patient positioning in operating theatre

7/23/2019 Patient Positioning in Operating Theatre

1/52

POSITIONING INPOSITIONING IN

OPERATINGOPERATINGTHEATRETHEATRE

BY MURSIDI H.ABY MURSIDI H.A

PATIENT SAFETY


2/52

To provide knowledge on common surgicalposition of patient in during surgery

To identify and develop awareness of

potential complication in patient positioning To practice measure to avoid injuries and

others complication to patient during

surgery To promote safety and safeguarding patient

well-being during intra-operative period

AIM AND OBJECTIVESAIM AND OBJECTIVES


3/52

UNDERSTANDING BODILYUNDERSTANDING BODILYSYSTEMSYSTEM

INTEGUENT!"# $#$TE%orces include pressure& shear& friction and%orces include pressure& shear& friction and

macerationmaceration

'!$(U)!" $#$TE*ilation of peripheral vessels lead to drop in +,*ilation of peripheral vessels lead to drop in +,

'enous compression predispose to thrombosis'enous compression predispose to thrombosis

NE"'U$ $#$TE(N$ depression due to anaesthetic drugs(N$ depression due to anaesthetic drugs

,ressure on nerves may lead to temporary or,ressure on nerves may lead to temporary or

permanent damagepermanent damage


4/52

NERVOUSNERVOUSSYSTEMSSYSTEMS


5/52

"E$,I"!T"# $#$TE!lteration in diaphragmatic movements and!lteration in diaphragmatic movements and

lung e.pansionlung e.pansion

Inade/uate tissue o.ygenation and perfusionInade/uate tissue o.ygenation and perfusion

U$(U)$0E)ET!) $#$TE)oss control of normal ")oss control of normal "

ay resulted in joint damage& muscle stretch&ay resulted in joint damage& muscle stretch&strain and dislocationstrain and dislocation

,otential of pressure formation,otential of pressure formation

UNDERSTANDING BODILYUNDERSTANDING BODILYSYSTEMSYSTEM


6/52

Occiput

Peri - orbital arch

Zygomatic Arch

Mastoid region

Acromion process

Scapulae

Thoracic vertebrae Iliac crest

Greater trochanter Medial or lateral femoral epicondyles

Tibial condyles Malleolus

Olecranon Sacrum and coccy

Patella

!alcaneus

BONY PROMINENCESBONY PROMINENCES


7/52

ASSOCIATED RISK PATIENT FACTORASSOCIATED RISK PATIENT FACTOR

!*'!N(E* !GE NUT"ITIN!) $T!TU$

"E$,I"!T"# *I$"*E"

(I"(U)!T"# *I$E!$E

+E$E ,!TIENT

(1"NI( I+I)IT#

,"E$("I+E* E*I(!TIN$

UN*E")#ING E*I(!) ,"+)E$

N!TU"E % $U"GE"#


8/52

GOAL OF PATIENT POSITIONINGGOAL OF PATIENT POSITIONING

,"TE ,",E" ,1#$I)GI(!)!)IGNENT

INI!) INTE%E"EN(E 2IT1 (I"(U)!TIN

,"TE(TIN % $0E)ET!) !N*NEU"!$(U)!" $T"U(TU"E$

,TIU E3,$U"E T ,E"!TI'E !N*!N!E$T1ETI$T $ITE

,"'I*E ,!TIENT4$ (%"T !N* $!%ET# !INTEN!N(E % ,!TIENT4$ *IGNIT#

$T!+I)IT# !N* $E(U"IT# IN ,$ITIN


9/52

OPERATIVE NURSINGOPERATIVE NURSINGROLESROLES

Be knowledgeable on table mechanism

Pe!ae table attachments and accessoies

"amilia with #aio$s !atient !osition %oo!tim$m s$ge& access

Placement o% !atient to com%otable !osition

'oect !osition !lacement when a table beakis needed inta(o!eati#el&

Pe#ent inte%eence with es!iation whilst

mo#ing


10/52

)ns$e !atient is %$ll& anaestheti*ed be%oe!ositioning

+e#e e!osition witho$t anaesthetist

s$!e#ision

,able %itting m$st be !laced witho$tobst$ction to incision site

All %itting and attachments m$st be sec$ecom!letel&

)gonomic cae whilst !ositioning

A!!l&ing diathem& !late

OPERATIVE NURSINGOPERATIVE NURSINGROLESROLES


11/52

INTRAOPERATIVE NURSINGINTRAOPERATIVE NURSINGCONSIDERATIONSCONSIDERATIONS

Maintenance o% $nim!aied es!iato& actionMaintenance o% $nim!aied es!iato& action

Maintenance o% !h&siological alignment %omMaintenance o% !h&siological alignment %om

!ess$e!ess$e

Maintenance o% ade-$ate cic$lation a#oidingMaintenance o% ade-$ate cic$lation a#oidingim!aied #eno$s et$nim!aied #eno$s et$n

Maintenance o% bod& tem!eat$e b& limitingMaintenance o% bod& tem!eat$e b& limiting

e!os$ee!os$e A#oiding metal contactA#oiding metal contact

S$%%icient sta%%s and e-$i!ments %o !ositioningS$%%icient sta%%s and e-$i!ments %o !ositioning

Pess$e o#e the !atientPess$e o#e the !atient


12/52

POSITION DEVICESPOSITION DEVICES

Patient(!ositioning de#ices can bePatient(!ositioning de#ices can be

di#ided into two categoiesdi#ided into two categoies

/ne which ae !imail& geaed towad/ne which ae !imail& geaed towad!ess$e(elie%!ess$e(elie%

/nes which ae designed to !o#ide/nes which ae designed to !o#ide

bette access to the s$gical sitebette access to the s$gical site


13/52

TABLE ACCESSORIESTABLE ACCESSORIESAND ATTACHMENTSAND ATTACHMENTS


14/52

TABLE FEATURES ANDTABLE FEATURES ANDATTACHMENTSATTACHMENTS

HYDRAULIC

WHEELED BASE

STAND

DETACHABLE

FOOT REST

MANUAL

LEVER

ARM BOARD

SLIDING

BARS

BREAKABLE

HEAD REST

ELEVATED

ARM REST LATERAL SUPPORT STIRRUPS

METAL SOCKET

T1E"$ 5 ,I))2$& 1E!* "ING& $!N*+!G$& ")) $U,,"T& $%T ,!*$& !TT"E$$


15/52

POSITION DURING INDUCTION OFPOSITION DURING INDUCTION OFANAESTHESIAANAESTHESIA

$U,INE ,$ITIN

1E!* E3TEN*E*

NE(0 %)E3E* !I 5 to visuali6ed ral&

,haryngeal and Tracheal

spaces

,$$I+)E (,)I(!TIN$ 5 Trauma to lips

and teeth& 7aw dislocations& laryngeal or vocal cords

injury& epista.is and trauma to pharyngeal wall


16/52

SURGICAL POSITIONINGSURGICAL POSITIONING


17/52

,he !atient lies %lat,he !atient lies %laton his backon his back

,he ams ma& be,he ams ma& be

!laced beside the!laced beside the

bod&0 on an amboadbod&0 on an amboad

o s$!!oted acosso s$!!oted acoss

the chest b& li%tingthe chest b& li%ting

$! the gown which acts as sling$! the gown which acts as sling Most common /!eati#e !osition0 s$ch as inMost common /!eati#e !osition0 s$ch as in

1a!aotom&0 cetain 2&necological and /tho!edic1a!aotom&0 cetain 2&necological and /tho!ediccasescases

SUPINE OR DORSAL POSITIONSUPINE OR DORSAL POSITION

SUPINE/DORSAL POSITION


18/52

NU"$ING ,"E(!UTIN$ ,TENTI!) (,)I(!TIN$

Head not H&!eetended Backache es$lted %om$ns$!!oted l$mbosacal

c$#at$e,o ens$e that ams aenot abd$cted 3 456Paal&sis o% am and hand d$eto o#e abd$ction

Amboad is !added

Hand in !one !osition

Radial o Ulna ne#e !als& d$eto am o elbow hanging otight sta!!ing

Ams do not o#ela! ohang o#e table edge

Patient !otected %om

metal contact'ontin$o$s !ess$e on thecal#es ma& ca$sed #eno$s stasises$lting thombosis which can

lead to P$lmona& )mbolisms

Bon& !ominences ae!otected (occiput, scapulae,thoracic vertebrae, olecranaon,

sacrum and coccyx, calcaneus)


19/52

Potential pe!!"e point!Potential pe!!"e point!


20/52

PRONE POSITIONPRONE POSITION

,he !atient l&ing with abdomen on table s$%ace

Ams ae !laced abo#e the head Pillows ae !laced $nde the sho$ldes0 hi!s and %eet

Access %o all s$geies in#ol#ing !osteio back

7ce#ical s!ine0 back0 ectal aea and dosal etemities8

PRONE POSITION


21/52


Pillow o towel $ndesho$ldes and hi!

%acilitate chest e!ansion0ed$ce abdominal

!ess$e and #eno$soo*ing at o!eation site

1owe neck and $!!e back!ain es$lting %om

h&!eetension o% head

Radial and $lna ne#e !als&d$e to am estaine

H&!otension es$lted %om!ess$e on in%eio #ena ca#aand !ooling o% blood in lowelimbs

Head not h&!eetended0!laced on side and ke!ts$!!oted

Pess$e !oint ae well!otected with !ad(cheek,ear, acromion process,breast, genitalia, patella,

dorsum of feet, toes)

Sho$lde dislocation d$ing am!ositioning

Bachial !le$s in9$& d$e to

o#e etension o% am 3 456


22/52

Potential Ne#e In$"ie!Potential Ne#e In$"ie!

Brachial Plexus


23/52



24/52

Patient l&ing in s$!inePatient l&ing in s$!ine

!osition with knees!osition with knees

o#e lowe beak o%o#e lowe beak o%

the tablethe table Head tilted down to :;Head tilted down to :;6 o accoding to the s$geon6 o accoding to the s$geon

!e%eences!e%eences

Ams ma& !laced on the chest o amboadAms ma& !laced on the chest o amboad

'ommon !osition %o la!aosco!ic s$geies in !el#ic o'ommon !osition %o la!aosco!ic s$geies in !el#ic o

lowe abdominal egionlowe abdominal egion

Using o% sho$lde o knee baces ma& bene%it !atientUsing o% sho$lde o knee baces ma& bene%it !atient

%om sliding%om sliding

TRENDELENBURG POSITIONTRENDELENBURG POSITION



25/52


Head not h&!eetended and amnot abd$cted be&ond 456

A


26/52

REVERSE TRENDELEBURGREVERSE TRENDELEBURGPOSITIONPOSITION

Patient in s$!ine

!osition with ams

b& sides o on amboad

,able tilted to ;(:56aising the head

A sand bag ma& $sed

below the neck and the sho$lde blade %o etension o% neck7RUSS ,)'H+I=U)8

,he head stabili*ed b& head ing

Position o%ten $sed %o head and neck s$ge& to ed$ce#eno$s congestion

,o !e#ent stomach eg$gitation d$ing ind$ction o%

anaesthesia

REVERSEREVERSE



27/52


Head not h&!eetended and am notabd$cted be&ond 456

Backache ma& es$lt %om$ns$!!oted l$mbosacal

c$#at$eHands on !added amboads aes$!inated Paal&sis ma& occ$ed d$eto o#e abd$ction o% amAms not o#ela! the table edge o

hang o#eUlna and adial !als& d$e to

elbow o am hanging o#ethe table o tight estaint

Patient is !otected %om metal contact

Bon& !ominences ae well !otected(occiput, scapulae, thoracicvertebrae, olecranon, sacrum and

coccyx and calcaneus)

P$lmona& embolisms as aes$lt o% #eno$s stasis

'adio#asc$la o#eloadedd$e to -$ick et$n

Anti embolic stocking ma& be $sed to!e#ent blood !ooling

Skin sheaing d$e to sliding

down

"oot backet ma& $sed to !e#ent

sliding


28/52



29/52

LITHOTOMY POSITIONLITHOTOMY POSITION

Patient lies in s$!ine

!osition with b$ttocks

at the lowe beak o%

the table 1ithotom& sti$!s !laced

in !osition le#el with

!atient ischial s!ine

Ams !laced o#e the chest o on an amboad 1egs ae li%ted togethe $!wads and o$twads and %eet

!laced in knee c$tch o cand& cane

'ommon !osition %o Uolog&0 2&necolog&0 !eineal o

ectal o!eations

LITHOTOMY POSITIONLITHOTOMY POSITION


30/52


,wo !eson e-$ied to aisedthe legs sim$ltaneo$sl& b&

gas!ing the sole and othehand s$!!oting the cal%

Se#ee backache ca$sed b& toohigh sti$!s

'al% holde ma& es$lted!eoneal o %emoal obt$atone#e damageSti$!s bas m$st be checked

and sec$e be%oe $se and it>s

height m$st be simila and nots$s!end the !atient weight

/steoathitis o sti%% hi!s d$eto o$gh handling

,oo -$ick o% loweing the legsma& ca$se h&!otension,he b$ttock m$st be e#en with

the edge o% bed to !e#entl$mbosacal stain "emoal ne#e damage d$e toac$tel& %leed thighs

Anti embolic stocking ma&$sed to !omote #eno$s et$n

Bon& !ominences !otected

Hi! dislocation o %act$e as a

es$lt %a$lt& sti$!s


31/52

Potential Ne#e In$"ie!Potential Ne#e In$"ie!


32/52

TYPES OF STIRRUPS AND IT%STYPES OF STIRRUPS AND IT%SHA&ARDSHA&ARDS

?+)) 'RU,'H?+)) 'RU,'H Pess$e on !eoneal ne#ePess$e on !eoneal ne#ees$lting %ootdo! andes$lting %ootdo! andne$o!athiesne$o!athies

'A+DY 'A+)'A+DY 'A+)

Pess$e on distals$al andPess$e on distals$al and!lanta ne#es which can!lanta ne#es which canca$se ne$o!athies o% theca$se ne$o!athies o% the%oot%oot

H&!eabd$ction ma&H&!eabd$ction ma&

eaggeated %leion andeaggeated %leion andstetch sciatic ne#estetch sciatic ne#e

B//,H ,YP)B//,H ,YP) Ma& !od$ce s$!!ot moeMa& !od$ce s$!!ot moe

e#enl& and ed$ce locali*ede#enl& and ed$ce locali*ed

!ess$e!ess$e

KNEE CRUTCH

BOOTH TYPE

CANDY CANE


33/52

Patient l&ing with onePatient l&ing with one

side %acing o!eati#eside %acing o!eati#eside $!!emostside $!!emost

,he legs %leed to 45,he legs %leed to 4566

and a !illow is !lacedand a !illow is !laced

in betweenin between U!!e am ested onU!!e am ested on

ele#ated am est and the othe emains %leed on the table oele#ated am est and the othe emains %leed on the table oamboadamboad

A oll bags ma& $sed below the hi!@kidne& to inceasedA oll bags ma& $sed below the hi!@kidne& to inceasede!os$e o% iliac egione!os$e o% iliac egion

Position is maintained b& $se o% sandbags o baces attached toPosition is maintained b& $se o% sandbags o baces attached tothe side o% bedthe side o% bed

Head s$!!oted on a !illowHead s$!!oted on a !illow

LATERAL OR KIDNEY POSITIONLATERAL OR KIDNEY POSITION

LATERAL/KIDNEY POSITIONLATERAL/KIDNEY POSITION

$ G (! $ ! ( (! $


34/52


I% table beak is $sed0 it m$stI% table beak is $sed0 it m$st

be coectl& le#el with iliacbe coectl& le#el with iliac

cest to !e#ent alteation incest to !e#ent alteation ines!iation and se#ee !ost(es!iation and se#ee !ost(

o!eati#e backacheo!eati#e backache

I% the kidne& est aised toom$ch0 the l$ngs will not e!andade-$atel& which will es$lt inc&anosis and h&!otension

In9$ies to bachial !le$s0median0 adial and $lna ne#es

can occ$ i% $!!e am is nots$!!oted

)ns$e ea is not ta!!ed)ns$e ea is not ta!!ed

when s$!!oting the headwhen s$!!oting the head

Ams ae s$!!oted withAms ae s$!!oted with

ade-$ate !adding to !e#entade-$ate !adding to !e#ent

!ess$e necosis!ess$e necosis

I% the head is not s$!!otedade-$atel&0 bachial !le$s can

get stetchedPeineal ne#e damage ma&es$lted %om com!ession on thedown knee against had s$%ace

Bon& !ominences ae %$ll&Bon& !ominences ae %$ll&

!otected!otected (ribs, iliac crest, greater(ribs, iliac crest, greatertrochanter, medial and lateral femoraltrochanter, medial and lateral femoral

epicondyles, Tibial condyles, Malleous)epicondyles, Tibial condyles, Malleous)


35/52



36/52

NEUROSURGICAL POSITIONNEUROSURGICAL POSITION

,he !atient ma& l&ing

in a s$!ine !osition0

!one o lateal ,he head is !ositioned

eithe on so%t ing o a

s!iked head est ,he head o% the table ma& be tilted a little to

%acilitate #eno$s dainage and to ed$ce 'S"

!ess$e in the bain

NEUROSURGICAL POSITIONNEUROSURGICAL POSITION



37/52


)ns$e !atient is %$ll&anaestheti*ed be%oe

Simila com!licationsas %o !one and s$!ine

!ositions!ositioning o insetion o heads!ike

De#elo!ment o% skin!ess$e o#e the ea0

cheek o %ace i% $singhead ing %o se#ealho$s 7s$!ine8

)&e ae well co#eed and %$ll&!otected b& !ads

Position o% s!ike m$st not ham!atient>s eas and e&es

"ace is !otected %om !ess$e

when in !one !osition Sciatic ne#e damagema& es$lt d$e to long!ess$e on the dos$m

o% the %oots

Ams ae in good anatomicalalignments

Bon& !ominences is !otectedwhilst in all !osition


38/52

Patient !ositioned ins$!ine with the !el#is

stabili*ed against well

!added #etical !eineal

!ost

,action o% o!eati#e leg is achie#ed eithe b& boot(sha!ed c$%% o de#ices with estaining sta!s

Un a%%ected leg ma& be ested on well !added0ele#ated leg holde

'ommon !osition %o /RI" o% hi! o closed %emoalnailing

FRACTURE TABLE POSITIONFRACTURE TABLE POSITION

FRACTURE TABLE POSITION


39/52

ORTHOPAEDIC FRACTURE TABLEORTHOPAEDIC FRACTURE TABLE



40/52

Patient $s$all& bo$ght intotheate with hos!ital bed andtaction a!!lied

Pess$e d$e to !eineal!ost ma& in9$ed genitalst$ct$e

)ns$e !atient is anaestheti*edbe%oe tans%e onto /, table

"ecal incontinence andloss o% !eineal sensationma& occ$ed as a es$lt o%

!ess$e in9$& to !einealand !$dendal ne#e

/!eating table ae andattachments ae ead& accodingto s$geon !e%eences ostandad man$al

,ight sta! ma& es$lted

!eoneal o %emoalobt$ato ne#e damagees$lting in %oot do!

'a$tions and eta cae egadingshea %oce in9$ies0m$sc$loskeletal and ne#o$ss&stem d$ing tans%e

Bon& !ominences !otected


41/52

Patient l&ing intoPatient l&ing into!one !osition!one !osition

Both legs ae abd$ctedBoth legs ae abd$cted

and %leed togetheand %leed togethe

at ight anglesat ight angles

?nees %leed and hi!?nees %leed and hi!

ele#atedele#ated

Head0 sho$ldes and chest est diectl& on the tableHead0 sho$ldes and chest est diectl& on the table Ams ae !laced abo#e the headAms ae !laced abo#e the head

Pima& !osition %o sigmoidosco!ies and laminectom&Pima& !osition %o sigmoidosco!ies and laminectom&

!oced$e!oced$e

KNEE'CHEST POSITIONKNEE'CHEST POSITION

KNEE-CHEST POSITIONKNEE-CHEST POSITION



42/52


1egs mo#ed togethe to!e#ent back stain

1owe neck and $!!e back!ain d$e to h&!eetended head

Ams gentl& li%t $! to!e#ent dislocation

Ulna o adial ne#e !alsies asa es$lt tight am estaine

Head is not h&!eetended

and !laced to the side on a!illow

H&!otension d$e to !ess$e on

in%eio #ena ca#a and !oolingo% blood at lowe etemities

Bon& !ominences aewell !otected (cheek, ear,

forehead, nose, eyes,acromion process, breast[women], genitalia, patella,dorsum of feet, toes)

Sho$lde dislocation o bachial!le$s in9$& when !lacing the

ams

Patient ma& %all %om table i%backet ae not sec$e and %ail

to s$!!ot !atient>s weight


43/52


SEMI FO(LER%S AND FO(LER%SSEMI FO(LER%S AND FO(LER%S


44/52

,he !atient !ositioned ins$!ine with the $!!e bod&

!at is %leed to ;6 o 456

and the knees slightl&

%leed and legs loweed

Ams ma& be !laced o#e

the la!s o amboad

A %ootest is $sed to !e#ent%ootdo! and head s!ike to stabili*ed head

Use%$l !osition %o caniotomies0 sho$lde o

beast econst$ction and )+,S>

SEMI'FO(LER%S AND FO(LER%SSEMI'FO(LER%S AND FO(LER%SPOSITIONPOSITION

SEMI-FOWLERS ANDFOWLERS POSITION



45/52


,he ce#ical0 thoacic andl$mba section o% s!ine m$st

be aligned once !ositionestablished

/thostatic h&!otension d$eto blood !ooling at lowe

etemitiesRisk o% #eno$s thombosisand embolisms as a es$lt o%im!ended #eno$s et$n

)ta !adding ae e-$ieso#e bon& !ominences

(coccyx, ischial tuberosities,calcaneus, elbows, knees andscapulae)

High isk o% de#elo!ment o%skin !ess$e o#e a%%ected

bon& !ominences,he $se o% anti(embolismstocking ma& necessa& toassist #eno$s et$n

Alteation on chestmo#ement d$e to estiction%om ested ams o tightsta!s

Re!osition a%te s$ge& m$st

be done gentl& and slowl&


46/52


JACKNIFE POSITIONJACKNIFE POSITION


47/52

JACKNIFE POSITIONJACKNIFE POSITION

A modi%ication o% !one

!osition

Patient hi!s ae s$!!oted

on a !illow and the table

ae %leed at 456 angle0aising the hi!s and loweing head and bod&

A sta!s $sed o#e the thigh to !e#ent sheaing and

sliding

,he head0 %ace0 sho$ldes0 chest and %eet ae s$!!oted b&

so%t !ads o olls to !e#ent bon& !ess$e

'ommon !osition %o hemohoidectom& o !ilonidal

sin$s !oced$es

JACKKNIFE POSITION

(KRASKES)



48/52

Pillow o towel $nde sho$ldesand hi! %acilitate cheste!ansion and ed$ced

abdominal !ess$e

1owe neck and $!!e back !aines$lting %om h&!eetensiono% head

In9$& to genitalia d$e to!ess$eAnti(embolisms stocking aid

#eno$s et$n Radial and $lna ne#e !als&d$e to am estaine

Head not h&!eetended0 !lacedon side and ke!t s$!!oted H&!otension es$lted %om!ooling o% blood in lowe limbsPess$e !oint ae well !otected

with !ad(cheek, ear, acromion

process, breast, genitalia,patella, dorsum of feet, toes)

Sho$lde dislocation d$ing am

!ositioningBachial !le$s in9$& d$e too#e etension o% am 3 456

Patient t$n $sing log(oll

techni-$e end o% !oced$e


49/52

POSITIONING OF ELDERLY PATIENTPOSITIONING OF ELDERLY PATIENT

%"!GI)E $0IN $U"%!(E$

!"T1"ITI( 7INT$

)IITE* "!NGE % TIN

,!"!)#$I$ )I%TING "!T1E" T1!N $)I*ING "*"!GGING

!'I* % !*1E$I'E T!,E %" $T"!,,ING

!*E8U!TE ,!**ING %" +N#,"INEN(E$

!))2 ,!TIENT T ,$ITINING +E%"E!N!E$T1ETI9E*

POSITIONING OF PAEDIATRICPOSITIONING OF PAEDIATRIC


50/52

POSITIONING OF PAEDIATRICPOSITIONING OF PAEDIATRICPATIENTPATIENT

Think of :appropriate si"e#

"ight si6e for bed and attachments

ay necessary to use safety strap

Never overe.tended limbs or keep in oneposition for longer periods

*ue to small si6e& children are prone to and

has greater risk of physiologicallycompromised

!ppropriate positioning and observation are

essential


51/52

$i" Spar%s an &' in O%lahoma

!ity( concludes( )It#s not all abouttechni*ue+ It#s about %no,ledge+

If you %no, ,hat causes

complications and ho, to preventthem( you ,ill be more li%ely to

%eep patient positioning in mindas something you should

routinely monitor+


52/52

THANK YOUTHANK YOU

patient positioning in operating theatre

Documents