An obese patient in a prone position

Question

Outline the risks associated with the following positions, and the actions you would take to ameliorate them. Provide rationales for your responses.
What will be an ideal response?

Answer 1

Answer:
Risks
The identified risks associated with placing an obese patient in the prone position include:
airway compromise and decreased pulmonary function
stress on carotid and vertebral arteries
brachial plexus injury and radial nerve damage
pressure injuries to the cheeks, ears, chin, lips, breasts and abdominal skin folds, genitalia (males), patellae and toes
increased risk of VTE
increased risk of compartment syndrome from overly tight BP cuffs and calf compression devices
greater risk of a fall.

Actions
Prior to patient arrival, positioning equipment should be checked for weight tolerance and prepared.
Rationale: To ensure that all required equipment (e.g. OR table, lifting device) is capable of lifting and holding the patient without mishap. Other equipment that must also be available includes additional padding because obese patients have a greater risk of sustaining peripheral nerve and pressure injuries, and two straps. Once on the OR table, two straps are required to secure the patient and prevent them from falling off the table.
An obese patient may require specialised lifting equipment such as air-assisted lateral transfer devices (e.g. HoverMatt) with adequate numbers of staff to perform the transfer safely.
Rationale: Use of the correct lifting device and adequate personnel ensures a safe, smooth patient transfer and that staff are protected from injury.
The patient may require modified positioning and additional padding to minimise risk.
Rationale: Gravity acting on a large body mass leads to increased compressional forces and therefore greater risk of pressure injury. Additionally, modified positioning may be required to minimise risk, such as ‘ramping' the torso to achieve airway alignment.
Special care must be taken to ensure that skin folds are not trapped under the patient or act to interfere with chest excursion.
Rationale: If a fold of skin becomes trapped, it will be at risk of a pressure injury. Obese patients have decreased pulmonary function and therefore it is very important that there are no further impediments to chest excursion.
Avoid overextension of arms and ensure they are secured to prevent them falling off arm boards or the operating table.
Rationale: Overextending the arms can result in damage to the brachial plexus. The arms should be moved down and forwards and placed on the arm board slowly and carefully, palms down. This minimises risk to the brachial plexus. Arms must not be allowed to hang over the edge of the table because radial nerve damage may occur.