The Chair Positioning Device: What Do I Need to Know?

The patient positioning device referred to as the beach chair, shoulder chair, or chair, is used to place the patient in a sitting position on the operating room table. It is most often used in orthopedic procedures, such as shoulder replacement or arthroscopy, and allows for greater range of motion and surgeon access to limbs. Patient and worker safety will be an essential consideration when using this device.

Patient Safety

Two important patient safety considerations when using a chair positioning device include maintaining the patient’s airway and skin integrity.

Maintaining the Airway

Maintaining the patient’s airway will be a coordinated effort with the anesthesia provider. Before the start of the procedure, it will be important to ask about the type of anesthesia planned and share any surgeon preferences related to patient positioning that could affect anesthesia; examples of pertinent considerations may include wanting the endotracheal tube connectors or EKG sensors placed away from the surgical site or wanting a recheck of the patient airway after they have been repositioned in the chair. The planned anesthesia type should be communicated to the surgical team. For shoulder procedures, the patient often has general anesthesia, which requires an endotracheal tube or laryngeal mask airway; nurses should be aware that the tubing connected to the mechanical respirator may easily catch and dislodge the endotracheal tube or laryngeal mask airway or become constricted.

During the procedure, the surgical drapes will cover the head, upper torso, and arms of the patient. Because the airway can be compromised during the procedure (for example, dislodged or disconnected due to positioning), nurses need to be prepared to assist the anesthesia provider with reintubation or emergency protocols. This means knowing who to call for additional support or assistance and the location of any emergency carts and supplies. 

Skin Integrity

Another point of patient safety is maintaining skin integrity, including being aware of possible “pinch points” (ie, where the patient’s skin and tissue can become constricted). When using a chair positioning device, the open spaces between the cushions on the operating room table can become pinch points when patients are repositioned from supine to sitting. For example, one pinch point could be where the shoulder chair attaches to the operating room table, where there is sometimes a slight gap; there is a potential for the patient’s buttocks/gluteal area tissue to occupy this gap, resulting in bruising or skin integrity problems.

Prior to positioning and before the patient is on the operating room table, additional padding or protection devices should be placed where gaps exist in the table padding to reduce the area of pinch points. After the patient has been repositioned into the sitting position, the pinch point areas should be assessed to ensure the patient’s skin is protected.

Worker Safety

To decrease the risk of musculoskeletal injury when using manual chair positioning devices, it is important for nurses to follow correct posture and body mechanics. Nurses should not attempt to reposition a patient themselves; instead, at least three to five individuals should be present to help with repositioning. The need for additional help to position the patient should be communicated before the procedure, such as during the pre-shift huddle.

AORN Resources 

AORN members can access: 

• Guideline Quick View: Positioning the Patient - AORN Journal
• Guidelines in Practice: Positioning the Patient - AORN Journal
• AORN: Positioning Guideline Essentials

If your facility subscribes to eGuidelines+, you can access:

• Positioning the Patient | AORN eGuidelines+
  
• Positioning at a Glance | AORN eGuidelines+