Patient Positioning Cheat Sheet 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. Condition
Position
Rationale & Additional Info
Bronchoscopy
After: SemiAFowler’s
To reduce aspiration risk from difficulty of swallowing
Cerebral angiography
During: Flat on bed with arms at sidesF kept still.
Apply firm pressure on site for 15 minutes after the procedure.
After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used. Myelogram (air contrast)
Pre9op: surgical table will be moved to various positions during test.
To disperse dye.
Post9op: HOB is lower than trunk. Myelogram (oilAbased dye)
Pre9op: surgical table will be moved to various positions during test.
To disperse dye.
Post9op: Flat on bed for 6 to 8 hours To prevent CSF leakage.
Myelogram (waterAbased dye)
Liver biopsy
Pre9op: surgical table will be moved to various positions during test. Post9op: HOB elevated for 8 hours.
To prevent dye from irritating the meninges.
During: Supine with RIGHT side of upper abdomen exposedF RIGHT arm raised and extended behind and and overhead and shoulder. After: RIGHT sideAlying with pillow under puncture site.
To expose the area.
To apply pressure and minimize bleeding. Lung biopsy
Flat supine with arms raised above head and hands health togetherF head and arms on pillow.
To expose and provide easy access to the area.
Renal biopsy
PRONE with pillow under the abdomen and shoulders.
To expose the area.
Arteriovenous fistula
Post9op: Elevate extremity
Don’t sleep on affected sideF encourage exercise by squeezing a rubber ball. Don’t use AV arm for BP reading and venipuncture.
Peritoneal Dialysis
When outflow is inadequate: turn patient from side to side.
Turning facilitates drainageF check for kinks in the tubing. Possible to have abdominal cramps and bloodAtinged outflow if catheter was placed in the last 1A2 weeks. Cloudy outflow is never normal.
Meniere's Disease
Change position slowlyF bedrest during acute phase
Autografting
Immobilize 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.
Provide protection when ambulating
Heart failure with pulmonary edema
Sitting up, with legs dangling
To decrease venous return and reduce congestionF promotes ventilation and relieves dyspnea.
Myocardial infarction
SemiAFowler’s
To help lessen chest pain and promote respiration.
Pericarditis
HighAFowlers, upright leaning forward.
To help lessen pain.
Peripheral artery disease
Depending on desired outcome. Slight elevation of legs but not above the heart or slightly dependent. Dangle legs on side of the bed.
To slow or increase arterial return
Shock
Flat on bed.
To improve or increase circulation. Trendelenburg is no longer a recommended position.
Sickle Cell Anemia
HOB elevated 30 degrees, avoid knee gatch and putting strain on painful joints
To promote maximum lung expansion and assist in breathing.
Varicose veins, leg ulcers, and venous insufficiency
Elevate extremities above heart level.
To prevent pooling of blood in the legs and facilitate venous returnF avoid prolonged standing.
Deep vein thrombosis
Bed rest with affected limb elevated. After 24 hours after heparin therapy, patient can ambulate if pain level permits.
To promote circulation.
Tracheoesophageal fistula (TEF)
HOB elevated 30A45 degrees.
To prevent reflux.
Ventriculoperitoneal shunt (for Hydrocephalus treatment)
After shunt placement: Place on nonAoperative side in flat position.
Avoid rapid fluid drainage.
HOB raised 15A30 degrees if ICP is increased. Do not hold infant with head elevated. Hyphema Blood in anterior chamber of eye
HOB elevated 30A45 degrees, with night shield.
To allow the hyphema to settle out inferiorly and avoid obstruction of vision and to facilitate resolution
Abdominal aneurysm
Post9op: HOB no more than 45 degrees
To avoid flexion of the graft.
Dehiscence
Place in lowAFowler’s position then raise knees or instruct knees and support them with a pillow.
To decrease tension on the abdomen.
Dumping Syndrome, prevention of
Take meals in reclining position, lie down for 20A30 minutes after.
To delay gastric emptying time. Restrict fluids during meals, low carb, low fiber diet in small frequent meals.
Evisceration
Place in lowAFowler’s position.
Instruct not to coughF place on NPOF keep intestines moist and covered with sterile saline until patient can be wheeled to OR.
Gastroesophageal reflux disease (GERD)
Reverse Trendelenburg, slanted bed with head higher.
To promote gastric emptying and reduce reflux.
Pediatric: prone with HOB elevated. Hiatal hernia
Upright position after meals.
To prevent gastric content reflux.
Pyloric stenosis
RIGHT sideAlying position after meals.
To facilitate entry of stomach contents into the intestines.
Extremity burns
Elevate extremity.
To reduce dependent edema and pressure.
Facial burns or trauma
Head elevated
To reduce edema
Autonomic dysreflexia
Initially place in sitting position or high Fowler’s position with legs dangling.
To reduce blood pressures below dangerous levels and provide partial symptom relief.
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Cerebral aneurysm
HOB elevated 30A45 degreesF bed rest
To prevent pressure on aneurysm site
Heat stroke
Supine, flat with legs elevated.
To promote venous return 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 30A45 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 flow. Avoid hip and neck flexion which inhibits drainage
Seizure
SideAlying 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 counterAtractionF use trapeze for movingF 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 during walking or exercise.
Hip replacement
On unaffected side: maintain abduction when in supine position with pillow between legs. HOB raised to 30A45 degrees.
Avoid extreme internal 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 alignmentF avoid strenuous exercises.
Total hip replacement
Help to sitting positionF place chair at 90 degrees angle to bedF stand on affected sideF 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 Pulmonary Disease (COPD)
High Fowler’s Orthopneic position
To promote maximum lung expansion and assist in breathing.
Emphysema
High Fowler’s
To promote maximum lung expansion 3
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 Turn 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 semiAFowler’s or sideAlying position
Monitor for postAtest labor onset.
Cord prolapse
Shrimp or fetal positionF 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: KneeAchest 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 turn to either side
Affected extremity should be kept straight.
Continuous Bladder Irrigation (CBI)
Tape catheter to thighF no other positioning restrictions
Prevents the catheter from being dislodged.
Ear drops
Position affected ear uppermost then lie on unaffected ear for absorption.
Pull outer ear upward and back for adultsF upward and down for children.
Ear irrigation
During procedure: Tilt head towards affected ear. After procedure: Lie on affected side for drainage.
Better visualization and drainage of the medium to the ear canal via gravity. 4
Eye drops
Tilt head back and look up, pull lid down.
Drop to center of the lower conjunctival sacF blink between dropsF press inner canthus near nose bridge for 1A2 min to prevent systemic absorption.
Lumbar puncture
During: Shrimp or fetal position (sideAlying with back bowed, knees drawn up to abdomen, neck flexed to rest chin on chest).
To maximize spine flexion. To prevent spinal headache and CSF leakage.
After: Flat on bed for 4A12 hours. Nasogastric tube insertion
High Fowler’s with head tilted forward
Closes the trachea and opens the esophagusF prevents aspiration.
Nasogastric tube irrigation and tube feedings
HOB elevated 30 to 45 degreesF keep elevated for 1 hour after an intermittent feeding.
To prevent aspiration.
With decreased LOC: RIGHT sideAlying with HOB elevated. With tracheostomy: Maintain in semiAFowler’s position
Promotes emptying of the stomach and prevents aspiration. To prevent aspiration.
Paracentesis
During: SemiAFowler’s in bed or sitting upright on side of bed with chairF support the feet. Post: Assist into any comfortable position
Empty the bladder before procedureF report elevated temperatureF assess for hypovolemia.
Postural Drainage
Trendelenburg
Lung area needing drainage should be in uppermost position
Rectal enema administration
Left sideAlying (Sims’ position) with right knee flexed.
Allows gravity to work into the direction of the colon by placing the descending colon at its lowest point.
Rectal enemas and irrigation
Left sideAlying, Sims’ position
To allow fluid to flow in the natural direction of the colon.
SengstakenABlakemore and Minnesota tubes
HOB elevated
To enhance lung expansion and reduce portal blood flow, permitting esophagogastric balloon tamponade.
Thoracentesis
Before: (1) Sitting on edge of bed while leaning on bedside table with feet supported by stoolF or lying in bed on unaffected side with head elevated 45 degrees. (2) Lying in bed on unaffected side with HOB elevated to Fowler’s.
Prevent fluid leakage into the thoracic cavity.
After: Assist patient into any comfortable position preferred. Total Parenteral Nutrition (TPN)
During insertion: Trendelenburg.
To prevent air embolism.
Vascular extremity graft
Bed rest for 24 hours, keep extremity straight and avoid knee or hip flexion
For maximal adhesion.
Perineal procedures
Lithotomy
For better visualization of the area.
Appendectomy
Post9op: Fowler’s position
Cataract surgery
Sleep on unaffected side with a night shield for 1 to 4 weeks. SemiAFowler’s or Fowler’s on back or on nonAoperative side.
To prevent edema.
Craniotomy
HOB elevated 30A45% with head in a midline, neutral position.
To facilitate venous drainage.
To relieve abdominal pain and ease breathing.
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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
Post9op: SemiAFowler’s, turn from back to nonA operative side
To promote gas exchange
Laminectomy
Back is kept straight. Patient is logrolled if turned. Sit straight in straightAbacked chair when out of bed or when ambulating.
Laryngectomy
HOB elevated 30A45 degrees
To maintain airway and decrease edema.
Mastectomy
SemiAFowler’s with arm on affected side elevated.
To allow lymph drainage. Turn only on back and on unaffected side.
Mitral valve replacement
Post9op: semiAFowler’s position.
To assist in 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 30A45 degreesF maintain head/neckline in midline neutral positionF avoid extreme hip and neck flexion.
To facilitate drainage.
Thyroidectomy
Post9op: High Fowler’s or semiAFowler’s. Avoid extension and movement by using sandbags or pillows.
To reduce swelling and edema in the neck area. To decrease tension on the suture line and support the head and neck.
Tonsillectomy
Post9op: prone or sideAlying
To facilitate drainage and relieve pressure on the neck.
Bone marrow aspiration/biopsy
Side lying with head tucked and legs pulled up orF Prone with arms folded under chin.
To expose the area. 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 musclesF 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.
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Fowler's • • • • •
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 degreesF 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.
Lateral position • • • • •
Orthopneic 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.
Sims Position •
Dorsal Recumbent • •
In dorsal recumbent or back9lying position, the client's head and shoulders are slightly elevated on a small pillow. This position provides comfort and facilitates healing following certain surgeries and anesthetics.
Supine or Dorsal position • •
Supine is a backAlying 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.
Prone • • • • •
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.
In lateral or sideAlying position, the patient lies on one side of the body with 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. In this 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' is a semiAprone 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 flexed at the shoulder and the elbow. Both legs are flexed in front of the client. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one. Sims' may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids. It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip. It is 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 patient's head and under the upper arm to prevent internal 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 return.
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.
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