When Melonie Marchak, RN, BSN, took over as the administrator at the Medical Group's Outpatient Surgery Center in Michigan City, Ind., one of her first tasks was to buy a new operating table - and the accompanying accessories: pads, support boards, stirrups, restraint straps and clamps.

"Even if I had an enormous budget and could get whatever I wanted, the basics would be the same," says Ms. Marchak. "If you add a new procedure or surgeon, your accessory needs may vary. But, until then, stick to the basics."

Here are 10 must-haves if you're buying table accessories for a multi-specialty facility.

1. Clamps. Many of your table's accessories, such as stirrups, arm boards, anesthesia screens and mayo tables, will be secured by clamps. You'll need two kinds: a clamp for flat-blade accessories and a clamp for round-post accessories, says Bob Cyzman, the product manager for surgical tables at Berchtold. Keep in mind that not all OR tables' rails have the same dimensions, so make sure your rail clamps will fit, says Jeff Baker, the president of Medical Technology Industries, Inc.

There's a big difference in how quickly clamps attach, says Jason Krieser, the director of marketing at Allen Medical/OR Direct. "High-end clamps instantly attach to the table at any location and are fast and easy for nurses to set up," he says. "Other clamps may only go on at certain places on the table."

2. Body/restraint straps. Whatever you do, patient safety requires that you use these basic necessities of patient positioning, says Mr. Cyzman. Look for straps that are made of durable material, capable of tolerating repetitive cleaning after each procedure and able to withstand the test of stress for a long time.

3. Multi-use stirrups. If your facility performs laparoscopy, GYN, urology or general surgery, you'll need a pair of stirrups. Before you buy, test drive them: once to be sure you're comfortable positioning the stirrup and once to assess patient comfort. "Especially if you're not under [general] anesthesia," says Mr. Baker, "stirrups vary between being comfortable and very uncomfortable." Traditional candy-cane stirrups not only are uncomfortable, they can cause nerve-pressure problems. When they're indicated, pay extra attention to patient safety, says Diana Procuniar, RN, BA, CNOR, the nurse administrator of the Winter Haven Ambulatory Surgical Center in Winter Haven, Fla.

Alternative boot stirrups may be a better option. "As you move the patient's leg, a floating boot will have give and won't torque the patient's leg; it will move with patient," says Mr. Krieser. "A booted stirrup allows for better pressure management. It's a major benefit for the nerves in the leg, especially during long procedures."

In addition to making patients more comfortable, stirrups can make surgeons' and nurses' positioning jobs easier. Lift-assist features help nurses handle the weight of the patient, but electrical stirrups can pose a safety concern. "The nurse can move the patient's leg into a position they shouldn't," says Mr. Krieser.

4. Fluid-management system. "If you do urology, you need a fluid-drainage pan or something that makes fluid spills more contained," says Ms. Marchak. Companies offer many alternatives from reusable to disposable to meet this need based on physician preference and your budget. "Disposables help reduce cross-contamination issues and save a lot of nursing time in clean up," says Mr. Krieser.

5. Knee holder. Nearly 70 percent of arthroscopic procedures are knee arthroscopies. Your knee holder should be lightweight, be able to conform to the patient's leg shape, allow for quick set up, and minimize or eliminate pinch points on the patient's leg. "But, most important," says Mr. Procuniar, "your surgeons must be comfortable with how the knee holder allows them manipulation and stability during a procedure. It is imperative to get their opinions before you buy to avoid wasting money on a holder they don't like."

6. Head support. You should have a selection of head rests as well as soft gel and cushion positioners to ensure patient comfort and protection. For example, if your procedure requires the prone position, you'll need a doughnut that supports the face but allows the person to breathe. "A headrest adapter bar lets you do a variety of head and neck procedures," says Mr. Cyzman. "Because it can accommodate your own headrest, it improves the flexibility of your table."

7. Arm boards. Arm boards may be the single-most important positioning device you purchase, says Ms. Procuniar. While there may not be much to the technology of their design, they are integral to nearly all surgical procedures. "Determine how quickly they attach to the table, how easily they attach to different sections of table and what the design is for longevity," says Mr. Krieser. "Ensure that, once attached, they demonstrate security and easy adjustability."

8. Arm and hand tables. For most upper-extremity procedures, this accessory is a must. Look for tables that are lightweight and adaptable to radiologic imaging requirements. Again, get the opinions of your surgeons - the users. "Look for [arm/hand] tables with optional legs," says Mr. Krieser. "That way, you can satisfy two groups of surgeons with one product: those who want the leg for additional support and those who want the leg removed because they feel it gets in the way."

9. Footboards and shoulder pads. Foot-boards and shoulder pads may be indicated for specific procedures. While not always an initially purchased accessory, discuss these positioning-specific items with your physicians to determine if purchase is necessary. Footboards are also good for a procedure that's one of the fastest-growing in the outpatient setting: bariatrics.

10. Anesthesia screen. As outpatient surgery and the use of conscious sedation continue to grow, patient comfort becomes a priority. An anesthesia screen allows good separation between patients and the surgical field, protecting them from potentially unpleasant visualization and promoting good infection-control practice. You also may want to purchase an additional accessory - an elongation tube for raising or lowering the screen. Ms. Marchak suggests that when you're buying a new table, negotiate some accessories as part of the deal. This allows for buying leverage for the accessory and assures that the accessories will be compatible with your table. If you're buying refurbished accessories for an existing table, just be sure to check that they'll fit.

Mr. Krieser notes that the patient-safety and comfort benefits of a table accessory that may last a decade could cost pennies per procedure.