1. Positioning patients properly is important for comfort, medical procedures, and preventing complications. It involves assessing the patient's needs and positioning them in alignments that promote circulation, relieve pressure, and allow for interventions.
2. Common positions discussed include supine, prone, lateral, lithotomy, Fowler's position, and Trendelenburg. Each position has specific indications and procedures to ensure patient safety and access for medical needs.
3. Special considerations are needed for obese patients to support their weight and prevent impaired circulation or breathing from positioning. Thorough documentation of assessments and interventions is also important.
3. DEFINITION
Positioning is defined as planning the person in a
proper body alignment for the purpose of
preventive, promotive, curative and rehabilitative
aspects of health or placing the patient in good body
alignment as needed therapeutically.
4. PURPOSES
To promote comfort to the patient
To relieve pressure on various parts
To stimulate circulation
To provide proper body alignment
To carry out nursing intervention
To perform surgical and medical interventions
To prevent complications caused by immobility
To promote normal physiological functions
5. PRINCIPLES
Maintain good body mechanics
Wash hands before and after procedure
Ensure patient’s comfort
Obtain assistance as required
Ensure that mattress is firm and level of bed is at
working hide
Follow safety measures to prevent accidents
Follow the systematic and orderly way of doing
Use right technique at right time
6. ASSESSMENT
The team should assess the following prior to
positioning of the patient:
Procedure length
Surgeon’s/Doctor’s preference of position
Required position for procedure
Anesthesia to be administered
Patient’s risk factors
age, weight, skin condition, mobility/limitations,
pre-existing conditions, etc.
Patient’s privacy and medical needs
Basics of anatomy & physiology
7. OVERVIEW
RN must be aware of the anatomic and physiologic changes
associated with anesthesia, patient positioning, and the
procedure.
The following criteria should be met to prevent injury from
pressure, obstruction, or stretching:
No interference with respiration
No interference with circulation
No pressure on peripheral nerves
Minimal skin pressure
Accessibility to operative site
Accessibility for anesthetic administration
No undue musculoskeletal discomfort
Maintenance of individual requirements
8. TEAM RESPONSIBILITIES
Physician:
-Optimal procedural exposure
Anesthesia:
-Physiologic requirements (A-B-C’s)
-Position timing
Nursing:
-Safe transfer using adequate personnel
-Use of adequate padding and
positioning aids
-Provide an ongoing assessment
11. 1. SUPINE POSITION
The patient lies on his back with his head and
shoulders are slightly elevated
Indication
Usual position
Examination of the chest and abdomen
PURPOSE
To provide comfort to the patient.
To perform physical examination.
To check vitals.
During surgical procedures and post operatively.
12. PROCEDURE
Place the patient on back with one pillow under
the head, arms and hands at the sides, knees
flexed and separated.
Place the air ring under the hips and cotton or
foam pads under the heels to reduce the pressure.
Place footboard under bottom of feet.
If the patient is a paralyzed, place hand role in
hand.
Align the patient’s body in good position.
14. SUPINE CONCERNS
Greatest concerns are circulation and pressure points
Most Common Nerve Damage:
o Brachial Plexus: positioning the arm >90*
o Radial and Ulnar: compression against the OR bed,
metal attachments, or when team members lean
against the arms during the procedure
o Peroneal and Tibial: Crossing of feet and plantar
flexion of ankles and feet
Vulnerable Bony Prominences:
(due to rubbing and sustained pressure)
Occiput, spine, scapula, Olecranon, Sacrum,
Calcaneous
16. 2. PRONE POSITION
Position in which the patient lies on the abdomen
with the head turned to one side with one small
pillow under the ankle.
Indications
Post operatively.
Patient with pressure sores, burns, injuries and
operations on the back.
To relieve abdominal distension.
17. CONTD..
Indications..
Renal biopsy.
Examine the back and spine.
Assess posterior thorax.
For patients after 24 hours of amputation of lower
limbs
Contraindications:
An unconscious patient or one with an abdominal
incision or breathing difficulty.
18. PROCEDURE
Explain the procedure
Provide privacy
Place the patient flat on abdomen with one pillow
under the head
Turn patients head to one side and align the patient
in good position
Place both arms at the side of the head and support
arm in flexed position at level of shoulder.
Support lower legs with pillows to elevate toes.
If needed place a pillow under the abdomen.
19. PRONE CONCERNS
Greatest concerns are to the respiratory and circulatory
systems and pressure points
Most Common Nerve Damage:
o Brachial, radial, median, ulnar
Vulnerable Bony Prominences:
o Temporal, acromion, clavicle, iliac
Vulnerable Vessels:
o Carotid, aorta, vena cava, saphenous
Susceptible to hyperextension of
the joints
21. 3. DORSAL RECUMBENT POSITION
Patient lies on back, knees fully flexed, thighs
flexed and externally rotated, feet flat on the bed.
In this position clients with painful disorders are
more comfortable with knees flexed.
This position should not be used for abdominal
assessment because it promotes contraction of
abdomen muscles.
22. INDICATIONS
It is used for catheterization, vaginal douche,
vulval, vaginal and rectal examination
It is also used for vaginal operations and insertion
of tampons
For rectal temperature
For perineal care
23. PROCEDURE
Place the patient on back in bed with two or more
pillows under the head for patient’s comfort.
Place the air ring under the hips and cotton rings or
foam pads under the heels to reduce pressure.
25. 4. LATERAL POSITION
The client lies on the side with weight on hip and
shoulder or the patient lies on his side with both arms
forward and his knees and hips flexed.
Here the head, neck and back is in straight line.
The upper leg is flexed more than the lower leg.
The upper knee and hip should be at the same level.
A pillow is given under the head, back and front to
support the arms and abdomen.
A small pillow is given in between the knees.
26. INDICATIONS
Patients who requires periodic position changes
In immediate post-operative patients
Used for examination of perineum and rectum.
Inserting rectal suppositories and flatus tube.
For taking rectal temperature.
Giving back care
For giving enema and colonic irrigation.
27. PROCEDURE
Explain the procedure
Provide privacy
Lower the head of bed as low as patient can tolerate.
Position the patient to side of bed
Turn the patient to one side
28. CONTD..
Place the air ring under the hips to reduce pressure in
trochanters and at the hip joints.
Position both arms in flexed position. Upper most arms
are supported by pillow on level with shoulder.
Place pillow under back
Place pillow under semi flexed upper leg at hip, from
groin to foot.
Place sand bag parallel to plantar surface of
dependent foot.
29. LATERAL CONCERNS
Greatest concerns are respiratory, circulatory, and
pressure points
Most Common Nerve Damage:
o Brachial, radial, median, ulnar, peroneal
Vulnerable Bony Prominences:
o Temporal, acromion, olecranon, iliac, greater
trochanter
Vulnerable Vessels:
o Carotid, axillary, brachial, aorta, vena cava, saphenous
31. 5. SIMS POSITION
In this position the client lies on either the right or
left side.
The lower arm behind the body and upper arm is
bent at the shoulder and elbow.
The knees are both bent, with the upper most leg
more acutely bent.
These positions similar to the lateral position except
that the patient’s weight is on the anterior aspect of
the patient’s shoulder girdle and hip.
32. INDICATIONS
Vaginal and rectal examination
Administration of enema and suppository
Used for relaxation in antenatal exercises
Position for sigmoidoscopy and protoscopy
Contraindication:
Patient with leg injuries or arthritis usually cannot
assume this position.
34. PROCEDURE
Explain the procedure to the patient
Provide privacy
Place the patient on the side
Place small pillow under head and neck
Place pillow under flexed upper arm, supporting arm
level with shoulder.
Place pillow under flexed upper leg, supporting leg level
with hip.
Place sand bags parallel to plantar surface of dependent
foot.
36. 6. LITHOTOMY POSITION
The client lies supine with hips flexed. The legs are
separated and thighs are flexed.
The patient’s buttocks are kept at the edge of the
table and legs are supported by stirrups.
38. PROCEDURE
Explain the procedure to the patient
Provide privacy
Position the patient to lie on his back with one pillow
under the head
Keep the legs well separated and the thighs well
flexed on the abdomen and the legs on the thighs
Buttocks are kept on the edge of the table and the
legs are supported on stirrups
42. 7. FOWLER’S POSITION
It is a sitting position in which the head is elevated
at 45˚ to 60˚, and the client knees are slightly
elevated, avoiding pressure on the popliteal
vessels.
Backrest and two pillows are used for the back and
head. Pillows can be used to maintain natural
alignment of the hands wrist and forearms.
45. INDICATIONS
To relieve dyspnea
To improve circulation
To relax the muscles of the abdomen, back and
thighs.
To relieve tension on abdominal stature.
46. PROCEDURE
Explain the procedure
Elevate the head of the bed
Rest the head against mattress or small pillow.
Use pillow to support arm.
Place a small pillow at lower back.
Place foot board at bottom of patient’s feet.
Place the patient in sitting position with arms at sides
and knees raised with pillow.
48. 8. TREDLENBERG POSITION
The patient is placed in the supine position while
the OR bed is modified to a head-down tilt of 35 to
45 degrees resulting in the head being lower than
the pelvis
Arms are in a comfortable position – either at the
side or on bilateral arm boards
49. INDICATION
Used in emergency situations like shock,
hemorrhage and hypotension
Postural drainage
Patients with deep vein thrombosis
50. PROCEDURE
Explain the procedure to patient
Place the patient in supine position
Lower the head end of the bed or if it is not
adjustable type, use bed block at foot end and tilt
entire frame of bed down. OR elevate the foot
end at 45˚angle.
The patient is carefully supported to prevent
from slipping.
52. REVERSE
TRENDELENBURG
The entire bed is tilted so the head is higher than the feet
Used for head and neck procedures
Facilitates exposure, aids in breathing and decreases blood
supply to the area
A padded footboard is used to prevent the patient from
sliding toward the foot
54. 9. KNEE CHEST POSITION
The patient rests on the knees and the chest.
The body is at 90˚ angle to the hips with back
straight, the arm above the head or kept at both
sides, and the head turned to one side.
The abdomen remains unsupported.
55. INDICATIONS
Used for vaginal and rectal examination
Used in first aid treatment in cord prolapse or
retroverted uterus
As exercise for postpartum and gynecology
patients.
56. PROCEDURE
Explain the procedure to the patient
Make the patient rest on the knees and chest
The head is turned to one side with the cheek on
a pillow.
The arm should be extended on the bed and
flexed at the elbows to support the patient
partially.
58. 10. ORTHOPNEIC POSITION
High fowler’s position with over bed table to be
placed across the front of the patient.
Patient to rest both hands on over bed table/on
pillow placed in it and leans forward.
Leaning forward facilitates respiration by
allowing maximum chest expansion by reducing
pressure of abdominal organs on diaphragm.
61. 11. JACKKNIFE POSITION
PROCEDURE:
Modification of the prone position
The patient is placed in the prone position on the OR
bed and then inverted in a V position
The hips are over the center break of the OR bed
between the body and leg sections
Hips are supported on a pillow and the table are flexed
at 90 degree, raising the hips and lowering head and
body
A strap is used over the thigh to prevent shearing and
sliding
62. CONTIN..
Chest rolls are placed to raise the chest
Arms are extended on angled arm boards with the elbows
flexed and the palms down
The head, face and shoulders are supported by soft
pads/pillows
A pillow is placed under the ankles to free the feet and toes of
pressure
Indications:
Used in gluteal and anorectal procedures and examination.
Common position for hemorrhoidectomy and pilonidal sinus
procedures
63. EFFECTS OF POSITIONING - OBESE
PATIENTS
Supine:
Normal blood flow may be impeded due to compression
of vena cava and aorta by abdominal contents
Impairs diaphragmatic movement and reduces lung
capacity
Trendelenburg:
Tolerated less well than supine
Added weight of abdominal contents on the diaphragm
may lead to atelectasis and hypoxemia
Prone:
Problematic
Requires additional support and monitoring of the
patient and pressure on the abdomen
Ventilation may be markedly more difficult
64. EFFECTS OF POSITIONING - OBESE
PATIENTS
Lateral:
Well tolerated
Correct sizing and placement of axillary roll is important
Ensure that pendulous abdomen does not hang over side of
OR bed
Head-Up: (Reverse Trendelenburg/Semi-recumbent)
Most safe
Weight of abdominal contents unloaded from diaphragm
Use of well-padded footboard to prevent sliding
66. Documentation should include:
Documentation includes nursing
assessments and interventions
Documenting nursing activities provides
an accurate picture of the nursing care
provided as well as the outcomes of the
care delivered
Document all of your findings
67. DON’T FORGET:
Good positioning starts with an assessment
Prevent health team members from leaning against patients
Arm board pads should be level with table pads
Cushioning of all pressure points is a priority - the correct use of
padding can protect the patient
Procedures longer than 2 ½ to 3 hours significantly increase the
risk of pressure ulcer formation
During a longer procedure, you should assist with shifting the
patient, adjusting the table, or adding/removing a positioning
device
The nurse must assess extremities at regular intervals for signs of
circulatory compromise
Documentation of the positioning process should be performed
accurately and completely