Proper Patient Positioning Guidelines: Lithotomy Position

The supine position is the most commonly used position in surgery and has many variants; one such variant is the lithotomy position. The patient is placed on their back and legs are elevated at their hips. It is primarily used for procedures involving the perineum, pelvic organs, rectum, and genitalia.1 If the nursing assessment indicates limited range of hip motion due to arthritis, prosthesis, contractures or other conditions, patients may be placed into the position while awake so that they can participate in ensuring their comfort.

The head is supported by a patient positioning headrest like the AliGel Head Positioneror Single-Use Head Donuts. Ensuring the head and spine are aligned and the neck is in a neutral position. The patient’s arms are secured, using a strap such as AliMed Soft Precut Patient Positioning Straps, on padded arm boards to prevent crushing fingers and hands. The arm boards should be positioned at no more than 90 degrees, AliMed’s pivoting Armboard allows for incremental adjustments and to secure the board firmly in place. The legs are elevated, abducted, and supported in stirrups, such as the Ultrafin Stirrups, with the buttocks even with the lower break of the table. During elevation, the feet are held in one hand and the lower part of the leg in the other while the legs are slowly flexed. To prevent hip dislocation or muscle strain from the exaggerated range of motion, the legs should be raised and lowered slowly and simultaneously. At-risk pressure points vary depending upon the type of stirrups used, so perioperative nurses should pay particular attention to the femoral epicondyle, tibial condyles, and lateral and medial malleoli. The inner thighs and sacrum should be free of pressure, which should be accomplished via sufficient padding1, the Azure Sacral Pad is designed to relieve pressure on the sacrum. Correct placement of the safety strap is difficult in the lithotomy position. There is not a best practice for its placement; however, the safety restraint should not be placed over the patient’s chest or abdomen.

Modifications of the lithotomy position include low, standard, high, hemi, and exaggerated as dictated by how high the lower body is elevated for the procedure.1

  • Low: The patient’s hips are flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 40 degrees to 60 degrees. The patient’s lower legs are parallel with the O.R. bed.2
  • Standard: The patient’s hips are flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 80 degrees to 100 degrees. The patient’s lower legs are parallel with the O.R. bed.
  • Hemi: The patient’s non-operative leg is positioned in standard lithotomy. The patient’s operative leg may be placed in traction.
  • High: The patient’s hips are flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 110 degrees to 120 degrees. The patient’s lower legs are flexed.
  • Exaggerated: The patient’s hips are flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 130 degrees to 150 degrees. The patient’s lower legs are almost vertical.

Following the procedure, the lower portion of the table is raided or replaced to align with the rest of the O.R. table. The patient’s legs are removed from the stirrups simultaneously, extended fully to prevent abduction of the hips and slowly lowered onto the table and the table strap, like the VeriClean Patient Safety Strap, is applied for safety.

REFERENCES

  1. Burlingame B, Davidson J, Denholm B, et al. Guideline for positioning the patient. Guidelines for Perioperative Practice. 2017;1. DOI: 10.6015/psrp.17.01.e1.
  2. Rowen L, Hunt D, Johnson KL. Managing obese patients in the OR. OR Nurse. 2012; 6(2):26-36.

Follow us on social media for the latest updates in B2B!

Image

Latest

security communication solutions
Game-Changing Security Communication Solutions On Display at IWCE
March 28, 2024

One of the spotlights at this year’s IWCE event in Orlando, Florida were the security communication solutions which make a significant different in sensitive environments like public schools. How can dealers successfully navigate partnerships with agencies to enhance their security measures? Jon Paul Beauchamp of Icom America caught up with Paul Toth, the Owner […]

Read More
four perspectives in 2024
Amend & Progress: Exploring Four Perspectives in 2024 and Beyond
March 28, 2024

In a dynamic exchange on the Amend & Progress podcast by Vodori, Annalise Ludtke explores four perspectives in 2024 that will help bring effective content to the market now and beyond. With the participation of Vodori’s CEO and Co-Founder, Scott Rovegno, the conversation unveils insights on macro-level topics crucial to the organization’s strategic direction. […]

Read More
retail in the digital age
APL Is Redefining Retail in the Digital Age with Tech-Infused Luxury Footwear
March 27, 2024

In an era where fashion and technology intersect more seamlessly than ever, particularly within the context of retail in the digital age, the discussion around innovation in the luxury footwear market is gaining momentum. This conversation comes at a crucial time when consumers are increasingly looking for products that not only offer aesthetic appeal […]

Read More
grid expansion
Voices of ChargeExpo 2024: Lilypad EV Unites Grid Expansion with EV Charging for a Better User Experience
March 27, 2024

At ChargeExpo 2024, a pivotal discussion unfolded, shedding light on the integral relationship between grid expansion and the future of electric vehicle (EV) charging infrastructure. As electric vehicles continue to surge in popularity, the spotlight has turned to the supporting infrastructure, underscoring a critical challenge: the need for significant grid expansion to accommodate the […]

Read More