3 Surgical Positioning and Specimen Handling
A practical guide to preventing positioning injuries and maintaining specimen identity and appropriate handling throughout the operating-room process.
Assess positioning risks
Positioning decisions should account for the patient’s condition and the length and requirements of the operation. Before positioning, document baseline findings, including limited mobility or pre-existing numbness, and plan the position and padding with the team. Protect affected or otherwise vulnerable areas, and communicate risks before anesthesia prevents the patient from reporting discomfort.
Protect nerves and pressure points
Position the body in a supported, stable way and avoid undue stretch, pressure, or awkward positioning. During supine positioning, support the arms and avoid excessive shoulder abduction or rotation. Check that padding and restraints do not create focal pressure, especially at the elbow or shoulder; do not place the patient’s weight on the upper arms.
For a patient who will remain in one position for several hours, pad vulnerable pressure points and check that skin, limbs, and devices are free from unintended pressure or entrapment. Use padding appropriately rather than adding it where it could create new pressure points. A pressure-redistributing surface does not remove the need for checks. Prolonged pressure and friction can damage skin and underlying tissue, so reassess positioning as appropriate during the procedure.
Reassess after position changes
After turning an anesthetized patient, verify the final alignment and protection of vulnerable areas, secure lines and airway equipment, and reassess the patient’s status before proceeding. Position changes can affect alignment, pressure points, and attached equipment.
For prone cases, pay particular attention to the face and eyes as well as other vulnerable areas. Do not assume that a planned position or padding alone means that the final position is safe.
Maintain
Place specimens from different sites in appropriate separate containers. Label each container with the required patient identifiers and a precise description of the source or site, then match the container information to the order. Follow facility policy for required identifiers; a container must be traceable to the correct patient and specimen site.
Before the specimen is sent, read the patient’s name, specimen description, and any orienting marks aloud and have the team verify them. This verbal confirmation, called a , provides an opportunity to catch labeling errors before the patient leaves the operating room.
Resolve label discrepancies
If a container and its requisition conflict—for example, one says “left breast” and the other says “right breast”—stop and resolve the with the responsible clinician before sending the specimen. Do not guess which side is correct, correct paperwork from memory, or silently remove conflicting site information. Verify the correct site with the responsible team member and correct the record according to facility policy.
Follow specimen-specific handling instructions
Handling requirements depend on the test. If a surgeon requests fresh tissue or special transport medium, confirm the required handling with the responsible clinician or receiving laboratory, then send the specimen promptly in the specified container or medium. Follow facility policy and laboratory instructions. Do not assume that formalin, freezing, or another handling method is appropriate for every tissue specimen.