Positioning in Nursing

Patient positioning involves properly maintaining a patient’s neutral body

alignment by preventing hyperextension and extreme lateral rotation to prevent
complications of immobility and injury. Positioning patients is an essential aspect
of nursing practice and a responsibility of the registered nurse.

Importance of positioning:
Proper positioning of the patient can facilitate access to anatomical locations
during surgical procedures and promote appropriate physiologic function during
pathologic states, for example, the Trendelenburg position to increase the venous
return in a hypovolemic patient.

Causes of improper positioning:

Prolonged obstruction of breathing, blood flow, or electrochemical impulses of
nerve pathways can result in temporary or permanent injuries known as “surgical
positioning injuries.”

Types of positioning:
1. Fowler's Position
2. High Fowler's Position
3. Supine Position
4. Jackknife Position
5. Kidney Position
6. Prone Position
7. Lithotomy Position
8. Sim's Position
9. Lateral Position
10.Trendelenburg Position
11.Reverse Trendelenburg Position
Here some of its types are given below:

1. Fowler's Position:
It is typically used for neurosurgery and shoulder surgeries. The beach chair
position is often used for nasal surgeries, abdominoplasty, and breast
reduction surgeries.
When positioning a patient in Fowler's position, the surgical staff should
minimize the degree of the patient's head elevation as much as possible and
always maintain the head in a neutral position. The patient's arms should be
flexed and secured across the body, the buttocks should be padded, and the
knees flexed 30 degrees. In Fowler's position, the patient is at an increased risk
for air embolism, skin injury from shearing and sliding, and DVT forming in the
patient's lower extremities. In this type of position, a patient has an increased
pressure risk in their scapulae, sacrum, coccyx, ischium, back of knees, and
heels.2,3
Figure:
Prone Position:
The Prone position is a patient position used during surgical procedures that
provide surgical access to the dorsal aspects of the patient’s body.1 In the prone
position, the patient is positioned face-down with their head in a neutral position
without excessive flexion, extension, or rotation. The patient’s arms should be
abducted less than 90 degrees with the elbows flexed and palms down to
maintain neutral alignment of the arms and wrists. Some common procedures
that are performed while the patient is in the prone position include spine and
neck surgeries, neurosurgeries, colorectal surgeries, vascular surgeries, and
tendon repairs.1,2

Figure:

Supine position:
In supine position, the patient is face up with their head resting on a pad
positioner or pillow and their neck in a neutral position. The patient’s arms,
maintained in a neutral thumb-up or supinated position, may be tucked at their
sides or abducted to less than 90 degrees on armboards.2

Supine
Right Lateral Recumbent:
The lateral position is used for surgical access to the thorax, kidney,
retroperitoneal space, and hip. Depending on the side of the body on
which the patient is being operated, the patient will lie on their left or right
side. Before being placed in the lateral position, the patient is induced in
the supine position.
Left Lateral Recumbent:
In the left lateral position, the patient lies on the left side of their body
for a surgical procedure on their right side. For surgery on the left side
of their body, the patient lies on the right side.
Trendelenburg position:
The Trendelenburg position is a position for a patient on the operating
table, most commonly used during lower abdominal surgeries and central
venous catheter placement. In Trendelenburg position, the patient is
supine on the table with their head declined below their feet at an
angle of roughly 16°.
Figure: