Identify the position required for this surgery, the general safety considerations and the specific positioning requirements needed for Mrs Tagaloa

Question

Mrs Lanuola Tagaloa is a 54-year-old Samoan woman who has lived in Australia for the past 15 years. She was admitted on the day of surgery for an elective vaginal hysterectomy with anterior/posterior colporrhaphy. She has a history of asthma and has type 2 diabetes mellitus (diagnosed at 42 years of age). Mrs Tagaloa has a history of grand multipara. She has a BMI of 30+ and falls into the obese category, but appears otherwise fit and well. She lives at home with her extended family and is responsible for the care of her mother and school-aged children. The admissions nurse informs you that Mrs Tagaloa is very softly spoken and did not maintain eye contact. She was accompanied by a female family member and overheard to be conversing in her native language.

What will be an ideal response?

Answer 1

Answer:
The lithotomy position is used for surgery on the perineal region, including hysterectomy and anterior/posterior vaginal repair. The patient requires supervision and guidance in order to transfer herself over to the operating table, as well as adequate numbers of surgical team members to assist. Team members should provide instruction, support and reassurance and ensure that the patient's dignity is maintained during the transfer process. Once the patient is anaesthetised, she will be placed into the lithotomy position.
General safety considerations
Use of a pressure-relieving mattress or gel overlay on the OR table and padding on stirrups is necessary to prevent pressure injury, risk of thrombus formation, compartment syndrome and injury to peripheral nerves.
Slow and simultaneous placement of the patient's legs into the stirrups is necessary to prevent femoral nerve damage, hip dislocation and blood pressure fluctuations.
In order to prevent lumbosacral strain and sciatic nerve damage, the patient's buttocks should be placed at the end of the lower table break and not be allowed to overhang.
Protecting the hands when adjusting stirrup joints and lower table break ensures prevention of crush injury to fingers.
Graduated compression stockings and an intermittent pneumatic compression device should be used to minimise the risk of thrombosis formation.
Specific requirements
Mrs Tagaloa's BMI places her in the obese category, therefore the weight loading of the OR table (particularly in an extended position) needs to be determined, as does consideration of the stirrups to be used. Review of the pressure risk assessment score and use of pressure-relieving aides are essential to distribute pressure across a greater surface area and minimise the risk of injury.
The patient has a history of asthma and type 2 diabetes mellitus. These comorbidities must be considered to ensure that respiratory function is not compromised (excess weight can compromise chest excursion and subsequent respiratory function). In addition, reduced perfusion to the extremities and peripheral neuropathy as a result of diabetes require careful placement and protection of the patient's lower limbs while in the stirrups. Patient screening and use of VTE risk assessment guidelines should be followed.
Mrs Tagaloa is to remain in the lithotomy position for an extended period of time. Consequently, boot-style stirrups should be used in preference to ‘pigtail' or ‘candy cane' stirrups.
Mrs Tagaloa is at high risk of compromise to her dignity and psychological discomfort related to the surgical procedure and associated positioning. Preservation of patient privacy, confidentiality and dignity is essential. Minimising patient exposure and using discretion when conversing with the patient is as much a priority as physical nursing care. Culturally sensitive care must be employed.