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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