Assessment of motor behaviour while prone
Mijna Hadders-Algra, Kirsten R. Heineman in The Infant Motor Profile, 2021
This chapter provides the description of the Infant Motor Profile items assessed in the prone position. Prone positions do not just include the situations in which the infant lies with his belly on the support surface; they also include locomotion while prone: for example, abdominal crawling or crawling on hands and knees. Young infants are placed in the prone position with their heads in the midline, both shoulders in adduction, and both elbows in flexion, with the hands approximately in line with the ears. Adaptability of head movements refers to the infant’s ability to select the most appropriate and efficient head movement in each situation. The functional ability of the shoulder girdle while prone is the capacity of the infant to lift his head and the upper part of his thorax up by active use of arms and hands. The presence of asymmetry in posture and movements of the arms and hands in prone is assessed.
Basic patient positioning
Peter Nightingale in Anaesthetics for Junior Doctors and Allied Professionals, 2018
The supine position is by for the most common position that anaesthetist will use. The biggest risks are to the eyes, compression damage to soft tissues and nerve injury. Ensure that the head is in a neutral position in order to prevent stretching the brachial plexus. Even gentle pressure sustained over a long time can injure an anaesthetised patient. Prevent ventilator tubing resting on patients, especially when the head is covered by drapes. The upper body positioning is the same as the supine position. The legs are placed in gutters and raised with the hips and knees flexed. The bottom end of the table is then removed to allow the surgeon access to the pelvis. The lateral position is used mainly for orthopaedic surgery. The brachial plexus and ulnar nerve are at risk. The prone position is a complicated position that carries a high risk of ocular, nerve and soft tissue damage if it is not performed correctly.
Abdominoperineal Excision of the Rectum and Anus
Stanley M Goldberg in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Abdominoperineal excision of the rectum and anus (APER) was popularized by Ernest Miles at the beginning of the last century. This procedure, that of combining the abdominal and perineal phases of the operation, was a natural extension of the staged procedure of a loop colostomy followed, several weeks later, by a perineal proctectomy performed with the patient in the left lateral position. Despite the inability to extend the excision much above the sacral promontory, this latter operation was the generally accepted procedure for rectal carcinoma, particularly in the pretransfusion era. Miles’ operation of combined abdominoperineal excision of the rectum and anus was developed in order to take account of the lymphatic spread of cancer in a cephalad direction and to obtain a wider clearance of the lymphovascular structures together with the tissues immediately adjacent to the tumor. A greater understanding of the mode of spread of rectal cancer, advances in stapling techniques, and the desire to avoid a permanent stoma has led to the procedure being performed less often; yet population-based audits 1, 2 have indicated its continued use in approximately 25 percent of patients with rectal cancer. There has been a resurgence of interest in APER in recent years following the publication of several studies which demonstrated that inadequate ‘clear surgical margins’ were associated with poor local cancer control. Recent technical advances in the performance of APER include sequential rather than combined abdominal and perineal phases to the operation, the use of the prone position for the perineal phase and adaptation of the planes of dissection to obtain a more cylindrical specimen with a wider circumferential clearance in the vicinity of the primary tumor.
Axillary sentinel node biopsy in prone position for melanomas on the upper back or nape
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Lutz Kretschmer, Simin Hellriegel, Naciye Cevik, Franziska Hartmann, Kai-Martin Thoms, Michael P. Schön
In patients with melanomas on the upper back or nape, axillary sentinel lymph node (SLN) biopsy (SLNB), when performed in the traditional supine position, is often disturbed by scattered radiation emitted from the primary tumor site. The results from the present study suggestthat axillary SLNB performed in the prone position can solve this problem. We compared two consecutive groups of patients with melanomas of the dorsal trunk or nape who received axillary SLNB performed either in the supine (n = 119) or in the prone position (n = 130). The number of SLNs detected and excised was significantly higher in prone position group (2.4 ± 1.5 SLNs versus 1.9 ± 0.95 SLNs, p = 0.002). Using the prone position, intra-operative repositioning of the patient for excision of a primary site of the upper back or neck was not necessary. The SLN identification rates and the SLN-positivity rates did not differ significantly between the two types of intraoperative patient positioning. There were no significant differences in survival outcomes or false-negative rates. In conclusion, axillary SLNB in prone position yields a higher number of excised SLNs in patients with melanomas of the upper back or nape. Axillary SLNB in prone position is easy to perform and reliable. Intraoperative repositioning of the patient is not necessary, which saves time and resources.
The Quarter Prone Position Increases Oxygen Saturation in Premature Infants Using Continuous Positive Airway Pressure
Published in Comprehensive Child and Adolescent Nursing, 2017
Yossy Utario, Yeni Rustina, Fajar Tri Waluyanti
A primary problem that occurs in premature infants is oxygenation disorders, thus requiring respiratory support, including continuous positive airway pressure (CPAP). The effectiveness of CPAP can be improved by adjusting the body’s position, so the aim of this study was to examine the effect of the quarter prone position on the oxygenation status of preterm infants using CPAP. This study used a randomized controlled trial with a crossover design. A group of 15 preterm infants receiving CPAP was selected, and randomization of allocation was done to divide the respondents into the intervention group (quarter prone) or the control group (supine). Oxygenation status was measured using an observation form, and the result showed a significant difference in the oxygen saturation levels of premature infants using CPAP in the quarter prone group compared to that in the supine group (p = .045). The quarter prone position was effective for improving the oxygenation status of premature infants using CPAP. It is recommended that the quarter prone position be applied as part of nursing care in neonatal nursing.
Transport of Mechanically Ventilated Patients in the Prone Position
Published in Prehospital Emergency Care, 2016
J. D. DellaVolpe, J. Lovett, C. Martin‐Gill, F. X. Guyette
Objective: We present seven cases of patients with severe respiratory failure refractory to conventional ventilation who were safely transported in the prone position. Methods: We describe all cases of patients transported by a regional critical care network in the prone position from January 2010-June 2015. All patients were mechanically ventilated for respiratory failure and transported by specialized nonphysician critical care teams. Utilizing direct medical oversight and real-time technical support from the clinical department, each patient underwent a thorough bedside evaluation, transport ventilator trial, and transfer to a transport stretcher either with the endotracheal tube secured by an anesthesia pillow or overhanging the stretcher. Results: Seven patients with acute respiratory distress syndrome were transported in the prone position. Four were female (57%), with a median weight of 78 kg (range 58-131) and median age of 53 years (range 37-78). Initial vital signs demonstrated a median oxygen saturation of 94% (range 90-97%) supported with a FiO2 of 100% for all patients with a median positive end-expiratory pressure (PEEP) of 16 (range 14-20). Seven patients were transported, six by helicopter and one transported by ground ambulance. The median transport time was 36 minutes (IQR 19, 51). There were no deaths or major incidents (tube dislodgement or line displacement) during patient transport. Conclusion: The transport of mechanically ventilated patients with respiratory failure in the prone position is feasible and safe, with minimal complications identified in this case series.