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Lithotomy position abdullah

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Lithotomy position abdullah

  1. 1.   To maintain patient’s airway and avoid constriction or pressure on the chest cavity  To maintain circulation  To prevent nerve damage  To provide adequate exposure of the operative site  To provide comfort and safety to the patient Goals of Proper Positioning
  2. 2.  Patient lies in supine position with buttocks at the lower break of the table.  The legs are flexed in the  hip ( 90 degrees ) and  abducted (30 degrees)  in the hip.  The knees are bent 70 to 90 degrees.  The lower legs are supported on padded leg shells.. Lithotomy
  3. 3.  Lithotomy stirrups placed in position level with patient ischial spine  Arms placed over the chest or on an armboard  Legs are lifted together upwards and outwards and feet placed in knee crutch or candy cane  The pelvis should be level  The head and trunk should be in a straight line
  4. 4.   Perineal  Vaginal  Urological  Rectal  Gynecology Procedures
  5. 5.  Frequently used for procedures that requires a vaginal or perineal approach  The patient is in the supine position with legs raised and abducted by stirrups  Once the feet are positioned in stirrups, the footboard is removed and the bottom section of the OR bed is lowered  It may be necessary to bring the patient’s buttocks further down to the edge of the OR bed break. High Lithotomy
  6. 6.   Placed in supine position with the legs raised and abducted in crutch-like or full lower leg support stirrups  The angle between the patient’s thighs and trunk is not as acute as for the high lithotomy position  Used in vaginal procedures Low Lithotomy
  7. 7.   Peroneal nerve injury:  Pressure of head of fibula by bar or support structures compresses nerve  Saphenous nerve injury:  Pressure on medial condyle of tibia compress nerve  Femoral nerve injury:  Due to angulation of thigh such that inguinal ligament is stretched & compresses nerve  Obturator nerve injury:  Due to greater degree of thigh flexion there is stretching of nerve as it exits the obturator foramen Nerve injuries in lithotomy
  8. 8. Saphenous nerve Peroneal nerve Femoral nerve Obturator nerve
  9. 9.  Potential Nerve Injuries
  10. 10. NURSING PRECAUTIONS POTENTIAL COMPLICATIONS Two person required to raised the legs simultaneously by grasping the sole and other hand supporting the calf Severe backache caused by too high stirrups Calf holder may resulted peroneal or femoral obturator nerve damageStirrups bars must be checked and secure before use and it’s height must be similar and not suspend the patient weight Osteoarthritis or stiff hips due to rough handling The buttock must be even with the edge of bed to prevent lumbosacral strain Too quick of lowering the legs may cause hypotension Femoral nerve damage due to acutely flexed thighs Hip dislocation or fracture as a result faulty stirrups
  11. 11.  KNEE CRUTCH  Pressure on peroneal nerve resulting footdrop and neuropathies CANDY CANE  Pressure on distalsural and plantar nerves which can cause neuropathies of the foot  Hyperabduction may exaggerated flexion and stretch sciatic nerve BOOTH TYPE  May produce support more evenly and reduce localized pressure TYPES OF STIRRUPS AND IT’S HAZARDS KNEE CRUTCH CANDY CANE BOOTH TYPE
  12. 12. Risk #1:  Hip/knee joint injury  Lumbar/sacral pressure  Vascular congestion Risk #2:  Neuropathy of obturator nerves, femoral nerves, common peroneal nerves/ulnar nerves Risk #3:  Restricted diaphragmatic movement  Pulmonary region Lithotomy Safety Consideration: – Place stirrups at even height – Elevate lower legs slowly and simultaneously from stirrups Safety Consideration: – Maintain minimal external hip rotation – Pad lateral or posterior knees/ankles to prevent pressure and contact with metal surface Safety Consideration: – Keep arms away from chest to facilitate respiration – Arms on arm boards at less than 90 degree angle or over abdomen