POSITIONS USED IN THEATRE

AND INCISIONS MADE DURING

OPERATIONS

BY NYIRONGO

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POSITIONS USED IN OPERATING THEATRE
 These are postures which patients
assume to gain quick good access to the
operation site or organs to be explored
which is consistent with vital functions of
respiration and circulation.

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GOALS OF PROPER POSITIONING
 To maintain patient’s airway and avoid
constriction or pressure on the chest
cavity
 To maintain circulation
 To prevent nerve damage
 To provide adequate exposure of the

operative site
 To provide comfort and safety to the

patient
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ASSESSMENT
 Theteam should assess the following
prior to positioning of the patient:
◦ Procedure length
◦ Surgeon’s preference of position
◦ Required position for procedure
◦ Anesthesia to be administered
◦ Patient’s risk factors
 age, weight, skin condition, mobility/limitations,
pre-existing conditions, etc.
◦ Patient’s privacy and medical needs
◦ Basics of anatomy & physiology
 Overview

 RN must be aware of the anatomic and physiologic

changes associated with anesthesia, patient
positioning, and the procedure.
 The following criteria should be met to prevent injury
from pressure, obstruction, or stretching:
◦ No interference with respiration
◦ No interference with circulation
◦ No pressure on peripheral nerves
◦ Minimal skin pressure
◦ Accessibility to operative site
◦ Accessibility for anesthetic administration
◦ No undue musculoskeletal discomfort
◦ Maintenance of individual requirements
TEAM RESPONSIBILITIES
Physician:
-Optimal procedural exposure
Anesthesia:
-PRhysiologic requirements (A-B-
C’s)
-Position timing
Nursing:
-Safe transfer using adequate
personnel
-Use of adequate padding and
positioning aids
-Provide an ongoing assessment
SUPINE/RECUMBENT POSITION
 Thefollowing are positions used in
theatre during operations;

 The patient lies on the back with arms

on the sides or secured on the chest.
 The head lies in the midline of the air

ring.
 It is used in the operation of the face,

chest, abdomen, legs and arms.

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SUPINE/RECUMBENT

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PRONE POSITION
 The patient lies on the abdomen with arms
secured on the sides.
 It is used in the operation of the cranium as well

as on the spine such as laminectomy

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LATERAL POSITION
 The patient lies either on the left or right side
depending on the site to be operated on.
 The knees and the feet are stabilized by supports
which are well padded.
 It is used for the operations on the chest and kidneys
and may also be modified for hip operation.

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LATERAL POSITION

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 KNEE CHEST/RABBIT POSITION
 The patient kneels on the operating table with the
head and the arms supported on a pillow and the
body is stabilized with supports.
 The foot end section of the operating table is

lowered or removed.
 This position is used for surgery on the lumber

spine or removal of a prolapsed inert vertebrae

disc.

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JACK KNIFE POSITION
 This position is used mainly for rectal
surgery. The patient lies in the prone position
with arms flexed around to the head and the
table tilted in reverse trendelenburg.

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 TRENDELENBURG POSITION
 This is a modified supine position
commonly used for intrapelvic operations.
 The aim is to displace the intestines away

from the pelvic cavity towards the

abdomen.
 The patient lie in supine position with

arms on the sides.

 The head side of the operating table is

lowered and the knees flexed.

 A reverse trendelenburg position is used

to expose abdominal organs.

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 LITHOTOMY POSITION
 This position is used for surgery of the

external genital organs, perineum and anal

regions.
 The patient lies in supine position with the

legs flexed on the hip, knees are raised with

feet supported in a webbing slings (stirrups
hanged from the lithotomy poles) supported
on the lithotomy poles.
 The arms are secured on the chest.
 The foot end is removed and the buttocks

projected over the edge of the table

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 INCISIONS
 An incision is a surgical cut made in the skin. The
following are incisions that can be made.

HIGH MIDLINE INCISION

 This is used for surgery on the stomach,liver,the
gall bladder and spleen. A vertical skin incision is
made from a xiphoid process to the umbilicus.

LOWER MIDLINE INCISION

 This is the incision used for surgery of urinary
bladder,uterus,rectum and lower bowel. The
incision extends from umbilical to the pubic
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 INCISIONS
PARAMEDIAN INCISION
 This incision primarily allows access to one side
of the abdomen and are placed accordingly.
 A vertical skin incision is made 2cm from the

midline and the extent of the incision depends

on the operation procedure. It may be on the left
or right incision and either upper and lower.

Mc BURNEY’S INCISION
 This is made in the right iliac fossa and is used
for removal of the appendix

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 INCISIONS
GRIDRIAN INCISION
 This is also used for the removal of the appendix
 SUBCOSTAL OR KOCHER’S INCISION
 An oblique incision is made along the costal

margins and is used for operations on the liver

and gall bladder. It is really used because of the
fear of the damaging the nerves supplying the
rectal muscles
PFANNENSTIEL OR TRANSVERSE ELLIPTICAL
 This incision is used mainly in gynaecology

surgery where the incision is just above the pubis.

It is preferred because scaring is less and also for
cosmetic purposes
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