BED POSITIONING

Patient positioning involves:

• properly maintaining a patient’s
neutral body alignment by
preventing hyperextension and
extreme lateral rotation to prevent
complications of immobility and
injury.
• In surgery, specimen collection, or
other treatments, proper patient
positioning provides optimal exposure
of the surgical/treatment site and
maintenance of the patient’s dignity
by controlling unnecessary exposure.
 Importance of Proper Bed
Positioning
Positioning patients provides:
• airway management and ventilation
• maintaining body alignment
• provide physiologic safety
 Goals of Patient Positioning
• The ultimate goal of proper patient
positioning is to safeguard the
patient from injury and
physiological complications of
immobility.
 Goals Of Patient Positioning

• Comfort
• Safety
• Dignity
• Privacy
• Support the patient’s airway and
maintain the circulation throughout
the procedure (e.g., in surgery, in
examination, specimen collection, and
treatment). Impaired venous return to
the heart, and ventilation-to-perfusion
mismatching are common
complications.
• Proper positioning promotes
comfort by preventing nerve
damage and by preventing
unnecessary extension or
rotation of the body.
• Maintaining patient dignity and
privacy. In surgery, proper positioning
is a way to respect the patient’s
dignity by minimizing exposure of the
patient who often feels vulnerable
perioperatively.
• Allows maximum visibility and
access. Proper positioning allows
ease of surgical access as well as
for anesthetic administration
during perioperative phase.
Guidelines for Patient Positioning

• Proper execution is needed during

patient positioning to prevent injury
for both the patient and the nurse.
Remember these principles and guidelines
when positioning clients:

1. Explain the procedure:

• Provide explanation to the client on why his
or her position is being changed and how it
will be done. Rapport with the patient will
make them more likely to maintain the new
position.
2. Encourage client to assist as much as
possible
• Determine if the client can fully or partially
assist. Clients that can assist will save strain
on the nurse. It will also be a form exercise,
increase independence, and self-esteem
for the client.
3. Get adequate help
• When planning to move or reposition
the client, ask help from other
caregivers. Positioning may not be a one-
person task.
4. Use mechanical aids
• Bed boards, slide boards, pillows,
patient lifts and slings can
facilitate ease of changing
positions.
5. Raise client’s bed
• Adjust or reposition the client’s
bed so that the weight is at the
level of the nurse’s center of
gravity.
6. Frequent position changes
Note that any position, correct or incorrect,
can be detrimental to the patient if
maintained for a long period.

• Repositioning the patient every 2 hours

helps prevent complications like pressure
ulcers and skin breakdown.
7. Avoid friction and shearing:
• When moving patients, lift rather than
slide to prevent friction that can abrade
the skin making it more prone to skin
breakdown.
8. Proper body mechanics: Observe good body
mechanics for you and your patient’s safety.
• Position self close to the client.
• Avoid twisting your back, neck, and pelvis by keeping
them aligned.
• Flex your knees and keep feet wide apart.
• Use your arms and legs and not your back.
• Tighten abdominal muscles and gluteal muscles in
preparation for the move.
• Person with the heaviest load coordinates efforts of
the nurse and initiates the count to 3.
 Common Patient Positions

The following are the commonly used

patient positions including a description
on how they are performed and the
rationale:
 Supine
Supine position, or dorsal recumbent, is wherein
the patient lies flat on the back with head and
shoulders slightly elevated using a pillow unless
contraindicated (e.g., spinal anesthesia, spinal
surgery).
Variation in position:
• In supine position, legs may be extended or slightly
bent with arms up or down.
• It provides comfort in general for patients under
recovery after some types of surgery.
Most commonly used position: Supine position is used
for general examination or physical assessment.
• Watch out for skin breakdown. Supine position
may put patients at risk for pressure ulcers and nerve
damage.
• Assess for skin breakdown and pad bony
prominences.
Support for supine position:
• Small pillows may be placed under the head
to and lumbar curvature.
• Heels must be protected from pressure by
using a pillow or ankle roll.
• Prevent prolonged plantar flexion and stretch
injury of the feet by placing a padded
footboard.
Supine position in surgery:
• Supine is frequently used on procedures
involving the anterior surface of the body (e.g.,
abdominal area, cardiac, thoracic area).
• A small pillow or donut should be used to
stabilize the head, as extreme rotation of the
head during surgery can lead to occlusion of the
vertebral artery.
Fowler’s Position
Fowler’s position, also known as semi-sitting
position, is a bed position wherein the head of
the bed is elevated 45 to 60 degrees.
Etymology:
• Fowler’s position is named
after George Ryerson Fowler
who saw it as a way to
decrease mortality of
peritonitis.
Variations of Fowler’s position include:
• Low Fowler’s (15 to 30 degrees)
• Semi-Fowler’s (30 to 45 degrees)
• High Fowler’s (nearly vertical).
Promotes lung expansion:
• Fowler’s position is used for patients who
have difficulty breathing because in this
position, gravity pulls the diaphragm
downward allowing greater chest and lung
expansion.
Useful for NGT:
• Fowler’s position is useful for patients
who have cardiac, respiratory, or
neurological problems and is often
optimal for patients who have
nasogastric tube in place.
Prepare for walking:
• Fowler’s is also used to prepare the
patient for dangling or walking.
• Nurses should watch out for dizziness or
faintness during change of position.
Poor neck alignment:
• Placing an overly large pillow behind the
patient’s head may promote the
development of neck flexion contractures.
• Encourage patient to rest without pillows
for a few hours each day to extend the neck
fully.
Used in some surgeries:
• Fowler’s position is usually used in
surgeries that involve neurosurgery or
the shoulders
Use a footboard:
• Using a footboard is recommended to keep
the patient’s feet in proper alignment and to
help prevent foot drop.
 Orthopneic
Or Tripod Position
Orthopneic or tripod position places the
patient in a sitting position or on the side of
the bed with an overbed table in front to lean
on and several pillows on the table to rest on.
Maximum lung expansion:
• Patients who are having difficulty
breathing are often placed in this
position because it allows maximum
expansion of the chest.
Helps in exhaling:
• Orthopneic position is particularly
helpful to patients who have
problems exhaling because they
can press the lower part of the
chest against the edge of the
overbed table.
 Prone Position

In prone position, the patient lies on

the abdomen with head turned to
one side and the hips are not flexed.
Extension of hips and knee joints:
• Prone position is the only bed
position that allows full extension of
the hip and knee joints. It also helps
to prevent flexion contractures of the
hips and knees.
Contraindicated for spine problems:
• The pull of gravity on the trunk when the
patient lies prone produces marked lordosis
or forward curvature of the spine thus
contraindicated for patients with spinal
problems. Prone position should only be
used when the client’s back is correctly
aligned.
Extension of hips and knee joints:
• Prone position is the only bed position
that allows full extension of the hip
and knee joints. It also helps to
prevent flexion contractures of the
hips and knees.
Drainage of secretions:
• 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.
Placing support in prone:
• 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 surgery:
Prone position is often used for
neurosurgery, in most neck and spine
surgeries.
 Lateral Position
• In lateral or side-lying 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. Increase in
flexion of the top hip and knee provides greater
stability and balance. This flexion reduces lordosis
and promotes good back alignment.
Relieves pressure on the sacrum and heels:
• Lateral position helps relieve pressure on
the sacrum and heels especially for
people who sit or are confined to bed rest
in supine or Fowler’s position.
Body weight distribution: 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.
Support pillows needed:
• To correctly position the patient
in lateral position, use of support
pillows are needed.
 Sims’ Position
Sims’ position or semiprone position is when
the patient assumes a posture halfway
between the lateral and the prone positions.
• The lower arm is positioned behind
the client, and the upper arm is flexed
at the shoulder and the elbow. The
upper leg is more acutely flexed at
both the hip and the knee, than is the
lower one.
Prevents aspiration of fluids:
• Sims’ may be used for unconscious
clients because it facilitates
drainage from the mouth and
prevents aspiration of fluids.
Reduces lower body pressure:
• It is also used for paralyzed clients
because it reduces pressure over the
sacrum and greater trochanter of the
hip.
Perineal area visualization and
treatment:
• It is often used for clients receiving
enemas and occasionally for clients
undergoing examinations or
treatments of the perineal area.
Pregnant women comfort:
• Pregnant women may find the
Sims position comfortable for
sleeping.
Promote body alignment with pillows:
• Support proper body alignment in Sims’
position by placing a pillow underneath the
patient’s head and under the upper arm to
prevent internal rotation. Place another
pillow between legs.
 Lithotomy Position
Lithotomy is a patient position in which the
patient is on their back with hips and knees
flexed and thighs apart.
• Lithotomy position is commonly
used for vaginal examinations
and childbirth.
Modifications of the lithotomy position include:
Low
Standard
High
Hemi
Exaggerated
• based on how high the lower body is raised or
elevated for the procedure. Please check with
your facility’s guidelines but typically:
Low Lithotomy Position:
• The patient’s hips are flexed until the angle
between the posterior surface of the
patient’s thighs and the O.R. bed surface is
40 degrees to 60 degrees. The patient’s
lower legs are parallel with the O.R. bed.2
Standard Lithotomy Position:
• The patient’s hips are flexed until the
angle between the posterior surface of
the patient’s thighs and the O.R. bed
surface is 80 degrees to 100 degrees.
The patient’s lower legs are parallel with
the O.R. bed.
Hemilithotomy Position:
• The patient’s non-operative leg is
positioned in standard lithotomy.
The patient’s operative leg may be
placed in traction.
High Lithotomy Position:
• The patient’s hips are flexed until
the angle between the posterior
surface of the patient’s thighs and
the O.R. bed surface is 110 degrees
to 120 degrees. The patient’s lower
legs are flexed.
Exaggerated Lithotomy Position:
• The patient’s hips are flexed until the
angle between the posterior surface
of the patient’s thighs and the O.R.
bed surface is 130 degrees to 150
degrees. The patient’s lower legs are
almost vertical.
Trendelenburg’s Position
Trendelenburg’s position involves lowering
the head of the bed and raising the foot of
the bed of the patient. The patient’s arms
should be tucked at their sides
Promotes venous return:
• Hypotensive patients can
benefit from this position
because it promotes venous
return.
Postural drainage:
• Trendelenburg’s position is used to provide
postural drainage of the basal lung lobes.
• Watch out for dyspnea, some patients may
require only a moderate tilt or a shorter
time in this position during postural
drainage. Adjust as tolerated.
 Reverse Trendelenburg’s
Position
Reverse Trendelenburg’s is a patient position
wherein the head of the bed is elevated with
the foot of the bed down. It is the opposite of
Trendelenburg’s position.
Gastrointestinal problems:
• Reverse trendelenburg is often used
for patients with gastrointestinal
problems as it helps minimize
esophageal reflux.
Prevent rapid change of position:
• Patients with decreased cardiac output may
not tolerate rapid movement or change from
a supine to a more erect position. Watch out
for rapid hypotension. It can be minimized
by gradually changing the patient’s position.
Prevent esophageal reflux:
• Promotes stomach emptying and
prevents reflux for clients with
hiatal hernia.
 Knee-Chest Position
Knee-chest position, can be in lateral or prone
position. In lateral knee-chest position, the
patient lies on their side, torso lies diagonally
across the table, hips and knees are flexed. In
prone knee-chest position, the patient kneels on
the table and lower shoulders on to the table so
chest and face rests on the table.
Lateral knee-chest position:
Can also be done prone.
• Two ways. Knee-chest position can be lateral
or prone.
• Sigmoidoscopy. Usual position adopted for
sigmoidoscopy without anesthesia.
• Patient dignity. Prone knee-chest
position can be embarrassing for some
patients.
• Gynecologic and rectal examinations.
Knee-chest position is assumed for a
gynecologic or rectal examination.
 Jack knife Position
Jackknife position, also known as Kraske, is
wherein the patient’s abdomen lies flat on the
bed. The bed is scissored so the hip is lifted and
the legs and head are low.
In surgery: Jackknife position is frequently
used for surgeries involving the anus,
rectum, coccyx, certain back surgeries, and
adrenal surgery.
Requires team effort: At least four people
are required to perform the transfer and
position the patient in the operating table.
Cardiovascular effects:
In jackknife position, compression of the
inferior vena cava from abdominal
compression also occurs, which decreases
venous return to the heart. This could increase
the risk for deep vein thrombosis.
Support paddings:
• Many pillows are required on the
operating table to support the body and
reduce pressure on the pelvis, back, and
the abdomen. Jackknife position also puts
excessive pressure on the knees. While
positioning, surgical staff should put extra
padding for the knee area.
 Kidney Position
In kidney position, the patient assumes a modified
lateral position wherein the abdomen is placed over a
lift in the operating table that bends the body. Patient is
turned on their contralateral side with their back placed
on the edge of the table. Contralateral kidney is placed
over the break in the table or over the kidney body
elevator (if attachment is available).
Access to retroperitoneal area:
• Kidney positions allows access and
visualization of the retroperitoneal
area. A kidney rest is placed under
the patient at the location of the lift.
Risk for falls:
• Patient may fall off the table at
anytime until the position is
secured.
Padding and stabilization support:
• Contralateral arm underneath the body is
protected with padding. Contralateral
knee is flexed and the uppermost leg is
left straight to improve stability. A large
soft pillow is placed in between the legs.
Kidney strap and tape are placed over the
hip to stabilize the patient.
 Support Devices
for Patient Positioning
The following are the devices or apparatus
that can be used to help position the patient
properly:
Bed Boards:
• Bed boards are plywood boards that are
placed under the entire surface area of
the mattress and are useful for
increasing back support and body
alignment.
Foot Boots:
• Foot boots are shoes made of rigid
plastic or heavy foam and keep the foot
flexed at the proper angle.
• It is recommended that they should be
removed 2 to 3 times a day to assess
the skin integrity and joint mobility.
Hand Rolls:
• Hand rolls maintain the fingers in a
slightly flexed and functional position
and keep the thumb slightly adducted
in opposition to the fingers.
Hand-Wrist Splints:
• These splints are individually molded
for the client to maintain proper
alignment of the thumb in a slight
adduction and the wrist in slight
dorsiflexion.
Pillows:
• Pillows provide support, elevate body parts,
splint incision areas, and reduce postoperative
pain during activity, coughing or deep breathing.
They should be of the appropriate size for the
body to be positioned.
Sandbags:
• Sandbags are soft devices filled with
substance that can be used to shape or
contour to the body’s shape and provide
support. They immobilize extremities and
maintain specific body alignment.
Side Rails:
• Side rails are bars along the sides of the
length of the bed. They ensure client safety
and are useful for increasing mobility. They
also provide assistance in rolling from side to
side or sitting up in bed. Check with your
agencies policies regarding the use of side
rails as they vary state to state.
Trochanter Rolls:
• These rolls prevent external rotation of
the legs when the client is in the supine
position. To form a roll, use a cotton bath
blanket or a sheet folded lengthwise to a
width extending from the greater
trochanter of the femur to the lowest
border of the popliteal space.
Wedge Pillows:
• Are triangular pillows made of heavy
foam and are used to maintain legs in
abduction following total hip
replacement surgery.
Documenting Patient
Positioning
Documenting change of patient position in the
patient’s chart. Note the following:
• Date and time of the procedure.
• Explanation of the procedure to the patient.
• Notation of the position the patient was placed
in including rationale.
• Pertinent teaching given.
• Patient’s response to the procedure.
 Cheat Sheet
for Patient Positions
The section below is a nursing cheat sheet for
different conditions or procedures and their
appropriate patient position with rationale:
Condition/ Rationale & Additional
Procedure Patient Position Info
To reduce risks for
Bronchoscopy After: Semi-Fowler’s aspiration from difficulty
of swallowing

During: Flat on bed with

arms at sides; kept still.
Cerebral After: Extremity in which Apply firm pressure on
contrast was injected is site for 15 minutes after
angiography kept straight for 6 to 8 the procedure.
hours. Flat, if femoral
artery was used.
 Pre-op: surgical
table will be moved
Myelogram to various positions To disperse
(air during test. dye.
contrast) Post-op: HOB is
lower than trunk.
 Pre-op: surgical table will be
Myelogram moved to various positions To disperse
(oil-based during test. dye.To prevent
dye) Post-op: Flat on bed for 6 to 8 CSF leakage.
hours
 To decrease venous
Heart return and reduce
failure with Sitting up, with congestion; promotes
pulmonary legs dangling ventilation and
edema relieves dyspnea.

To help lessen chest

Myocardial Semi-Fowler’s pain and promote
infarction respiration.
 To improve or increase
circulation.
Shock Flat on bed. Trendelenburg is no longer
a recommended position.

HOB elevated 30
To promote
degrees, avoid knee
Sickle maximum lung
gatch and putting
Cell Anemia strain on painful expansion and assist
in breathing.
joints
 To prevent
pooling of blood
Varicose veins, Elevate in the legs and
leg ulcers, and extremities facilitate venous
venous above heart return; avoid
insufficiency level. prolonged
standing.
 Bed rest with
affected limb
elevated.
Deep vein After 24 hours after To promote
thrombosis heparin therapy, circulation.
patient can
ambulate if pain
level permits.

Tracheoesop
HOB elevated 30-45 To prevent
hageal fistula
degrees. reflux.
(TEF)
 After shunt placement:
Ventriculo Place on non-operative
peritoneal side in flat position.
Avoid rapid
shunt (for HOB raised 15-30 degrees
fluid drainage.
Hydrocephal if ICP is increased.
us Do not hold infant with
treatment) head elevated.
 Place in low-Fowler’s
position then raise To decrease
Dehiscence knees or instruct knees tension on the
and support them with a abdomen.
pillow.

Abdominal an Post-op: HOB no more To avoid flexion of

eurysm than 45 degrees the graft.
 To delay gastric
Dumping Take meals in emptying time.
Syndrome, reclining position, Restrict fluids during
prevention lie down for 20-30 meals, low carb, low
of minutes after. fiber diet in small
frequent meals.

Cerebral HOB elevated 30- To prevent pressure

45 degrees;
aneurysm rest bed on aneurysm site
 Instruct not
to cough; place on
NPO; keep
Place in low- intestines moist
Evisceration Fowler’s and covered with
position. sterile saline until
patient can be
wheeled to OR.
 Reverse
Trendelenburg,
Gastroesopha slanted bed with To promote
geal head higher. gastric emptying
reflux disease Pediatric: prone and reduce
(GERD) with HOB reflux.
elevated.
 To promote venous
Supine, flat with return and maintain
Heat stroke
legs elevated. blood flow to the head.

To reduce ICP and

encourage blood
Hemorrhagic HOB elevated drainage. Avoid hip and
stroke 30 degrees. neck flexion which
inhibits drainage.
 To promote
venous drainage.
Elevate HOB 30-45 Avoid flexion of
Increased degrees, maintain the neck, head
intracranial head midline and in rotation, hip
pressure (ICP) neutral position. flexion, coughing,
sneezing and
bending forward.
 HOB flat in To facilitate venous drainage
Ischemic midline, and encourage arterial
stroke neutral blood flow.
position. Avoid hip and neck flexion
which inhibits drainage

Side-lying or To drain secretions and

Seizure recovery prevent aspiration.
position.
 Immobilize on spinal
backboard, head in neutral
position and immobilized
Spinal To prevent any
with a firm, padded cervical
cord movement and
collar.
injury further injury.
Must be log rolled without
allowing any twisting or
bending movements
 To decrease
intracranial
Elevate HOB 30 (ICP).Keep head pressure
Head degrees, head from flexing or
injury should be kept in rotating.
neutral position. Avoid frequent
suctioning.
 Use splints, wedge
pillow, or pillows
Affected between legs.
Hip extremity needs Avoid stooping,
fracture to be abducted. flexion position during
sex, and overexertion
during walking or
exercise.
 Support affected To maintain proper
Osteomyeliti extremity with body alignment; avoid
s pillows or splints strenuous exercises.

Acute To promote
Respiratory oxygenation via
High Fowler’s
Distress Syndrome maximum chest
(ARDS) expansion.
 Patient should be
immediately
Air embolism Turn to LEFT repositioned with the
from dislodged side or place right atrium above the
central venous in gas entry site so that
line Trendelenburg. trapped air will not
move into the
pulmonary circulation.
 High Fowler’s
Tripod position: To promote
sitting position oxygenation via
Asthma
while leaning maximum chest
forward with hands expansion.
on knees.
To promote
Chronic Obstructive
High Fowler’s maximum lung
Pulmonary Disease
Orthopneic position expansion and assist
(COPD)
in breathing.
 High Fowler’s To promote maximum
Emphysema Orthopneic position lung expansion
Pleural
High Fowler’s To provide maximal
Effusion

To maximize breathing
High Fowler’s mechanisms.
Lay on affected side
Pneumonia To splint and reduce
Lay with affected pain.
lung up To reduce congestion.
 To promote
maximum lung
Pneumothorax High Fowler’s expansion and assist
in breathing.
High Fowler’s,
Pulmonary legs To decrease edema
edema dependent and congestion
position
 High Fowler’s
To promote maximum
Pulmonary Turn patient to
lung expansion and
embolism LEFT side and
assist in breathing.
lower HOB
To provide maximal
Flail chest High Fowler’s comfort and maximize
breathing mechanisms.

Rib High To promote maximum

fracture Fowler’s lung expansion and
assist in breathing.
Contraction Placed in semi-
Monitor for post-
stress test Fowler’s or side-lying
test labor onset.
(CST) position
To prevent
pressure on the
Shrimp or fetal cord. If cord
position; modified
Cord prolapse prolapses, cover
Sims’ or with sterile saline
Trendelenburg. gauze to prevent
drying.
 To reduce
Turn mother to compression of
Fetal distress her LEFT side. the vena cava
and aorta.
Late
To allow more
decelerations Turn mother to
(placental her LEFT side. blood flow to
the placenta.
insufficiency)
To minimize
Placenta previa Sitting position. bleeding.
 To remove pressure off
Variable the presenting part of
Place mother in the cord and prevent
decelerations
Trendelenburg gravity from pulling
(cord
position.
compression) the fetus out of the
body.

Prone (on To prevent sac

Spina Bifida abdomen). rupture.
 Relieves pressure or gravity
During labor:
Prolapsed from pulling the cord.
Knee-chest
umbilical Hand in vagina to hold
position
cord presenting part of fetus off
or Trendelenburg. cord.

Postural Trendelenburg Lung area needing

Drainage drainage should be in
uppermost position
 During: Shrimp or fetal
position (side-lying with
To maximize
back bowed, knees
spine flexion.
Lumbar drawn up to abdomen,
To prevent spinal
puncture neck flexed to rest chin
headache and
on chest).
CSF leakage.
After: Flat on bed for 4-
12 hours.
 HOB elevated 30 to 45
degrees; keep elevated for 1 To prevent
Nasogastric hour after an intermittent aspiration.
Tube feeding. Promotes emptying
Irrigation With decreased LOC: RIGHT of the stomach and
and tube side-lying with HOB prevents aspiration.
feedings elevated. To prevent
With tracheostomy: Maintai aspiration.
n in semi-Fowler’s position
 Allows gravity to work
Left side-lying into the direction of
Rectal enema (Sims’ position) the colon by placing the
administration with right knee descending colon at its
flexed. lowest point.

HOB elevated 30-45% with

head in a midline, neutral
To facilitate
position.
Craniotomy Never put client on operative venous
drainage.
side, especially if bone was
removed.
 To prevent edema.
Elevate for first To provide for hip
Amputation: 24 hours using extension and
above the pillow. Position stretching of flexor
knee prone twice muscles; prevent
daily. contractures, abduction