Lithotomy position abdullah
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Transcript of Lithotomy position abdullah
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
Goals of Proper Positioning
Patient lies in supine position with buttocks at the lower break of the table.
The legs are flexed in the hip ( 90 degrees ) and abducted (30 degrees) in the hip.
The knees are bent 70 to 90 degrees. The lower legs are supported on padded leg
shells..
Lithotomy
Lithotomy stirrups placed in position level with patient ischial spine
Arms placed over the chest or on an armboard
Legs are lifted together upwards and outwards and feet placed in knee crutch or candy cane
The pelvis should be level The head and trunk should be in a
straight line
Frequently used for procedures that requires a vaginal or perineal approach
The patient is in the supine position with legs raised and abducted by stirrups
Once the feet are positioned in stirrups, the footboard is removed and the bottom section of the OR bed is lowered
It may be necessary to bring the patient’s buttocks further down to the edge of the OR bed break.
High Lithotomy
Placed in supine position with the legs raised and
abducted in crutch-like or full lower leg support stirrups
The angle between the patient’s thighs and trunk is not as acute as for the high lithotomy position
Used in vaginal procedures
Low Lithotomy
Peroneal nerve injury: Pressure of head of fibula by bar or support
structures compresses nerve Saphenous nerve injury: Pressure on medial condyle of tibia compress nerve Femoral nerve injury: Due to angulation of thigh such that inguinal
ligament is stretched & compresses nerve Obturator nerve injury: Due to greater degree of thigh flexion there is
stretching of nerve as it exits the obturator foramen
Nerve injuries in lithotomy
NURSING PRECAUTIONS POTENTIAL COMPLICATIONS
Two person required to raised the legs simultaneously by grasping the sole and other hand supporting the calf
Severe backache caused by too high stirrups
Calf holder may resulted peroneal or femoral obturator nerve damageStirrups bars must be checked
and secure before use and it’s height must be similar and not suspend the patient weight
Osteoarthritis or stiff hips due to rough handling
The buttock must be even with the edge of bed to prevent lumbosacral strain
Too quick of lowering the legs may cause hypotension
Femoral nerve damage due to acutely flexed thighs
Hip dislocation or fracture as a result faulty stirrups
KNEE CRUTCH
Pressure on peroneal nerve resulting footdrop and neuropathies
CANDY CANE Pressure on distalsural
and plantar nerves which can cause neuropathies of the foot
Hyperabduction may exaggerated flexion and stretch sciatic nerve
BOOTH TYPE May produce support
more evenly and reduce localized pressure
TYPES OF STIRRUPS AND IT’S HAZARDS
KNEE CRUTCH CANDY CANE
BOOTH TYPE
Risk #1:
Hip/knee joint injury Lumbar/sacral pressure Vascular congestion
Risk #2: Neuropathy of obturator
nerves, femoral nerves, common peroneal nerves/ulnar nerves
Risk #3: Restricted diaphragmatic
movement Pulmonary region
LithotomySafety Consideration:
– Place stirrups at even height– Elevate lower legs slowly and
simultaneously from stirrupsSafety Consideration:
– Maintain minimal external hip rotation
– Pad lateral or posterior knees/ankles to prevent pressure and contact with metal surface
Safety Consideration:– Keep arms away from chest to
facilitate respiration– Arms on arm boards at less
than 90 degree angle or over abdomen