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Patient POSITIONING
Positions• Four basic
positions include:–Supine–Prone–Lateral–Lithotomy
• Variations include:–Trendelenburg–Reverse
trendelenburg–Fowler’s– Jackknife–High lithotomy–Low lithotomy
Supine• Most common with the least amount of harm• Placed on back with legs extended and uncrossed at the
ankles• Arms either on arm boards abducted <90* with palms up or
tucked (not touching metal or constricted)• Spinal column should be in alignment with legs parallel to
the bed• Padding is placed under the head, arms, and heels with a
pillow placed under the knees• Safety belt placed 2” above the knees while not impeding
circulation
Prone • Face down, resting on the abdomen and chest• Chest rolls x2 placed lengthwise under the axilla and along
the sides of the chest from the clavicle to iliac crests• One roll is placed at the iliac or pelvic level• Arms lie at the sides or over head on arm boards• Head is face down and turned to one side with accessible
airway• Padding to bilateral feet, arms and knees• Safety strap placed 2” above knees
Lateral • Shoulder & hips turned simultaneously to prevent torsion of
the spine & great vessels• Lower leg is flexed at the hip; upper leg is straight• Head must be in cervical alignment with the spine• Axillary roll placed to the axillary area of the downside arm• Padding placed under lower leg, to ankle and foot of upper
leg, and to lower arm (palm up) and upper arm• Pillow placed lengthwise between
legs and between arms • Stabilize patient with safety
strap and silk tape, if needed
Trendelenburg • The patient is placed in the supine position while
the bed is modified to a head-down tilt of 35 to 45 degrees, the head being lower than the pelvis
• In addition to a safety strap, strips of 3” tape may be used to assist with holding the patient in the position
• Used for procedures in the lower abdomen or pelvis
Reverse Trendelenburg • The 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
Fowler’s Position (Sitting/Lawnchair/Beachchair)
• Foot of the bed is lowered, flexing the knees, while the body section is raised to 35 – 45 degree
• Feet rest against a padded footboard• Arms are crossed loosely over
the abdomen and placed on a pillow on the patient’s lap
• A pillow is placed under the knees.• For cranial procedures, the head is
supported in a head rest and/or with sterile tongs
• This position can be used for shoulder or breast reconstruction procedures
Jackknife • Modification of the prone position• The patient is placed in the prone position on the bed and
then inverted in a V position• Chest rolls are placed to raise the chest• Arms are extended on angled arm boards with the elbows
flexed and the palms down• A pillow is placed under the ankles to free the feet and toes
of pressure
• The bed leg section is lowered, and the bed is flexed at a 90 degree angle
• Used in gluteal and anorectal procedures
Lithotomy • With the patient in the supine position, the legs are raised
and abducted to expose the perineal region• The legs and feet are placed in stirrups that support the
lower extremities• Stirrups should be placed at an even height• Adequate padding and support for the legs/feet should
eliminate pressure on joints and nervus plexus• The position must be symmetrical
High Lithotomy • Frequently used for procedures that requires a vaginal or
perineal approach• The patient is in the supine position with legs raised and
abducted by stirrups• Once the feet are positioned in stirrups, the footboard is
removed and the bottom section of the bed is lowered• It may be necessary to bring the
patient’s buttocks further down to the edge of the bed break
Low Lithotomy • All of the positioning techniques used to high
lithotomy apply• Placed in supine position with the legs raised and
abducted in crutch-like or full lower leg support stirrups
• The angle between the patient’s thighs and trunk is not as acute as for the high lithotomy position
• Used in vaginal procedures
Safety Considerations
Key Points• Use safe body mechanics during transfers
and positioning – ensure adequate assistance is used
• Maintain stretcher/bed in a locked position prior to patient transfers and positioning
• Verify weight limit on OR table or bed to be used
• Ensure that the patient is adequately secured to the OR table or bed to be used
• One strap placed across the patient’s thighs and the second across the lower legs
• Extra care must be taken to ensure that loose skin is protected (ie lithotomy position)
SupineRisk #1:• Pressure points:
– occiput;scapulae;thoracic vertebrae;olecranon process;sacrum/coccyx;calcaneaus;knees
Risk #2:• Neural injuries of
extremities, brachial plexus, ulna, radial nerves
Safety Considerations:
• Padding to heels, elbows, knees
• Spine, head alignment with hips
• Legs parallel, uncrossed at ankles
Safety Consideration:
• Arm board at less than 90 degrees
• Head in neutral position• Arm board pads level
with OR bed
ProneRisk #1:
– Head, eyes, nose
Risk #2:– Chest compression,
iliac crest, breast, male genitalia
Risk #3:– Knees
Risk #4:– Feet
Safety Consideration:– Maintain cervical neck
alignment– Protection of forehead,
eyes, chin– Padded headrest to
provide airwaySafety Consideration:
– Chest rolls to allow chest movement and decrease abdominal pressure
– Breasts and genitalia free from torsion
Safety Consideration:– Padded with pillows
Safety Consideration:– Padded footboard
LateralRisk #1:
– Bony prominences and pressure points on dependent side
Risk #2:– Spinal alignment
Safety Consideration:– Axillary roll for
dependent axilla– Lower leg flexed at hip– Upper leg straight with
pillow between legs– Padding between
knees, ankles and feetSafety Consideration:
– Maintain spinal alignment during turning
– Padded support to prevent lateral neck flexion
LithotomyRisk #1:
– Hip/knee joint injury– Lumbar/sacral pressure– Vascular congestion
Risk #2:– Neuropathy of obturator
nerves, femoral nerves, common peroneal nerves/ulnar nerves
Risk #3:– Restricted
diaphragmatic movement
– Pulmonary region
Safety Consideration:– Place stirrups at even
height– Elevate lower legs slowly
and simultaneously from stirrups
Safety Consideration:– Maintain minimal external
hip rotation– Pad lateral or posterior
knees/ankles to prevent pressure and contact with metal surface
Safety Consideration:– Keep arms away from
chest to facilitate respiration
– Arms on arm boards at less than 90 degree angle or over abdomen
Documentation
• Documentation should include:– Preoperative assessments– Type and location of positioning and/or
padding devices– Names and titles of persons positioning
the patient– Intra-operative positioning changes– Postoperative outcome evaluation
• 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
Don’t Forget:• Good positioning starts with an assessment• Prevent team members from leaning against patients• 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
One last note…Positioning problems can result
in significant injuries and successful lawsuits.