Patient Safety, Positioning, and Equipment
Patient safety, positioning, and equipment tests prevention of positioning injuries, equipment-related burns, retained items, and wrong-site events. The RNFA participates in the time-out and is often the last person to see a pressure point before the drapes go on.
Core rules and concepts
- Positioning: pad all bony prominences; keep arms at less than 90 degrees abduction to protect the brachial plexus; use an axillary roll for lateral decubitus; in lithotomy, avoid prolonged hip flexion and external rotation that stretch the common peroneal nerve.
- Table safety: secure the patient before tilt or Trendelenburg; confirm straps do not compress nerves or chest; test stirrups and supports.
- Electrosurgery: place the dispersive pad on dry, muscular, well-perfused skin close to the operative site; avoid bony prominences, scars, and metal; check the pad and cord.
- Fire safety: know the fire triangle and stop oxygen flow before using energy near the airway; keep flammable prep dry.
- Counts and retention: count before the case, at closure, and at skin closure; reconcile any discrepancy before the patient leaves the room.
Worked example
A patient in lithotomy has a foot externally rotated and pressed against a stirrup for two hours. The RNFA recognizes that sustained pressure and stretch can injure the common peroneal nerve. The legs are repositioned, padding is added, and the case is paused briefly to check perfusion and alignment.
Traps
Abducting the arm more than 90 degrees; placing the electrosurgical pad over a scar or bony point; relying on a single count; and assuming the surgeon checked laterality when the site mark is hidden by drapes.