Tuck the Draw Sheet to Safely Secure Arms
It all comes back to something that happened to one of our own, who ended up with nerve damage due to improper positioning during a surgical procedure at another surgery center. In my role in perioperative education and staff development at our center, I focus on hands-on skills in multiple areas, including surgical prepping, so we know we are doing everything we can to avoid these kinds of situations.
An example would be teaching how to properly tuck the draw sheet when the patient is in the supine position. Tucking the draw sheet over the arm and under the OR mattress might seem like an OK option, but if it isn't secure enough, the patient's arm could fall off the side of the bed and lodge in between the sheet and mattress, potentially causing a nerve injury. On the other hand, tucking the draw sheet between the patient and the mattress helps to prevent the arm from falling off of the mattress.
It's important to tuck the draw sheet somewhat snugly, but not so snug that it compromises blood flow. Also, pay attention to any IV lines, blood-pressure cuffs or anything else that could be compressed into the patient's skin. Whenever possible, position the patient before anesthesia so he can tell you if he's comfortable. "Is anything pinching or uncomfortable? Does this feel OK for you?"
In some cases you might also have to use bed extensions, plastic arm sleds or other positional aids with some type of padding, but the goal with every patient is to make sure the arms fit safely and securely within the confines of the mattress.