• Check patient's neck and spine for proper alignment to avoid trauma.
• Check that patient's legs are straight and ankles uncrossed. Crossed ankles cause pressure on tissue, vessels, and nerves.
• Place a safety strap 5 cm above patient's knees, tight enough to restrain without compromising superficial venous return. Applied too tightly, the safety strap may cause venous thrombosis or compression of tibial, peroneal, or sciatic nerves.
• Secure patient's arms at sides with a draw sheet with palms down, making sure no part of the arm or hand extends over the mattress. Alternatively, secure patient's arms on padded arm boards at less than a 90-degree angle from the body, with palms supinated. Hyperextension can cause injury to the brachial plexus. Supination of palms minimizes pressure.
• Apply eye pads if patient's eyelids won't remain closed or if surgery is being performed on the head, neck, or chest. If allowed to remain open, the eye may dry out and become infected. Corneal abrasions may result from drapes and other foreign material rubbing against the eye.
• If surgery is expected to last more than 2 hours or if patient is predisposed to a pressure injury, place padding under patient's occiput, scapulae, olecranon, sacrum, coccyx, and calcaneus to protect potential pressure points. Apply a padded footboard to support patient's feet, avoid plantar flexion, and prevent stretching of the tibial nerve and subsequent foot drop.
• Unless contraindicated, place a foam doughnut or small pillow under patient's head to prevent stretching of the neck muscles.

• Make sure at least four staff members assist when turning patient to ensure safety.
• Check the lower eye and ear for excessive pressure. Apply eye pads. Head support helps maintain cervical and thoracic spine alignment. Checking the dependent ear and eye lowers the risk of pressure injury. Pads protect the eyes.
• Place patient's arms on arm boards extended in front beside patient's head with the elbows slightly flexed and palms pronated to prevent strain on the shoulder, elbows, and wrist joints.
• Check for proper alignment of the neck and spine to avoid trauma.
• Check a female patient's breasts and male patient's genitalia for excessive pressure from chest rolls or a laminectomy brace to avoid soft tissue and nerve injury.
• Check the bilateral pulses of upper and lower extremities. The top and bottom edges of chest rolls or a laminectomy brace may compress radial and femoral arteries.
• Place padding under patient's knees to avoid injury to soft tissue and knee joint.
• Place a pillow under patient's ankles to avoid putting pressure on toes and feet, stretching the tibial nerve, or causing plantar flexion.

• Make sure at least four staff members assist when turning patient to ensure safety.
• Check patient's neck and spine for proper alignment to avoid trauma.
• Check patient's dependent eye and ear for excessive pressure. Apply eye pads. Head supports help maintain cervical and thoracic spine alignment. Checking the dependent ear and eye lowers the risk of pressure injury. Pads protect patient's eyes.
• Place a small roll under patient's dependent lower axilla to relieve pressure on chest and axilla, allow for adequate chest expansion, and prevent compression of the brachial plexus by the humeral head.
• Place patient's lower arm on arm board at less than 90-degree angle from the body, with palm supinated. Place patient's upper arm on an elevated padded support at less than a 90-degree angle from the body with palm pronated, and apply restraints to avoid injury to brachial plexus.
• Place the bottom leg flexed at the hip and knee and the top leg straight. Flexing the bottom leg provides greater stability for the torso, decreases pressure on the lateral aspect of the lower leg, and prevents the bony areas of the knees and ankles from pressing against each other.
• Place pillows between patient's knees and ankles to support the top leg, prevent strain on the top hip, and pad pressure points on the medial aspects of both legs.
• Place padding under the lateral aspects of patient's bottom knee and ankle to reduce the risk of tissue injury to the area over the lateral malleolus of the ankle and peroneal nerve damage (foot drop).
• Place a safety strap across patient's upper thighs or wide tape over the hips. Attach a strap or tape to the bed to ensure safety.

• Secure patient's arms on arm boards or at the sides. If the arms are placed at patient's sides, position the fingers away from the break in the table to prevent the fingers from becoming compressed in the bed mechanism.
• Check patient's neck and spine for proper alignment to avoid trauma.
• Position the stirrups at equal height and attach them to the bed securely to prevent accidental movement. Uneven leg flexion and hip abduction can cause strain on the lumbar and sacral areas.
• Place the loop straps of the post stirrup behind patient's ankle and under the foot. Pad the post portion of the stirrup if it could come in contact with the leg. Loop straps support and secure the legs.
• Pad popliteal knee support stirrups to prevent possible thrombosis of superficial vessels and pressure injury to femoral and obturator nerves.
• With the help of a coworker, raise and lower patient's legs simultaneously and slowly to prevent ankle and knee injury and hip dislocation. Lowering legs too quickly may cause sudden hypotension.
• Assess patient position following each positional change to ensure proper body alignment and adequate padding and support.
• Apply restraints after positioning patient to prevent falls and injury.

Suggested NIC Interventions