Neglecting patient positioning can result in serious post-op complications for your sedated or anesthetized patients, who can't protect themselves from the stress and strain that surgery can put on a body. As you'll see over the next few pages, a wide range of positioning devices are available to support your patients, redistribute pressure, and prevent intraoperative skin, nerve, circulatory and musculoskeletal injuries.

Selecting the most effective positioners begins with an assessment of the specialties in your ORs and a discussion with the physicians who perform them. What types of cases do you host most often? What positions do they require? How are patients at risk?

Orthopedic surgeons tend to have the most positioning needs, and each may have differing methods of achieving them. Some put shoulder patients in the lateral position, for instance, others upright or semi-recumbent. Standardizing techniques or compromising on equipment may be necessary to spare your budget.

If your facility hosts a high volume of bariatric cases or heavyset patients, a positioner's effective weight capacity is important to consider. The rising tide of outpatient spine surgeries demands specialized table attachments as well as head positioners that avoid ocular pressure and allow intraoperative eye examinations to prevent the post-op vision loss or impairment that can follow surgeries in the prone position.

Compare physicians' input on positioners' ease of use and functionality (and nurses' and techs' input, too, if they're the ones positioning patients), as well as their reusability, cleanability, durability or other necessary factors to the pricing offers your purchaser (who should be included in these discussions) has secured from vendors. Is one product's modestly greater benefit worth its higher cost over a close competitor?

Materials used for positioning should be able to:

• absorb compressive force;
• redistribute pressure;
• prevent excessive stretching; and
• provide support for optimum stability.

Manufacturers may present data on their products' pressure management abilities, but unless the data came from an independent study, the company may have conducted or paid for it themselves. Always be sure to trial positioners yourself, with your own nurses and techs, in your ORs or even at conference exhibit halls, to ensure that they work, that they're safe and that they're comfortable for patients and promote patient safety.

Action Products
Action Pads, Positioners
and Support Surfaces
(800) 228-7763
www.actionproducts.com
List price: $40 to $1,029
FYI: Action Products' expansive range of reusable patient positioning devices offer anatomically designed, cost-effective pressure relief and shear reduction solutions for every department. The company's proprietary Akton viscoelastic polymer redistributes weight and heat, will not leak, flow or absorb fluids and doesn't bottom out under heavy loads. Easy to clean and repair, it's latex-free, radiolucent and doesn't support bacterial growth.

AirPal Patient Transfer Systems
RAMP (Rapid Airway Management Positioner)
(800) 633-4725
www.airpal.com
List price: $4,000 to $8,000
FYI: Patient positioning is a key component of airway management in the OR. AirPal's RAMP, one of its modular Safe Anatomic Positioning systems, lets you quickly, easily and accurately position patients to optimize intubation. Convenient, easy-to-use AirPods are placed beneath patients of all sizes and inflated with compressed air or nitrogen and a handheld controller.

Allen Medical
Lift-Assist Beach Chair
(978) 266-4200
www.allenmedical.com
List price: $4,599
FYI: Allen's Lift-Assist Beach Chair, designed for use in shoulder or upper extremity procedures, offers unobstructed posterior access. Its mechanism reduces the effort needed to lift heavy patients, making positioning and repositioning a quick, easy, one-handed job. The device weighs less than 30 lbs. with the back support panels installed, allowing for single-person setup, and has a weight capacity of 500 lbs.

CFI Medical Solutions
Custom Table Pads
(810) 750-5300
www.cfimedical.com
List price: $200 to $1,000, depending on design and materials
FYI: Worn out your table pads? Replace them with CFI Medical Solutions' custom-made pads for surgical and imaging tables, urology tables (pictured) and stretchers. They're durable, comfortable, cleanable and manufactured to your specifications. A wide selection of foam densities and covering materials are available to meet your clinical needs and your budget. For a quotation, e-mail a sketch with measurements to [email protected] or fax it to (810) 750-5310.

HealthCare Positioners
AirSoft OR Table Pads
(760) 636-5116
www.healthcarepositioners.com
List price: $1,200 to $1,800 for 5-piece pad set
FYI: HealthCare Positioners' AirSoft is a line of 4-inch table pads whose fabric covers have no stitch holes and are RF welded to fluid-proof their seams. Patient- and procedure-tested, the pads incorporate viscoelastic foam for pressure distribution and shear reduction and a medical-grade membrane for venting while providing a bacterial barrier. Independent pressure studies on primary positions are available. All AirSoft pads are latex-free.

ISI: Instrument Specialists, Inc.
Carter Arm Pillow
(800) 537-1945
www.isisurgery.com
List price: $45 for adult size, $39 for pediatric size
FYI: Designed by a hand surgeon, the Carter Arm Pillow keeps post-op patients' hands and upper limbs elevated above heart level to reduce swelling and promote recovery. The ambidextrous device, available in both adult and pediatric sizes, has been redesigned in softer, more durable, wrinkle-free foam that is latex-free and fire retardant, says the company

MHP Medical
Gel Adult Head Donut
(877) 856-9233
www.mhpmedical.com
List price: as low as $45 each
FYI: MHP Medical's Gel Adult Head Donut is designed to cradle, support and protect the patient's head from pressure injuries, friction and shear in a wide range of medical procedures without obstructing access to the head, neck or shoulder. Made in the United States of Comfort Plus brand viscoelastic polymer gel, the donut, like MHP's 300 sizes and shapes of positioners for neonatal, pediatric, adult and bariatric patients, is latex-free.

Mizuho OSI
Ultra Shoulder Positioner
(800) 777-4674
www.mizuhosi.com
List price: $3,950 to $7,380
FYI: Mizuho OSI's Ultra Shoulder Positioner provides safe and stable support for a wide range of shoulder, neck and upper extremity surgeries that use the beach chair position. Its range of motion includes neck flexion, lateral tilt and height adjustment. The lightweight device easily attaches to any OR table without the need for side rail clamps.

Oakworks Medical
Spine Positioning System
(800) 558-8850
www.oakworks.com
List price: $1,200
FYI: Designed for use in interventional pain management procedures, Oakworks Medical's Spine Positioning System improves visualization of the cervical, thoracic and lumbar spine to enable safer, more accurate spinal injections. Fully radiolucent and able to be used on any table, it solves the imaging, stability and comfort issues often associated with spine procedures.

SchureMed
Linear Motion Shoulder Chair
(888) 724-8763
www.schuremed.com
List price: $5,494
FYI: SchureMed's shoulder chair attaches to any surgical table with integrated, adjustable mounting clamps. Motion control technology eliminates manual positioning: Users raise and lower patients at the push of a button. It has a 500-lb. weight capacity, articulation range of up to 90 ? and pull-away panels for access to the surgical site. A self-contained motor means it doesn't depend on the table for power.

Skytron
Sof Pad
(800) SKYTRON
www.skytron.us
List price: $150 to $600
FYI: All of Skytron's Sof Pads are "welded" at the seams to seal out fluid. They incorporate a 3-layer, multi-density foam system, including viscoelastic memory foam, fire-retardant polyurethane open-cell foam and vinyl nitrile closed-cell foam, to redistribute pressure, cushion bony prominences and protect against skin shear without bottoming out. The pads' exterior coverings are treated with triclosan for antibacterial action.

Steris Corporation
Aquagel Pressure Management System
(800) 548-4873
www.steris.com
List price: Individual positioners, $50 to $350, full table sets, $1000.
FYI: Steris's Aquagel Pressure Management System features dual-density layers, 3-dimensional cradling, anatomically specific contouring and volumetric distribution of pressure. The company offers devices that redistribute pressure beneath the sacrum, lower leg and heel, head, arm and shoulders, and pads that support prone, lateral and supine positioning.

Xodus Medical
Foam Positioners
(800) 963-8776
www.xodusmedical.com
List price: $8 to $12 each
FYI: Xodus Medical's Foam Positioners promote compliance with pressure-injury-prevention guidelines while allowing access to patients and operative sites. High-density foam provides a stable yet cushioning surface to protect sensitive skin and enable patient adjustment. In addition to the Slotted Head Rest with Viscoelastic Topper (pictured), Xodus offers a variety of head positioners, arm boards and cradles, ulnar nerve/heel protectors, positioning kits for Jackson, Wilson and Andrews tables, and gel positioners.