Lithotomy PositionBy …..ABDULLAH

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

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

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

Perineal Vaginal Urological Rectal Gynecology

Procedures

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

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

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

Saphenous nerve

Peroneal nerve Femoral nerve

Obturator nerve

Potential Nerve Injuries

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

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

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

LithotomySafety Consideration:

– Place stirrups at even height– Elevate lower legs slowly and

simultaneously from stirrupsSafety 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