Patent Publication Number: US-10322052-B2

Title: Left arm trans access positioning apparatus

Description:
BACKGROUND 
     In diagnosing and treating heart diseases caused by occlusion of the coronary arteries, a physician may perform various tests and non-surgical procedures in which a catheter is guided through an artery in the arm or leg and into the selected coronary artery of the heart. Once in place, the catheter is then used for performing diagnostic tests such as a coronary angiography in which a radio imaging material is injected to visualize the arteries, or therapeutic interventions such as a coronary angioplasty, stenting, or atherectomy. A physician may insert the catheter in the patient using a femoral, brachial, or transradial coronary intervention approach. 
     In a transradial approach, the catheter is introduced into the aorta via the radial artery in the wrist. The radial artery and the ulnar artery are two small arteries in the wrist that communicate through the palmar arch. The physician may introduce the catheter via either the right or left radial artery. The physician may choose to access the left radial artery due to accessibility for engaging the left subclavian artery and the left internal mammary artery (LIMA), proximity to the LIMA and subclavian artery, proximity to a subclavian graft, compromised access of the right radial artery, medical conditions of the patient, or other conditions of the patient where accessing the right radial artery is not medically advised. However, a problem with the use of performing this technique on the left radial artery of the patient is that the physician stands on the patient&#39;s right side and has to lean over the patient and reach around the patient&#39;s abdomen to perform the procedure on the left wrist, causing strain on the physician&#39;s lower back and upper body. Another problem with this technique is that positioning the patient&#39;s left wrist and arm in a steady and comfortable manner is difficult due to the patient&#39;s movement due to discomfort or lack of proper support of the patient&#39;s arm. To position the arm, the left arm may be propped up using standard hospital pillows and blankets used for patients&#39; beds. However, the problem with this technique is that pillows and blankets may move around or are not dense enough to properly position the patient&#39;s arm and keep it in a steady and comfortable position. The physician or support staff needs to often reposition the pillow and blankets to find a suitable position that is high enough for performing the procedure. For example, the physician may have trouble reaching a morbidly obese patient&#39;s wrist due to having to reach over a large abdomen. Even if the physician may reach the patient&#39;s wrist, a different position may enable the physician to maintain a more comfortable posture while performing the procedure. 
     Another problem with this technique is that pillows and blankets may move around or are not dense enough to properly position the patient&#39;s arm and keep it in a steady, stationary and comfortable position. The physician may apply some pressure on the arm and wrist during the procedure that may cause the arm and wrist to move or push the arm into the pillows and blankets. Additionally, pillows and blankets do not keep a form that is comfortable for the enough and maintains the arm in a steady and still position for the duration of the procedure and recovery time. The patient may become uncomfortable during the procedure or become fidgety and move their arm, making accessing the left radial artery and engaging the LIMA more difficult or may dislodge the catheter. Pillows and blankets do not provide enough firm shape that maintains the arm&#39;s stationary position in a comfortable manner and limits movement. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a perspective view illustrating an example left arm trans access positioning apparatus that may be used to reduce the movement of the patient&#39;s arm during a left transradial approach procedure, in accordance with one or more techniques of the present disclosure. 
         FIGS. 2A-C  are illustrations depicting further details of one example of left arm trans access positioning apparatus as shown in  FIG. 1 , in accordance with one or more techniques of the present disclosure. 
         FIGS. 3A-E  are illustrations depicting further examples of a left arm trans access positioning apparatus as shown in  FIG. 1 , in accordance with one or more techniques of the present disclosure. 
         FIG. 4  is a perspective view illustrating further details of a left arm trans access positioning apparatus as shown in  FIG. 1 , in accordance with one or more techniques of the present disclosure. 
         FIG. 5  is an illustration showing further details of a left arm trans access positioning apparatus as shown in  FIG. 1 , in accordance with one or more techniques of the present disclosure. 
         FIGS. 6A-B  are illustrations depicting further details of one example of a left arm trans access positioning apparatus as shown in  FIG. 1 , in accordance with one or more techniques of the present disclosure. 
         FIG. 7  is an illustration showing further details of one example of a left arm trans access positioning apparatus as shown in  FIG. 1 , illustrating a fourth extended portion. 
     
    
    
     DETAILED DESCRIPTION 
     In general, this disclosure is directed to techniques that may assist a patient&#39;s left arm in maintaining a generally immobile position while on an operating table during a left transradial surgical procedure. More particularly, as the patient lies in a supine position, the left forearm maintains a trans access position above the abdomen and may supinate for access to the radial or ulnar arteries. This disclosure is directed to a medical device that limits the movement of the left forearm. During a transradial catheterization, the physician standing on the right side of the patient delicately and precisely works with catheters and wires that may easily dislodge or cause damage to the arterial system if improper movement occurs. Thus, limiting movement of the patient&#39;s forearm, may prevent complications during the procedure, and may reduce equipment movement thereby improving patient safety. The left arm trans access positioning bends the elbow so that the patient&#39;s wrist is approximately above their femoral artery, but exact positioning depends on the size of the patient. The disclosure of this invention relates to a medical apparatus used to maintain the patient&#39;s forearm in a raised and steady position during a left arm trans access surgical procedure. The physician performing the procedure may perform the procedure via either the radial or ulnar arteries. 
     The left arm trans access positioning board (the “positioning board”) maintains the forearm in an elevated trans access position above the plane of the patient&#39;s body, for example, by positioning a main panel against the patient&#39;s upper arm and a second panel against the patient&#39;s forearm when the patient is in the supine position. The arm panels become immobile when a third panel is under the patient. The weight of the patient&#39;s body presses the third panel onto the surgical table, holding it in a stationary position. The stationary third panel becomes the base for immobilizing the positioning board, so that the main panel remains next to the upper arm and the positioning panel remains above and extending over the patient&#39;s abdomen. When the patient&#39;s forearm is positioned on the positioning board, the forearm becomes immobile so that the patient cannot straighten their arm. The immobile position of the positioning board limits motion of the forearm by a portion of the positioning board placed next to the forearm, allowing forearm rotation towards their head, but not toward their feet. Securing the positioning board to the main panel also limits forearm movement when the physician is performing a transradial catheterization. During the procedure, the physician may apply pressure to the radial side of the patient&#39;s wrist without the forearm moving horizontally out of position. The positioning board extends from the main panel to a proximal side, located approximately near the patient&#39;s wrist. The proximal side of the positioning board may end just below the patient&#39;s wrist, allowing the hand to rotate at the wrist. 
     The positioning, main and base panels forming the positioning board may be three integrally connected pieces, or formed from one continuous piece. In either case, angles between the panels form the positioning board. For example, the main panel and the extended panel, which extends outward from the main panel, together form an obtuse angle. The obtuse angle receives the elbow creating a bend in the patient&#39;s arm between the upper arm and forearm, forming a similar obtuse angle when the forearm lies next to the positioning board that is above the patient and positioned in proximity to the patient&#39;s groin. In this position, the physician standing on the patient&#39;s right side during the procedure is then closer to the patient&#39;s left wrist and does not have to reach across the patient. The exact positioning of the forearm and wrist varies due to the patient&#39;s body size and shape. 
     The positioning board panel conforms to the patient&#39;s abdomen. The positioning board has a curved side, which extends between the side attached to the main panel and the proximal side next to the patient&#39;s wrist. The curved side is the underside that is next to the patient&#39;s abdomen and has a concave recess shaped to receive the patient&#39;s abdomen so that the positioning board can extend over the patient&#39;s body without the body impeding positioning of the positioning board. In some cases, depending on the size of the patient, the positioning board may rest on the patient&#39;s abdomen, providing additional support and limiting the movement of the positioning board during a procedure. The positioning board may position the forearm of the patient higher the abdomen when the dimensions of the over the proximal side of the positioning board may arch over the patient&#39;s abdomen, so that the forearm is raised above the abdomen of the patient. 
     The positioning board may be lined with an elongated piece of malleable material. The material cushions the patient&#39;s arm for comfort and supports the arm as the material holds the arm in position. The malleable material may be memory foam or other resilient material that can comfortably support the arm during the procedure and further limit that movement of the arm. The material is an elongated member at the inner surface of the extended panel portion. The elongated member may extend longer to also be at the inner surface of the main panel portion and may extend down far enough to the base panel portion. In this configuration, the elongated member of malleable material may be at the center, or core, of the positioning board. At this position, the elongated member helps to position the forearm by placing the material so that it is under the elbow and forearm may. Additionally, the elongated member may elevate the arm above the abdomen in a better access position for the physician. The malleable material may be formed or may mold around the patients arm, limiting movement. 
     During a catheterization procedure, imaging is also part of the procedure, allowing visualization of the catheter, wire, stent, etc. placement, and to see blood flow through the cardiovascular system. Thus, the material used to make the positioning board cannot interfere with imaging, for example, computed tomography (CT) scans, x-rays, and fluoroscopy. Materials used to make the positioning board, such as the main, base and extended panel portions may include at least one of radiolucent acrylic material, polycarbonate, or radiolucent plastic material. These materials allow the imaging equipment to image the catheter or equipment placement within the cardiovascular system without significant interference. Similarly, material used to make the elongated member may also not interfere with imaging, such as foam or other plastic or rubber base materials. 
     Further tethering means may be used to further immobilize the left arm so that the tethers do not obstruct access to the radial artery and do not interfere with equipment used, or obstruct imaging during a transradial catheterization procedure. Additional securing means to secure the positioning board may also be used, for example, an additional panel or piece extending from the main panel, opposite the extended panel, to receive the patient&#39;s left shoulder and further prevent horizontal or longitudinal movement of the positioning board. Tethering means may also be used to further secure the positioning board to the patient, for example, or a surgical bed. 
     The invention will be better understood and its advantages appreciated from the following description. Referring now to the drawings, an embodiment of the positioning board according to the invention is shown in  FIGS. 1 through 7 . 
       FIG. 1  is a schematic illustrating an example of a left trans access positioning board for use during surgical medical procedures, such as a positioning board  10  used during a left transradial catheterization, in accordance with one or more aspects of the present disclosure. As shown in  FIG. 1 , positioning board  10  may be associated with a patient  2  and includes a main panel  20  connected to an extended panel  140 . Main panel  20  may have an inner surface  30  and an outer surface  40 . Inner surface  30  and outer surface  40  may be opposite to one another. The edges extending between inner surface  30  and outer surface  40  are a first longitudinal side edge  100 , a second longitudinal side edge  60  located opposite of first longitudinal side edge  100 , a first latitudinal side edge  110  and a second latitudinal side edge  80  located opposite of first latitudinal side edge  110 . In one example, main panel  20  may have a generally rectangular shape with four corners, where first latitudinal side edge  110  second latitudinal side edge  80  may extend between opposite ends of first longitudinal side edge  100  and second longitudinal side edge  60 . In other examples, second latitudinal side edge  80  may be longer than first latitudinal side edge  110 . Second latitudinal side edge  80  may have a length between 5 to 18 inches. Generally, the corners formed where the edges meet may be straight, creating a sharp corner, or rounded, so that inner surface  30  and outer surface  40  have rounded corners or the edges are rounded where they meet inner surface  30  or outer surface  40 . Main panel  20  may have other non-rectangular shapes. The upper arm of patient  2  may lie next to inner surface  30  of main panel  20  or may lie next to cushion material lining inner surface  30 , for example as illustrated in  FIG. 2B . 
     In one example, second latitudinal side edge  80  of main panel  20  may be adjacent to extended panel  140 . Extended panel  140  may have a distal end edge  200 , a proximal end edge  230 , a top side edge  220  and a bottom side edge  210 , and may have an inner surface  160  and an outer surface  180 . Distal end edge  200  of extended panel  140  may be adjacent to second latitudinal side edge  80 . Generally, extended panel  140  may position the left forearm of patient  2  inward, trans-abdominally. Extended panel  140  may extend generally outward from an upper portion, away from base panel  120 , of second latitudinal side  80  of main panel  20 . For example, extended panel  140  may form an obtuse angle with main panel  20 , so that inner surface  160  of extended panel  140  angles towards a base panel  120 . The obtuse angle may receive the left elbow of patient  2 , so that upper arm and forearm of patient  2  form a similar obtuse angle when the forearm is next to inner surface  160  of extended panel  140 . 
     In some examples, main panel  20  presses the upper arm in toward the body, particularly at the elbow, causing the forearm to naturally rise over the abdomen. In other examples, bottom side edge  210  of extended panel  140  may have an arcuate shape, at least partially, extending between proximal end edge  230  and said distal end edge  200 . The curved shape of bottom side edge  210  creates a concave recess, so that extended panel  140  may receive the left abdominal side of patient  2 . The curve shape of bottom edge  210  may extend upward, traversing above at least part of the abdomen, so that proximal end edge  230  is above the lower mid abdomen of patient  2 . In this position, a larger abdomen of patient  2  will not substantially interfere with placement of positioning board  10 . A greater curve angle of bottom side edge  210  of extended panel  140  may receive a patient that has a larger body mass index or a larger sized abdomen. Additionally, the forearm of patient  2  may extend along extended panel  140 , positioning the forearm above the abdomen of patient  2 . The curve angle and length of bottom side edge  210  may increase to extend the length of the extended panel  140  in the proximal direction and may increase the height of proximal end edge  230 , but relative to increasing the length of top side edge  220 . 
     The obtuse angle of main panel  20  and extended panel  140 , and the curved shape of extended panel  140  around the abdomen of patient  2 , positions the forearm across the abdomen, so that the hand and wrist of patient  2  extend beyond proximal end edge  230  of extended panel  140 , and in proximity to above the right femoral artery. Top side edge  220  may extend to a length so that proximal end edge  230  is next to the forearm of patient  2 , and extended panel  140  does not extend next to or beyond the wrist. In this way, the hand can more freely rotate at the wrist, without extended panel  140  limiting or interfering with and rotation. The location of the left hand and wrist in proximity to extended panel  140  may vary due to the length and size of the patient. 
     Positioning board  10  may also have a base panel  120 . Base panel  120  may extend generally outward from second longitudinal side edge  60 , and may extend perpendicularly from main panel  20 . In some examples, when the patient is in the supine position, base panel  120  is at least partially under the patient&#39;s back and above the surgical table. Base panel  120  may extend under the back side of patient  2  in the direction from the left arm to the right arm, extending long enough so that sufficient body weight of patient  2  pushes base panel  120  into the surgical bed to immobilize it. 
     In some examples, as illustrated in  FIG. 2A , base panel  120  may comprise a first side edge  330  of base panel  120  and a second side edge  340  that is generally opposite of first side edge  330 . Base panel  120  may also have an adjacent side edge  310  and an opposing side edge  260 , both extending between first and second side edges  330  and  340 . Base panel  120  may also have an upper surface  350  and a lower surface  360  that opposes upper surface  350 . When patient  2  lays on a surgical bed in a supine position, upper surface  350  is in proximity to the back of patient  2  and lower surface  360  is in proximity to the surgical bed. The weight of patient  2  presses down on upper surface  350  of base panel  120  and pushes base panel  120  down on the surgical bed, and thus, prevents positioning board  10  from sliding or rotating out of position on the surgical bed. Additionally, because main panel  20  connects to adjacent base panel  120 , main panel  20  is also immobilized from the rigid connection. Similarly, the rigid connection to main panel  20  from the weight of patient  2  on base panel  120 , also limits the movement of extended panel  140 , because extended panel  140  frigidly connects to main panel  20 . In other words, the patient&#39;s weight on base panel  120  indirectly limits the movement of extended panel  140  via the rigid connections to main panel  20 . In some examples, a corner member  265  may attach at inner surface  30  of main panel  20  and upper surface  350  of base panel  120 , and may extend at least part of the length of second longitudinal side edge  60 . Corner member  265  may reinforce the attachment of main panel  20  to base panel  120 . 
     Adjacent side edge  310  of base panel  120  may be the same length of second longitudinal side edge  60  of main panel  20 . For example, adjacent side edge  310  may between 10 to 18 inches in length. In other examples, adjacent side edge  310  of base panel  120  may be longer than second longitudinal side edge  60 , so that base panel  120  extends below the buttocks of patient  2 . For example, adjacent side edge  310  may be between 13 to 24 inches long. Extending base panel  120  increases the area of upper surface  350  of base panel  120  that receives the force of weight of patient  2 , and increasing the surface area of base panel  120  receiving the patient&#39;s weight directly increases the immobility of base panel  120 . Additionally, extending the length of adjacent side edge  310  beyond the length of longitudinal side edge  60  may fit the body of patient  2  for taller patients, patients with longer torsos or patients with a greater body mass index. To further increase the area, the length of first side edge  330  and second side edge  340  may increase, and may be in a range from 2 inches to 24 inches. 
     Inner surface  160  of extended panel  140  may be flat or curved shape that is near the forearm. Cushion material may line inner surface  160  and is further discussed in regard to  FIG. 2B . Generally, the cushion material may be foam, for example memory foam, or other high resiliency material that is comfortable and forms around the arm when pressure is applied to the material. The material must be resilient and dense enough to create support for the forearm. 
       FIG. 2B  is an example of an elongated member  287  made of cushion material that lines the inner surfaces of positioning board  10  to improve support of the left arm in the trans access position, lifting the elbow and forearm of patient  2  above the abdomen. Elongated member  287  may have recesses to help keep the forearm in a steady position, for example, elongated member  287  is a generally elongated member that extends longitudinally along main panel  20  and extended panel  140 . 
       FIG. 2B  elongated member  287  includes a proximal end  290  and a distal end  280 . A top edge  292  extends between proximal end  290  and distal end  280 . Top edge  292  may have a curved shape to receive the arm of patient  2 . The curved shape may have a relatively “U”-shape or a recess extending along top edge  292 . Elongated member  287  may have a side edge  294  adjacent to top edge  292 . Side edge  294  may have a curved shape, for example a concave shape, for receiving the abdomen of patient  2 . Top edge  292  may bend at an obtuse angle, for example at bend  270  as illustrated in  FIG. 2B . Bend  270  receives the elbow of patient  2 , so that the arm in the recessed portion of top edge  292  bends at the angle of bend  270 . The portion of elongated member  287  between bend  270  and proximal end  290  has extension portion  285  where the material extends from side edge  294 . Extension material  285  supports the forearm and is under the forearm, extending from side edge  294  to over the abdomen. In another example, the material of elongated member  287  is flexible, so top end  292  does not have bend  270  and is straight, such as in  FIG. 5 . Elongated member  287  may bend to form  270 , as illustrated in  FIG. 2B , or may have bend  270  in its form without bending the material, when placed at the inner surfaces of positioning board  10 . 
     The top portion may have a form for receiving an arm of the patient during a transradial approach procedure. The top portion may have at least one groove or recessed portion that may have a depth between 0 in-5 in running between proximal end  290  and distal end  280  of elongated member  287 . The depth of the recessed portion of top edge  292  may vary between proximal end  290  and distal end  280 . In some examples, proximal end  290  portion may have a different recess depth than distal end  280  portion. To illustrate one of many examples, proximal end  290  may be 2-5 inches deep to accommodate and receive the patient&#39;s elbow, but the proximal end  290  has a recess depth of only 0-2 inches to accommodate and receive a more distal portion of the patient&#39;s arm, such as the patient&#39;s wrist. 
     In another example of the form of elongated member  287 ,  FIG. 2C  illustrates a lower section  297  for receiving the right side of the patient&#39;s abdomen. When the patient assumes the supine position and their left arm assumes the transradial access position, the patient&#39;s upper arm, particularly the shoulder, lies next to a middle section  296 . However, taller patients may have the upper arm next to middle section  296 . The patient&#39;s body size and shape varies, and thus, the exact positioning may vary. The patient&#39;s upper arm then follows along the form of elongated member  287 , so that the upper arm is next to a first recess portion  295 , and the elbow is at a second recess portion  294 . The form of elongated member  287  may help to support the left arm in a trans axial position, so that as the upper arm angles inward (the wrist moving from the patient&#39;s left side towards the right side). The patient&#39;s left arm elevates over the left ribs. Second recess portion  294  is at the patient&#39;s elbow, further supporting the arm in the elevated position positioning the left upper arm over the left ribs. Second recess portion  294  is a bend point where the material of elongated member  287  curves or bends inward generally towards the patient, in relation to the angle created with extended panel  140  of  FIG. 2A  and main panel  20 . Elongated member  287  continues to a third recess portion  293 . In position, that patient&#39;s left forearm is at third recess portion  293 . 
     The material of elongated member  287  is dense enough so that it does not collapse or compress while the patient&#39;s arm is on elongated member  287  and withstands the weight of the patient&#39;s arm and pressure during the procedure. The density is also sufficient so that elongated member  287  does not move due to the patient&#39;s arm movement and pressure applied to elongated member  287  during a left transradial catheterization procedure. 
     As shown in  FIG. 3A  illustrates another example of elongated member  287  and a single recessed side  321 .  FIG. 3B  shows a similar recessed side  326  and a top recess  324  that extends along elongated member  287  (as illustrated in  FIG. 2B ) to create a continuous groove.  FIG. 3B  also shows an angled portion  322 , which allows elongated member  287  to be wedged into position. The elongated member  287  may be inserted into position next to positioning board  10  after positioning board  10  is next to the patient, or elongated member  287  may be attached to positioning board  10 . 
       FIG. 3C  illustrates the recess or curve of proximal end  331  is wider than the recess or curve of distal end  336 . The recess or curved shape extends from proximal end  331  to the distal end  336  creating a narrowing groove extending along elongated member  287 . 
       FIG. 3D  illustrates another example of elongated member  287  of  FIG. 1 . Elongated member  287  also has a bottom portion  345  that is narrower than a top edge  341 . Bottom portion  343  allows elongated member  287  to fit around a patient that may have a larger mid-section, allowing a wide curve of a side edge  338 , or half-U shape, to fit around a large abdomen of patient  2 . 
       FIG. 3E  illustrates different materials used in positioning board  10 . A first material for elongated member  287 , particularly covering a top recess  344  and a side recess  346 . The first material may be malleable to conform to the shape of the patient&#39;s body, for example memory foam, and to comfortably cushion the patient&#39;s arm. The first malleable material may further improve stability by conforming to the patient&#39;s body, and thus, limiting motion of the patient&#39;s arm. A second different material on an outer side portion  348  of elongated member  287 , may be sufficiently ridged so that it does not compress or bend when pressure is applied to outer side portion  348 . 
       FIG. 3E  further shows a second material covering the outside of at least one exterior portion such as the side portion, the bottom portion, or the angled portion. The second material seals the exterior sides of elongated member  287 . The second material may improve sterility of elongated member  287  by sealing elongated member  287  off one or more of the exterior portions with a barrier that prevents moisture, bacteria, etc. from getting in the denser material of the elongated member and the cushion material. 
       FIG. 4  illustrates a first position  478   a  and a second position  478   b  of the arm on elongated member  287 . First position  478   a  has the arm along the patient&#39;s left side.  FIG. 5  is an example of first position  478   a.  Second position  478   b  is located higher and next to the curved portion  480  of elongated member  287 . The higher position of the second position  478   b  is due to curved portion  480  being longer on distal end  482 . The longer raised curved portion  480  helps to position the hand in second position  78   b , so that it is elevated and positioned closer to the center of the patient&#39;s body and extending over the abdomen of the patient. In some examples, a second top portion  476 , being over curved portion  480 , may be longer than a first top portion  474 , so that the corner of second top portion  476  and curved portion  80  meet at a point that would be over the patient&#39;s abdomen. The configuration of elongated member  287  with respect to main panel  20  may change from, for example, first position  478   a  to second position  478   b  because may have an adjustable positioning means for extended panel  140  (as illustrated in  FIG. 1 ). First position  478   a  may be between 30 to 80 degrees different from second position  478   b.    
     Extended panel  140  may be a removable piece may attach to base panel  120  using, as one example, a pin-in-hole means. In other examples, the removable piece may move into place using a spring means. The spring may push the second piece that would raise the patient&#39;s arm and angle the arm inward (angled from the proximal end or pivoting joint such as an elbow or shoulder), positioning it over the body of the patient. The pressure from the spring in an extended position may hold the patient&#39;s arm in a raised position over the abdomen by applying pressure to the second extended piece when the spring extends. Other securing means are possible such that the removable piece is securely attached to the elongated member and limits movement of the removable piece while it is attached. 
     In other examples, main panel  20  (illustrated in FIG. 1 ) may also be moveable independent from base panel  120 . Main panel  20  may be attached to base panel  120  by groove means, so that main panel  20  may slide along the groove to accommodate different body shapes so that positioning board  10  better accommodates the patient&#39;s size. Other means for attaching main panel  20  to base panel  120  may include pin-in-hole or spring means. 
       FIG. 6A  and  FIG. 6B  illustrate another example of a form of elongated member  287 , such as the one illustrated in  FIG. 4 . The patient&#39;s forearm may be at a first recess  652  when the arm is straight, but when the arm moves to a second recess  650 , then the patient&#39;s arm is in the trans access position. Side recess potion  654  is at the abdomen of the patient in both positions. 
     In another example,  FIG. 7  illustrates a fourth panel  710  that is adjacent to a first latitudinal side edge  110  of main panel  20 . Fourth panel  710  receives the patient&#39;s left shoulder for limiting longitudinal movement of the apparatus towards that patient&#39;s feet. Fourth panel  710  further secures that positioning board  10  in place. However, tethering means could also further limit the motion of positioning board  10  by securing main panel  20  or base panel  120  to, for example, the surgical bed or the patient. 
     The disclosure relates to an apparatus for positioning a patient&#39;s forearm during a medical procedure comprising a main panel portion having an inner surface and an outer surface, a first longitudinal side edge, a second longitudinal side edge, a first latitudinal side edge and a second latitudinal side edge. The apparatus may also comprise an extended panel portion having a proximal end edge and a distal end edge, and an inner surface, wherein said distal end edge forms an angled configuration with said main panel portion for positioning the patient&#39;s left forearm and wrist suitably for receiving an arterial catheter, and a base panel portion having a first longitudinal side edge and a second longitudinal side edge, said first longitudinal side edge of said base panel portion extending generally perpendicularly outward from said second longitudinal side edge of said main panel portion. The extended panel portion further has a bottom surface, a top edge and a bottom edge. The bottom edge of said extended panel portion has an at least partially curved shape extending between said distal end edge and said proximal end edge, the curved shape is a recess for receiving the patient&#39;s abdomen. The arch of said bottom edge of extended panel portion extends over the patient&#39;s abdomen while patient is lying in the supine position, sufficiently positioning the patient&#39;s wrist above or in proximity to the patient&#39;s sacrum. The proximal end edge ends at the patient&#39;s forearm below the wrist. 
     The base panel portion of the apparatus may further have an upper surface to support the back of the patient lying in a supine position. The adjacent side edge of the base panel may be longer than said second longitudinal side edge of the main panel portion. 
     The angled configuration formed with said main panel portion and said extended panel portion is within a range of 90 to 165 degrees. The extended panel portion has an inner surface, wherein said inner surface has cushioning to comfortably support the patient&#39;s forearm. The inner surface is next to an elongated core member made of malleable material. The elongated core member is a support with a top surface and a trough portion along the top surface for positioning the patient&#39;s forearm in said trough portion. The extended portion may have restraining means for restraining the patient&#39;s forearm in a supinated position suitable for receiving an arterial catheter. 
     The main, base and extended panel portions are formed of at least one of radiolucent acrylic material, radiolucent polycarbonate or radiolucent plastic material. The main, base and extended panel portions are formed integrally as a one piece positioning board. 
     The extended panel portion is configured to move from a first position to a second position, wherein the first position is configured to position the patient&#39;s left arm next to the patient&#39;s left side and the second position is configured to position the patient&#39;s left forearm in a trans access position. 
     The apparatus for positioning a patient&#39;s forearm during a medical procedure may further comprise a fourth panel, wherein said fourth panel is adjacent to said first latitudinal side edge of the main panel portion and receives the patient&#39;s left shoulder for limiting longitudinal motion of the apparatus. 
     The disclosure may also relate to a method for positioning a patient&#39;s forearm during a medical procedure comprising providing a main panel portion having an inner surface and an outer surface, a first longitudinal side edge, a second longitudinal side edge, a first latitudinal side edge and a second latitudinal side edge. The method may further comprise providing an extended panel portion having a proximal end edge and a distal end edge, and an inner surface, wherein said distal end edge forms an angled configuration with said main panel portion, and positioning the patient&#39;s forearm on said extended panel portion to position the patient&#39;s left forearm and wrist suitable for receiving an arterial catheter. 
     The extended panel portion further has a top edge and a bottom edge, said bottom edge of said extended panel portion has an at least partially curved shape extending between said distal end edge and said proximal end edge, wherein the method further comprises positioning the abdomen of the patient at least partially in said at least partially curved shape of said bottom edge. The extended panel portion has an inner surface, further comprising providing cushioning at the inner surface of the extended panel portion to comfortably support the patient&#39;s forearm. The inner surface may be next to an elongated core member made of malleable material for support, further comprising positioning the patient&#39;s forearm material at least partially in a trough portion along a top surface of the elongated core member. 
     The invention has been described by reference to detailed examples and methodologies. These examples are not meant to limit the scope of the invention. Variations within the concepts of the invention are apparent to those skilled in the art. The disclosures of the cited references throughout the application are incorporated by reference herein. Various examples have been described. These and other examples are within the scope of the following claims.