The document outlines the definition, purpose, principles, and procedures for proper patient positioning in healthcare. It discusses various positions like supine, prone, lateral, and lithotomy, along with their indications, contraindications, and safety considerations to promote patient comfort and prevent complications. It emphasizes the importance of proper assessment, documentation, and the need for collaboration and safety measures during positioning.

1. PATIENT
POSITIONING

2. Definition
• Positioning is defined as placing the patient in such a
way to perform therapeutic interventions to promote
the health of an individual.
• Positioning is also defined as placing the person in a
proper body alignment for the purpose of preventive,
promotive, curative and rehabilitative aspect of
health.

3. Purpose of positioning
• To promote comfort to the patient
• To relieve pressure on various parts
• To improve circulation
• To prevent formation of deformity
• To carryout investigations
• To perform surgical and medical investigations
• To prevent pressure sores
• To provide proper body alignment
• To conduct delivery/labor
• To carryout nursing interventions

4. Principles of positioning
• Systematic and orderly way of doing
• Cooperation between the two
• Follow safety measures to prevent accidents
• Active participation
• Using a right technique at the right time
• Ensure patients’ comfort

5. Factors involved in positioning
• Need of an individual
• Self care ability
• Extend of disability
• Nature of disease condition
• Level of consciousness
• Protocol of the hospital

6. Positions
• Four basic positions
include:
– Supine
– Prone
– Lateral
– Lithotomy
• Variations include:
– Trendelenburg
– Reverse
Trendelenburg
– Fowler’s position
– Jackknife
– High Lithotomy
– Low Lithotomy
– Knee chest

8. Type of patients who need special care
• Unconscious patient
• Infant and children
• Hemiplegic and paraplegic patients
• Immediate postoperative patients
• Orthopedic patients
• Cardiac patients

9. General instructions
• Maintain good body alignment of the patient at all
times
• Support body parts in good alignment by using the
supportive devices to promote comfort and prevent
muscle strain
• Avoid prolonged flexion of any one body segment by
changing the position at every two hours
• Reduce pressure caused by body weight of his or her
body or object by changing the position and using
protective devices

10. Preliminary Assessment
• Check the patient’s general condition
• Check the physicians order for any limited movements
• Assess the self care ability of an individual
• Arrange the comfort devices near the bedside
• Identify the deformed extremity
• Support and immobilize area during positioning

11. Equipment
• Extra man power if needed
• Extra pillows
• Sheets and sheet rolls
• Comfort devices such as backrest, cardiac table,
sandbags

12. Procedure
• Explain the procedure to the patient
• Provide privacy
• Arrange the articles and man power
• Untie the bed sheets
• Turn / lift / ambulate gently
• Place and support with extra pillows under pressure
points
• Special care taken at the pressure areas
• Cover the patient with top sheet
• Hand wash
• Record the time, position and condition of the skin

13. Supine/ Dorsal position
• Most common with the least amount of harm
• Patient Placed lie on the back with legs extended and
uncrossed at the ankles
• Arms either on arm boards abducted <90* with palms
up or tucked (not touching metal or constricted)
• Spinal column should be in alignment with legs parallel
to the bed
• Padding is placed under the head, arms, and heels with
a pillow placed under the knees
• Safety belt placed 2” above the knees while not
impeding circulation

14. Indications & contraindications for
supine position
Indications
• The usual positions used by the patient
• Used for examination of the chest and abdomen
• Patients with operations on the abdomen, chest and
thorax
Contraindications
Elderly patients
Prone hypostatic pneumonia
Patients with long standing illness and neurological
conditions

15. Dorsal Recumbent
• Patient lies on his back, knees fully flexed, thighs flexed
and externally rotated feet flat on the bed
Indications
• Used for catheterization,vaginal douche,vulval, vaginal
and rectal examination
• For vaginal operations and insertion of tampons
• Patients with chest conditions
• Patients with abdominal or pelvic operations unless
erect sitting position is indicated
• Patients with gastric conditions
• Patients who are in convalescent period

16. Procedure
• Place the patient on the back with two or more
pillows under the head and one pillow under the
knees or maintain his position by elevating the top of
bed with blocks.
• Place the air ring under the hips and cotton rings or
form pads under the heels to reduce the pressure
• Align the patients body in good position
• Support the body parts in good alignment when the
patient is paralyzed

17. Prone
• Position which the patient is placed Face down, resting
flat on the abdomen and chest
• Arms lie at the sides or over head on arm boards
• Head is faced down and turned to one side with
accessible airway
• One soft pillow is given under head
• One extra pillow is given under the ankles to keep toes
from touching the bed
• Padding to bilateral feet, arms and knees
• Safety strap placed 2” above knees

18. Indication for prone position
• This position is used postoperatively to prevent
aspiration of saliva and mucus
• Used in postoperative cases, tonsils, vesicovaginal
fistula and spinal cases
• To prevent bedsores
• To release abdominal distension
• Used for patients having injuries and burns on the back
Contraindication
Position is Not well tolerated by the elderly or patients
with cardiovascular or respiratory problems

19. Procedure
• Explain the procedure to the patient
• Provide privacy
• Place the patient flat on abdomen with one pillow
under the head
• Turn patients head to one side and align the patient
in good position
• Support the body parts in good alignment for
comfort
• Place both arms lies at the sides of the heads

20. Lateral
• Patient lies on left/right side with legs flexed at the
thighs
• Shoulder & hips turned simultaneously to prevent
torsion of the spine & great vessels
• Lower leg is flexed at the hip; upper leg is straight
• Head must be in cervical alignment with the spine
• Pillow kept infront of the abdomen, at the back and
under the upper leg
• Padding placed under lower leg, to ankle and foot of
upper leg, and to lower arm (palm up) and upper arm
• Pillow placed lengthwise between
legs and between arms
• Stabilize patient with safety
strap and silk tape, if needed

21. Indications
• Lateral position is used for giving back the enemas
and colonic irrigation
• Used for examination of perineum or rectum
inserting suppositories
• For taking rectal temperature
• For change of position
• Lateral position is a relaxing position
• Giving back care

22. Sims' position/semi-prone/Recovery
• Sims position is similar to the lateral position except that
the patients weight is on the anterior aspect of the
patient’s shoulder girdle and hip.
• The patients lower arm is behind him and the upper arm
is flexed at the shoulder and Elbow.
Indications
• Used for unconscious patients
• Used for rectal examination
• Used for vaginal examination
• Used for relaxation in antenatal exercises
Contraindications. Contraindicated in pts with deformities
of the hip or knee maybe unable to assume this position

23. Procedure
• Explain the procedure to the patient
• Collect articles needed at the bedside
• Provide privacy
• Place the patient on the sides
• One pillow is placed under the head with the left cheek
resting on it
• The left arm is drawn behind the body and the right arm
may be in any position comfortable for the position
• The right thigh is flexed against the abdomen
• The left leg is extended well
• Cover the patient with the top sheet neatly

25. Advantages of the left side position
• Left side positioning is referred to by several
terms: recovery positioning, left side positioning
• Keeps the airway open in unresponsive
breathing victim without spinal cord injury
• It protects the lungs from aspiration should
vomiting occur
• It delays vomiting by placing the oesophagus
above the stomach

26. • It delays poison effects by retaining the poison in
the stomach(the pyloric sphincter is kept straight
up). A poison can be better dealt within the
stomach than in the small intestines
• It relieves pressure on a pregnant woman’s vena
cava(the body’s largest vein. Many women will
pass out or at least feel dizzy if they lie supine( on
their backs) because of reduced blood flow

27. Trendelenburg
• The patient is placed in the supine position while the
bed is modified to a head-down tilt of 35 to 45 degrees,
the head being lower than the pelvis
• In addition to a safety strap, strips of 3” tape may be
used to assist with holding the patient in the position
• Used for procedures in the lower abdomen or pelvis

28. Reverse Trendelenburg
• The bed is tilted so the head is higher than the feet
• Used for head and neck procedures
• Facilitates exposure, aids in breathing and decreases
blood supply to the area
• A padded footboard is used to prevent the patient
from sliding toward the foot

29. Fowler’s Position
(Sitting/Lawnchair/Beachchair)
• Foot of the bed is lowered, flexing the knees, while the
body section is raised to 35 – 45 degree. Backrest and
two pillows are used for the back and head
• Feet rest against a padded footboard
• Arms are crossed loosely over
the abdomen and placed on
a pillow on the patient’s lap
• A pillow is placed under the knees.
• For cranial procedures, the head is
supported in a head rest and/or
with sterile tongs

30. Indications
Flowler’s position the main weight bearing areas of the
head are the heels, sacrum and posterior aspects of the
ileum.
• To relieve dyspnea
• To improve circulation
• To prevent thrombosis
• Postoperatively to assist drainage from abdominal or
pelvic cavity
• To relax muscles of the abdomen, back and thighs
• To promote comfort
• To relieve edema of the chest and abdomen
• To localize infection

31. Procedure
• Explain the procedure to the patient
• Arrange the articles as needed at the bed side
• Provide privacy
• Place the patient in a sitting up position with arms at
the sides and knees raised with pillow
• Maintain the position; elevate the head of the bed to
an angle of 45-60 degree angle(semi-fowler) or 60-90
degree angle (High–fowler)
• Elevate the knee rest to an angle of 15 degree or
place a small pillow under the knees

32. Jackknife
• Modification of the prone position
• The patient is placed in the prone position on the bed
and then inverted in a V position
• Chest rolls are placed to raise the chest
• Arms are extended on angled arm boards with the
elbows flexed and the palms down
• A pillow is placed under the ankles to free the feet and
toes of pressure
• The bed leg section is
lowered, and the bed is
flexed at a 90 degree angle
• Used in gluteal and anorectal
procedures

33. Lithotomy
• With the patient in the supine position, the legs are
raised and abducted to expose the perineal region
• The legs and feet are placed in stirrups or straps that
support the lower extremities
• Stirrups should be placed at an even height
• Adequate padding and support for the legs/feet
should eliminate pressure on joints and nervus plexus
• The position must be symmetrical

34. High Lithotomy
• Frequently used for procedures that requires a
vaginal or perineal approach
• The patient is in the supine position with legs raised
and abducted by stirrups
• Once the feet are positioned in stirrups, the
footboard is removed and the bottom section of the
bed is lowered
• It may be necessary to bring the
patient’s buttocks further down to the
edge of the bed break

35. Low Lithotomy
• All of the positioning techniques used to high
Lithotomy apply
• Placed in supine position with the legs raised and
abducted in crutch-like or full lower leg support
stirrups
• The angle between the patient’s thighs and trunk is
not as acute as for the high Lithotomy position
• Used in vaginal procedures.

36. Knee chest/genu-pectoral position
• Patients rest on the knees and the chest. The head is
turned to one side with one cheek on a pillow. A pillow is
placed under the chest, weight is on the chest and
knees.
Indications
• This position is used for sigmoidoscopy
• Used for rectal and vaginal examination
• Used in first Aid treatment in cord prolapse or
retroverted uterus
• As exercise for postpartum and gynecology patients
NB. Contraindicated in patients with cardiovascular and
respiratory problems for this position.

37. Procedure
• Explain the procedure to the patient
• Collect the needed articles at the bedside
• Provide privacy
• Make the patient rest on the knees and chest
• The head is turned to one side with the cheek on the
pillow
• The arms should be extended on the bed and flexed at
the elbows to support the patient partially.
• The weight should rest on the chest and knees which
are flexed so that the thighs are at right angles to the
legs.

38. Safety Considerations

39. Key Points
• Use safe body mechanics during transfers and
positioning – ensure adequate assistance is used
• Maintain stretcher/bed in a locked position prior
to patient transfers and positioning
• Verify weight limit on or table or bed to be used
• Ensure that the patient is adequately secured to
the or table or bed to be used
• One strap placed across the patient’s thighs and
the second across the lower legs
• Extra care must be taken to ensure that loose
skin is protected (i.e. Lithotomy position)

40. Supine
Risk #1:
• Pressure points:
– occiput; scapulae;
thoracic vertebrae;
olecranon process;
sacrum/coccyx;
calcaneaus; knees
Risk #2:
• Neural injuries of extremities,
brachial plexus, ulna, radial
nerves
Safety
Considerations:
• Padding to heels,
elbows, knees
• Spine, head
alignment with
hips
• Legs parallel,
uncrossed at
ankles
Safety
Consideration:
• Arm board at less
than 90 degrees

41. Prone
Risk #1:
– Head, eyes, nose
Risk #2:
– Chest compression,
iliac crest, breast, male
genitalia
Risk #3:
– Knees
Risk #4:
– Feet
Safety Consideration:
– Maintain cervical neck
alignment
– Protection of forehead,
eyes, chin
– Padded headrest to
provide airway
Safety Consideration:
– Chest rolls to allow
chest movement and
decrease abdominal
pressure
– Breasts and genitalia
free from torsion
Safety Consideration:
– Padded with pillows

42. Lateral
Risk #1:
– Bony prominences
and pressure points
on dependent side
Risk #2:
– Spinal alignment
Safety Consideration:
– Axillary roll for
dependent axilla
– Lower leg flexed at hip
– Upper leg straight with
pillow between legs
– Padding between
knees, ankles and feet
Safety Consideration:
– Maintain spinal
alignment during
turning
– Padded support to
prevent lateral neck
flexion

43. Lithotomy
Risk #1:
– Hip/knee joint injury
– Lumbar/sacral
pressure
– Vascular congestion
Risk #2:
– Neuropathy of
obturator nerves,
femoral nerves,
common peroneal
nerves/ulnar nerves
Risk #3:
– Restricted
diaphragmatic
movement
Safety Consideration:
– Place stirrups at even
height
– Elevate lower legs slowly
and simultaneously
from stirrups
Safety Consideration:
– Maintain minimal
external hip rotation
– Pad lateral or posterior
knees/ankles to prevent
pressure and contact
with metal surface
Safety Consideration:
– Keep arms away from
chest to facilitate

44. Conclusion
• Positions used for the comfort are one of the important
aspects in nursing intervention. Nurses caring for client in
many setting and situations can adapt various
comfortable positions, to provide them a comfortable
stay. Different positions are used for physical
examinations so that the body parts are accessible and
clients stay is comfortable .
• Patient’s ability to assume positions depends upon their
physical strength and degrees of wellness. Their privacy
should be kept as the top priority while doing physical
examination as it will keep them at ease and provide
greater accessibility and accuracy in accessing body parts.

45. Documentation

46. • Documentation should include:
– Preoperative assessments
– Type and location of positioning and/or padding
devices
– Names and titles of persons positioning the patient
– Intra-operative positioning changes
– Postoperative outcome evaluation
• Documentation includes nursing assessments and
interventions
• Documenting nursing activities provides an accurate
picture of the nursing care provided as well as the
outcomes of the care delivered
• Document all of your findings

47. Don’t Forget:
• Good positioning starts with an assessment
• Prevent team members from leaning against patients
• Cushioning of all pressure points is a priority - the correct use of
padding can protect the patient
• Procedures longer than 2 ½ to 3 hours significantly increase the
risk of pressure ulcer formation
• During a longer procedure, you should assist with shifting the
patient, adjusting the table, or adding/removing a positioning
device
• The nurse must assess extremities at regular intervals for signs of
circulatory compromise
• Documentation of the positioning process should be performed
accurately and completely

48. One last note…
Positioning problems can result
in significant injuries and
successful lawsuits.