SUPINE POSITION (DORSAL RECUMBENT) Use.

This is the usual position for administering general anesthesia and for doing most surgery of the abdomen such as laparotomy, herniorrhaphy, and appendectomy. With slight modifications, it is also used for other types of surgery, such as surgery on the arms or legs.

Figure 1-5. Supine (dorsal recumbent) position. TRENDELENBURG POSITION Use. The Trendelenburg position is used for operations on the bladder, prostate gland, colon, female reproductive system, or for any operation in which it is desirable to tilt the abdominal viscera away from the pelvic area for better exposure.

Figure 1-6. Trendelenburg position. Note that the knees are over the lower break in the table and shoulder braces are in place. REVERSE TRENDELENBURG POSITION Use. The reverse Trendelenburg position may be used for surgery on the neck, such as thyroidectomy, and for certain abdominal surgery, such as liver or gallbladder operations.

Figure 1-7. Reverse Trendelenburg position. LATERAL KIDNEY POSITION Use. The lateral kidney position is used for surgery on the kidney or the proximal third of the ureter.

Figure 1-8. Right kidney position. Note the kidney strap across the hips for stabilizing the body and raised kidney elevator for hyperextending operative areas. LATERAL CHEST POSITION Use. The lateral chest position (see figure 1-9) is used for thoracoplasty, pneumonectomy, and lobectomy.

Figure 1-9. Right lateral position. Note the strap across the hips and body rest for stabilizing the body. LITHOTOMY POSITION Use. The lithotomy position is used for surgery in the perineal area, such as drainage of rectal abscesses and perineal prostatectomies, and for gynecological surgery such as vaginal hysterectomy.

Figure 1-10. Lithotomy position.

PRONE POSITION Use. The prone position is used for surgical procedures-major or minor-that are performed on the back, shoulders, neck, or back of the head. Placement of the patient in the prone position for minor surgery, using local anesthesia, differs in some respects with placement for general anesthesia.

Figure 1-11. Prone position. JACKKNIFE (KRASKE) POSITION Use. The jackknife (Kraske)see figure 1-12) position is used for surgery on the coccyx, buttocks, or rectum, particularly when the patient has had spinal anesthesia and there is no objection to his being placed either face downward or head low.

Figure 1-12. Kraske position. Note that the hips are over the table break, and the table is flexed at a 90-degree angle.

SITTING POSITION Use. Included in surgery for which the patient sits upright are various operations on the nose and throat, as well as some plastic surgical procedures. The sitting position is described using the operating table as a chair.

Figure 1-13. Sitting position.

POSITIONS FOR SPINAL ANESTHESIA

Figure 1-14. Lying position for spinal anesthesia. This is the Sims position and is often referred to as the curled lateral position and is useful in establishment of subarachnoid and epidural anesthesia c. Sitting Position Sometimes, the anesthetist has reason to believe that, due to the condition of the patient, he may have difficulty in performing the lumbar puncture satisfactorily with the patient lying down. Faced with this type of situation, the anesthetist may order that the specialist place the patient in a sitting position.

Figure 1-15. Sitting position for spinal anesthesia.

Duties and Responsibilities: I. Scrub Nurse A. Before the Surgery: 1. Checks with the surgeon and circulating nurse for completion and adequacy of set-up necessary for the procedure. 2. Scrubs, gowns and gloves himself. 3. Arranges table set-up for instruments. Linens, supplies and other sterile equipments. 4. Counts instruments, needles and sponges together with the circulating nurse. 5. Gloves and gowns the surgeon after scrubbing. 6. Assists in draping the patient and hook up attachments like suctions, cautery pencil and other equipments that has to be plugged and yet keeping the upper end of each tip sterile. B. During the Surgery: 1. Anticipates surgeons needs and hands instruments, sponges and supplies as called for. 2. Discards soiled sponges and always keeps the operative field clean and neat. 3. Notifies the circulating nurse for any needed articles not included to the set-up. 4. Calls the attention of the surgical team for any break in sterile technique. 5. Counts instruments, needles and sponges with the circulating nurse immediately before closure of the first layer (peritoneum) and closure of the skin. C. After the Surgery: 1. Assists the surgeon or resident in applying sterile dressing over the wound. 2. Sorts out sharps, used sharps, scissors and probes to protect others from accidental cuts. 3. Takes a personal care or endorses accordingly tissue specimen providing for container, preservative and label. 4. Wheels out instruments, tables used and supplies to the workroom for cleaning. Gives priority to the surgeons instruments and return accordingly. II. Circulating Nurse A. Before the Surgery: 1. Fetches patient one hour before scheduled time of operation. 2. Identifies the patient, checks consent for operation and pre-operative preparations. 3. Positions the patient according to operative procedure observing proper strapping, warmth, comfort and reassurance. 4. Stays with patient during stages of general anesthesiologist, immediate needs. 5. Prepares the machine necessary for the surgery to be performed, records and charts documents, labels specimen bottles which has to be used during obtaining specimen. B. During Surgery 1. Watches progress of operation and keep the members of the team supplied with all the necessary items. 2. Be alert to the needs of the scrub nurse being one step ahead of her call. 3. Makes necessary counting of sponges needles and instruments before closure of any surface whether it is an organ or skin, a final count should be done with scrub nurse. 4. Announces accordingly whether the result of the counting were complete or not. If incorrect, institute necessary remedial measures. C. After Surgery 1. Assists with adhesive tapes, gowning patients, and transferring patients to stretcher. 2. Accomplishes charting in nurses notes including operations performed, anesthesia, medications, drains, packing general condition of the patient. 3. Have surgeon sign records before leaving the room. 4. Together with the anesthesiologist and attendant, accompany the patient to the recovery room or back to the ward if necessary and make proper endorsements. 5. Do charges when charge clerk is not on duty.