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2023 Positioning patients correctly is important for a variety of reasons. In surgery, proper positioning provides optimal exposure of the surgical site and maintenance of the patient's dignity by controlling unnecessary exposure. Additionally, positioning patients provides airway management and ventilation, maintaining body alignment, and provide physiologic safety. Here’s a list of the common conditions, procedures, and diseases with their recommended position and rationale for each. Cond Bronchoscopy Posi After: SemisFowler's To reduce aspiration risk from difficulty of swallowing Cerebral angiography During: Flat on bed with arms at sides* kept still After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used Apply firm pressure on site for 15 minutes after the procedure Myelogram (air contrast) Pre9op: surgical table will be moved to various To disperse dye. positions during test. Post9op: HOB is lower than trunk Myelogram (oilAbased dye) Pre9op: surgical table will be moved to various To disperse dye. positions during test. Post9op: Flat on bed for 6 to 8 hours To prevent CSF leakage. Myelogram (waterbased dye) Pre9op: surgical table will be moved to various positions during test. Post9op: HOB elevated for 8 hours. To prevent dye from irritating the meninges. Liver biopsy During: Supine with RIGHT side of upper abdomen To expose the area exposedF RIGHT arm raised and extended behind and and overhead and shoulder. After: RIGHT sidedlying with pillow under puncture site. To apply pressure and minimize bieeding. Lung biopsy Flat supine with arms raised above head and hands To expose and provide easy access tothe area health together? head and arms on pillow. Renal biopsy PRONE with pillow under the abdomen and shoulders. To expose the area, Arteriovenous fistula Post9op: Elevate extremity Dont sleep on affected side encourage exercise by squeezing a rubber ball Don't use AV arm for BP reading and venipuncture. Peritoneal Dialysis When outflow is inadequate: tum patient from side to side. Tuming facilitates crainageF check for kinksin the tubing Possible to have abdominal cramps and blooditinged outflow if catheter was placed in the last 1A2 weeks. Cloudy outflow is never normal Meniere's Disease Change position slowly bedrest during acute phase Provide protection when ambulating Autografting Immobiize site for 3 to 7 days. To promote healing and maximal adhesion Internal radiation, during treatment Strict bedrest while implant is in place To prevent dislodgement of the implant device. Provide own urinal or bedpan to patient. Heart failure with pulmonary edema Sitting up, with legs dangling To decrease venous return and reduce congestionF promotes ventilation and relieves dyspnea. Cerebral aneurysm HOB elevated 30/45 degrees bed rest To prevent pressure on aneurysm site Heat stroke Supine, flat with legs elevated To promote venous retum and maintain blood flow to the head. Hemorrhagic stroke HOB elevated 30 degrees. To reduce ICP and encourage blood drainage. Avoid hip and neck flexion which inhibits drainage. Increased intracranial pressure (ICP) Elevate HOB 30445 degrees, maintain head midline and in neutral position To promote venous drainage. Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and bending forward. Ischemic stroke HOB flat in midline, neutral position. To facilitate venous drainage and encourage arterial blood fiow. Avoid hip and neck flexion which inhibits drainage Seizure Sidedlying or recovery position To drain secretions and prevent aspiration Spinal cord injury Immobilize on spinal backboard, head in neutral position and immobilized with a firm, padded cervical collar Must be log rolled without allowing any twisting or bending movements To prevent any movement and further injury Head injury Elevate HOB 30 degrees, head should be kept in neutral position To decrease intracranial pressure (ICP) Keep head from flexing or rotating Avoid frequent suctioning Buck's Traction Elevate FOB for counteritraction’ use trapeze for moving place pillow beneath lower legs. Ask patient to dorsiflex foot of the affected leg to assess function of peroneal nerve, weakness may indicate pressure on the nerve. Casted arm Elevate at or above level of heart To minimize swelling Delayed prosthesis fitting Elevate foot of bed to elevate residual limb. To hasten venous return and prevent edema. Hip fracture Affected extremity needs to be abducted. Use splints, wedge pillow, or pillows between legs. Avoid stooping, flexion position during sex, and ‘overexertion dunng walking or exercise. Hip replacement On unaffected side: maintain abduction when in supine position with pillow between legs. HOB raised to 30445 degrees. Avoid extreme intemal or external rotation. Immediate prosthesis fitting Elevate residual limb for 24 hours. Rigid cast acts to control swelling Osteomyelitis Support affected extremity with pillows or splints To maintain proper body alignment avoid strenuous exercises. Total hip replacement Help to sitting position‘ place chair at 90 degrees angle to bed? stand on affected side* pivot patient to unaffected side. To prevent dizziness and orthostatic hypotension. Acute Respiratory Distress Syndrome (ARDS) High Fowler's To promote oxygenation via maximum chest expansion Air embolism from dislodged central venous line Turn to LEFT side or place in Trendelenburg Patient should be immediately repositioned with the right atrium above the gas entry site so that trapped air will not move into the pulmonary circulation Asthma High Fowler's Tripod position: sitting position while leaning forward with hands on knees. To promote oxygenation via maximum chest expansion Chronic Obstructive High Fowler's To promote maximum lung expansion and assist in Pulmonary Disease (COPD) Orthopneic position breathing Emphysema High Fowler's To promote maximum lung expansion Orthopneic position Pleural Effusion High Fowler's To provide maximal Pneumonia High Fowler's To maximize breathing mechanisms. Lay on affected side To splint and reduce pain Lay with affected lung up To reduce congestion. Pneumothorax High Fowler's To promote maximum lung expansion and assist in breathing Pulmonary edema High Fowler's, legs dependent position To decrease edema and congestion Pulmonary embolism High Fowler's Tum patient to LEFT side and lower HOB To promote maximum lung expansion and assist in breathing Flail chest High Fowler's To provide maximal comfort and maximize breathing mechanisms Rib fracture High Fowler's To promote maximum lung expansion and assist in breathing Contraction stress test (CST) Placed in semisF owler's or sidetlying position Monitor for postitest labor onset. Cord prolapse Shrimp or fetal position? modified Sims’ or Trendelenburg. To prevent pressure on the cord. If cord prolapses, cover with sterile saline gauze to prevent drying Fetal distress Turn mother to her LEFT side To reduce compression of the vena cava and aorta. Late decelerations (placental insufficiency) Turn mother to her LEFT side. To allow more blood flow to the placenta. Placenta previa Sitting position To minimize bleeding Variable decelerations (cord compression) Place mother in Trendelenburg position To remove pressure off the presenting part of the cord and prevent gravity from pulling the fetus out of the body Spina Bifida Prone (on abdomen) To prevent sac rupture. Cleft lip (congenital) Position on back or in infant seat. Hold in upright position while feeding To prevent trauma to suture line. Prolapsed umbilical cord During labor: Kneetchest position or Trendelenburg Relieves pressure or gravity from pulling the cord. Hand in vagina to hold presenting part of fetus off cord Cardiac catheterization (post) HOB elevated no more than 30 degrees or flat as prescribed May tum to either side Affected extremity should be kept straight. Continuous Bladder Irrigation (cBl) Tape catheter to thighF no other positioning restrictions Prevents the catheter from being dislodged. Ear drops Position affected ear uppermost then lie on unaffected Pull outer ear upward and back for adults? upward ear for absorption and down for children. Ear irrigation During procedure: Tilt head towards affected ear Better visualization and drainage of the medium to After procedure: Lie on affected side for drainage. the ear canal via gravity. Never put client on operative side, especially if bone was removed. Hemorrhoidectomy During: Prone Jackknife position Provides better visualization of the area. Hypophysectomy ‘Surgical removal of the pituitary gland. HOB elevated. To prevent increase in ICP. Infratentorial surgery Incision at back of head, above nape of neck Flat and lateral on either sideF avoid neck flexing, To facilitate drainage. Kidney transplant Postiop: SemitFowler’s, tum from back to nond operative side To promote gas exchange Laminectomy Back is kept straight Patient is logrolled if tumed Sit straight in straighttbacked chair when out of bed or when ambulating Laryngectomy HOB elevated 30/45 degrees To maintain airway and decrease edema. Mastectomy SemisFowlers with arm on affecied side elevated. To allow lymph drainage Tum only on back and on unaffected side. Mitral valve replacement Postop: semi!Fowler’s position To assistin breathing. Myringotomy Post9op: Position on side of affected ear To allow drainage of secretions Retinal detachment Bed rest with minimal activity and repositioning. Area of detachment should be in the dependent position Helps detached retina fall into place. Supratentorial surgery Incision front of head below hairline HOB elevated 30}45 degrees* maintain head/neckline in midline neutral position? avoid extreme hip and neck flexion. To facilitate drainage. Thyroidectomy Postiop: High Fowler's or semi(Fowler’s. To reduce swelling and edema in the neck area. Avoid extension and movement by using sandbags or To decrease tension on the suture line and support pillows. the head and neck. Tonsillectomy Postiop: prone or sidellying To facilitate drainage and relieve pressure on the neck Bone marrow Side lying with head tucked and legs pulled up off To expose the area aspiration/biopsy Prone with arms folded under chin. Apply pressure to the area after the procedure to stop the bleeding Amputation: above the knee Elevate for first 24 hours using pillow. Position prone twice daily. To prevent edema. To provide for hip extension and stretching of flexor muscles* prevent contractures, abduction Amputation: below the knee Foot of bed elevated for first 24 hours. Position prone daily. To prevent edema To provide for hip extension Fowler's Orthop! Dorsal Supine Fowler's position, is a bed position wherein the head and trunk are raised 40 to 90 degrees. Fowler's position is used for people who have difficulty breathing because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion In low Fowler's or semi9Fowler's position, the head and trunk are raised to 15 to 45 degrees in high Fowler's, the head and trunk are raised 90 degrees. This position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have nasogastric tube in place Using a footboard is recommended to keep the patient's feet in proper alignment and to help prevent foot drop neic or Tripod Orthopneic or tripod position places the patients 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. Patients who are having difficulty breathing are often placed in this position since it allows maximum expansion of the chest. Recumbent In dorsal recumbent or back9lying position, the client'shead and shoulders are slightly elevated on a small pillow. This position provides comfort and facilitates healing following certain surgeries and anesthetics. or Dorsal position Supine is a backilying position similar to dorsal recumbent but the head and shoulders are not elevated. Just like dorsal recumbent, supine position provides comfort in general for patients recover after some types of surgery. In prone position, the patient lies on the abdomen with head turned to one sidef the hips are not flexed. This is the only bed position that allows full extension of the hip and knee joints. 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 Prone position should only be used when the client's back is correctly aligned, and only for people with no evidence of spinal abnormalities. To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen. Lateral position In lateral or side4lying position, the patient lies on one side of the body wth 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 The greater the flexion of the top hip and knee, the greater the stability and balance in this position. This flexion reduces lordosis and promotes good back alignment Lateral position helps relieve pressure on the sacrum and heels in people who sit for much of the day or confined to bed rest in Fowler's or dorsal recumbent Inthis 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. Sims Position Sims' is a semiiprone position where the patient assumes a posture halfway between the lateral and prone positions. The lower arm is positioned behind the client, and the upper arm is floxed at the shoulder and the elbow. Both logs aro floxed in front of the client. The upper leg is more acutely flexed at both the hip and the knoe, than is the lower ono. Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids. Itis also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip. Itis often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area. Pregnant women may find the Sims position comfortable for sleeping Support proper body alignment in Sims's position by placing a pillow underneath the patients head and under the upper arm to prevent intemal rotation. Place another pillow between legs. Trendelenburg's Trendelenburg's position involves lowering the head of the bed and raising the foot of the bed of the patient Patient's who have hypotension can benefit from this position because it promotes venous retum. Reverse Trendelenburg Reverse Trendelenburg is the opposite of Trendelenburg's position. Here the HOB is elevated with the foot of bed down. This is often a position of choice for patients with gastrointestinal problems as it can help minimize esophageal reflux. 
