Make sure your patients are in good hands with this guide on the different positions for patient procedures. Proper positioning helps to prevent complications and makes a long surgery more comfortable for the professionals involved. To determine the best position for your patient, you must first consider the type of operation, how long it will take, what kind of IV access you need, and other details of the procedure. A successful procedure relies on a position that’s comfortable for the patient and accessible for the doctor.
#TRENDELENBURG POSITION HOW TO#
I would ask her to explain it one more time.As a nurse or doctor, it’s important to know how to position your patient before their operation. Ī related device with a larger gastric balloon capacity (about 500 ml), the Linton–Nachlas tube, is used for bleeding gastric varices. It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications. The tube is often kept in the refrigerator in the hospital's emergency department, intensive care unit and gastroenterology ward. It may be difficult to position, particularly in an unwell patient, and may inadvertently be inserted in the trachea, hence endotracheal intubation before the procedure is strongly advised to secure the airway. Generally it is used only in emergencies where bleeding from presumed varices is impossible to control by administration of medication. The gastric lumen is for aspirating stomach contents. The esophageal balloon should not remain inflated for more than six hours, to avoid necrosis. If the use of traction alone cannot stop the bleeding, the esophageal balloon is also inflated to help stop the bleeding. A traction of 1 kg is applied to the tube so that the gastric balloon will compress on the gastroesophageal junction to reduce the blood flow to esophageal varices. It is passed down into the oesophagus and the gastric balloon is inflated inside the stomach. More modern models also have an opening near the upper esophagus such devices are properly termed Minnesota tubes. Apart from the balloons, the tube has an opening at the bottom (gastric tip) of the device. The device consists of a flexible plastic tube containing several internal channels and two inflatable balloons. The one for GI bleeds.mostly esophageal varicies bleeds.is called a Blakemore and it must be placed by the MD. There are "NGT" that needs to be placed by the MD. with all those students ready to pounce if you say the wrong thing! I can't imagine having to say the correct thing every time for 3 hrs. Her actual quote on the pt positioning was "reverse tendelenburg" with their "head down & feet up" which is trendelenburg. But I'll at the very least ask her for her rationale and see where she goes with it. Sometimes it's hard as a nursing student when prof's say stuff and you're like, "wait, what?" Then I go home and start thinking about what they said and how it doesn't make any sense at all.but I'm a nursing student and they are a seasoned 40 yr + RN. I would've thought that I, or another RN, would be placing it instead of standing around waiting for the provider to show up. Thank you so much for the response! My program is in the US and we learned how to place NGT our first semester.so I was also confused why she said the provider would place it. Sometimes called a modified Trendelenburg position, this position has been found to support blood pressure without the negative consequences of the traditional Trendelenburg position However, evidence-based practice does support elevating the lower extremities-without using a head-down tilt position-to mobilize fluid from the lower extremities to the core during hypotensive episodes.
If you are talking evidence based medicine.The evidence doesn't support its use to treat hypotension.
It impairs pulmonary gas exchange and increases the aspiration risk.
I have believed that the Trendelenburg position has little, if any, positive effect on cardiac output and blood pressure. The result is impaired gas exchange-hypercarbia and hypoxemia.
Lung compliance, vital capacity, and tidal volumes decrease while the work of breathing increases. Abdominal contents shift upward, increasing pressure on and limiting movement of the diaphragm and reducing lung expansion. It also impairs lung function by compromising pulmonary gas exchange. Evidence shows that while this position shifts fluid, it adversely engorges the right ventricle, causing it to become dilated, which further reduces cardiac output and blood pressure. As far back as the 1960s, researchers found undesirable effects of the Trendelenburg position, including decreased blood pressure, engorged head and neck veins, impaired oxygenation and ventilation, increased aspiration risk, and greater risk of retinal detachment and cerebral edema.
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