From OR table pads to table attachments and from limb positioners to head donuts, a massive variety of products are available for positioning and redistributing pressure. Here are some tips on selecting the products that are right for your patients.

Positioning in the outpatient OR
As of Oct. 1, Medicare no longer reimburses hospitals for treating advanced stage pressure injuries acquired after admission. By definition, ambulatory surgery doesn't keep its patients bedridden for nearly as long as a hospital stay might, so you won't likely see these types of injuries at your facility. That doesn't mean, however, that patient positioning isn't a safety concern in the outpatient OR.

A surgical facility's protocol for positioning patients and preventing pressure injuries should be the same regardless of whether it's a hospital setting or an ASC. It's advised that the protocol be modeled on the assessment, alignment and accessory guidelines compiled in an anesthesia textbook or AORN's Perioperative Standards and Recommended Practices. AORN has, in fact, thoroughly updated and expanded its published standards for patient positioning. The section, which once ran about six pages, now occupies more than 20.

Your positioning devices should also meet all relevant safety recommendations. For instance, studies examining OR table pads have shown that standard two-inch foam pads present a statistically significant increased risk of perioperative pressure ulcers. Unfortunately, that's what the majority of ORs are using, even though studies have shown that viscoelastic foam pads or products incorporating fluid immersion simulation or fluid gel are much more efficient. Similarly, boot stirrups are much safer for the lithotomy position than candy cane stirrups, which can result in nerve injuries; yet many ORs still use the candy canes.

It's very important to look at the available scientific data when you're selecting positioning products. The research that vendors should provide you with or, even better, independent outcome studies can help to separate proven, high-quality devices from cleverly designed but ineffective products and can show, for instance, whether a device's pressure redistribution has an effect at the musculoskeletal and cellular level, not just at the skin level. (I won't soon forget the time I heard someone admit that they'd bought an OR table simply because "it felt really good when we sat on it.") The American Society for Testing and Materials (www.astm.org) and the ECRI Institute (www.ecri.org) are useful sources for safety testing information.

Another aspect of efficacy is whether the device is compatible with the equipment you already have and whether it's sufficiently customizable to work the way your surgical team does.

Budgeting for positioning
It's a common complaint that positioning devices are low on the budgetary totem pole. After staffing and supplies and capital equipment, administrators say, we don't have the money. My response is: You don't not have the money, especially since the prevention of positioning and pressure injuries is far less expensive than the alternative, which may include litigation. When judging what will fit into your budget, be sure to consider cost-effectiveness over the long haul. Think of how many cases you'll use it for, over how many years, and that you have enough for each room, so simultaneous cases don't slight one patient of safety. Also take into account whether the more expensive product will provide you with better patient outcomes.

Knowing what positioning equipment you need depends on what problems you expect to encounter. Of course, the challenge of positioning safety in ambulatory surgery is that there's little or no feedback available from the patient on potential problems. Hospital-bound patients may complain of pain or stiffness, or show a symptom of nerve damage, during their stays. By the time injuries resulting from an outpatient procedure would become evident to clinicians, however, the patient is already home. They might not realize anything's wrong or report any signs of a problem at a follow-up visit. That's why it's important to include information on the warning signs of positioning or pressure injuries in your spoken and written discharge instructions and to have questions specifically seeking out the symptoms in post-op calls. With this data, you'll have a better idea of the problems your facility routinely faces.

Action Products
Back to Basics Kits
(800) 228-7763
www.actionproducts.com
List price: $480 to $780
FYI: The positioning devices in Action Products' Back to Basics Kits were chosen to address the minimum pressure sore prevention needs of the head, scapula, sacrum, elbows, arms and heels of every patient in every OR, says the company. A kit in your surgical suite will ensure your staff will be equipped for patient safety at all times.

Airpal
RAMP (Rapid Airway Management Positioner)
(800) 633-4725
www.airpal.com
List price: for standalone RAMP, $4,000; for all-in-one Airpal patient transfer device with attached RAMP, $8,000
FYI: Airpal's RAMP, an inflatable patient positioning device envisioned by an emergency physician, builds on the company's lateral transfer device platform for safe handling throughout your facility, says the company. The RAMP quickly achieves ear to sternal notch positioning in even the largest patients, facilitating proper airway alignment and maximizing upper airway patency for quicker, smoother and safer direct laryngoscopy.

AliMed
Multi-Axis Armboard
(888) 625-4633 x316
www.alimed.com
List price: from $321 to $518, depending on material composition and size.
FYI: Available in phenolic resin or RhinoBoard, and in shorty, standard or widebody sizes, the Multi-Axis Armboard easily connects to the OR table's side rail, adjusts to the correct height, reduces pinch points between the shoulder and the arm and doesn't interfere with imaging, says the company.

Allen Medical
C-Flex Polar Head Positioning System
(800) 433-5774
www.allenmedical.com
List price: $15,000
FYI: The C-Flex Polar Head Positioning System, which is compatible with the Allen Spine System, the Jackson table and the Mayfield skull clamp, allows fast, easy and accurate cervical positioning for any spinal procedure, says Allen. To operate the system, a user grips the handles, positions the head and releases the handles to lock the position.

Cygnus Medical
Air Flow Patient Positioning Aids
(800) 990-7489
www.cygnusmedical.com
List price: not disclosed
FYI: Cygnus' Air Flow positioning products use contoured channels to increase airflow and improve patient comfort, says the company. The product line's designs include ulnar nerve pads, adult- and child-sized donuts, heel protectors, abduction pillows (pictured), arm boards and OR table pads.

DeRoyal Industries
Surgical Positioners
(800) 251-9864
www.deroyal.com
List price: $1 to $30 per item
FYI: Prevention is the best medicine. That's why DeRoyal offers a complete line of surgical positioners to help prevent tissue distress and protect your patients before, during and after surgery. DeRoyal's durable positioners are made of quality foam and patient-friendly materials to provide safety for your patients and peace of mind for your staff, says the company.

Ethox International
P3 Pneumatic Patient Positioners
(800) 521-1022
www.ethoxint.com
List price: $40 to $60
FYI: The Shoulder Float, Pelvic Tilt and Delgado Inflatable Post are easily inserted under patients and inflated to lift them into the optimal position, says the company. A few pumps lift patients, even large-bodied patients, and a turn of the stopcock lowers them.

Mercury Medical
Troop Elevation Pillow
(800) 237-6418
www.mercurymed.com
List price: not disclosed
FYI: An anesthesiologist designed and developed this elevation pillow to facilitate airway management for obese and large-framed patients. The properly placed pillow aligns upper airway axes to achieve the head-elevated laryngoscopy position, recommended for the optimal airway management of obese patients, says the company. Easy to set up, it eliminates the need for stacking blankets.

Oakworks
Spinal Imaging Platform
(800) 558-8850
www.oakworks.com
List price: $799
FYI: The Oakworks Spinal Imaging Platform promotes secure prone patient positioning during fluoroscopic imaging procedures, says the company. Recognized by pain management physicians and orthopedic surgeons, the spinal imaging platform is ideal for cervical, thoracic and lumbar injections as well as for vertebroplasty and kyphoplasty procedures.

Skytron
Singer Starr Stacker
(800) SKYTRON
www.skytron.us
List price: $1,240
FYI: Skytron's Singer Starr Stacker lateral positioning accessory consists of soft stackable pads, which securely hold a patient's arms, and a special armboard, which attaches quickly and articulates with an easy-to-reach adjustment handle. The Singer Starr Stacker allows fast and easy lateral patient positioning during any case, says the company.

Steris Corporation
Foam Immersion Technology Patient Positioners
(800) 548-4873
www.steris.com
List price: $277 to $2,300 per package
FYI: Steris' Foam Immersion Technology Patient Positioners help to provide high levels of protection against tissue trauma and neuropathy during surgical procedures, says the company. The unique features of FIT table pads maximize the skin-to-pad contact area and minimize interface pressures. Steris FIT positioners are available individually and in sets for common surgical postures.

Trumpf Medical Systems
Arch Table Extension
(888) 474-9359
www.us.trumpf-med.com
List price: $56,000
FYI: With Trumpf's Arch Table Extension, optimal leg positioning — including hyperextension, abduction and external rotation — can be achieved with constant, measurable, safe traction and precise reference points, says the company. The Arch is placed at the foot of any manufacturer's surgical table, the patient's foot is placed into the traction boot, and the boot moves along the device's frame to facilitate easy and safe leg positioning.

Vortek Surgical
EPS-30 Endoscopy Positioning System
(888) 867-8351
www.vorteksurgical.com
List price: $299
FYI: Designed for endoscopic procedures when the patient is in the lateral or prone position, the Vortek EPS-30 features supportive head and trunk bolsters to reduce the risk of reflux and aspiration and a shoulder recess to reduce upper extremity compression, says the company. The positioner's durable vinyl surface is easy to clean.

Xodus Medical
Slotted Head Positioner with Visco Topper
(800) 963-8776
www.xodusmedical.com
List price: not disclosed
FYI: In an effort to help hospitals comply with patient safety requirements, Xodus Medical introduces a unique headrest. It provides the durable support offered by the company's standard foam positioning products with the added comfort and protection provided by a layer of memory foam, says Xodus. It includes a convenient side slot for tube placement.