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Positioning / Draping

Amanda LaLonde, PT, DPT, GCS


PT 6280
Ch. 6-7 in text
Objectives
 Understand the purpose of draping and
positioning
 Demonstrate correct draping techniques

 Identify properly supported patient


position for supine, sidelying, and prone
 Understand supported positioning for
sitting in a w/c
 Understand the complications of improper
long-term positioning
Key Terms
 Draping
– The covering of patients to only expose only the
body parts needed for treatment
 Contracture
– Shortening or tightening of the skin, muscle,
fascia and/or joint capsule
– Prevents normal movement
 Shear
– A force that causes an opposite, but parallel
sliding motion of the planes of an object
 Spasticity
- A form of hypertonicity
- Gradual increase in resistance to movement
Short-Term Positioning
 Safety
 Safe, protected, non-restrictive position
 Comfort
 Maintain spinal alignment
 PT Access
 Position so intervention can be
performed
Short-Term Positioning
Checklist:
 Isthe patient safe?
 Do they have good alignment?

 Are the necessary areas accessible


(and only the necessary areas)?
 Are the trunk and extremities
supported for comfort?
Treatment Preparation
 Gather needed items ahead of time
 Linen, pillows, modalities
 Prepare the treatment table
 Minimal adjustment after the patient gets on
the table
 Drapeareas not needed to be
exposed
 Inform your patient
Preparation of the Table

 Materials needed
– 2 full sized sheets
– 2 pillows and pillow cases
– 2 towels
Table Preparation, cont.
– Place one full size sheet (folded
lengthwise) on plinth
– Place a towel at each end of table
– Place a folded sheet on the table to be
used as a drape
– Have additional pillows, towels,
blankets, etc. ready
Preparation of the Patient:
– Instruct the patient in what they are to
take off
 Provide gowns & a dressing room
– Tell the person how to position on the
table
 Easily understood terms
– Assist them as much as needed to
support weak or injured parts
 Help patient “keep their dignity”
Treatment Positioning in Supine
 Patient is straight & centered on mat
 Small pillow or towel roll
– Under the neck
– Underneath knees (could use a bolster)
– Under bilateral ankles
Treatment Positioning in Prone
 Centered on the mat with parallel shoulders and hips
 Face/Neck support
– Small roll under forehead
– Turn head to side
– Can use mat cut out
 Pillow underneath abdomen to decrease lordosis
 Towel roll under bilateral ankles
 Drape
Treatment Positioning in Sidelying
 Instruct patient to lie on back & roll onto their side
– Stand on side they are rolling toward
 Place one pillow under the head
 Move hip forward slightly to avoid pressure on the trochanter
 Place a pillow between the patient’s knees with the top leg in
slight flexion at the hip and the knee
 Place a pillow under the upper arm
 Drape
Draping
 Reposition

 Access a body part for treatment


 After completing treatment

Don’t forget about what is (or could


be) exposed during your treatment
ANTICIPATE
Long-Term Positioning
 Also called “Preventative Positioning”
 Objectives
– Prevent negative effects of long-term
immobility
 Safety:
Maintain open airways, avoid falls,
accommodate medical limitations
 Prevention:Prevent pressure ulcers, contractures,
edema and promote function of body systems
 Comfort: Normal alignment, and relieve jt stress
Assessing the Patient

– Level of consciousness
– Medical or surgical precautions
– Are they in pain
– Do they have a loss of sensation
– What is their muscular function
– Do they have spasticity or other abnormal
muscle tone
Assessing the Patient
– Amount of tissue to protect bony prominences
– Any bowel or bladder incontinence
– Can they assist
– Do they have contractures
 Acute (developing) or chronic
– Do they have edema, skin rashes, redness,
irritation, infection
Preventing Pressure Ulcers
 Lesion caused by unrelieved pressure
– Damage of the underlying tissue
 Healthy person should reposition in bed at
least every 2 hours
 Maximum repositioning time in sitting

– 15 minutes
 Patients who are medically unstable need
to be repositioned more frequently
High Risk Areas for Skin
Breakdown: Supine

Johansson & Chinworth text page 161

• Occiput
• Scapulae especially inferior angles
• Spinous processes
• Elbows
• Sacrum and coccyx
• Ischeal tuberosities
• Lateral malleoli (if hips are in external rotation)
• Heels
High Risk Areas for Skin
Breakdown: Sidelying

Johansson & Chinworth text page 162

• Ear
• Humeral head
• Hip/greater trochanter
• Lateral femoral condyle (underside of inferior leg)
• Medial femoral condyle (inside both knees)
• Medial malleoli (inside ankles of both legs)
High Risk Areas for Skin
Breakdown: Sitting
 Occiput (in a high back chair)
 Scapulae (inf. Angles)
 Spinous processes
 Elbows (when resting on
armrests)
 Sacrum and coccyx
 Ischial tuberosities
 Heels

Johansson & Chinworth text page 162


Precautions: Pressure Ulcers
– Avoid folded linens underneath a patient
 Remote, cell phone, pens, comb, bed pan,
syringe caps, pills, spirometers, pads, sheets,
soiled briefs, lines, food, drains . . . .
– Protect bony prominences
– Don’t position extremities off of surface
– Caution with
 Confusion
 Decreased sensation
 Poor circulation
 Altered consciousness
Preventing Contractures
 Without movement, stiffness occurs
Muscles, tendons & ligaments
 Physiological changes within a joint
cause stiffness
 Muscle in a shortened range

– Agonist has decrease in sarcomeres


– Adhesions form
– Antagonist becomes over-lengthened
Common areas for Contractures
 Supine & Sitting
– Shoulder flexion (and IR)
– Elbow flexion (wrist/finger flexion)
– Hip & knee flexion
– Hip adduction
– Ankle plantar flexors
Edema & Cardiopulmonary
Complications
 Return of fluid is facilitated by muscle
contractions
– Skeletal pumps
 Orthostatic Hypotension
 Deep vein thrombosis (DVT)

 Breathing
– With immobility air exchange is ↓
– Body must rely on gravity to drain moisture
from lungs
Long- Term Positioning: Supine
 Be able to call for assistance
 No active feeding tubes in
supine
 Be sure pt can breathe &
swallow
 Cushion head
 Shoulders & hips parallel
 Legs in neutral rot
 Hips in neutral flex
Johansson & Chinworth text page 166
 Knees extended
 Elevate/float heels
 Forearms supported
 Hands open
Long-Term Positioning: Sidelying
 Be able to call for assistance
 Airway clear
 Head cushioned
 Body aligned and centered on bed
 Rotate trunk slightly forward/underside hip forward
 Underside knee straight/top leg flexed
 Pillow between knees & ankles
 Upper arm abducted
 Underneath scapula int. rot. (protracted)
 Elbow straight
 Arm and hand supported
 Can tuck pillow behind the pt to maintain position
Long-Term Positioning: Sitting
 Means to call for
assistance
 Hips to back of the chair
 Lateral support
 Arms supported
 Hips centered
 Shoulders above hips
 Small lumbar support
 Weight distributed evenly
 Appropriate seat cushion
 Lower leg elevation as
needed
 Padding for additional
contact as needed
Special Considerations
 Total Hip Arthroplasty
– Posterior approach
 No hip flex beyond 90°
 Do not cross legs
 No IR past neutral
– Anterior approach
 No hip ext beyond neutral
 No hip adduction
 No hip ER past neutral
 After amputation
– Support the limb
– No pillows under the hip or knee- why?
 S/p stroke
– Position to promote protraction (scapula, pelvis)- why?
– Elevate and handle UE with care
Objectives Re-Visited
 Understand the purpose of draping and
positioning
 Demonstrate correct draping techniques

 Identify properly supported patient


position for supine, sidelying, and prone
 Understand supported positioning for
sitting in a w/c
 Understand the complications of improper
long-term positioning
Lab

 Revieweach of the scenarios


 Complete as therapist and patient

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