Surgical Positioning Nerve Injuries
Nerve injuries resulting from surgical positioning are a significant yet often under-recognized complication in the operating room. These injuries related to surgical positioning can occur when a patient is placed in a particular position for an extended period during a procedure. Nerve injuries can range from temporary numbness to severe, long-lasting damage. Unlike injuries caused directly by surgical intervention, these result from the pressure or stretching of nerves due to the patient's position on the operating table.
Key Causes of Positioning-Related Nerve Injuries
These injuries are primarily caused by prolonged pressure or strain on a nerve. During various surgical procedures, patients are positioned in ways that may not typically pose a risk during shorter durations. For instance, the lithotomy position, used in certain surgeries, can stretch nerves in the lower limbs. In contrast, the prone position, often required in back surgeries, can exert pressure on nerves in the arms and legs.
Factors increasing the risk of nerve injuries include:
Length of Surgery: The longer the surgery, the higher the risk, as nerves are pressured for more extended periods.
Patient Health Factors: Conditions like diabetes or poor circulation can make patients more susceptible to nerve injuries.
Surgical Equipment: Inadequate or improperly used equipment can increase the risk.
Awareness of the Surgical Team: Continuous monitoring and adjustment of patient positioning are crucial.
Vulnerable Body Parts
The risk to specific nerves depends on the surgical position:
Ulnar Nerve: Commonly affected during surgeries with the patient in a supine position and arms extended, potentially leading to issues in the ring and little fingers.
Brachial Plexus: This nerve network can suffer in various positions, affecting shoulder and arm functions.
Peroneal Nerve: Located near the knee, it's at risk during lithotomy position surgeries, impacting foot and ankle movement.
Sciatic Nerve: This nerve can be affected in prolonged surgeries, especially in the prone position, leading to leg and foot issues.
Prevention Strategies
Preventing these injuries involves several key strategies:
Thorough Preoperative Assessment: Identifying patient-specific risks can help in planning safer positioning strategies.
Effective Team Communication: Continuous dialogue among surgeons, anesthesiologists, and nurses is essential for ongoing monitoring and adjustment of patient positioning.
Appropriate Equipment Use: Using well-padded and adjustable surgical tables and protective padding can reduce pressure points.
Periodic Repositioning: In long surgeries, changing the patient's position can help prevent prolonged pressure on any one nerve.
Vigilant Postoperative Care: Early detection and management of any signs of nerve injury are vital.
The Importance of Awareness and Training
Educating all members of the surgical team about the risks and prevention of nerve injuries due to positioning is crucial. Regular training sessions, updated guidelines, and a culture that prioritizes patient safety can significantly reduce the incidence of these injuries.
Conclusion
In conclusion, while nerve injuries from surgical positioning present a challenging aspect of surgical care, understanding their causes and diligently implementing prevention strategies can significantly mitigate these risks. It is imperative for all healthcare professionals involved in surgical care to be aware of these risks and work collaboratively towards ensuring patient safety and optimal outcomes.
AEC Consulting LLC specializes as a surgical nursing expert, including pre-, intra- and post-operative patient care. Alexis Chaudron is the owner of AEC Consulting LLC, an independent nurse legal consulting practice through which she provides legal nurse consultant expertise honed through 15+ years of healthcare experience. She is currently clinically practicing as a circulating nurse and provides charge nurse coverage. Alexis is an operating room nurse expert, with a specialty in orthopedic and spine surgeries. Additionally, Ms. Chaudron was trained and worked in Neurosurgical, General, ENT, Plastics, DaVinci, GYN, Cystoscopy, and Pediatric surgical cases.
Alexis provides surgery nurse expert witness services for medical legal cases. She has analyzed medical charts, depositions, declarations and other related documents to ascertain if the nursing standard of care has been met. As an operating room nurse expert, she utilizes nursing textbooks, guidelines and peer reviewed articles and journals to bolster her surgical nursing expertise. Alexis has provided depositions, expert testimony, affidavits and reports as needed depending on case requirements. She has worked for both plaintiffs and defense in medical malpractice and wrongful termination cases.
The initial call is confidential and complimentary. Alexis can discuss your legal issues and how she can best assist your organization.
