Perioperative Care of the Morbidly Obese Patient in the ... - AORN

September 2010 Vol 92 No 3 BENNICOFFaround the patient’s ankles and lower legs on topof the SCDs to redistribute pressure and thencarefully adjusted the height of the lifts to an appropriateheight for the procedure.The circulating nurse assessed the patient’sposition for potential pressure areas and madeadjustments as needed; however, the patient’s sizemade finding bony landmarks difficult and ruledout the use of graduated compression stockings.The nurse monitored the patient’s legs throughoutthe procedure.The scrub person, surgeon, and surgical assistantsplaced the drapes for the surgical field. Extradrapes were needed to adequately cover thelifts. After draping the surgical field, the surgeonbegan the surgical procedure. One limitation thatteam members noted was that space at the end ofthe bed to perform the surgery was unavoidablylimited by the sling size and placement. The circulatingnurse provided team members with extrasteps so team members could participate asneeded (eg, retracting surgical tissue) withoutleaning on the patient or inadvertently moving thepatient’s legs.The procedure lasted 90 minutes and was uneventful.After the procedure was completed, theteam members carefully lowered the slings andmoved the patient’s legs from the slings backonto the bed surface. The circulating nurse assessedthe patient for positioning injuries and didnot observe any. The patient’s skin appeared tobe in the same condition as it had been on arrivalin the OR. Team members reinflated the patienttransfer pad to move the patient back onto thebariatric cart and transferred her to the postanesthesiacare unit without incident. The patient recoveredwell and was discharged to home thenext day.Postoperative PhaseA postanesthesia care unit nurse called the patient48 hours after surgery. The patient reported thatshe had not noted any positioning injuries, whichindicates that the preoperative anticipation andplanning contributed to the patient’s positive outcome.The surgeon informed the team membersthat the patient’s recovery had been uneventfuland that the patient was pleased with the resultsof the surgery.EvaluationAfter the surgery, the team members discussedtheir success and identified opportunities forimproving this modified positioning protocol. Incaring for this patient, team members discoveredthat preplanning for positioning and padding wasrequired to prevent patient and staff memberinjury, additional transport and transfer help wasrequired, use of transfer devices (eg, an inflatable patienttransfer pad) was essential, extra staff members were needed and care hadto be taken to avoid injury to staff memberswhen moving a patient of this size, power lifts for the slings were necessary andfunctioned successfully, draping had to be adjusted to adequately coverthe lifts and provide a sterile field, space at the end of the bed to perform the surgerywas unavoidably limited by the sling sizeand placement, and extra steps were needed to ensure visibility ofthe surgical site and prevent inadvertent patientinjury.In reviewing the modified equipment used in positioningthe patient for this procedure and thepatient’s surgical outcomes, the team membersdetermined that use of patient slings was a safealternative to stirrups when caring for this patientwho was morbidly obese and required surgery inthe lithotomy position.CONTINUED SUCCESSTeam members have since participated in additionalprocedures requiring this method of legsupport and experienced the same success. Team308 AORN Journal