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Essential Patient Positioning Techniques

Apr 13, 2025

Patient Positioning Lecture Notes

Supine Position

  • Description: Patient lies on their back, head resting flat, legs extended.
  • Mnemonic: "Put the patient on their spine to be supined."
  • Uses:
    • Sleeping
    • Post-procedures (e.g., lumbar puncture, heart catheterization, C-section)
    • Head-to-toe assessments, especially anterior body.
  • Risks:
    • Pressure injuries at bony prominences (heels, ankles, sacral/coccyx, elbows, scapula, back of head).
    • Foot drop in immobile patients.

Prone Position

  • Description: Patient lies flat on the abdomen, head turned to either side.
  • Mnemonic: "Lying on their esophagus and entrails."
  • Uses:
    • Spinal surgery
    • Respiratory problems (e.g., ARDS, COVID-19)
  • Benefits: Improves lung function, gas exchange, reduces heart workload.
  • Risks:
    • Airway complications with mechanical ventilation
    • Pressure injuries on ears, eyes
    • Brachial plexus injury

Dorsal Recumbent Position

  • Description: Similar to Supine but with knees flexed.
  • Mnemonic: "Dorsal = Back, Recumbent = Bent (like dolphins)."
  • Uses:
    • Foley catheter insertion (female)
    • Peri-care
  • Risks: Pressure injuries similar to Supine.

Lithotomy Position

  • Description: Legs flexed at 90°, calves in stirrups.
  • Uses:
    • Stone removal surgery
    • Vaginal procedures (childbirth, exams)
  • Risks:
    • Pressure injuries
    • Nerve pressure in legs

Sims Position

  • Description: Patient lies on the left side, right knee and hip flexed, left leg extended.
  • Also Known As: Semi-prone.
  • Uses:
    • Alternative for Foley catheter insertion
    • Enemas
    • Sleeping
  • Risks: Pressure injuries to ear, greater trochanter, heel/ankle.

Lateral Position

  • Description: Patient lies on the left or right side.
  • Uses:
    • Seizures, unconscious patients
    • Surgery with drainage
  • Risks: Pressure injuries to the side of the body.

Fowler’s Positions

  • General: Based on bed angle; for all positions, knees can be flexed or extended.
    • Low Fowler’s: 15-30°
    • Semi-Fowler’s: 30-45°
    • Fowler’s: 45-60°
    • High Fowler’s: 60-90°
  • Uses:
    • Sleeping, respiratory ease
    • Post-op care
    • Intracranial pressure management
    • Prevent aspiration during GI feedings
  • Risks: Pressure injuries (sacral, coccyx, shoulders, heels).

Trendelenburg Positions

  • Trendelenburg: Supine, head lowered, feet elevated.

    • Uses: Central venous catheter line placement, pelvic surgeries.
    • Controversial: More evidence needed for hypotension use.
  • Reverse Trendelenburg: Supine, head elevated, feet lowered.

    • Uses: Head/neck surgeries, decreases blood flow/blood loss.
  • Modified Trendelenburg: Supine, head level, feet elevated.

    • Uses: Hemodynamic improvements.

Conclusion

  • Positioning is critical for patient care, understanding risks and benefits of each position is vital.
  • Always check hospital protocols and guidelines for specific situations.