Anti-skid materials

Potential risk factors associated with slipping:

AORN RecommendationsAORN standard VIII.j.1 recommends that we take measures to prevent patient sliding. It warns that the risk of shear injury is greater in Trendelenburg postion.

Shoulder braces have been associated with brachial plexus injuries.

AORN: VIII.j.2 recommends that we avoid the use of shoulder braces.

AORN: VIII.j.2 recommends the use of padded foot boards in reverse trendelenburg position.

Trendelenburg Position: What if the Patient Slips?

pressure injuries

perineal nerve damage

shearing-tissue damage

robotic arm injuries

use anti-skid materials

brachial nerve damage

avoid stirrups

eliminate shoulder braces & straps

The use of anti-skid materials in the O.R will:

Reduce the incidence of shearing injury on soft tissues

Greatly reduce the risk of nerve injury , robotic injury and necrosis

Simplify the process of safely positioning patients

Promote positive patient outcomes

Trendelenburg PositionTrendelenburg position can require a tilt of up to 40 degrees.This can result in a gradual slipping of the patient on the operating table. Shifts of up to six inches have been reported

Potential risks associated with slipping

Nerve Injury

Injury to the brachial plexus due to pressure exerted on the clavicle by shoulder braces has been the most cited nerve injury.

One in 15 people undergoing robot-assisted Genito Urinary Surgery developed a nerve injury speci�cally related to positioning. Injuries included weakness, numbness or immobility in the hands or feet.

Perineal nerve injury can occur when stirrups are used, which can lead to foot drop.

Robotic Injury

Robots are incapable of adjusting to any change in patient position. As a consequence, instruments and trocars can be wrongly positioned causing internal injury. The robotic arm may become the primary restraint for the patient - a situation sometimes re�ered to the ‘meathook restraint technique’ and which can result in post op pain, bruising and / or necrosis at the primary port sites.

Tissue Necrosis

Shearing forces act parallel to the skin surface and are a�ected by the amount of force, the angle of incline and the surface contact area.The skin is pulled in an opposite direction to the bones and muscles of the sacrum, shoulders, arms and legs.

The deeper fascia slides downward with the bone; the super�cial fascia remains attached to the dermis. Blood supply may be compromised, causing ischemia and subsequent tissue necrosis. Shear and friction go hand in hand—one rarely occurs without the other.

Ms Niamh Devitt, RGN, PG Dip. Clinical Practice. Clinical Education Manager, TrulifeAllen, D. (2013) Positioning and the Surgical Robot. http://www.da-surgical.com/clinical-articles.html | AORN (2013) Perioperative Standards and Recommended Practices 2013 Edition | Hess, CT. (2004) Did You Know? The Di�erence between Friction & Shear 17(5)p222. Advances in Skin & Wound Care | Pittman, G (2013) Robotic surgery ties to temporary nerve injuries. http://www.reuters.com/article/2013/03/29/us-robotic-surgery-idUSBRE92S0D120130329 | Wetcher, ME. (2010) Trendelenburg Slide Prevention Study. Mayo Clinic ClinicalTrials.gov

externalfriction

internalshear

gravity

peripheral nerveendings

dermis

epidermis

capillaries

table surface