spruce


Positioning the surgical patient requires teamwork and communication from all perioperative team members. Each has a unique role in positioning the patient safely and monitoring the patient for potential injury. Teams come together to assess the patient and plan preoperatively, position the patient for optimal exposure of the operative site, and monitor the patient for potential injury. This chapter provides information for all team members involved in positioning patients in various surgical positions and gives safety strategies for all patients and those with special needs such as the obese patient.


Surgical positioning Equipment injury Positioning injury Surgical teams Surgical positions 


  1. 1.
    Murphy EK. Negligence cases concerning positioning injuries. AORN J. 2004;80(2):311–4.CrossRefPubMedGoogle Scholar
  2. 2.
    O’Connell M. Positioning impact on the surgical patient. Nurs Clin N Am. 2006;41(2):173–92.CrossRefGoogle Scholar
  3. 3.
    Nagelhout JJ, Plaus KL. Nurse anesthesia. St. Louis, MO.: Saunders/Elsevier; 2010.Google Scholar
  4. 4.
    Kaplan J. Kaplan’s cardiac anesthesia. Philadelphia, PA: Elsevier Saunders; 2006.Google Scholar
  5. 5.
    Barach P. The impact of the patient safety movement on clinical care. Adv Anesth. 2003;21:51–80.Google Scholar
  6. 6.
    Phillips NF, Berry EC, Kohn ML. Berry & Kohn’s operating room technique. Louis, MO: St. Mosby; 2007.Google Scholar
  7. 7.
    Primiano M et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94(6):555–66.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nilsson UG. Intraoperative positioning of patients under general anesthesia and the risk of postoperative pain and pressure ulcers. J Perianesth Nurs. 2013;28(3):137–43.CrossRefPubMedGoogle Scholar
  9. 9.
    National Pressure Ulcer Advisory Panel. European pressure ulcer advisory panel and pan pacific pressure injury alliance. Prevention and treatment of pressure ulcers: quick reference guide. Haesler E, editor. Perth, WA: Cambridge Media; 2014.Google Scholar
  10. 10.
    AORN. Guideline for positioning the patient. In: Guidelines for perioperative practice. AORN, Inc: Denver, CO; 2015. p. 563–81.Google Scholar
  11. 11.
    Reddy M, Gill S, Rochon P. Preventing pressure ulcers: a systematic review. JAMA. 2006;296(8):974.CrossRefPubMedGoogle Scholar
  12. 12.
    Kirkland-Walsh H, Teleten O, Wilson M, Raingruber B. Pressure mapping comparison of four or surfaces. AORN J. 2015;102(1):61.e1–9.CrossRefGoogle Scholar
  13. 13.
    Reason J. Safety in the operating theatre—Part 2: human error and organisational failure. Curr Anaesth Crit Care. 1995;6(2):121–6.CrossRefGoogle Scholar
  14. 14.
    Barach P, Johnson J. Team based learning in microsystems-an organizational framework for success. Technol Instr Cogn Learn. 2006;3:307–21.Google Scholar
  15. 15.
    Bradshaw A, Advincula A. Postoperative neuropathy in gynecologic surgery. Obstet Gynecol Clin N Am. 2010;37(3):451–9.CrossRefGoogle Scholar
  16. 16.
    Codd R, Evans M, Sagar P, Williams G. A systematic review of peripheral nerve injury following laparoscopic colorectal surgery. Colorectal Dis. 2013;15(3):278–82.CrossRefPubMedGoogle Scholar
  17. 17.
    St-Arnaud D, Paquin M. Safe positioning for neurosurgical patients. AORN J. 2008;87(6):1156–72.CrossRefPubMedGoogle Scholar
  18. 18.
    Wen T, Deibert C, Siringo F, Spencer B. Positioning-related complications of minimally invasive radical prostatectomies. J Endourol. 2014;28(6):660–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Lowenstein L, Mustafa M, Burke Y, Mustafa S, Segal D, Weissman A. Steep Trendelenburg position during robotic sacrocolpopexy and heart rate variability. Eur J Obstet Gynecol Reprod Biol. 2014;178:66–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Sukhu T, Krupski T. Patient positioning and prevention of injuries in patients undergoing laparoscopic and robot-assisted urologic procedures. Curr Urol Rep. 2014;15(4):398.CrossRefPubMedGoogle Scholar
  21. 21.
    Roth S, Barach P. Post-operative visual loss: still no answers yet. Anesthesiology. 2001;95(3):575–7.Google Scholar
  22. 22.
    Shveiky D, Aseff J, Iglesia C. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol. 2010;17(4):414–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Mohr J, Batalden P, Barach P. Integrating patient safety into the clinical microsystem. Qual Saf Health Care. 2004;13:34–8.Google Scholar
  24. 24.
    Song J, Vemana G, Mobley J, Bhayani S. The second “time-out”: a surgical safety checklist for lengthy robotic surgeries. Patient Saf Surg. 2013;7(1):19.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Agah M, Ghasemi M, Roodneshin F, Radpay B, Moradian S. Prone position in percutaneous nephrolithotomy and postoperative visual loss. Urol J. 2011;8:191–6.PubMedGoogle Scholar
  26. 26.
    Spruce L, Van Wicklin S. Back to basics: positioning the patient. AORN J. 2014;100(3):298–305.CrossRefPubMedGoogle Scholar
  27. 27. Obesity and overweight for professionals: adult: defining—DNPAO—CDC [Internet]. 2015 [cited 21 August 2015]. Available from:
  28. 28.
    Brodsky J. Positioning the morbidly obese patient for anesthesia. Obes Surg. 2002;12(6):751–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Bennicoff G. Perioperative care of the morbidly obese patient in the lithotomy position. AORN J. 2010;92(3):297–312.CrossRefPubMedGoogle Scholar
  30. 30.
    Abdullah H, Chung F. Perioperative management for the obese patient. Anesthesiology. 2014;27(6):576–82.Google Scholar
  31. 31.
    Graling P, Elariny H. Perioperative care of the patient with morbid obesity. AORN J. 2003;77(4):801–19.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Association of PeriOperative Registered NursesDenverUSA

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