OR Tables
OR tables are designed to be versatile and accommodate various positions required for many surgical specialties. The height of the beds can be adjusted, and they can tilt in various directions including laterally Trendelenburg and reverse Trendelenburg. Most beds are powered electrically with battery power as a backup. All OR tables are equipped with wheels and may have manual and/or electrical brakes.
The basic OR table has 3 major sections (select the + hotspots in the image to reveal information):
Breaking the Bed
Each section of the OR table has a removable mattress pad attached to velcro or straps. Between each of the three sections, there is a “break,” so each section can move together or independently. When one section is raised or lowered, this is referred to as “breaking the bed” (select the + hotspots in the image to reveal the degrees of rotation each section of the bed can be rotated).
Accessory Clamps and Attachments
There are rails that run the length of each side of the bed that allow for attachments such as straps, clamps, sockets for arm boards, stirrups, anesthesia equipment, and various retractor systems. Some also come with a section underneath to hold an X-ray cassette, while newer models are radiopaque for intraoperative fluoroscopy (this is the space for the x-ray cassettes).
Special Headrests
OR tables can also have the headrest removed which is required for some cranial surgeries to allow for a special headrest to be inserted. For tall people, foot attachments can be added to increase length, along with side extensions for bariatric patients. Each table has a weight limit, with a higher limit on special beds for bariatric patients. It is important to know the weight limit of the OR table and your patient’s weight.
The middle section (torso) of the table is attached to the base of the bed to support the heaviest portion of the patient. This section can also be flexed or lowered and has a cut-out at the distal end for patients in the lithotomy position for access to the perineum.
Most standard OR tables have a hand-held electronic controller that operates the bed’s electrohydraulic system.
Positioning Accessories
There are several types of positioning accessories to create a desired position for the patient while ensuring pressure points are properly cushioned. Most accessories are reusable and require washing or sterilization between use. Some examples of positioning accessories are stirrups, hand tables, footboards, arm boards, various headrests, mattress pads, foam, safety straps, and gel pads which come in many sizes and shapes. We will look more closely at each in the following pages.
OR Mattress Pad
Mattress pads are designed to evenly distribute the patient’s body weight and reduce the risk of pressure injuries. They are made from a durable impermeable material that allows for cleaning in between patients and are bacteria growth resistant. Typical mattress pads tend to be two inches thick, four inches for bariatric pads, and made from foam to prevent patients from bottoming out. There are also interchangeable non-standard mattress pads which provide even more cushioning and pressure reduction. These pads are best used for those at an elevated risk of pressure injury and an anticipated long length of surgery.
Gel Accessory Pads
Gel pad products are made from a viscoelastic polymer that provide additional cushioning and protection for patients’ vulnerable areas and boney prominences. They come in varying shapes and sizes. They are durable and pliable and reduce shear forces.
Safety Strap/Belt
This is a particularly important accessory used for positioning to prevent falls. It is a wide strap made of a durable material with a metal fastener. It is placed and fastened over the patient’s thighs above the knees, and loops around the bed. This is the recommended placement as it prevents the legs from flexing.
When applying the safety strap, it needs to be tight enough without compromising circulation. There should be enough room to place two fingers under the strap. There should be padding between the patient and the strap. If the strap does not come pre-padded, there should be enough padding to protect the underlying skin.
Note that there are some positions, such as the lithotomy position, for which this strap is not used as it can compress the abdomen. In that case, the safety strap should be used both before and after the legs are down.
Other Devices
See the list below of additional positioning accessories to view their function and when they are used.