A patient is positioned in the lateral decubitus position for a thoracotomy. Which intervention is most important to prevent a positioning-related injury?
- A.Place a kidney rest under the lower chest to improve surgical access
- B.Place an axillary roll under the dependent chest wall, just below the axilla
- C.Position the lower arm across the patient's chest
- D.Secure the dependent arm in full extension on an arm board
Show answer & rationale
Correct answer
B. Place an axillary roll under the dependent chest wall, just below the axilla
Rationale
B is correct: An axillary roll (a rolled towel or gel roll) placed just distal to the axilla on the dependent chest wall prevents compression of the brachial plexus and axillary vessels by the body weight. Without this, the neurovascular bundle is compressed, risking brachial plexus injury and upper extremity ischemia. A is incorrect: A kidney rest elevates the flank for surgical access but does not protect the dependent arm or brachial plexus. C is incorrect: Placing the lower arm across the chest would compress it under the patient's weight, causing ischemia and nerve injury. D is incorrect: Full extension of the dependent arm stretches the brachial plexus and should be avoided; the arm should be comfortably positioned on a padded arm board at less than 90 degrees.
Key concepts