Positioning of Patients

Positioning a patient in bed is a common procedure in the hospital. There are various positions
possible for patients in bed, which may be determined by their condition, preference, or
treatment related to an illness. These are the positions:

 Supine position- Patient lies flat on back. Additional supportive devices may be added
for comfort.
 Prone position- Patient lies on stomach with head turned to the side.
 Lateral position- Patient lies on the side of the body with the top leg over the bottom leg.
This position helps relieve pressure on the coccyx.
 Sims position- Patient lies between supine and prone with legs flexed in front of the
patient. Arms should be comfortably placed beside the patient, not underneath.
 Fowler’s position- Patient’s head of bed is placed at a 45-degree angle. Hips may or may
not be flexed. This is a common position to provide patient comfort and care.
 Semi-Fowler’s position- Patient’s head of bed is placed at a 30-degree angle. This
position is used for patients who have cardiac or respiratory conditions, and for patients
with a nasogastric tube.
 Orthopneic or tripod position- Patient sits at the side of the bed with head resting on an
over-bed table on top of several pillows. This position is used for patients with breathing
difficulties.
 Trendelenburg position- Place the head of the bed lower than the feet. This position is
used in situations such as hypotension and medical emergencies. It helps promote venous
return to major organs such as the head and heart.
 High-Fowlers- Head of body 60-90° with the patient sitting up in bed.
 Reverse Trendelenburg-Flat on back, head raised higher than feet by 15-30°.
 Purpose of positioning

 High-Fowlers- During episodes of respiratory distress, when inserting a nasogastric tube,

during oral intake with feeding precautions.
 Fowler’s- Facilitates chest expansion so it is helpful with patients who are having
difficulty breathing, during tube feeding administration because it facilitates peristalsis
while minimizing aspiration risk, simply a comfortable position, also used in the
postpartum period to facilitate excretion of lochia.
 Semi Fowler’s- Necessary in some neurological and cardiac conditions, after procedures
or surgeries to facilitate hemostasis at the insertion site (like a cardiac catch with a
femoral approach) or drainage from various drains.
 Supine- Post procedures to maintain hemostasis at insertion site, frequent position for
many surgeries.
 Prone- Not used frequently; use as a therapeutic measure in advanced acute respiratory
distress, during and after some surgeries.
 Trendelenburg- During CVC (subclavian or IJ) placement, if an air embolism is
suspected as it traps air in the right ventricle, when positioned this way with a Valsava it
can convert supraventricular tachycardia, during various surgeries, respiratory distress to
increase perfusion.
 Reverse Trendelenburg- For some surgeries or procedures, pre-surgery intervention for
some vascular surgeries, may be used to facilitate respirations in patients who need to lay
flat post-procedure, reduces gastroesophageal reflux disease symptoms.
 Dorsal recumbent- During or after various surgeries, for comfort.
 Lateral- Relieves pressure on sacrum, great for patients who are immobile as it is
typically quite comfortable and provides good spine alignment, supporting and off-
loading common pressure points.
 Sim’s- Occasionally used with unconscious patients as it facilitates drainage of oral
secretions, pregnancy, during enemas, for patients who are paralyzed as it takes pressure
off of the hip and sacrum.
 Orthopneic- Facilitates respiratory expansion, makes it easier to breath in patients with
respiratory difficulty and used during a thoracentesis.