Catherine A.
Prado BSN II – B
Surgical Procedure
1. Cardiovascular Procedure
2. Cystoscopy/Urology/Gyn
Procedures
3. Pancreatic Surgery
NCM 109 SKILLS
Activity 3
SURGICAL POSITIONS AND INCISIONS
Surgical Incision Surgical Position Nursing Responsibilities and Precautions
 Watch out for skin breakdown. Supine
position may put patients at risk for
pressure ulcers and nerve damage. Assess
for skin breakdown and pad bony
prominences.
 Support for supine position. Small pillows
may be placed under the head to and
lumbar curvature. Heels must be protected
from pressure by using a pillow or ankle
roll. Prevent prolonged plantar flexion and
Median Sternotomy Supine Position stretch injury of the feet by placing a
padded footboard.
 Tucked the patient’s arm at the patient's
sides with a bedsheet, secured with arm
guards to sleds. The arms may be flexed
and secured across the body or extended
and secured on padded arm-boards.
 Patient may risk pressure ulcers and nerve
damage. This position causes extra
pressure on the skin and bony prominences
over the occiput, scapulae, elbows,
sacrum, coccyx and heels.
 Avoid hyperabduction of the patient's hips
and leaning against their inner thighs.
Stirrups used on a patient in this position
Pfannenstiel Incision Lithotomy Position should disperse support and pressure over
wide areas.
 Determine whether stirrups or leg holder
will b used.
Chevron Incision Reverse Trendelenburg  Put padded foot boards to prevent the
Position
Catherine A. Prado BSN II – B
4. Hip Replacement Surgery
5. Shoulder Procedure
patient from sliding on the surgical table
and reduce the potential for injury to the
peroneal and tibial nerves from foot or
ankle flexion.
 Risks to a patient in this position include
deep vein thrombosis, sliding and
shearing, perineal nerve, and tibial nerve.
 Place a pillow or head-positioner under the
patient's head with the depended ear
assessed after positioning.
 Maintain the patient's physiologic spinal
and neck alignment during the procedure.
 Secure safety restraint across the patient's
hips.
Hardinge, Transgluteal Lateral Position  Risks to a patient in Lateral position
include pressure to points on the dependent
side of the body such as ears, shoulders,
ribs, hips, knees and ankles, as well as
brachial plexus injury, venous pooling,
diminished lung capacity and DVT. 
 Minimize the degree of the patient's head
elevation as much as possible and
always maintain the head in a neutral
position.
 Place the patient's arms in flexed and
secure across the body, the buttocks should
be padded, and the knees flexed 30
Deltopectoral Fowler's Position degrees.
 In Fowler's position, the patient is at an
increased risk for air embolism, skin injury
from shearing and sliding, and DVT
forming in the patient's lower extremities.
In this position, a patient has an increased
pressure risk in their scapulae, sacrum,
coccyx, ischium, back of knees, and heels.
Catherine A. Prado BSN II – B
6.  Herniated Disc Surgery
7. Laparoscopic Colon
Surgery
8. Internal Sphincterotomy
9. Endoscopy
10. Nephrectomy
Microdisectomy Incision
Single-Incision
Parallel or Vertical Incision
Oblique Lumbar Incision
 Placing support in prone. To support a
Prone Position patient lying in prone, place a pillow under
the head and a small pillow or a towel roll
under the abdomen.
 Place the patient's arms in tucked at their
sides.
 Secure the patient from sliding on the
surgical table.
Trendelenburg Position  Risks to a patient while in this position
include diminished lung capacity,
diminished tidal volume and pulmonary
compliance, venous pooling toward the
patient's head, and sliding and shearing.
 Place extra padding for the knee area.
 In jackknife position, compression of the
Jackknife Position inferior vena cava from abdominal
compression also occurs, which decreases
venous return to the heart. This could
increase the risk for deep vein thrombosis.
 Safely secure the patient with Body
restraints to the operating table.
 Support proper body alignment in Sims’
Sims Position position by placing a pillow underneath the
patient’s head and under the upper arm to
prevent internal rotation. Place another
pillow between legs.
 Padding and stabilization support. place a
large soft pillow in between the legs. place
Kidney Position kidney strap and tape over the hip to
stabilize the patient.
 Risk to fall. Patient may fall off the table at
any time until the position is secured.