Position

Before I started working in an operating room, I never gave much thought to the positioning of the patient. It always seemed like one of those mundane things. But now that I am the one bringing a patient in, monitoring them through surgery, and then wheeling them out to recovery, I have gotten to know all our operating rooms well. In some, you have to go in head first; in others, feet first. There isn't a lot of room in the operating theater to do a complete turn. Most times, the head is close to anesthesia; that way, we can keep an eye on the airway. During the operation, the surgeons often ask us to move the bed up or down. While this may seem like a stupid task, I learned quickly that it was my responsibility as I raised the patient up and down that lines didn't get caught, tubes moved, catheters displaced, or things crushed.

The cases I've learned to dread have to do with complex positioning. Some patients are turned 180 degrees so that their feet face us while the ear-nose-throat surgeons or plastic surgeons work on the head. In these cases, we have to secure the breathing tube extremely well because we don't have ready access to the airway. In back surgeries or neck surgeries, we flip the patient over (from supine to prone). I've learned the toughest part of these cases is getting into the right position. When turning the bed 180 degrees, we have disconnect as much as we can (but some things - like the IV - can't come out), and turning the bed leads to all sorts of entanglement. When flipping a patient over, we have to support the head and face, maintain access to the breathing tube, and protect the eyes and nose - all difficult to do in an asleep obese patient. Positioning is a routine and mundane thing, but doing it right isn't simple.