The perioperative period may involve transferring patients between different areas or changing their position, as patients are often prepared in a different location than the procedure room. Post-procedure, they are often transferred to the Post Anesthesia Care Unit (PACU) for immediate care, with critically ill patients potentially going directly to the Intensive Care Unit (ICU) in hospitals. Transferring patients requires collaboration between different medical providers, such as the OR team, registered nurses, and emergency services. The anesthesia provider ensures the patient is calm and stable before and after the procedure. When a patient is undergoing or recovering from a procedure and anesthesia, adjusting their position also requires careful approaches to prevent hemodynamic instability, injury, or discomfort.
Patient transport carries inherent risks, including the potential for falls, collisions, and equipment-related incidents. These events can lead to injuries ranging from minor scrapes to major injuries. Abrupt movements when transferring patients in the perioperative period can cause hemodynamic decompensation, particularly in critically ill patients, leading to complications such as hypoxemia, cardiac arrhythmias, and even cardiac arrest. To mitigate these risks, healthcare facilities employ various resources for smooth patient transport. These include wheelchairs, stretchers, and specialized rolling beds designed for safe and comfortable movement. Additionally, hospitals often implement safety measures such as mirrors on corners to improve visibility and dedicated elevators for patient transport to minimize the risk of collisions and delays.
Patient positioning during surgery enables optimal access to the surgical site and patient safety. The supine position, with the patient lying flat on their back, is most commonly used for various procedures involving the anterior body surface. The Trendelenburg position, a variation of supine with the head lowered, is often used for pelvic and lower abdominal surgeries. The lithotomy position, where the patient is supine with legs elevated and apart, is typically used for gynecological, rectal, and urological procedures. For neurosurgery and shoulder surgeries, Fowler’s position (sitting position) is often employed. The prone position, with the patient lying face down, is used for posterior fossa skull surgeries, spine procedures, and operations on the buttocks or lower extremities. The lateral position, where the patient lies on their side, is common for thoracic, kidney, and hip surgeries. Each position requires careful consideration of the patient’s anatomy, the surgical site, and potential physiological effects to ensure safety and optimal surgical access.
Moving a patient during surgery for medical reasons or to provide access to a specific area requires careful coordination and monitoring to minimize cardiopulmonary risks. The safest methods involve gradual, controlled movements with continuous monitoring of vital signs. When transitioning to positions like Trendelenburg or reverse Trendelenburg, it’s crucial to adjust the angle slowly, typically in 5-degree increments, allowing time for the patient’s cardiovascular system to adapt. For prone positioning, a team approach using specialized frames or pillows to support the chest and pelvis helps maintain proper ventilation. To monitor hemodynamics during surgery, continuous electrocardiography, non-invasive or invasive blood pressure monitoring, and pulse oximetry are essential. For high-risk patients or complex procedures, advanced monitoring such as arterial line placement for beat-to-beat blood pressure readings, central venous pressure monitoring, and transesophageal echocardiography may be employed. Regular assessment of blood gases and end-tidal CO2 levels helps ensure adequate oxygenation and
ventilation throughout position changes. It’s crucial to maintain communication between the surgical team, anesthesiologist, and nursing staff to promptly address any hemodynamic instability during repositioning.
Moving and transferring patients during the perioperative period is often necessary, requiring all relevant clinicians to understand the associated risks and considerations. By employing best practices, specialized equipment, and continuous monitoring, healthcare teams can effectively reduce the likelihood of adverse events and enhance overall patient safety and comfort.
References
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