In veterinary surgery, patient positioning is a critical factor that significantly impacts both the procedure's success and the animal's safety. Proper positioning ensures optimal access to the surgical site, prevents complications, and supports the comfort of the animal during the procedure. Whether it's a routine spay, complex orthopedic surgery, or an emergency procedure, understanding the fundamentals of patient positioning is key to a successful outcome. This blog delves into the importance of patient positioning in veterinary surgery, its best practices, and some challenges that veterinary teams may encounter.
The Importance of Patient Positioning
Proper patient positioning is essential for multiple reasons in veterinary surgery:
- Maximizing Surgical Access: The most obvious reason for careful positioning is to provide the surgeon with optimal access to the surgical site. For instance, an abdominal surgery requires the patient to be in a dorsal recumbency, while orthopedic procedures may require positioning the animal laterally.
- Preventing Pressure Injuries: During surgeries that last several hours, animals are at risk of developing pressure sores or other injuries from prolonged contact with hard surfaces. Proper positioning with cushioning and padding can reduce these risks.
- Maintaining Circulation: Adequate positioning can help prevent circulatory problems, such as hypotension or decreased blood flow to certain body parts. When blood flow is compromised, complications like tissue necrosis, pressure sores and poor wound healing may occur.
- Supporting Respiratory Function: Depending on the type of surgery, certain positions can help maintain proper ventilation and reduce the risk of respiratory complications. Elevating the chest can aid breathing in surgeries that involve the thorax.
- Safety of Anesthesia: Anesthesia carries risks, and positioning must consider the potential impact of anesthesia on an animal's circulatory and respiratory systems. Improper positioning can increase the risk of complications such as hypoventilation, aspiration, or even organ dysfunction.
Types of Patient Positions in Veterinary Surgery
Patient positioning varies greatly depending on the type of surgery being performed. Below are the most common positions used during veterinary procedures:
1. Dorsal Recumbency
This is the most common position for abdominal procedures such as spays, neuters, or bowel surgery and occasionally thoracic procedures. In this position, the animal lies on its back with the legs extended outward.
- Advantages: Provides excellent access to the abdominal and thoracic regions. It allows the surgeon to make an incision along the midline and ensures that the patient remains stable.
- Challenges: Dorsal recumbency can cause pressure on the diaphragm, which may impede respiratory function, particularly in deep-chested animals. Proper padding is essential to reduce pressure points on the body and prevent nerve damage.
Best Practices for Dorsal Recumbency:
- Ensure the head is aligned with the body to avoid neck strain.
- Use padding under the limbs to avoid hyperextension.
- Elevate the head slightly to improve breathing.
- Position the forelimbs outstretched and the hindlimbs slightly flexed.
2. Lateral Recumbency
Lateral recumbency is typically used for orthopedic surgeries, particularly those involving the limbs, such as fractures or joint repairs.
- Advantages: Provides excellent access to the limbs, particularly when working on the forelimbs or hindlimbs. It also helps maintain better respiratory function by allowing the non-operative side of the chest to expand fully.
- Challenges: One of the challenges in lateral recumbency is the risk of pressure sores. The patient may need to be repositioned or have additional padding to ensure comfort and prevent injuries from the hard surface.
Best Practices for Lateral Recumbency:
- Use a soft, thick pad under the animal to prevent pressure sores.
- Secure the animal with tie-downs or sandbags to prevent unnecessary movement.
- Maintain alignment of the spine and limbs to reduce strain on joints and muscles.
3. Sternal Recumbency
Sternal recumbency is less common but may be used for procedures that involve the front limbs, the thoracic region as well as the spine. This position also allows the animal to breathe more easily, as the pressure on the diaphragm is reduced.
- Advantages: Sternal recumbency is often used in smaller animals for procedures involving the chest, such as thoracotomy or procedures that require access to the heart and lungs.
- Challenges: This position can be difficult to maintain, especially in larger animals or when the patient is under anesthesia. Proper support must be provided to avoid sudden changes in posture.
Best Practices for Sternal Recumbency:
- Ensure the animal is comfortable by providing padding under the chest and abdomen.
- Monitor respiratory function closely, as this position can still cause respiratory distress in certain animals.
4. Trendelenburg Position (Head Down)
In some surgeries, particularly those involving the abdomen or lower limbs, the Trendelenburg position is used. In this position, the animal's head is tilted downward, and the hind limbs are elevated.
- Advantages: This position helps shift abdominal contents, such as intestines, away from the surgical site, providing better visibility for abdominal surgeries. It also aids in reducing the risk of aspiration during certain procedures.
- Challenges: The Trendelenburg position can exacerbate respiratory problems, particularly in deep-chested or brachycephalic animals, and may increase intracranial pressure.
Best Practices for Trendelenburg Position:
- Use a wedge, padded surface or tilt table to safely tilt the animal.
- Continuously monitor the respiratory rate and effort to avoid complications.
- Avoid prolonged use of this position unless absolutely necessary.
5. Prone Position
The prone position is less frequently used but may be beneficial for specific surgical cases, such as spinal or orthopedic procedures. It is very similar to sternal recumbency.
- Advantages: This position can allow better access to certain regions of the body, such as the back or the posterior limbs. It can also be helpful in procedures involving the spine, as it aligns the vertebrae more naturally.
- Challenges: This position can pressure the abdominal organs and spine significantly. It is essential to carefully monitor the animal’s circulatory and respiratory systems when in this position.
Best Practices for Prone Position:
- Provide extra padding for the chest and abdomen to prevent pressure injuries.
- Monitor for signs of respiratory distress or circulatory compromise.
Techniques to Ensure Safe and Comfortable Patient Positioning
To prevent complications during surgery, there are several positioning techniques and tools that veterinary teams employ to ensure the patient’s comfort, safety, and surgical success:
- Padding and Support: Soft padding, foam cushions, vacuum-activated positioners, or padded surgical tables are essential to avoid injury from pressure points. Strategic placement of pads under joints, ribs, and the neck helps prevent nerve damage and circulatory issues.
- Tie-Downs: Ties, or specialized positioning devices, are used to stabilize the animal and prevent unnecessary movement during surgery. These are particularly useful when working with patients under anesthesia.
- Monitoring: Continuous monitoring of the animal’s vital signs—heart rate, blood pressure, respiratory rate, and temperature—is critical, especially when the patient is in more extreme positions like Trendelenburg or dorsal recumbency.
- Regular Repositioning: For lengthy surgeries, repositioning the animal periodically can prevent tissue damage, reduce the risk of pressure sores, and promote better circulation. Ideally, the animal should be turned every 30-60 minutes.
- Anesthesia Considerations: Proper positioning is important for surgical access and for managing anesthesia. For instance, the anesthetist may adjust the animal’s positioning to help maintain airway patency, ensure adequate ventilation, and avoid complications like aspiration.
Challenges in Veterinary Patient Positioning
While positioning is crucial, it does not come without its challenges. Some of the most common challenges include:
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Size and Breed Variations
Different species, and even breeds within a species, may require different positioning methods. Large dogs like Great Danes and small dogs like Chihuahuas will need different strategies to ensure comfort and stability during surgery. -
Uncooperative Patients
Especially in emergency surgeries, animals may not be properly sedated or anesthetized prior to the procedure, making it difficult to achieve the necessary positioning. The surgical team may need to employ additional measures, such as physical restraint or sedative agents. -
Anatomical Considerations
Certain breeds, such as brachycephalic dogs or deep-chested dogs, may have respiratory issues that make certain positions more challenging. Veterinary professionals need to understand these anatomical concerns and adjust their positioning strategies accordingly. -
Duration of Surgery
The longer the surgery, the greater the risk of complications arising from poor positioning. Careful planning, monitoring, and repositioning during long surgeries are essential to prevent pressure sores, nerve damage, and other issues.
Conclusion
In conclusion, patient positioning plays a pivotal role in the safety and success of veterinary surgeries. It ensures that the surgeon has optimal access to the surgical site, helps reduce the risk of complications like pressure sores and nerve damage, and supports the animal’s overall well-being during the procedure. Veterinary professionals must carefully consider the type of surgery, the animal’s unique anatomy, and potential risks associated with anesthesia when choosing the best positioning method.
By employing careful positioning techniques, using proper padding, and continuously monitoring the animal’s vital signs, veterinary teams can greatly improve the outcome of the surgery, enhancing the overall experience for both the animal and the veterinary staff. Proper training and experience are key to mastering patient positioning and delivering the highest level of care to every animal that requires surgery.
HUG-U-VAC Patient Positioners
The HUG-U-VAC patient positioners have a long track record of patient safety, comfort, and clinical efficiency. Since they are vacuum activated, they conform to all the contours of the patient’s body, supporting all aspects of the anatomy equally to prevent pressure sores and nerve damage and improve respiration. The HUG-U-VAC patient positioners can be used for any procedure and any position, be it dorsal, sternal, lateral, or Trendelenburg. No barbaric tie-downs are necessary. They all come with four limb restraints for gentle limb accommodation. They have been proven equally effective in positioning for preop prep, any surgery, and post-op recovery. The HUG-U-VAC patient positioners come in five sizes to accommodate any patient, from small cat to jumbo dog.
More about the Hug-U-Vac Patient Positioning
