Proper patient positioning prior to and during surgical procedures is very important. Unfortunately, getting the patient into the appropriate position is not without its problems and risks. Often, configuring and maintaining the patient’s body position throughout the course of an operation requires table articulations and the use of positioning aids, which may need to be adjusted from time to time. Plus, in longer procedures, depending on how the patient is positioned, he or she may run the risk of developing pressure ulcers or nerve damage.

STERIS’s Cmax Table with the split-leg positioner.
These problems are only compounded and intensified when the patient is obese. The very size of obese and bariatric patients poses a risk not just to themselves, but to the caretakers that must maneuver them. Fortunately, these positioning problems have prompted a number of medical device manufacturers to develop tables and tools that ease the job of surgeons and OR staff, and comfort the large patients as well.

A world leader in the manufacturing and marketing of medical devices, STERIS Corporation (Mentor, OH) offers a number of general surgery and specialty tables that are rated to accommodate the greater weight of bariatric patients. Included in their extensive product line is the Cmax™ General Surgical Table. The Cmax boasts a 1100-pound weight capacity and an 18-inch longitudinal slide that provides full body C-arm access without having to reverse patient orientation on the table.

The Cmax General Surgical Table from STERIS Corporation boast a weight capacity of 1100 pounds.
In addition to their high capacity surgical tables, STERIS also provides the largest offering of bariatric accessories in the industry. Designed to mimic the clinical safety, ease of use and versatility of posturing devices built for normal sized patients, these devices support a variety of surgical applications. Among these accessories are bariatric width extensions for the Amsco ® 3080, Amsco 3085 and Cmax surgical tables. The extensions add an additional eight inches to the width of the table without compromising the maximum operating weight of each table. These bariatric table width extenders enhance control of the surgical patient, which contributes to a safer work environment for OR personnel.

To further serve the positioning needs of surgeons catering to the obese, the Bariatric Power-lift Stirrups offer the versatility of a booted stirrup while supporting patients weighing up to 800 pounds. STERIS also offers bariatric reverse Trendelenburg straps that are effective for posturing patients in severe reverse Trendelenburg position, and split-leg positioners that are effective in positioning even the largest patients for a broad range of MIS and open procedures. Education and staff in-service programs on proper techniques for posturing bariatric patients are also provided.

To assist in positioning obese patients during Total Hip Procedures, Innovative Medical Products (IMP) (Plainville, CT) offers a variety of positioning devices and systems. The MorphBoard™ Positioning System is ideal for multiple applications that require the patient to be positioned laterally and/or supine. It is comprised of lightweight, modular components that allow for customized patient positioning. Pegs of varying lengths can be fit into the MorphBoard’s center board providing both versatility and a better fit for secure positioning. To accommodate bariatric patients, and even allow them to fit on a standard OR table, the center board can rotate from 20 inches to 30 inches wide.

Bariatric foam positioning product from Xodus Medical evenly distribute the weight of obese patients.
IMP’s De Mayo Hip Positioner™ can also be used in hip procedures on bariatric patients. It features a stabilizing arm that comes over the top and never pushes against the bariatric patient’s abdomen. The Universal Lateral Hip Positioner™ (large size) has a longer base plate than the standard model to better accommodate bariatric patients and features a removable inferior arm that allows room for the patient’s abdomen. It can also be equipped with a longer 13-inch adjustable horizontal arm. In addition, to serve the needs of bariatric patients in the future, IMP will be introducing a line of gel products designed to help prevent decubitus ulcers in procedures lasting longer than two hours.

Xodus Medical, Inc. (New Kensington, PA) is introducing a bariatric line of foam positioning products. These positioners feature wider and thicker foam, enabling the weight of larger patients to be distributed more evenly, reducing the risk of nerve damage. The high density foam construction of these products provide both consistent support and body alignment to ensure proper circulation is maintained throughout surgical procedures. Plus, the utilization of Visco elastic memory foam for the headrests provides a more comfortable solution for patient support. A variety of designs are available to provide maximum exposure to the operative site.

The 46-inch by 46-inch Bariatric Vacuum-Pac BeanBag Positioner from David Scott Company is constructed with a durable, black urethane film and features a U-shaped shoulder cutout.
For more than 35 years, David Scott Company (Framingham, MA) has supplied positioning products to the healthcare industry in the United States and internationally. Their product line of polymer gel positioner includes gel table pads, chest rolls and gel positioners for all parts of the body. They also offer a variety of positioners and positioning aids designed specifically for meeting the needs of bariatric patient, such as bariatric length conductive patient restraints (which are available with an optional gel strap to protect against skin breakdown), table width extenders and bariatric lift-assisted stirrups. Most of these bariatric positioners can be used in a variety of applications. The polymer gel positioners aid not only in the positioning of patients, but also in protecting them from pressure soars and skin ulcers.

Unique to the David Scott product line is the Bariatric Vacuum-Pac BeanBag positioner. The 46-inch by 46-inch bean bag is constructed with a durable black urethane film and features a U-shaped shoulder cutout. Easily attached to a suction line, a simple push-button release mechanism returns the bean bag to its original shape. For added convenience, the proprietary valve system on the Bariatric BeanBag Positioner is replaceable if compromised, which can save hundreds in replacement costs.

A major global provider of surgical tables and an extensive array of other medical devices that is currently catering to the bariatric market is Skytron (Grand Rapids, MI). With a number of surgical table rated with weight capacities well in excess of 700 pounds, Skytron can assist ORs in meeting nearly every bariatric need. Their Hercules 6700B Surgical Table provides powerful 1200-pound lift and full articulation of 1000 pounds, as well as full body imaging capability for the most advanced general purpose and bariatric procedures. These features effectively reduce the need for multiple support accessories and optimize the ease of patient set-ups. The Hercules 6700B also offers 210-degree top rotation, a low table height of just 23 inches and 30 degrees of patient articulation with full table functions. A full line general purpose and bariatric table accessories is also available.

The Hercules 6700B Surgical Table from Skytron lifts 1200 pounds and articulates 1000 pounds.
Other Skytron surgical tables capable of handling the positioning requirements of bariatric patients are the UltraSlide 3600B Full Function, Top Slide Surgical Table, which provides powerful 1000-pound lift, 800-pound articulation and 24-inch low table height, and the new EZ Slide 3501B Top Slide Surgical Table that provides 21-inch top slide with the precision positioning of an imaging table and 700-pound lift and 600-pound articulation capacity.

Action Products (Hagerstown, MD) offers a myriad of products that are suitable for use with obese surgical patients. Assorted positioners, pads and heavy duty O.R. table replacement mattresses are just some of the examples of the products that can assist in the effective handling and positioning of very heavy patients. All of these positioning products can be utilized in a variety of surgical procedures depending on the needs of the surgical team.

Action® positioners can assist in the positioning requirements of the OR and offer support to the heavy patient without bottoming out like some foam products. The pressure relieving OR table mattress upgrade can reduce the risk of injury by providing the support surface needed for very heavy patients.

Bariatric positioners from Action Products meet the positioning need of the OR and offer support to heavy patients without bottoming out.
The Akton® polymer used in Action’s positioners and other products exhibits properties that not only addresses perpendicular pressure but also shear. These are the two most common causes of skin breakdown in the surgical patient. And the obese, because of their weight, are at an increased risk for these problems.

And once again, this is the very root of the problem. Due to their excessive weight, width and overall size, obese patient are at higher risk of complications from many common problems in the healthcare setting. The risk of injury to a bariatric patient in transport, transfer and positioning in the OR and throughout the hospital is far greater than that experienced by patients of normal size. Rolling a patient of moderate build into the lateral position may be nothing more than in inconvenience for the patient and staff, but for an obese person, the risk of falling or being injured in the move or in the final position itself is a serious concern.

Sadly, as the percentage of the adult population that is overweight and obese continues to increase, these problems are only going to become more prevalent. While there are currently no bariatric patient transfer or positioning systems currently on the market that meet all the needs of both the patient and the staff, there are a number of companies and medical centers that are researching common problems in hopes of finding efficient and effective solutions. Until those solutions are discovered, though, the bariatric patient positioning aids currently available provide surgeons and healthcare workers with definite advantage. After all, any step toward the safer handling and positioning of patients is a step in the right direction.