Best Presentation

2. 
 To maintain patient’s airway and avoid constriction
or pressure on the chest cavity
 To maintain circulation
 To prevent nerve damage
 To provide adequate exposure of the operative site
 To provide comfort and safety to the patient
Goals of Proper
Positioning

3.  Patient lies in supine
position with buttocks
at the lower break of
the table.
 The legs are flexed in the
 hip ( 90 degrees ) and
 abducted (30 degrees)
 in the hip.
 The knees are bent 70 to 90 degrees.
 The lower legs are supported on padded leg shells..
Lithotomy

4.  Lithotomy stirrups placed
in position level with
patient ischial spine
 Arms placed over the chest or on an
armboard
 Legs are lifted together upwards and
outwards and feet placed in knee crutch
or candy cane
 The pelvis should be level
 The head and trunk should be in a
straight line

5. 
 Perineal
 Vaginal
 Urological
 Rectal
 Gynecology
Procedures

6.  Frequently used for procedures that
requires a vaginal or perineal
approach
 The patient is in the supine position
with legs raised and abducted by
stirrups
 Once the feet are positioned in
stirrups, the footboard is removed
and the bottom section of the OR bed
is lowered
 It may be necessary to bring the
patient’s buttocks further down to the
edge of the OR bed break.
High Lithotomy

7. 
 Placed in supine position with the legs raised and
abducted in crutch-like or full lower leg support stirrups
 The angle between the patient’s thighs and trunk is not
as acute as for the high lithotomy position
 Used in vaginal procedures
Low Lithotomy

8. 
 Peroneal nerve injury:
 Pressure of head of fibula by bar or support structures
compresses nerve
 Saphenous nerve injury:
 Pressure on medial condyle of tibia compress nerve
 Femoral nerve injury:
 Due to angulation of thigh such that inguinal ligament is
stretched & compresses nerve
 Obturator nerve injury:
 Due to greater degree of thigh flexion there is stretching
of nerve as it exits the obturator foramen
Nerve injuries in lithotomy

9. Saphenous nerve
Peroneal nerve
Femoral nerve
Obturator nerve

11. 
Potential Nerve Injuries

12. NURSING PRECAUTIONS POTENTIAL COMPLICATIONS
Two person required to raised
the legs simultaneously by
grasping the sole and other
hand supporting the calf
Severe backache caused by too
high stirrups
Calf holder may resulted
peroneal or femoral obturator
nerve damageStirrups bars must be checked
and secure before use and it’s
height must be similar and not
suspend the patient weight
Osteoarthritis or stiff hips due to
rough handling
The buttock must be even with
the edge of bed to prevent
lumbosacral strain
Too quick of lowering the legs
may cause hypotension
Femoral nerve damage due to
acutely flexed thighs
Hip dislocation or fracture as a
result faulty stirrups

13. 
KNEE CRUTCH
 Pressure on peroneal
nerve resulting footdrop
and neuropathies
CANDY CANE
 Pressure on distalsural
and plantar nerves which
can cause neuropathies
of the foot
 Hyperabduction may
exaggerated flexion and
stretch sciatic nerve
BOOTH TYPE
 May produce support
more evenly and reduce
localized pressure
TYPES OF STIRRUPS AND IT’S HAZARDS
KNEE CRUTCH CANDY CANE
BOOTH TYPE

14. Risk #1:
 Hip/knee joint injury
 Lumbar/sacral pressure
 Vascular congestion
Risk #2:
 Neuropathy of obturator nerves,
femoral nerves, common
peroneal nerves/ulnar nerves
Risk #3:
 Restricted diaphragmatic
movement
 Pulmonary region
Lithotomy
Safety Consideration:
– Place stirrups at even height
– Elevate lower legs slowly and
simultaneously from stirrups
Safety Consideration:
– Maintain minimal external hip
rotation
– Pad lateral or posterior
knees/ankles to prevent
pressure and contact with metal
surface
Safety Consideration:
– Keep arms away from chest to
facilitate respiration
– Arms on arm boards at less than
90 degree angle or over
abdomen