The perioperative circulating nurse has prepared the OR for a craniotomy for tumor excision and has assembled the primary bed base attachments for the head fixation positioning system.She has verified with the surgeon and anesthesia provider that the bed attachment is properly secured before the start of patient positioning and is prepared for positioning and securing the patient's head with the skull clamp.After the skull pins are secured,the nurse will step back to view the head placement and symmetry,ensuring that:

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When properly placed,the pins in the rocker arm are equidistant from the centerline of the patient's head and the single pin in the extension arm is exactly at the centerline.The pins are at an angle of 90 degrees,the necessary pounds of clamping force are applied,and the rocker arm is in the "CLOSED" position.Only properly trained OR staff should be permitted to operate these devices.The nurse must verify that the bed attachment is properly secured before the start of patient positioning.Once the anesthesia provider has determined that the patient is ready for positioning,the designated member of the OR team will pin the patient's head with the skull clamp.Improper positioning of the skull pins may cause serious injury to the patient.Special attention should be paid to avoiding the areas of the frontal sinus,temporal fossa,blood vessels,and nerves.

The Perioperative Circulating Nurse Has Prepared the OR for a Craniotomy