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Patient Positioning Cheat Sheet

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 patients dignity by controlling unnecessary exposure. Additionally, positioning patients provides
airway management and ventilation, maintaining body alignment, and provide physiologic safety. Heres a list of the common
conditions, procedures, and diseases with their recommended position and rationale for each.

Fowler's Lateral position


Fowler's position, is a bed position wherein the head and trunk In lateral or side-lying position, the patient lies on one side of the
are raised 40 to 90 degrees. body with the top leg in front of the bottom leg and the hip and
Fowler's position is used for people who have difficulty breathing knee flexed.
because in this position, gravity pulls the diaphragm downward Flexing the top hip and knee and placing this leg in front of the
allowing greater chest and lung expansion. body creates a wider, triangular base of support and achieves
In low Fowler's or semi-Fowler's position, the head and trunk greater stability.
are raised to 15 to 45 degrees; in high Fowler's, the head and The greater the flexion of the top hip and knee, the greater the
trunk are raised 90 degrees. stability and balance in this position. This flexion reduces
This position is useful for patients who have cardiac, respiratory, lordosis and promotes good back alignment.
or neurological problems and is often optimal for patients who Lateral position helps relieve pressure on the sacrum and heels
have nasogastric tube in place. in people who sit for much of the day or confined to bed rest in
Using a footboard is recommended to keep the patient's feet in Fowler's or dorsal recumbent.
proper alignment and to help prevent foot drop. 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.
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 Sims Position
to lean on and several pillows on the table to rest on. Sims' is a semi-prone position where the patient assumes a
Patients who are having difficulty breathing are often placed in posture halfway between the lateral and prone positions. The
this position since it allows maximum expansion of the chest. 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
Dorsal Recumbent and the knee, than is the lower one.
In dorsal recumbent or back-lying position, the client's head Sims' may be used for unconscious clients because it facilitates
and shoulders are slightly elevated on a small pillow. drainage from the mouth and prevents aspiration of fluids.
This position provides comfort and facilitates healing following It is also used for paralyzed clients because it reduces pressure
certain surgeries and anesthetics. 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
Supine or Dorsal position area.
Supine is a back-lying position similar to dorsal recumbent but Pregnant women may find the Sims position comfortable for
the head and shoulders are not elevated. sleeping.
Just like dorsal recumbent, supine position provides comfort in Support proper body alignment in Sims's position by placing a
general for patients recover after some types of surgery. pillow underneath the patient's head and under the upper arm to
prevent internal rotation. Place another pillow between legs.
Prone
In prone position, the patient lies on the abdomen with head Trendelenburg's
turned to one side; the hips are not flexed. Trendelenburg's position involves lowering the head of the bed
This is the only bed position that allows full extension of the hip and raising the foot of the bed of the patient.
and knee joints. Patient's who have hypotension can benefit from this position
Prone position also promotes drainage from the mouth and because it promotes venous return.
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 Reverse Trendelenburg
correctly aligned, and only for people with no evidence of spinal Reverse Trendelenburg is the opposite of Trendelenburg's
abnormalities. position.
To support a patient lying in prone, place a pillow under the head Here the HOB is elevated with the foot of bed down.
and a small pillow or a towel roll under the abdomen. This is often a position of choice for patients with gastrointestinal
problems as it can help minimize esophageal reflux.
Condition Position Rationale & Additional Info

Bronchoscopy After: Semi-Fowlers To reduce aspiration risk from difficulty of swallowing

Cerebral angiography During: Flat on bed with arms at sides; 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) Pre-op: surgical table will be moved to various To disperse dye.
positions during test.

Post-op: HOB is lower than trunk.

Myelogram (oil-based dye) Pre-op: surgical table will be moved to various To disperse dye.
positions during test.

Post-op: Flat on bed for 6 to 8 hours


To prevent CSF leakage.

Myelogram (water-based Pre-op: surgical table will be moved to various


dye) positions during test.

Post-op: 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.
exposed; RIGHT arm raised and extended behind
and and overhead and shoulder.
After: RIGHT side-lying with pillow under puncture site.

To apply pressure and minimize bleeding.

Lung biopsy Flat supine with arms raised above head and hands To expose and provide easy access to the area.
health together; head and arms on pillow.

Renal biopsy PRONE with pillow under the abdomen and shoulders. To expose the area.

Arteriovenous fistula Post-op: Elevate extremity Dont sleep on affected side; encourage exercise by
squeezing a rubber ball.
Dont use AV arm for BP reading and venipuncture.

Peritoneal Dialysis When outflow is inadequate: turn patient from side to Turning facilitates drainage; check for kinks in the
side. tubing.
Possible to have abdominal cramps and blood-tinged
outflow if catheter was placed in the last 1-2
weeks.
Cloudy outflow is never normal.

Meniere's Disease Change position slowly; bedrest during acute phase Provide protection when ambulating

Autografting Immobilize site for 3 to 7 days. To promote healing and maximal adhesion.

Internal radiation, during Strict bedrest while implant is in place To prevent dislodgement of the implant device.
treatment Provide own urinal or bedpan to patient.

Heart failure with pulmonary Sitting up, with legs dangling To decrease venous return and reduce congestion;
edema promotes ventilation and relieves dyspnea.

Myocardial infarction Semi-Fowlers To help lessen chest pain and promote


respiration.

Pericarditis High-Fowlers, upright leaning forward. To help lessen pain.

Peripheral artery disease Depending on desired outcome. Slight elevation of legs To slow or increase arterial return
but not above the heart or slightly dependent.
Dangle legs on side of the bed.
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 To promote maximum lung expansion and assist in
putting strain on painful joints breathing.

Varicose veins, leg ulcers, Elevate extremities above heart level. To prevent pooling of blood in the legs and facilitate
and venous insufficiency venous return; avoid prolonged standing.

Deep vein thrombosis Bed rest with affected limb elevated. To promote circulation.
After 24 hours after heparin therapy, patient can
ambulate if pain level permits.

Tracheoesophageal fistula HOB elevated 30-45 degrees. To prevent reflux.


(TEF)

Ventriculoperitoneal shunt After shunt placement: Place on non-operative side in Avoid rapid fluid drainage.
(for Hydrocephalus flat position.
treatment)
HOB raised 15-30 degrees if ICP is increased.

Do not hold infant with head elevated.

Hyphema HOB elevated 30-45 degrees, with night shield. To allow the hyphema to settle out inferiorly and
Blood in anterior chamber of avoid obstruction of vision and to facilitate
eye resolution

Abdominal aneurysm Post-op: HOB no more than 45 degrees To avoid flexion of the graft.

Dehiscence Place in low-Fowlers position then raise knees or To decrease tension on the abdomen.
instruct knees and support them with a pillow.

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

Evisceration Place in low-Fowlers position. Instruct not to cough; place on NPO; keep intestines
moist and covered with sterile saline until patient
can be wheeled to OR.

Gastroesophageal reflux Reverse Trendelenburg, slanted bed with head higher. To promote gastric emptying and reduce reflux.
disease (GERD)
Pediatric: prone with HOB elevated.

Hiatal hernia Upright position after meals. To prevent gastric content reflux.

Pyloric stenosis RIGHT side-lying 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 Fowlers position To reduce blood pressures below dangerous levels
with legs dangling. and provide partial symptom relief.

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 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.
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Increased intracranial Elevate HOB 30-45 degrees, maintain head midline and To promote venous drainage.
pressure (ICP) in neutral position. 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 Side-lying or recovery position. To drain secretions and prevent aspiration.

Spinal cord injury Immobilize on spinal backboard, head in neutral To prevent any movement and further injury.
position and immobilized with a firm, padded
cervical collar
Must be log rolled without allowing any twisting or
bending movements

Head injury Elevate HOB 30 degrees, head should be kept in To decrease intracranial pressure (ICP).
neutral position. Keep head from flexing or rotating.
Avoid frequent suctioning.

Bucks Traction Elevate FOB for counter-traction; use trapeze for Ask patient to dorsiflex foot of the affected leg to
moving; place pillow beneath lower legs. 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 Avoid extreme internal or external rotation.
position with pillow between legs.
HOB raised to 30-45 degrees.

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 prevent dizziness and orthostatic hypotension.
to bed; stand on affected side; pivot patient to
unaffected side.

Acute Respiratory Distress High Fowlers To promote oxygenation via maximum chest
Syndrome (ARDS) expansion.

Air embolism from dislodged Turn to LEFT side or place in Trendelenburg. Patient should be immediately repositioned with the
central venous line right atrium above the gas entry site so that
trapped air will not move into the pulmonary
circulation.

Asthma High Fowlers To promote oxygenation via maximum chest


Tripod position: sitting position while leaning forward expansion.
with hands on knees.

Chronic Obstructive High Fowlers To promote maximum lung expansion and assist in
Pulmonary Disease (COPD) Orthopneic position breathing.

Emphysema High Fowlers To promote maximum lung expansion


Orthopneic position

Pleural Effusion High Fowlers To provide maximal

Pneumonia High Fowlers To maximize breathing mechanisms.

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Lay on affected side To splint and reduce pain.

Lay with affected lung up To reduce congestion.

Pneumothorax High Fowlers To promote maximum lung expansion and assist in


breathing.

Pulmonary edema High Fowlers, legs dependent position To decrease edema and congestion

Pulmonary embolism High Fowlers To promote maximum lung expansion and assist in
Turn patient to LEFT side and lower HOB breathing.

Flail chest High Fowlers To provide maximal comfort and maximize breathing
mechanisms.

Rib fracture High Fowlers To promote maximum lung expansion and assist in
breathing.

Contraction stress test (CST) Placed in semi-Fowlers or side-lying position Monitor for post-test labor onset.

Cord prolapse Shrimp or fetal position; modified Sims or To prevent pressure on the cord. If cord prolapses,
Trendelenburg. 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 Turn mother to her LEFT side. To allow more blood flow to the placenta.
insufficiency)

Placenta previa Sitting position. To minimize bleeding.

Variable decelerations (cord Place mother in Trendelenburg position. To remove pressure off the presenting part of the
compression) 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. To prevent trauma to suture line.
Hold in upright position while feeding.

Prolapsed umbilical cord During labor: Knee-chest 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 Affected extremity should be kept straight.
prescribed.
May turn to either side

Continuous Bladder Irrigation Tape catheter to thigh; no other positioning restrictions Prevents the catheter from being dislodged.
(CBI)

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.

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Eye drops Tilt head back and look up, pull lid down. Drop to center of the lower conjunctival sac; blink
between drops; press inner canthus near nose
bridge for 1-2 min to prevent systemic absorption.

Lumbar puncture During: Shrimp or fetal position (side-lying with back To maximize spine flexion.
bowed, knees drawn up to abdomen, neck flexed to To prevent spinal headache and CSF leakage.
rest chin on chest).

After: Flat on bed for 4-12 hours.

Nasogastric tube insertion High Fowlers with head tilted forward Closes the trachea and opens the esophagus;
prevents aspiration.

Nasogastric tube irrigation HOB elevated 30 to 45 degrees; keep elevated for 1 To prevent aspiration.
and tube feedings hour after an intermittent feeding.

With decreased LOC: RIGHT side-lying with HOB


elevated. Promotes emptying of the stomach and prevents
aspiration.
With tracheostomy: Maintain in semi-Fowlers position
To prevent aspiration.

Paracentesis During: Semi-Fowlers in bed or sitting upright on side Empty the bladder before procedure; report elevated
of bed with chair; support the feet. temperature; assess for hypovolemia.
Post: Assist into any comfortable position

Postural Drainage Trendelenburg Lung area needing drainage should be in uppermost


position

Rectal enema administration Left side-lying (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 side-lying, Sims position To allow fluid to flow in the natural direction of the
colon.

Sengstaken-Blakemore and HOB elevated To enhance lung expansion and reduce portal blood
Minnesota tubes flow, permitting esophagogastric balloon
tamponade.

Thoracentesis Before: (1) Sitting on edge of bed while leaning on Prevent fluid leakage into the thoracic cavity.
bedside table with feet supported by stool; or lying
in bed on unaffected side with head elevated 45
degrees.
(2) Lying in bed on unaffected side with HOB
elevated to Fowlers.

After: Assist patient into any comfortable position


preferred.

Total Parenteral Nutrition During insertion: Trendelenburg. To prevent air embolism.


(TPN)

Vascular extremity graft Bed rest for 24 hours, keep extremity straight and avoid For maximal adhesion.
knee or hip flexion

Perineal procedures Lithotomy For better visualization of the area.

Appendectomy Post-op: Fowlers position To relieve abdominal pain and ease breathing.

Cataract surgery Sleep on unaffected side with a night shield for 1 to 4 To prevent edema.
weeks.
Semi-Fowlers or Fowlers on back or on non-operative
side.

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Craniotomy HOB elevated 30-45% with head in a midline, neutral To facilitate venous drainage.
position.
Never put client on operative side, especially if bone
was removed.

Hemorrhoidectomy During: Prone Jackknife position. Provides better visualization of the area.

Hypophysectomy HOB elevated. To prevent increase in ICP.


Surgical removal of the
pituitary gland.

Infratentorial surgery Flat and lateral on either side; avoid neck flexing. To facilitate drainage.
Incision at back of head,
above nape of neck

Kidney transplant Post-op: Semi-Fowlers, turn from back to non- To promote gas exchange
operative side

Laminectomy Back is kept straight.


Patient is logrolled if turned.
Sit straight in straight-backed chair when out of bed or
when ambulating.

Laryngectomy HOB elevated 30-45 degrees To maintain airway and decrease edema.

Mastectomy Semi-Fowlers with arm on affected side elevated. To allow lymph drainage.
Turn only on back and on unaffected side.

Mitral valve replacement Post-op: semi-Fowlers position. To assist in breathing.

Myringotomy Post-op: Position on side of affected ear . To allow drainage of secretions

Retinal detachment Bed rest with minimal activity and repositioning. Helps detached retina fall into place.
Area of detachment should be in the dependent
position.

Supratentorial surgery HOB elevated 30-45 degrees; maintain head/neckline To facilitate drainage.
Incision front of head below in midline neutral position; avoid extreme hip and
hairline neck flexion.

Thyroidectomy Post-op: High Fowlers or semi-Fowlers. 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 Post-op: prone or side-lying To facilitate drainage and relieve pressure on the
neck.

Bone marrow Side lying with head tucked and legs pulled up or; 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. To prevent edema.
Position prone twice daily. 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. To prevent edema.
Position prone daily. To provide for hip extension.

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