Positioning During Endoscopy
Oct 31, 2024Keep on Rollin - Patient positioning for Endoscopy
Positioning of patients during surgical procedures can be advantageous for the proceduralist, but can present difficulties for the Anaesthetic team. For example, a modified prone position for an ERCP reduces technical difficulties for the proceduralist, but without a definitive airway, this positioning can pose a serious threat if the airway is lost, and cause significant delays in establishing an airway whilst the patient is repositioned for intubation.
Ease of access to the airway generally tends to be one of the bigger concerns in patient positioning, but there are a number of other factors and risks to consider too (with some examples):
Ventilatory impairment
- Supine and head down positioning reduces FRC
- Lateral positioning for extended time frames can cause VQ mismatching
Corneal damage
- Higher risk in prone and lateral positions
- Positioning of the head must be monitored throughout the case as it can easily move
Nerve damage
- lateral positioning can cause damage to the brachial plexus
- Incorrect positioning of the arms in the supine position can cause damage to the brachial plexus and/or ulnar nerve
- Finger and hand damage can occur easily when arms are tucked
Pressure sores
- prolonged pressure on bony prominences
- Incorrect use or omission of adequate padding
Exacerbation of patient condition
- Patients with osteoarthritis may have limitations in their joint movements
- The supine position creates a loss of natural lordosis in the lower back, which can exacerbate or cause lower back pain post operatively
- Inadequate prone positioning can increase intraabdominal pressure and reduce venous return
What can you do to ensure comfort and safety for your patients?
- Staff should have training in patient positioning to understand the risks associated and the correct process of positioning
- Closely monitor your patient throughout the procedure to identify any shifts or changes to positioning
- For prolonged cases, be aware of pressure injury risks and ensure adequate use of cushioning and gel pads
- For high risk patients, consider whether an alternative, safer position can be used
Build Knowledge
Improve Safety
References:
Knight, D.J., Mahajan, R.P. (2004) Patient positioning in anaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. V4(5) pp 160-163. https://doi.org/10.1093/bjaceaccp/mkh044
Polese, L., Giugliano, E., Valmasoni, M. (2023) Patient Position in Operative Endoscopy. J Clin Med.V12(21) pp 6822. doi: 10.3390/jcm12216822
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