This document discusses positioning and pressure relief techniques to prevent decubitus ulcers. It notes that 95% of pressure ulcers occur over 5 bony areas and lists positioning considerations for various diagnoses. Positions like supine, prone, side-lying are described along with how to pad and support the body. It emphasizes repositioning patients every 2 hours in bed and every 15 minutes when sitting to relieve pressure on high-risk areas.

1. PTHA 1405
Basic Patient Care
DRAPING AND POSITIONING

2. Basic Patient Care
Decubitus
 Decubitus (pressure sore)- ulceration of soft tissue
caused by unrelieved pressure and/or shearing
forces.
 Shearing forces- the forces applied to the movement
of tissues away from skin held in place by friction.
Pressure ulcers are most commonly found over
boney prominences subject to external
pressures.

3. Basic Patient Care
Decubitus Prevention
 95 % of all pressure sores are located over 5
locations: sacrum, heels, greater trochanters, lateral
malleolus, and ischial tuberosity.

4. Basic Patient Care
Pressure Locations
Supine Prone Side-lying Sitting
Occipital Forehead Lateral ear Ischial tuberosity
tuberosity
Spine of scapula Lateral ear Lateral ribs Spine of scapula
Inferior angle of ASIS Medial eipcondyle Inferior angle of
the scapula scapula
Medial epicondyle Humeral head Greater trochanter Medial epicondyle
Spinous processes Patella Medial condyle Spinous process
Posterior iliac Anterior tibia Lateral malleolus
crest
Sacrum Dorsum of foot Medial malleous
Greater trochanter
Head of fibula
Heels
Lateral malleolus

5. Basic Patient Care
Positioning
 Positioning should be tailored to the patient’s needs
 Positioning should prevent skin breakdown
 Prevent soft tissue / joint contractures
 Support the trunk and extremities
 Promote efficient function of organ systems
 Encourage awareness of affected side (CVA, TBI)
 Provide access to treatment area
 Provide patient comfort (with a few exceptions)

6. Basic Patient Care
Positioning
Position Description
Fowler Supine with head of bed elevated
between 45 and 60 degrees
Semi-Fowler Supine with head of bed elevated to 30
degrees
Trendelenburg Head down with trunk and LE elevated
Supine Lying on back
Semi-supine Upper and/ or lower body ½ way
between supine and side lying
Side lying On left or right side
Prone Lying on belly
Semi-prone Upper and/ or lower body ½ way
between prone and sidelying

7. Basic Patient Care
Positioning
 Supine
 Place pillow under the patient’s head
 Place pillow under popliteal fossas to maintain a moderate
lumbar lordosis
 Place a small towel under the posterior anterior ankles to
relieve pressure on calcaneus, but avoid knee hyperextension.

8. Basis Patient Care
Positioning
 Prone
 Place pillow under the patient’s head or place a towel role
under the forehead
 Place a pillow under the lower chest or abdomen (with a few
exceptions)
 Place a pillow under anterior ankles

9. Basic Patient Care
Positioning
 Side-lying
 Place pillow under the patient’s head
 Place a pillow under the uppermost UE
 Place pillow under the uppermost LE (between knees and
ankles)
 Place pillow along posterior trunk to prevent patient from
rolling back

10. Basic Patient Care
Positioning for Specific Diagnosis
Diagnosis Positioning considerations
Respiratory-Orthopenea Difficulty breathing in any position
except an erect position. Fowler, Semi-
Fowler, 2 plus Pillows
Respiratory- COPD Fowler, Semi-Fowler
Respiratory- Tracheotomy Avoid Prone
Cardiovascular-venous insufficiency Elevate the involved extremity
Cardiovascular- Arterial insufficiency Place involved extremity in flat of
dependant position
Pregnancy Avoid prolonged lying on right side and
supine during 3rd trimester to avoid
pressure on the vena cava

11. Basic Patient Care
Positioning
Neurological- CVA Support affected shoulder to
avoid subluxation
Maintain neutral wrist and finger
alignment
Maintain neutral ankle alignment
to avoid PF contracture
Amputation-AKA Avoid prolonged hip flexion
Recommend periodic prone positoning
Amputation-BKA Avoid prolonged hip and knee flexion
Burns and Grafts -Avoid positions of comfort
-Stress and tension of the healing tissue
is necessary for healing and function
-Avoid direct pressure on graft sites

12. Basic Patient Care
Pressure Relief
 In bed – the patient should be or encourage to
reposition every 2 hours. Positions should be
alternated.
 Sitting- Patients in wheelchairs should perform
pressure relief every 15 minutes for 15-30 seconds
each time. Patients that are unable to perform
pressure relief should be assisted and or have
equipment at assist repositioning. Example tilt in
space wheelchair

13. Basic Patient Care
Positioning

14. Basic Patient Care
Pressure Relief Techniques
WC push up
Forward lean
Sideways lean

15. Basic Patient Care
 Questions???