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.