POSITION USED IN HOSPITAL

1. DR.ANJALATCHI M.SC(N)MD(AM)MBA(HA)

2. LEVEL

3. Patient Positioning?
 Patient positioning involves properly maintaining a
patient’s neutral body alignment by preventing
hyperextension and extreme lateral rotation to prevent
complications of immobility and injury. Positioning
patients is an essential aspect of nursing practice and a
responsibility of the registered nurse

4. Purpose of position
 In surgery, specimen collection, or other treatments,
proper patient positioning provides optimal exposure
of the surgical/treatment site and maintenance of the
patient’s dignity by controlling unnecessary exposure.
In most settings, positioning patients provide airway
management and ventilation, maintaining body
alignment, and provide physiologic safety.

5. Goals of Patient Positioning
 The ultimate goal of proper patient positioning is to safeguard the
patient from injury and physiological complications of immobility.
Specifically, patient positioning goals include:
 Provide patient comfort and safety. Support the patient’s airway and
maintain the circulation throughout the procedure (e.g., in surgery, in
examination, specimen collection, and treatment). Impaired venous
return to the heart, and ventilation-to-perfusion mismatching are
common complications. Proper positioning promotes comfort by
preventing nerve damage and by preventing unnecessary extension or
rotation of the body.
 Maintaining patient dignity and privacy. In surgery, proper
positioning is a way to respect the patient’s dignity by minimizing
exposure of the patient who often feels vulnerable perioperatively.
 Allows maximum visibility and access. Proper positioning allows
ease of surgical access as well as for anesthetic administration during
perioperative phase.

6. Guidelines for Patient Positioning
 Proper execution is needed during patient positioning to prevent injury for
both the patient and the nurse. Remember these principles and guidelines
when positioning clients:
 Explain the procedure. Provide explanation to the client on why his or her
position is being changed and how it will be done. Rapport with the patient
will make them more likely to maintain the new position.
 Encourage client to assist as much as possible. Determine if the client can
fully or partially assist. Clients that can assist will save strain on the nurse. It
will also be a form exercise, increase independence, and self-esteem for the
client.
 Get adequate help. When planning to move or reposition the client, ask help
from other caregivers. Positioning may not be a one-person task.
 Use mechanical aids. Bed boards, slide boards, pillows, patient lifts and slings
can facilitate ease of changing positions.
 Raise client’s bed. Adjust or reposition the client’s bed so that the weight is at
the level of the nurse’s center of gravity.

7. Continued
 Frequent position changes. Note that any position, correct or
incorrect, can be detrimental to the patient if maintained for a
long period. Repositioning the patient every 2 hours helps
prevent complications like pressure ulcers and skin breakdown.
 Avoid friction and shearing. When moving patients, lift rather
than slide to prevent friction that can abrade the skin making it
more prone to skin breakdown.
 Proper body mechanics. Observe good body mechanics for
you and your patient’s safety.
 Position self close to the client.
 Avoid twisting your back, neck, and pelvis by keeping them aligned.
 Flex your knees and keep feet wide apart.
 Use your arms and legs and not your back.
 Tighten abdominal muscles and gluteal muscles in preparation for
the move.
 Person with the heaviest load coordinates efforts of the nurse and
initiates the count to 3.

8. Common Patient Positions
 The following are the commonly used patient
positions including a description on how they are
performed and the rationale:

9. List of position
 Supine or Dorsal Recumbent Position

10. Supine or Dorsal Recumbent
Position
 Supine position, or dorsal recumbent, is wherein the
patient lies flat on the back with head and shoulders
slightly elevated using a pillow unless contraindicated (e.g.,
spinal anesthesia, spinal surgery).

11. Supine position uses
 Variation in position. In supine position, legs may be extended or slightly
bent with arms up or down. It provides comfort in general for patients under
recovery after some types of surgery.
 Most commonly used position. Supine position is used for general
examination or physical assessment.
 Watch out for skin breakdown. Supine position may put patients at risk for
pressure ulcers and nerve damage. Assess for skin breakdown and pad bony
prominences.
 Support for supine position. Small pillows may be placed under the head to
and lumbar curvature. Heels must be protected from pressure by using a pillow
or ankle roll. Prevent prolonged plantar flexion and stretch injury of the feet by
placing a padded footboard.
 Supine position in surgery. Supine is frequently used on procedures
involving the anterior surface of the body (e.g., abdominal area, cardiac,
thoracic area). A small pillow or donut should be used to stabilize the head, as
extreme rotation of the head during surgery can lead to occlusion of the
vertebral artery.

12. Fowler’s Position
 Fowler’s position, also known as semi-sitting position,
is a bed position wherein the head of the bed is elevated 45
to 60 degrees. Variations of Fowler’s position include: low
Fowler’s (15 to 30 degrees), semi-Fowler’s (30 to 45
degrees), and high Fowler’s (nearly vertical).

13. Fowler’s position has different
variations and used
 .
 Promotes lung expansion. Fowler’s position is used for patients who have
difficulty breathing because in this position, gravity pulls the diaphragm
downward allowing greater chest and lung expansion.
 Useful for NGT. Fowler’s position is useful for patients who have cardiac,
respiratory, or neurological problems and is often optimal for patients who
have nasogastric tube in place.
 Prepare for walking. Fowler’s is also used to prepare the patient for dangling
or walking. Nurses should watch out for dizziness or faintness during change of
position.
 Poor neck alignment. Placing an overly large pillow behind the patient’s head
may promote the development of neck flexion contractures. Encourage patient
to rest without pillows for a few hours each day to extend the neck fully.
 Used in some surgeries. Fowler’s position is usually used in surgeries that
involve neurosurgery or the shoulders
 Use a footboard. Using a footboard is recommended to keep the patient’s feet
in proper alignment and to help prevent foot drop.
 Etymology. Fowler’s position is named after George Ryerson Fowler who saw it
as a way to decrease mortality of peritonitis.

14. Orthopneic or Tripod Position
 Orthopneic or tripod position places the patient in a sitting
position or on the side of the bed with an over bed table in front
to lean on and several pillows on the table to rest on.

15. Orthopneic or tripod position is
uses
 Orthopneic or tripod position is useful for maximum
lung expansion.
 Maximum lung expansion. Patients who are having
difficulty breathing are often placed in this position
because it allows maximum expansion of the chest.
 Helps in exhaling. Orthopneic position is
particularly helpful to patients who have problems
exhaling because they can press the lower part of the
chest against the edge of the overbed table.

16. Prone Position
 In prone position, the patient lies on the abdomen
with head turned to one side and the hips are not
flexed.

17. Prone position uses
 Prone position is comfortable for some patients.
 Extension of hips and knee joints. Prone position is the only bed position
that allows full extension of the hip and knee joints. It also helps to prevent
flexion contractures of the hips and knees.
 Contraindicated for spine problems. The pull of gravity on the trunk when
the patient lies prone produces marked lordosis or forward curvature of the
spine thus contraindicated for patients with spinal problems. Prone position
should only be used when the client’s back is correctly aligned.
 Drainage of secretions. Prone position also promotes drainage from
the mouth and useful for clients who are unconscious or those recover from
surgery of the mouth or throat.
 Placing support in prone. To support a patient lying in prone, place a pillow
under the head and a small pillow or a towel roll under the abdomen.
 In surgery. Prone position is often used for neurosurgery, in most neck and
spine surgeries.

18. Lateral Position
 In lateral or side-lying position, the patient lies on one side of
the body with the top leg in front of the bottom leg and the hip
and knee flexed. Flexing the top hip and knee and placing this
leg in front of the body creates a wider, triangular base of
support and achieves greater stability. Increase in flexion of the
top hip and knee provides greater stability and balance. This
flexion reduces lordosis and promotes good back alignment.

19. Lateral position uses
 Relieves pressure on the sacrum and heels. Lateral
position helps relieve pressure on the sacrum and
heels especially for people who sit or are confined to
bed rest in supine or Fowler’s position.
 Body weight distribution. In this position, most of
the body weight is distributed to the lateral aspect of
the lower scapula, the lateral aspect of the ilium, and
the greater trochanter of the femur.
 Support pillows needed. To correctly position the
patient in lateral position, use of support pillows are
needed.

20. Sims’ Position
 Sims’ position or semiprone position is when the patient
assumes a posture halfway between the lateral and the
prone positions. The lower arm is positioned behind the
client, and the upper arm is flexed at the shoulder and the
elbow. The upper leg is more acutely flexed at both the hip
and the knee, than is the lower one.

21. Sims’ position uses
 Prevents aspiration of fluids. Sims’ may be used for
unconscious clients because it facilitates drainage from the
mouth and prevents aspiration of fluids.
 Reduces lower body pressure. It is also used for paralyzed
clients because it reduces pressure over the sacrum and greater
trochanter of the hip.
 Perineal area visualization and treatment. It is often used for
clients receiving enemas and occasionally for clients undergoing
examinations or treatments of the perineal area.
 Pregnant women comfort. Pregnant women may find the Sims
position comfortable for sleeping.
 Promote body alignment with pillows. Support proper body
alignment in Sims’ position by placing a pillow underneath the
patient’s head and under the upper arm to prevent internal
rotation. Place another pillow between legs.

22. Lithotomy Position
 Lithotomy is a patient position in which the patient is
on their back with hips and knees flexed and thighs
apart.

23. Lithotomy position uses
 Lithotomy position is commonly used for vaginal examinations and childbirth.
 Modifications of the lithotomy position include low, standard, high, hemi, and
exaggerated based on how high the lower body is raised or elevated for the
procedure. Please check with your facility’s guidelines but typically:
 Low Lithotomy Position: The patient’s hips are flexed until the angle between
the posterior surface of the patient’s thighs and the O.R. bed surface is 40
degrees to 60 degrees. The patient’s lower legs are parallel with the O.R. bed.2
 Standard Lithotomy Position: The patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed surface is
80 degrees to 100 degrees. The patient’s lower legs are parallel with the O.R. bed.
 Hemilithotomy Position: The patient’s non-operative leg is positioned in
standard lithotomy. The patient’s operative leg may be placed in traction.
 High Lithotomy Position: The patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed surface is
110 degrees to 120 degrees. The patient’s lower legs are flexed.
 Exaggerated Lithotomy Position: The patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed surface is
130 degrees to 150 degrees. The patient’s lower legs are almost vertical.

24. Trendelenburg’s Position
 Trendelenburg’s position involves lowering the head
of the bed and raising the foot of the bed of the
patient. The patient’s arms should be tucked at their
sides

25. Trendelenburg position use
 Promotes venous return. Hypotensive patients can
benefit from this position because it promotes venous
return.
 Postural drainage. Trendelenburg’s position is used
to provide postural drainage of the basal lung lobes.
Watch out for dyspnea, some patients may require only
a moderate tilt or a shorter time in this position during
postural drainage. Adjust as tolerated.

26. Reverse Trendelenburg’s Position
 Reverse Trendelenburg’s is a patient position
wherein the the head of the bed is elevated with the
foot of the bed down. It is the opposite of
Trendelenburg’s position.

27. Reverse trendelenburg’s position
uses
 Gastrointestinal problems. Reverse trendelenburg is
often used for patients with gastrointestinal problems as it
helps minimize esophageal reflux.
 Prevent rapid change of position. Patients
with decreased cardiac output may not tolerate rapid
movement or change from a supine to a more erect
position. Watch out for rapid hypotension. It can be
minimized by gradually changing the patient’s position.
 Prevent esophageal reflux. Promotes stomach emptying
and prevents reflux for clients with hiatal hernia.

28. Knee-Chest Position
 Knee-chest position, can be in lateral or prone position.
In lateral knee-chest position, the patient lies on their side,
torso lies diagonally across the table, hips and knees are flexed.
In prone knee-chest position, the patient kneels on the table
and lower shoulders on to the table so chest and face rests on the
table.

29. Uses of knee chest position
 Two ways. Knee-chest position can be lateral or prone.
 Sigmoidoscopy. Usual position adopted for
sigmoidoscopy without anesthesia.
 Patient dignity. Prone knee-chest position can be
embarrassing for some patients.
 Gynecologic and rectal examinations. Knee-chest
position is assumed for a gynecologic or rectal
examination.

30. Jackknife Position
 Jackknife position, also known as Kraske, is wherein the
patient’s abdomen lies flat on the bed. The bed is scissored
so the hip is lifted and the legs and head are low.

31. Uses
 In surgery. Jackknife position is frequently used for surgeries
involving the anus, rectum, coccyx, certain back surgeries, and
adrenal surgery.
 Requires team effort. At least four people are required to
perform the transfer and position the patient in the operating
table.
 Cardiovascular effects. In jackknife position, compression of
the inferior vena cava from abdominal compression also occurs,
which decreases venous return to the heart. This could increase
the risk for deep vein thrombosis.
 Support paddings. Many pillow sare required on the operating
table to support the body and reduce pressure on the pelvis,
back, and the abdomen. Jackknife position also puts excessive
pressure on the knees. While positioning, surgical staff should
put extra padding for the knee area.

32. Kidney Position
 In kidney position, the patient assumes a modified lateral position
wherein the abdomen is placed over a lift in the operating table that
bends the body. Patient is turned on their contralateral side with their
back placed on the edge of the table. Contralateral kidney is placed
over the break in the table or over the kidney body elevator (if
attachment is available). The uppermost arm is placed in a gutter rest
at no more than 90º abduction or flexion.

33. Uses
 Access to retroperitoneal area. Kidney positions allows
access and visualization of the retroperitoneal area. A
kidney rest is placed under the patient at the location of
the lift.
 Risk for falls. Patient may fall off the table at anytime
until the position is secured.
 Padding and stabilization support. Contralateral arm
underneath the body is protected with padding.
Contralateral knee is flexed and the uppermost leg is left
straight to improve stability. A large soft pillow is placed in
between the legs. Kidney strap and tape are placed over the
hip to stabilize the patient.

34. Common breast feed positions

35. References and Sources
 The following are the references and sources for this patient positioning study guide:
 Ritchie, I. K. (2003). Positioning Patients for SurgeryBy Chris Servant & Shaun Purkiss
Greenwich Medical Media ISBN 1841100528£ 22.50.
 Miranda, A. B., Fogaça, A. R., Rizzetto, M., & Lopes, L. C. C. (2016). Surgical positioning:
nursing care in the transoperative period. Rev SOBECC, 21(1), 52-8. [Link]
 Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., … & Stanley,
D. (2018). Kozier and Erb’s Fundamentals of Nursing [4th Australian edition].
 Rosdahl, C. B., & Kowalski, M. T. (Eds.). (2008). Textbook of basic nursing. Lippincott
Williams & Wilkins.
 Park, C. K. (2000). The effect of patient positioning on intraabdominal pressure and
blood loss in spinal surgery. Anesthesia & Analgesia, 91(3), 552-557.
 Beckett, A. E. (2010). Are we doing enough to prevent patient injury caused by
positioning for surgery?. Journal of perioperative practice, 20(1), 26-29.
 Price, P., Frey, K. B., & Junge, T. L. (2004). Surgical technology for the surgical
technologist: A positive care approach. Taylor & Francis.