Patient Positioning:

Complete Guide for

Nurses
What is Patient Positioning?
►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.
►In surgery, specimen collection, or other
treatments, proper patient positioning provides
optimal exposure of the surgical/treatment site and
maintenance of the patient’s dignity by controlling
unnecessary exposure.
►In most settings, positioning patients provide
airway management and ventilation, maintaining
body alignment, and provide physiologic safety.
 Goals of Patient Positioning
►Provide patient comfort and safety. Support the patient’s airway and
maintain the circulation throughout the procedure (e.g., in surgery, in
examination, specimen collection, and treatment).
► Impaired venous return to the heart, and ventilation-to-perfusion
mismatching are common complications. Proper positioning promotes
comfort by preventing nerve damage and by preventing unnecessary
extension or rotation of the body.
►Maintaining patient dignity and privacy. In
surgery, proper positioning is a way to respect
the patient’s dignity by minimizing exposure
of the patient who often feels vulnerable
perioperatively.
 ►Allows maximum visibility and
access. Proper positioning allows ease of
surgical access as well as for anesthetic
administration during perioperative phase.
Guidelines for Patient Positioning
►Explain the procedure. Provide explanation to the
client on why his or her position is being changed
and how it will be done. Rapport with the patient
will make them more likely to maintain the new
position.
 ►Encourage client to assist as much as
possible. Determine if the client can fully or
partially assist. Clients that can assist will save
strain on the nurse. It will also be a form exercise,
increase independence, and self-esteem for the
client.
►Get adequate help. When planning to move
or reposition the client, ask help from other
caregivers. Positioning may not be a one-
person task.
►Use mechanical aids. Bed boards, slide
boards, pillows, patient lifts and slings
can facilitate ease of changing positions
►Raise client’s bed. Adjust or reposition
the client’s bed so that the weight is at
the level of the nurse’s center of gravity.
►Frequent position changes. Note
that any position, correct or
incorrect, can be detrimental to
the patient if maintained for a long
period. Repositioning the patient
every 2 hours helps prevent
complications like 
pressure ulcers and skin
breakdown.
►Avoid friction and shearing.
When moving patients, lift
rather than slide to prevent
friction that can abrade the skin
making it more prone to skin
breakdown.
Common Patient
Positions
 Supine or Dorsal Recumbent Position

►Supine position, or dorsal

position, is wherein the
patient lies flat on the back
with head and shoulders
slightly elevated using a
pillow unless contraindicated
(e.g., spinal anesthesia, spinal
surgery)
► Variation in position. In ► Watch out for skin breakdown. Supine
supine position, legs may be position may put patients at risk for
extended or slightly bent with pressure ulcers and nerve damage.
Assess for skin breakdown and pad
arms up or down. It provides bony prominences.
comfort in general for
► Support for supine position. Small
patients under recovery after pillows may be placed under the head
some types of surgery. to and lumbar curvature. Heels must be
► Most commonly used protected from pressure by using a
position. Supine position is pillow or ankle roll. Prevent prolonged
used for general examination plantar flexion and stretch injury of the
feet by placing a padded footboard.
or physical assessment.
►Supine position in surgery. Supine is frequently
used on procedures involving the anterior surface
of the body (e.g., abdominal area, cardiac,
thoracic area). A small pillow or donut should be
used to stabilize the head, as extreme rotation of
the head during surgery can lead to occlusion of
the vertebral artery.
 Dorsal Recumbent Position
►In dorsal recumbent position, legs are
slightly bent with arms up or down. It
provides comfort in general for patients
under recovery after some types of
surgery.
►Examination of the abdomen, vaginal,
or rectal area. Gown is opened in the
front. both feet should be flat on the
table.
Fowler’s Position

►Fowler’s position, also known as semi-

sitting position, is a bed position wherein
the head of the bed is elevated 45 to 60
degrees. Variations of Fowler’s position
include: low Fowler’s (15 to 30 degrees),
semi-Fowler’s (30 to 45 degrees), and high
Fowler’s (nearly vertical
►Promotes lung expansion. ►Prepare for walking.
Fowler’s position is used for Fowler’s is also used to
patients who have difficulty prepare the patient for
breathing because in this dangling or walking. Nurses
position, gravity pulls the should watch out for
diaphragm downward allowing dizziness or faintness during
greater chest and lung change of position.
expansion.
►Useful for NGT. Fowler’s
position is useful for
patients who have cardiac,
respiratory, or neurological
problems and is often
optimal for patients who
have nasogastric tube in
place.
 ►Poor neck
alignment. Placing an
overly large pillow behind ►Used in some surgeries.
the patient’s head may Fowler’s position is
promote the development of usually used in surgeries
neck flexion contractures. that involve neurosurgery
Encourage patient to rest or the shoulders
without pillows for a few
hours each day to extend
the neck fully.
►Use a footboard. Using a footboard
is recommended to keep the patient’s
feet in proper alignment and to help
prevent foot drop.
►Etymology. Fowler’s position is
named after George Ryerson Fowler
who saw it as a way to decrease
mortality of peritonitis.
Orthopneic or Tripod Position

►Orthopneic or tripod position

places the patient in a sitting
position or on the side of the bed
with an overbed table in front to
lean on and several pillows on
the table to rest on.
 ►Maximum lung ►Helps in exhaling. Orthopneic
expansion. Patients who position is particularly helpful
are having difficulty to patients who have problems
breathing are often placed exhaling because they can press
in this position because it the lower part of the chest
allows maximum expansion against the edge of the overbed
of the chest. table.
Prone Position

►In prone position, the

patient lies on the
abdomen with head
turned to one side and
the hips are not flexed.
► Extension of hips and ► Contraindicated for spine
knee joints. Prone problems. The pull of gravity on
position is the only bed the trunk when the patient lies prone
position that allows full produces marked lordosis or
extension of the hip and forward curvature of the spine thus
knee joints. It also helps to contraindicated for patients with
prevent flexion spinal problems. Prone position
should only be used when the
contractures of the hips
client’s back is correctly aligned.
and knees.
►Drainage of secretions. Prone ► Placing support in prone. To
position also promotes support a patient lying in
drainage from the mouth and prone, place a pillow under
useful for clients who are the head and a small pillow or
unconscious or those recover a towel roll under the
from surgery of the mouth or abdomen.
throat. ► In surgery. Prone position is
often used for neurosurgery,
in most neck and spine
surgeries.
Lateral Position
►In lateral or side-lying position, the patient lies on one side
of the body with the top leg in front of the bottom leg and
the hip and knee flexed. Flexing the top hip and knee and
placing this leg in front of the body creates a wider,
triangular base of support and achieves greater stability.
Increase in flexion of the top hip and knee provides greater
stability and balance. This flexion reduces lordosis and
promotes good back alignment.
►Relieves pressure on the 
sacrum and heels. Lateral
position helps relieve pressure
on the sacrum and heels
especially for people who sit
or are confined to bed rest in
supine or Fowler’s position.
►Body weight distribution. In this position, most of the
body weight is distributed to the lateral aspect of the
lower scapula, the lateral aspect of the ilium, and the
greater trochanter of the femur.
►Support pillows needed. To correctly position the
patient in lateral position, use of support pillows are
needed.
Sims’ Position

►Sims’ position or semi prone position is when the patient

assumes a posture halfway between the lateral and the
prone positions. The lower arm is positioned behind the
client, and the upper arm is flexed at the shoulder and the
elbow. The upper leg is more acutely flexed at both the
hip and the knee, than is the lower one.
 ►Prevents aspiration of
fluids. Sims’ may be used for
unconscious clients because
it facilitates drainage from
the mouth and prevents 
aspiration of fluids
►Reduces lower body pressure. It is also used for paralyzed
clients because it reduces pressure over the sacrum and
greater trochanter of the hip.
►Perineal area visualization and treatment. It is often used
for clients receiving enemas and occasionally for clients
undergoing examinations or treatments of the perineal area.
►Pregnant women comfort. Pregnant women may find the
Sims position comfortable for sleeping.
►Promote body alignment with pillows. Support proper
body alignment in Sims’ position by placing a pillow
underneath the patient’s head and under the upper arm to
prevent internal rotation. Place another pillow between
legs.
Lithotomy Position
►Lithotomy is a patient
position in which the
patient is on their back
with hips and knees flexed
and thighs apart.
►Lithotomy position is
commonly used for vaginal
examinations and
childbirth.
►Modifications of the ► Low Lithotomy Position: The patient’s
lithotomy position include hips are flexed until the angle between the
low, standard, high, hemi, posterior surface of the patient’s thighs
and exaggerated based on and the O.R. bed surface is 40 degrees to
60 degrees. The patient’s lower legs are
how high the lower body is
parallel with the O.R. bed.2
raised or elevated for the
► Standard Lithotomy Position: The
procedure. Please check with patient’s hips are flexed until the angle
your facility’s guidelines but between the posterior surface of the
typically: patient’s thighs and the O.R. bed surface
is 80 degrees to 100 degrees. The
patient’s lower legs are parallel with the
O.R. bed.
►Hemilithotomy Position: The patient’s non-operative leg is
positioned in standard lithotomy. The patient’s operative leg may be
placed in traction.
►High Lithotomy Position: The patient’s hips are flexed until the
angle between the posterior surface of the patient’s thighs and the
O.R. bed surface is 110 degrees to 120 degrees. The patient’s lower
legs are flexed.
►Exaggerated Lithotomy Position: The patient’s hips are flexed
until the angle between the posterior surface of the patient’s thighs
and the O.R. bed surface is 130 degrees to 150 degrees. The patient’s
lower legs are almost vertical.
 Trendelenburg’s Position
►Trendelenburg’s position involves ►Postural drainage.
lowering the head of the bed and Trendelenburg’s position is
raising the foot of the bed of the used to provide postural
patient. The patient’s arms should be drainage of the basal lung lobes.
tucked at their sides Watch out for dyspnea, some
►Promotes venous return. Hypotensive patients may require only a
patients can benefit from this position moderate tilt or a shorter time in
because it promotes venous return. this position during postural
drainage. Adjust as tolerated.
 Reverse Trendelenburg’s Position
► Reverse Trendelenburg’s is a patient
position wherein the head of the bed
is elevated with the foot of the bed
down. It is the opposite of
Trendelenburg’s position.
► Gastrointestinal
problems. Reverse trendelenburg is
often used for patients with
gastrointestinal problems as it helps
minimize esophageal reflux.
►Prevent rapid change of position. Patients with
decreased cardiac output may not tolerate rapid
movement or change from a supine to a more erect
position. Watch out for rapid hypotension. It can be
minimized by gradually changing the patient’s
position.
►Prevent esophageal reflux. Promotes stomach
emptying and prevents reflux for clients with hiatal
hernia.
Knee-Chest Position
►Knee-chest position, can be in lateral or
prone position. In lateral knee-chest
position, the patient lies on their side,
torso lies diagonally across the table, hips
and knees are flexed. In prone knee-chest
position, the patient kneels on the table
and lower shoulders on to the table so
chest and face rests on the table
►Two ways. Knee-chest position can be lateral or prone.
►Sigmoidoscopy. Usual position adopted for
sigmoidoscopy without anesthesia.
►Patient dignity. Prone knee-chest position can be
embarrassing for some patients.
►Gynecologic and rectal examinations. Knee-chest
position is assumed for a gynecologic or rectal
examination.
Jackknife Position
►In surgery, Jackknife position
is frequently used for surgeries
►Jackknife position, also involving the anus, rectum,
known as Kraske, is coccyx, certain back surgeries,
wherein the patient’s and adrenal surgery.
abdomen lies flat on the ►Requires team effort. At least
bed. The bed is scissored four people are required to
so the hip is lifted and the perform the transfer and
legs and head are low. position the patient in the
operating table.
►Cardiovascular effects. In
jackknife position, compression
of the inferior vena cava from
abdominal compression also
occurs, which decreases venous
return to the heart. This could
increase the risk for deep vein
thrombosis.
►Support paddings. Many pillow are required
on the operating table to support the body and
reduce pressure on the pelvis, back, and the
abdomen. Jackknife position also puts
excessive pressure on the knees. While
positioning, surgical staff should put extra
padding for the knee area.
Kidney Position
►In kidney position, the patient assumes a modified lateral position
wherein the abdomen is placed over a lift in the operating table
that bends the body. Patient is turned on their contralateral side
with their back placed on the edge of the table. Contralateral
kidney is placed over the break in the table or over the kidney
body elevator (if attachment is available). The uppermost arm is
placed in a gutter rest at no more than 90º abduction or flexion.
►Right lateral kidney position
►Access to retroperitoneal ►Padding and stabilization support.
area. Kidney positions allows Contralateral arm underneath the
access and visualization of the body is protected with padding.
retroperitoneal area. A kidney Contralateral knee is flexed and the
rest is placed under the patient uppermost leg is left straight to
at the location of the lift. improve stability. A large soft pillow
is placed in between the legs.
►Risk for falls. Patient may fall
Kidney strap and tape are placed
off the table at any time until over the hip to stabilize the patient.
the position is secured.
 Support Devices for Patient Positioning

► Bed Boards. Bed boards are plywood boards

that are placed under the entire surface area of
the mattress and are useful for increasing back
support and body alignment.
► Foot Boots. Foot boots are shoes made of
rigid plastic or heavy foam and keep the foot
flexed at the proper angle. It is recommended
that they should be removed 2 to 3 times a
day to assess the skin integrity and joint
mobility.
►Hand Rolls. Hand rolls maintain the
fingers in a slightly flexed and
functional position and keep the thumb
slightly adducted in opposition to the
fingers.
►Hand-Wrist Splints. These splints are
individually molded for the client to
maintain proper alignment of the
thumb in a slight adduction and the
wrist in slight dorsiflexion.
► Pillows. Pillows provide support,
elevate body parts, splint incision areas,
and reduce postoperative pain during
activity, coughing or deep breathing.
They should be of the appropriate size
for the body to be positioned.
► Sandbags. Sandbags are soft devices
filled with substance that can be used to
shape or contour to the body’s shape
and provide support. They immobilize
extremities and maintain specific body
alignment.
► Side Rails. Side rails are bars along the sides of the
length of the bed. They ensure client safety and are useful
for increasing mobility. They also provide assistance in
rolling from side to side or sitting up in bed. Check with
your agencies policies regarding the use of side rails as
they vary state to state.
► Trochanter Rolls. These rolls prevent external rotation
of the legs when the client is in the supine position. To
form a roll, use a cotton bath blanket or a sheet folded
lengthwise to a width extending from the greater
trochanter of the femur to the lowest border of the
popliteal space.
► Wedge Pillows. Are triangular pillows made of heavy
foam and are used to maintain legs in abduction
following total hip replacement surgery.