Part Three

- General conditions of patients

Required requirements :

Cushions of any pillow, rolls, towels, small pieces of rubber-coated plastic.

Blaster (tape).

Trapezoidal distances are suitable operations.

Note: (see the following points for specific situations).

Steps: 

1.       Review the operating schedule and the patient's file to determine the position in which the patient will be placed for the operation.

2.       Collect all the Required Needs in the room before the patient arrives.

3.       Bring the patient to the room.

4.       Hold the trolley well with a boot in front of the operating railing.

A-use the brake to stop the calf.

B-transfer the patient on the operating table.

C-ensure that the patient does not move away from the middle of the operating table.

D-for safety reasons, it is better to have another person standing at the other end of the operations platform.

5.       Check with the anesthesiologist before the injection – he may want to start the anesthesia before placing it.

6.       If he starts to anesthetize

- Ensure that the seat belt is placed around the patient's thigh to secure him on the operating platform.

7.       The patient is placed after the approval of the anesthesiologist.    

- Ensure that there are enough people to place the patient.

8.       Lay the patient should be slowly and carefully.

9.       Ensure that the patient is positioned using pillows or wraps and plastering plasters.

- Ensure that all bone parts are fully protected and the procedures are in a normal position with the body.And there is additional care in a natural position with the body.

10.   Ensure that there is no direct contact between the body parts and any metal.

11.   In the case of extending the patient's arm on the arm holder, it should be ensured that the head is in the direction of the injured arm.

12.   Leave the patient covered with a sheet or blanket until the operation begins.

Supine position on the back

This is the mode that is most often used :

1.  The patient lies on his back in an upright position with his head facing up.

2.  The arms are on the side of the body with the shoulders down.

3.  The legs are parallel, not crossed, and the feet are not contiguous.

4.  The head is in an upright position with the spine.

Required requirements:

Ankylosis fascia (joint of the foot).

2 elbow holders.

A belt above the thigh (when needed).

Steps: 

1.    Place the patient on the operating table with his arm next to him.

   A-the man is straight, parallel and in line with the head and spine.

  B-the heel is parallel to the spine.

  C-this achieves a normal body position and a relaxed posture.

  D-make sure that the legs do not cross.

2.       If the seat belt is placed on the patient's knees

  A-it must be ensured that the belt is not tightened.

 B-in the case if the patient is not anesthetized, the operation should be explained so that the patient is not afraid 

3.      Secure the arm with an elbow strap.

  A-ensure that the elbow strap is not pushed too hard on the elbow.

  B-ensure that the hands are not pushed under the patient's body.

4.    Place the joint roll under the foot joint and the foot is not in contact.

5.    Place a pillow under the patient's head.

6.    If necessary, a small pillow can be placed under the lumbar.

The supine position on the back with the arm extended

This position is used with mastectomy, upper limb and hand operations. And when the patient is under treatment with solutions and the doctor needs anesthetic to reach the arm a lot.

The patient is in a supine position on the back with one or both arms extended.

 Additional equipment needed:

An edge for the arm.

A pillow for this edge.

A belt for the Hand joint.

Steps: 

1.    The patient is on the platform and in a supine position on the back and the affected side on the edge of the platform.

- If the operation involves the armpit, the arm is at the lower end of the edge of the arm.

2.    Make sure that the edge of the arm is fixed with the trapeze on the affected side.

3.    Place the lever on its edge and use additional padding if necessary.

4.    Beware of the arm more than 45 degrees from the body.

5.    A belt for the Hand joint can be used if the operation allows or if the arm is extended until the anesthetist reaches it.

6.    Turn the patient's face towards the affected area and leave it back.

7.    Make sure that the face does not have to be on the proper side.

Shoulder operations or anterior external segment 

The patient is on his back, but the affected side is raised.

Additional equipment needed :

A small sandbag or a round pillow for placement under the shoulder.

Steps: 

1.    The patient is placed and tied on the trapeze in the manner described earlier.

2.    Place a small sandbag or a round pillow under the affected shoulder and with this you lift the shoulders off the railing and reveal the place of the operation in a correct way.

3.    A safety belt can be put on the thighs.

4.    Shoulders and buttocks should be leveled.

5.    The arms can be left next to the patient secured with elbow rests with which the elbow is placed.

6.    Use additional pillows when necessary (if necessary) or the arm can be placed on the arm holder or raised above the patient's head.

- The precaution of moving the arms within the limits of their natural movement with the flexibility of the elbow.

7.    Put a pillow under the head and move it in one direction.

8.    Put a pillow under the anklet and under the foot.

9.    Adjust the legs with a safety harness in a position below the knees.

Reverse trendelenberg mode 

This position is used for gallbladder and bile duct operations, as it allows the stomach to fall away from the upper part of the abdomen, giving an entrance to the upper abdomen.

It is also used in cases of thyroidectomy to help the patient breathe and reduce the blood supply to the area.

The patient lies on his back in an upright position.

Tilt the trapeze of the operations so that the head is in a high position from the legs.

 Required requirements:

For surgery of glands

 2 The elbow rest is a foot barrier

Safety belt and thin cushion

Lumbar arch pillow, pillow for the back of the head (cough)

A roll down the knees or a pillow under the head

Steps: 

1.    The patient is placed and secured on the operating table in the same way as described in the upright position.

A-the use of elbow supports for the freedom of the arms.

B-put a pillow under the head.

2.    Place seat belts around the patient's legs and under the knees.

- If the patient is not sedated, explain to him what to do.

3.    Set the footboard with the bottom of the operation trellis at an angle of 45 degrees relative to the trellis – use additional pads if necessary.

4.    Place the pillow under the lumbar curvature.

5.    Put a roll under the knees.

6.    The table foot is tilted down depending on the needs of the surgeon.

7.    To remove the thyroid gland, place a thin pillow under the shoulders and place the pillow under the head with a scraper under the head.

8.    The armrests can be left next to the patient temporarily with elbow rests and an elbow thread.

- Use additional pillows as necessary if necessary.

Lying on the face

This position is used for operations on the lower chest, spine, legs, and sometimes in the rectal area.

The patient lies on the abdomen with pillows to push his weight off the chest to be able to breathe.

Additional requirements:

Safety tape.

A pillow for under the joint (ANKL) and foot.

Wave an arm when needed.

An elbow holder when needed.

A pillow under the head.

Roll (roll) under the armpit and chest.

Steps: 

1.    When the patient and anesthesiologists are given permission to turn the patient carefully and slowly turn over on his stomach.

2.    The anesthesiologist performs a head and shoulders turn.

3.    One person stands under the two seats (pelvis) and the other arm above the two seats, lifting it and turning it into position.

4.    A person grabs the legs and turns them over in the position at the same time as the shoulders and the Withers.

5.    The arms remain on the side of the patient and care should be taken that the patient's weight is not on his low arm.

6.    Place the shoulder roll under the armpits and at the chest to lift the body weight off the abdomen. 

Kidney position (side) 

This mode is used for kidney and side operations.

The patient is in the lateral position and the kidney area is above the curve of the trapezoid of the operations.

When the table is bent, the operation area is stretched, giving more exposure. The patient's body is straight from the shoulders to the pelvis (sitz).

Additional requirements :

Armrest

Safety belt on the pelvis (breech).

1 pillow between the knees.

1 cushion for the joints (ANKL).

A safety belt on the lower leg.

Steps: 

1.       When the patient is anesthetized and the anesthesiologist allows the patient to be turned on the uninjured side, the back is at the edge of the table and the kidney area is on the curve of the table.

2.       The anesthesiologist offers to support and wrap the head and shoulders.

3.       The arm is placed under the chair, the other on the chair and the patient is lifted to take his position.

4.       The legs are raised and placed so that the lower leg is bent under the upper leg, which is straight (straight).

5.       A large pillow is placed between the legs and a pillow is placed under the joint (ankle) to rest it on the operating table.

6.       Secure the legs with a safety tape placed on the knees.

7.       The lower hand is stretched out on a padded armrest and secured at the wrist with a wrist strap.

8.       The upper hand is lifted and bent at the elbow and placed under the patient's head.

9.       Put the pillow under the patient's head.

10.   A backrest is placed to the patient's back and secured with a trapezoid.

11.   Use an extra pillow if necessary.

12.   Place a chest support in front of the patient and secure it with the operating table.

- This armrest should be well padded to avoid bruising the chest.

13.   Security of the patient's body another tape is placed on the Sitz.

14.   The trapezoid of the processes is bent from the middle.

- If a kidney lifter is available, it can be used to lift the space between the ribs and the iliac bone as much as required and tilt the head slightly down.

15.   Before closing the wound, the operating table is placed in an upright position to allow tissue convergence.

The position of the calcaneal fissure or the sacral dorsal position

This position is used for vaginal, anal (rectal) operations and some cystoscopy.

The patient lies on his back and the area of the feet on the lower part of the table at an angle of 90 degrees relative to the body of the operating table.

The patient's knees are bent, the legs are in an external position relative to the stand, and the foot is dangled from the belts.

The buttocks are pulled forward towards the edge of the operating table.

Additional requirements :

2 holders with laces (belts).

2 small pillows.

1 head pillow.

2 elbow holders.

Steps: 

1.       When the patient is anesthetized and the anesthesiologist allows him to be placed in the desired position.

2.       The patient is raised on the table so that the buttocks are on the bend of the table between the foot and the body – making sure that the buttocks are not placed on the edge of the table.

3.       The patient's legs are raised and secured.

4.       The position of the foot on the operating table is bent down as far as possible – until it is at a right angle relative to the body of the operating table.

5.       As an alternative, before the patient is anesthetized, the area of the feet on the table is bent down and the patient and his buttocks are placed at the edge of the trapeze – the patient's legs are secured on other straps so that we put the legs in the belts after anesthesia.

6.       Fix the holders in the catcher on one side of the table – adjust the holders so that the two are the same height and facing each other – making sure that the catcher is well secured.

7.       It takes two people to lift the legs at the same time.- Hold the foot with one hand and support the knees with the other.

8.       Carefully put the legs out of the racks.

9.       Place the foot in the straps so that there is a lace around the toe and a lace around the foot landmark (making sure that the laces are not twisted).

10.   Place pillows between the legs and tripods.

11.   The arms are bent over the abdomen and secured with a blanket wrapped around the elbow or with elbow rests.

12.   A pillow is placed under (under) the patient's head.

Lying on the back

The patient is in this position when examining the vagina and inserting a catheter to the woman.

The patient is lying on his back.

The knees are bent.

The two heels are joined together.

Equipment needed:-

1 pillow for under the head.

1 pillow for the knees (if needed).

Steps: :-

1.    The patient is in a supine position on the back with his arms tied to the abdomen.

2.    The legs are bent at the knees and the thighs are facing outward.

3.    He brings the heels closer together until they almost touch while they are placed on the railing.

4.    A pillow can be placed under the knees.

Fowler's situation

This position is used in craniofacial operations.

The patient is placed half-seated so that the operating trapezoid is clamped and tilted to obtain proper posture.

Required requirements:

Headrest

Safety belt

A large pillow

Footrest

Steps: 

1.    The patient is placed on the operating table on his back on the curved lower part of the table.

2.    The footrest is secured at the end of the trapeze and raised, stuff the footrest with an additional pillow if necessary.

3.    Lower the foot slightly from the operating table so that the knees are bent.

4.    Lift the body off the table at an angle of 45 degrees so that the back is comfortable.

5.    Lift the arm off the large pillow placed on the patient's stone.

6.    Secure the legs with a safety tape placed above the knees.

7.    Place the headrest from the top of the table so that the patient's head rests on it.

8.    Carefully secure the rest at the table.

9.    Hope the table head down to avoid the patient sliding forward.