This is a relatively simple procedure, easily mastered with careful attention to detail.
POSITION OF THE PATIENT DURING THE CAUDAL PUNCH
A pose on the abdomen (with a face), with a pillow under the pelvis, so that the hips are slightly bent and the gluteal muscles relaxed. At the same time, the patient is asked to slightly open the hips and turn the legs so that the heels “look” laterally, and the toes — medially. This maneuver does not move the buttocks apart. Advantages: firstly , no helpers are needed, and secondly , it is easier to determine the median sagittal plane. The disadvantage is poor access to the patient’s airway.
Knee and chest posture
This is the least “romantic” posture, but the most effective for “falling away” of the gluteus muscles from the sacral opening.
Pregnant women cannot lie on their stomachs. Therefore, they are placed face down with legs picked up under the body. The advantages and disadvantages are the same as with a pose on the abdomen.
Lateral posture in adults is used less frequently — it is difficult to find reference points.
The Sims pose is named after the American gynecologist JMSims (1813–1883), who also invented the mirror of Sims. If you are right, the patient is placed on the left side. His left leg is only slightly bent at the hip and knee joints, and his right, more bent, –
lies above the left foot. The entire right lower leg, from the knee to the foot, is safely placed on the table. Bending of the lower back (as with lumbar epidural puncture) is not only unnecessary, but also undesirable, so that the patient does not stiffen. In order not to interfere with the slipping down of the interdigital fold, it is possible to ask the assistant to slightly delay the patient’s right buttock. But not much, so as not to drag the fold up! Advantages: (1) it is convenient to lie down and breathe even to pregnant wives; (2) quite comfortable to you; (3) venous access is better preserved; (4) good access to the patient’s airway, which is important for pre-deep sedation and in cases of complications. The disadvantage is that it is somewhat more difficult to determine the median sagittal plane.