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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 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.
• 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.
Fowler's • Lateral position helps relieve pressure on the sacrum and heels
• Fowler's position, is a bed position wherein the head and trunk in people who sit for much of the day or confined to bed rest in
are raised 40 to 90 degrees. Fowler's or dorsal recumbent.
• Fowler's position is used for people who have difficulty breathing • In this position, most of the body weight is distributed to the
because in this position, gravity pulls the diaphragm downward lateral aspect of the lower scapula, the lateral aspect of the ilium,
allowing greater chest and lung expansion. and the greater trochanter of the femur.
• In low Fowler's or semi-Fowler'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. Sims Position
• This position is useful for patients who have cardiac, respiratory, • Sims' is a semi-prone position where the patient assumes a
or neurological problems and is often optimal for patients who posture halfway between the lateral and prone positions. The
have nasogastric tube in place. lower arm is positioned behind the client, and the upper arm is
• Using a footboard is recommended to keep the patient's feet in flexed at the shoulder and the elbow. Both legs are flexed in front
proper alignment and to help prevent foot drop. 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
Orthopneic or Tripod drainage from the mouth and prevents aspiration of fluids.
• Orthopneic or tripod position places the patients in a sitting • It is also used for paralyzed clients because it reduces pressure
position or on the side of the bed with an over bed table in front over the sacrum and greater trochanter of the hip.
to lean on and several pillows on the table to rest on. • It is often used for clients receiving enemas and occasionally for
• Patients who are having difficulty breathing are often placed in clients undergoing examinations or treatments of the perineal
this position since it allows maximum expansion of the chest. area.
• Pregnant women may find the Sims position comfortable for
sleeping.
Dorsal Recumbent • Support proper body alignment in Sims's position by placing a
• In dorsal recumbent or back-lying position, the client's head pillow underneath the patient's head and under the upper arm to
and shoulders are slightly elevated on a small pillow. prevent internal rotation. Place another pillow between legs.
• This position provides comfort and facilitates healing following
certain surgeries and anesthetics.
Trendelenburg's
• Trendelenburg's position involves lowering the head of the bed
Supine or Dorsal position and raising the foot of the bed of the patient.
• Supine is a back-lying position similar to dorsal recumbent but • Patient's who have hypotension can benefit from this position
the head and shoulders are not elevated. because it promotes venous return.
• Just like dorsal recumbent, supine position provides comfort in
general for patients recover after some types of surgery.
Reverse Trendelenburg
• Reverse Trendelenburg is the opposite of Trendelenburg's
Prone position.
• In prone position, the patient lies on the abdomen with head • Here the HOB is elevated with the foot of bed down.
turned to one side; the hips are not flexed.
• This is often a position of choice for patients with gastrointestinal
• This is the only bed position that allows full extension of the hip problems as it can help minimize esophageal reflux.
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 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.
Condition Position Rationale & Additional Info

Bronchoscopy After: Semi-Fowler’s 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) To disperse dye.


Pre-op: surgical table will be moved to various
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 dye)


Pre-op: surgical table will be moved to various
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 To expose and provide easy access to the area.


Flat supine with arms raised above head and hands
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


Don’t 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: 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.

Strict bedrest while implant is in place


Internal radiation, during To prevent dislodgement of the implant device.
treatment Provide own urinal or bedpan to patient.

Sitting up, with legs dangling


Heart failure with pulmonary To decrease venous return and reduce congestion;
edema promotes ventilation and relieves dyspnea.

2
Myocardial infarction Semi-Fowler’s
To help lessen chest pain and promote
respiration.

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

Peripheral artery disease To slow or increase arterial return


Depending on desired outcome. Slight elevation of legs
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 putting To promote maximum lung expansion and assist in
strain on painful joints breathing.

Elevate extremities above heart level.


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

Deep vein thrombosis To promote circulation.


Bed rest with affected limb elevated.
After 24 hours after heparin therapy, patient can
ambulate if pain level permits.

HOB elevated 30-45 degrees. To prevent reflux.


Tracheoesophageal fistula
(TEF)

Ventriculoperitoneal shunt Avoid rapid fluid drainage.


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

Do not hold infant with head elevated.

HOB elevated 30-45 degrees, with night shield.


Hyphema 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 To decrease tension on the abdomen.


Place in low-Fowler’s position then raise knees or 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-Fowler’s 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 To promote gastric emptying and reduce reflux.


Reverse Trendelenburg, slanted bed with head higher.
disease (GERD)
Pediatric: prone with HOB elevated.

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

3
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 Fowler’s 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.

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 To prevent any movement and further 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

Head injury Elevate HOB 30 degrees, head should be kept in neutral


To decrease intracranial pressure (ICP).
position.
Keep head from flexing or rotating.
Avoid frequent suctioning.

Buck’s 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 Avoid extreme internal or external rotation.


On unaffected side: maintain abduction when in supine
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.

4
Osteomyelitis Support affected extremity with pillows or splints
To maintain proper body alignment; avoid strenuous
exercises.

Total hip replacement To prevent dizziness and orthostatic hypotension.


Help to sitting position; place chair at 90 degrees angle
to bed; stand on affected side; pivot patient to
unaffected side.

High Fowler’s
Acute Respiratory Distress 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 To promote oxygenation via maximum chest


High Fowler’s
expansion.
Tripod position: sitting position while leaning forward
with hands on knees.

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

Emphysema To promote maximum lung expansion


High Fowler’s
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 To promote maximum lung expansion and assist in
Turn patient to LEFT side and lower HOB 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 semi-Fowler’s 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.

5
Fetal distress Turn mother to her LEFT side. To reduce compression of the vena cava and aorta.

Turn mother to her LEFT side. To allow more blood flow to the placenta.
Late decelerations (placental
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) To prevent trauma to suture line.


Position on back or in infant seat.
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) Affected extremity should be kept straight.


HOB elevated no more than 30 degrees or flat as
prescribed.
May turn to either side

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

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 To maximize spine flexion.


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

After: Flat on bed for 4-12 hours.

Nasogastric tube insertion High Fowler’s 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
With tracheostomy: Maintain in semi-Fowler’s position aspiration.

To prevent aspiration.

6
Paracentesis Empty the bladder before procedure; report elevated
During: Semi-Fowler’s in bed or sitting upright on side
temperature; assess for hypovolemia.
of bed with chair; support the feet.
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 Prevent fluid leakage into the thoracic cavity.


Before: (1) Sitting on edge of bed while leaning on
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 Fowler’s.

After: Assist patient into any comfortable position


preferred.

During insertion: Trendelenburg. To prevent air embolism.


Total Parenteral Nutrition
(TPN)

Vascular extremity graft For maximal adhesion.


Bed rest for 24 hours, keep extremity straight and avoid
knee or hip flexion

Perineal procedures Lithotomy For better visualization of the area.

Appendectomy Post-op: Fowler’s position To relieve abdominal pain and ease breathing.

Cataract surgery To prevent edema.


Sleep on unaffected side with a night shield for 1 to 4
weeks.
Semi-Fowler’s or Fowler’s on back or on non-operative
side.

Craniotomy To facilitate venous drainage.


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

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

HOB elevated. To prevent increase in ICP.


Hypophysectomy
Surgical removal of the
pituitary gland.

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

7
Kidney transplant To promote gas exchange
Post-op: Semi-Fowler’s, turn from back to nonoperative
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-Fowler’s with arm on affected side elevated. To allow lymph drainage.
Turn only on back and on unaffected side.

Mitral valve replacement Post-op: semi-Fowler’s position. To assist in breathing.

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

Retinal detachment Helps detached retina fall into place.


Bed rest with minimal activity and repositioning.
Area of detachment should be in the dependent position.

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

Thyroidectomy
Post-op: 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 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; Prone
To expose the area.
aspiration/biopsy 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
To prevent edema.
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. Position To prevent edema.
prone daily. To provide for hip extension.