SUSPENDED ARM For an elbow or shoulder arthroscopy, patients have to lie with their arm extended over their head for extended periods of time for prepping and surgery. Rather than having a staff member hold the patient's arm, securely suspend it by hanging it from a gauze roll tied off on a weighted IV pole.

PRONE POSITION In the prone position, you must consider the patient's body from head to toe. You want the patient lying face down in the prone holder, but slightly elevated (or tilted to the left or right) so that the anesthetist can maintain the airway. To keep patients well oxygenated, make sure the chest is well supported so they can get good ventilation if under general anesthesia or they can breathe normally if under monitored sedation. Gel chest rolls or rolled blankets offer good chest support. You should also pad the knees. Finally, take care not to squish women's breasts or compress men's genitals.

LEG HOLDER A surgical assistant places the patient into a leg holder for a knee arthroscopy. Note that the tourniquet is high up on the thigh so it doesn't pinch the patient's skin. The stockinette under the tourniquet also helps protect the skin. To decrease the risk of injury, a staff member holds the leg while the assistant positions it in the leg holder.

PRESSURE POINTS When patients are in the lateral position, egg crate padding between their legs keeps such pressure points as knees, heels, and feet from touching.

BEACH CHAIR The common shoulder surgery position requires many positioning aids. The beige bean bag positioner, filled with foam pellets that harden when you suction the air out of the bag, conforms to the patient and comfortably secures his lower back and buttocks in place. Soft pillows wedged under the patient's knees relieve pressure on the lower lumbar spine and legs. Egg crate padding cushions the heels. The blue safety strap secures the patient at the waist.

NON-OPERATIVE LIMB While the operative leg is in a holder (with a folded towel underneath it), the non-operative leg is in a foam holder to keep it in an anatomically neutral position. In the inset photo, staff prop the operative leg on a padded prep stand so it doesn't dangle before they apply the prep.

STIRRUPS Make sure your stirrups are well padded, the patient's heel is snugly seated in the cup of the stirrup and her leg is anatomically aligned with the rest of her body. To prevent hip and back injuries, always put the patient's legs in stirrups simultaneously (you'll need 2 staff members to do this).

HEAD HOLDER Notice how this horseshoe-shaped headrest attachment holds the patient's head snugly but firmly in place in a neutral, aligned position. The head's not pitching forward and the ears are directly over the shoulders. You know that you've properly positioned the head if you can draw an imaginary straight line down through the head and the center of the body. A ball-and-socket mechanism on the headrest lets you manipulate the headrest in order to get the proper alignment. The soft white padding cushions the patient's skin around the forehead, temples and jaw to prevent shearing.