1. Positioning patients properly is important for comfort, medical procedures, and preventing complications. It involves assessing the patient's needs and positioning them in alignments that promote circulation, relieve pressure, and allow for interventions. 2. Common positions discussed include supine, prone, lateral, lithotomy, Fowler's position, and Trendelenburg. Each position has specific indications and procedures to ensure patient safety and access for medical needs. 3. Special considerations are needed for obese patients to support their weight and prevent impaired circulation or breathing from positioning. Thorough documentation of assessments and interventions is also important.

1. COMFORT
POSITIONS
Mrs. Babitha K Devu
Asstt. Professor
SMVCoN

2. INTRODUCTION

3. DEFINITION
Positioning is defined as planning the person in a
proper body alignment for the purpose of
preventive, promotive, curative and rehabilitative
aspects of health or placing the patient in good body
alignment as needed therapeutically.

4. PURPOSES
To promote comfort to the patient
To relieve pressure on various parts
To stimulate circulation
To provide proper body alignment
To carry out nursing intervention
To perform surgical and medical interventions
To prevent complications caused by immobility
To promote normal physiological functions

5. PRINCIPLES
Maintain good body mechanics
Wash hands before and after procedure
Ensure patient’s comfort
Obtain assistance as required
Ensure that mattress is firm and level of bed is at
working hide
Follow safety measures to prevent accidents
Follow the systematic and orderly way of doing
Use right technique at right time

6. ASSESSMENT
The team should assess the following prior to
positioning of the patient:
Procedure length
Surgeon’s/Doctor’s preference of position
Required position for procedure
Anesthesia to be administered
Patient’s risk factors
age, weight, skin condition, mobility/limitations,
pre-existing conditions, etc.
Patient’s privacy and medical needs
Basics of anatomy & physiology

7. OVERVIEW
RN must be aware of the anatomic and physiologic changes
associated with anesthesia, patient positioning, and the
procedure.
The following criteria should be met to prevent injury from
pressure, obstruction, or stretching:
No interference with respiration
No interference with circulation
No pressure on peripheral nerves
Minimal skin pressure
Accessibility to operative site
Accessibility for anesthetic administration
No undue musculoskeletal discomfort
Maintenance of individual requirements

8. TEAM RESPONSIBILITIES
Physician:
-Optimal procedural exposure
Anesthesia:
-Physiologic requirements (A-B-C’s)
-Position timing
Nursing:
-Safe transfer using adequate personnel
-Use of adequate padding and
positioning aids
-Provide an ongoing assessment

9. POSITIONING A PATIENT FOR
EXAMINATION OR TREATMENT

10. I. Supine/Horizontal Recumbent Position

11. 1. SUPINE POSITION
The patient lies on his back with his head and
shoulders are slightly elevated
Indication
Usual position
Examination of the chest and abdomen
PURPOSE
To provide comfort to the patient.
To perform physical examination.
To check vitals.
During surgical procedures and post operatively.

12. PROCEDURE
Place the patient on back with one pillow under
the head, arms and hands at the sides, knees
flexed and separated.
Place the air ring under the hips and cotton or
foam pads under the heels to reduce the pressure.
Place footboard under bottom of feet.
If the patient is a paralyzed, place hand role in
hand.
Align the patient’s body in good position.

13. AIR BAGS FOOT BOARD

14. SUPINE CONCERNS
Greatest concerns are circulation and pressure points
Most Common Nerve Damage:
o Brachial Plexus: positioning the arm >90*
o Radial and Ulnar: compression against the OR bed,
metal attachments, or when team members lean
against the arms during the procedure
o Peroneal and Tibial: Crossing of feet and plantar
flexion of ankles and feet
Vulnerable Bony Prominences:
(due to rubbing and sustained pressure)
Occiput, spine, scapula, Olecranon, Sacrum,
Calcaneous

15. 2. PRONE POSITION

16. 2. PRONE POSITION
Position in which the patient lies on the abdomen
with the head turned to one side with one small
pillow under the ankle.
Indications
Post operatively.
Patient with pressure sores, burns, injuries and
operations on the back.
To relieve abdominal distension.

17. CONTD..
Indications..
Renal biopsy.
Examine the back and spine.
Assess posterior thorax.
For patients after 24 hours of amputation of lower
limbs
Contraindications:
An unconscious patient or one with an abdominal
incision or breathing difficulty.

18. PROCEDURE
Explain the procedure
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
Place both arms at the side of the head and support
arm in flexed position at level of shoulder.
Support lower legs with pillows to elevate toes.
If needed place a pillow under the abdomen.

19. PRONE CONCERNS
Greatest concerns are to the respiratory and circulatory
systems and pressure points
Most Common Nerve Damage:
o Brachial, radial, median, ulnar
Vulnerable Bony Prominences:
o Temporal, acromion, clavicle, iliac
Vulnerable Vessels:
o Carotid, aorta, vena cava, saphenous
Susceptible to hyperextension of
the joints

20. 3. DORSAL RECUMBENT POSITION

21. 3. DORSAL RECUMBENT POSITION
Patient lies on back, knees fully flexed, thighs
flexed and externally rotated, feet flat on the bed.
 In this position clients with painful disorders are
more comfortable with knees flexed.
This position should not be used for abdominal
assessment because it promotes contraction of
abdomen muscles.

22. INDICATIONS
It is used for catheterization, vaginal douche,
vulval, vaginal and rectal examination
It is also used for vaginal operations and insertion
of tampons
For rectal temperature
For perineal care

23. PROCEDURE
Place the patient on back in bed with two or more
pillows under the head for patient’s comfort.
Place the air ring under the hips and cotton rings or
foam pads under the heels to reduce pressure.

24. 4. LATERAL POSITION

25. 4. LATERAL POSITION
The client lies on the side with weight on hip and
shoulder or the patient lies on his side with both arms
forward and his knees and hips flexed.
Here the head, neck and back is in straight line.
The upper leg is flexed more than the lower leg.
The upper knee and hip should be at the same level.
A pillow is given under the head, back and front to
support the arms and abdomen.
A small pillow is given in between the knees.

26. INDICATIONS
Patients who requires periodic position changes
In immediate post-operative patients
Used for examination of perineum and rectum.
Inserting rectal suppositories and flatus tube.
For taking rectal temperature.
Giving back care
For giving enema and colonic irrigation.

27. PROCEDURE
Explain the procedure
Provide privacy
Lower the head of bed as low as patient can tolerate.
Position the patient to side of bed
Turn the patient to one side

28. CONTD..
Place the air ring under the hips to reduce pressure in
trochanters and at the hip joints.
Position both arms in flexed position. Upper most arms
are supported by pillow on level with shoulder.
Place pillow under back
Place pillow under semi flexed upper leg at hip, from
groin to foot.
Place sand bag parallel to plantar surface of
dependent foot.

29. LATERAL CONCERNS
Greatest concerns are respiratory, circulatory, and
pressure points
Most Common Nerve Damage:
o Brachial, radial, median, ulnar, peroneal
Vulnerable Bony Prominences:
o Temporal, acromion, olecranon, iliac, greater
trochanter
Vulnerable Vessels:
o Carotid, axillary, brachial, aorta, vena cava, saphenous

30. 5. SIMS POSITION

31. 5. SIMS POSITION
In this position the client lies on either the right or
left side.
The lower arm behind the body and upper arm is
bent at the shoulder and elbow.
The knees are both bent, with the upper most leg
more acutely bent.
These positions similar to the lateral position except
that the patient’s weight is on the anterior aspect of
the patient’s shoulder girdle and hip.

32. INDICATIONS
Vaginal and rectal examination
Administration of enema and suppository
Used for relaxation in antenatal exercises
Position for sigmoidoscopy and protoscopy
Contraindication:
Patient with leg injuries or arthritis usually cannot
assume this position.

33. SIGMOIDOSCOPY
PROTOSCOPY

34. PROCEDURE
Explain the procedure to the patient
Provide privacy
Place the patient on the side
Place small pillow under head and neck
Place pillow under flexed upper arm, supporting arm
level with shoulder.
Place pillow under flexed upper leg, supporting leg level
with hip.
Place sand bags parallel to plantar surface of dependent
foot.

35. 6. LITHOTOMY POSITION

36. 6. LITHOTOMY POSITION
The client lies supine with hips flexed. The legs are
separated and thighs are flexed.
The patient’s buttocks are kept at the edge of the
table and legs are supported by stirrups.

37. INDICATIONS
For vaginal delivery of baby
For rectal examination & genitourinary surgeries
For vaginal examination & hysterectomy

38. PROCEDURE
Explain the procedure to the patient
Provide privacy
Position the patient to lie on his back with one pillow
under the head
Keep the legs well separated and the thighs well
flexed on the abdomen and the legs on the thighs
Buttocks are kept on the edge of the table and the
legs are supported on stirrups

39. TYPES OF LITHOTOMY
High Lithotomy Low Lithotomy

40. LITHOTOMY CONCERNS
Particular attention needs to be given to
the popliteal space behind the knee where
the legs rest in the stirrups

41. 7. FOWLER’S POSITION

42. 7. FOWLER’S POSITION
It is a sitting position in which the head is elevated
at 45˚ to 60˚, and the client knees are slightly
elevated, avoiding pressure on the popliteal
vessels.
Backrest and two pillows are used for the back and
head. Pillows can be used to maintain natural
alignment of the hands wrist and forearms.

43. TYPES OF
FOWLER’S

44. TYPES OF FOWLER’S

45. INDICATIONS
To relieve dyspnea
To improve circulation
To relax the muscles of the abdomen, back and
thighs.
To relieve tension on abdominal stature.

46. PROCEDURE
Explain the procedure
Elevate the head of the bed
Rest the head against mattress or small pillow.
Use pillow to support arm.
Place a small pillow at lower back.
Place foot board at bottom of patient’s feet.
Place the patient in sitting position with arms at sides
and knees raised with pillow.

47. 8. TREDLENBERG POSITION

48. 8. TREDLENBERG POSITION
The patient is placed in the supine position while
the OR bed is modified to a head-down tilt of 35 to
45 degrees resulting in the head being lower than
the pelvis
Arms are in a comfortable position – either at the
side or on bilateral arm boards

49. INDICATION
Used in emergency situations like shock,
hemorrhage and hypotension
Postural drainage
Patients with deep vein thrombosis

50. PROCEDURE
Explain the procedure to patient
Place the patient in supine position
Lower the head end of the bed or if it is not
adjustable type, use bed block at foot end and tilt
entire frame of bed down. OR elevate the foot
end at 45˚angle.
The patient is carefully supported to prevent
from slipping.

51. TRENDELENBURG
CONCERNS
Lung volume is decreased
The pressure of the organs against the
diaphragm mechanically compresses the heart

52. REVERSE
TRENDELENBURG
The entire 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

53. 9. KNEE CHEST POSITION

54. 9. KNEE CHEST POSITION
The patient rests on the knees and the chest.
The body is at 90˚ angle to the hips with back
straight, the arm above the head or kept at both
sides, and the head turned to one side.
The abdomen remains unsupported.

55. INDICATIONS
Used for vaginal and rectal examination
Used in first aid treatment in cord prolapse or
retroverted uterus
As exercise for postpartum and gynecology
patients.

56. PROCEDURE
Explain the procedure to the patient
Make the patient rest on the knees and chest
The head is turned to one side with the cheek on
a pillow.
The arm should be extended on the bed and
flexed at the elbows to support the patient
partially.

57. 10. ORTHOPNEIC POSITION

58. 10. ORTHOPNEIC POSITION
High fowler’s position with over bed table to be
placed across the front of the patient.
Patient to rest both hands on over bed table/on
pillow placed in it and leans forward.
Leaning forward facilitates respiration by
allowing maximum chest expansion by reducing
pressure of abdominal organs on diaphragm.

59. INDICATIONS
Patients with severe dyspnea
Cardiac patients
Position for thoracocentesis
Patient with chest drainage tubes

60. 11. JACKKNIFE (KRASKE)
POSITION

61. 11. JACKKNIFE POSITION
PROCEDURE:
Modification of the prone position
The patient is placed in the prone position on the OR
bed and then inverted in a V position
The hips are over the center break of the OR bed
between the body and leg sections
Hips are supported on a pillow and the table are flexed
at 90 degree, raising the hips and lowering head and
body
A strap is used over the thigh to prevent shearing and
sliding

62. CONTIN..
 Chest rolls are placed to raise the chest
 Arms are extended on angled arm boards with the elbows
flexed and the palms down
 The head, face and shoulders are supported by soft
pads/pillows
 A pillow is placed under the ankles to free the feet and toes of
pressure
Indications:
 Used in gluteal and anorectal procedures and examination.
 Common position for hemorrhoidectomy and pilonidal sinus
procedures

63. EFFECTS OF POSITIONING - OBESE
PATIENTS
Supine:
 Normal blood flow may be impeded due to compression
of vena cava and aorta by abdominal contents
 Impairs diaphragmatic movement and reduces lung
capacity
Trendelenburg:
 Tolerated less well than supine
 Added weight of abdominal contents on the diaphragm
may lead to atelectasis and hypoxemia
Prone:
 Problematic
 Requires additional support and monitoring of the
patient and pressure on the abdomen
 Ventilation may be markedly more difficult

64. EFFECTS OF POSITIONING - OBESE
PATIENTS
 Lateral:
 Well tolerated
 Correct sizing and placement of axillary roll is important
 Ensure that pendulous abdomen does not hang over side of
OR bed
 Head-Up: (Reverse Trendelenburg/Semi-recumbent)
 Most safe
 Weight of abdominal contents unloaded from diaphragm
 Use of well-padded footboard to prevent sliding

65. DOCUMENTATION

66. Documentation should include:
 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

67. DON’T FORGET:
 Good positioning starts with an assessment
 Prevent health team members from leaning against patients
 Arm board pads should be level with table pads
 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

68. ONE LAST NOTE…
Positioning problems can result
in significant injuries and
successful lawsuits.