Patient Positioning:

Common Patient Positions

The following are the commonly used patient positions including a description on how they are
performed and the rationale:

Supine or Dorsal Recumbent Position

Supine position, or dorsal recumbent, 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).

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Supine position

● Variation in position. In supine position, legs may be extended or slightly bent with
arms up or down. It provides comfort in general for patients under recovery after some
types of surgery.
 ● Most commonly used position. Supine position is used for general examination or
physical assessment.
● Watch out for skin breakdown. Supine position may put patients at risk for pressure
ulcers and nerve damage. Assess for skin breakdown and pad bony prominences.
● Support for supine position. Small pillows may be placed under the head to and
lumbar curvature. Heels must be protected from pressure by using a pillow or ankle
roll. Prevent prolonged plantar flexion and stretch injury of the feet by placing a
padded footboard.
● 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.

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).

Fowler’s position has different variations.

 ● Promotes lung expansion. Fowler’s position is used for patients who have difficulty
breathing because in this position, gravity pulls the diaphragm downward allowing
greater chest and lung 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.
● Prepare for walking. Fowler’s is also used to prepare the patient for dangling or
walking. Nurses should watch out for dizziness or faintness during change of position.
● Poor neck alignment. Placing an overly large pillow behind the patient’s head may
promote the development of neck flexion contractures. Encourage patient to rest
without pillows for a few hours each day to extend the neck fully.
● Used in some surgeries. Fowler’s position is usually used in surgeries that involve
neurosurgery or the shoulders
● 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.
Orthopneic or tripod position is useful for maximum lung expansion.

● Maximum lung expansion. Patients who are having difficulty breathing are often
placed in this position because it allows maximum expansion of the chest.
● Helps in exhaling. Orthopneic position is particularly helpful to patients who have
problems exhaling because they can press the lower part of the chest against the edge
of the overbed table.

Prone Position
In prone position, the patient lies on the abdomen with head turned to one side and the hips
are not flexed.
Prone position is comfortable for some patients.

● Extension of hips and knee joints. Prone position is the only bed position that allows
full extension of the hip and knee joints. It also helps to prevent flexion contractures of
the hips and knees.
● Contraindicated for spine problems. The pull of gravity on the trunk when the
patient lies prone produces marked lordosis or forward curvature of the spine thus
contraindicated for patients with spinal problems. Prone position should only be used
when the client’s back is correctly aligned.
● Drainage of secretions. Prone position also promotes drainage from the mouth and
useful for clients who are unconscious or those recover from surgery of the mouth or
throat.
● Placing support in prone. To support a patient lying in prone, place a pillow under the
head and a small pillow or a towel roll under the abdomen.
● 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.

Lateral position.

● 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 semiprone 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.

Sims’ position

● 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.

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Lithotomy
position

● Lithotomy position is commonly used for vaginal examinations and childbirth.

● Modifications of the lithotomy position include low, standard, high, hemi, and
exaggerated based on how high the lower body is raised or elevated for the procedure.
Please check with your facility’s guidelines but typically:
o Low 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 40 degrees to 60 degrees. The patient’s lower legs are parallel with the O.R.
bed.2
o Standard 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 80 degrees to 100 degrees. The patient’s lower legs are parallel with the
O.R. bed.
o Hemilithotomy Position: The patient’s non-operative leg is positioned in
standard lithotomy. The patient’s operative leg may be placed in traction.
 o 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.
o 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 lowering the head of the bed and raising the foot of the bed
of the patient. The patient’s arms should be tucked at their sides

● Promotes venous return. Hypotensive patients can benefit from this position because
it promotes venous return.
● Postural drainage. Trendelenburg’s position is used to provide postural drainage of
the basal lung lobes. Watch out for dyspnea, some patients may require only a
moderate tilt or a shorter time in this position during postural drainage. Adjust as
tolerated.
Reverse Trendelenburg’s Position
Reverse Trendelenburg’s is a patient position wherein the 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.

Lateral knee-chest position. Can also be done prone.

● 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
Jackknife position, also known as Kraske, is wherein the patient’s abdomen lies flat on the bed.
The bed is scissored so the hip is lifted and the legs and head are low.

● In surgery. Jackknife position is frequently used for surgeries involving the anus,

rectum, coccyx, certain back surgeries, and adrenal surgery.
● Requires team effort. At least four people are required to perform the transfer and
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 sare 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 area. Kidney positions allows access and visualization of
the retroperitoneal area. A kidney rest is placed under the patient at the location of the
lift.
● Risk for falls. Patient may fall off the table at anytime until the position is secured.
● Padding and stabilization support. Contralateral arm underneath the body is
protected with padding. Contralateral knee is flexed and the uppermost leg is left
straight to improve stability. A large soft pillow is placed in between the legs. Kidney
strap and tape are placed over the hip to stabilize the patient.

Support Devices for Patient Positioning

The following are the devices or apparatus that can be used to help position the patient
properly.

● 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.

Documenting Patient Positioning

Documenting change of patient position in the patient’s chart. Note the following:

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● Date and time of the procedure.

● Explanation of the procedure to the patient.
● Notation of the position the patient was placed in including rationale.
● Pertinent teaching given.
● Patient’s response to the procedure.
Cheat Sheet for Patient Positions
The section below is a nursing cheat sheet for different conditions or procedures and their
appropriate patient position with rationale:

Condition/Procedure Patient Position Rationale & Additional Info

To reduce aspiration risk from

Bronchoscopy After: Semi-Fowler’s
difficulty of swallowing

During: Flat on bed with arms at sides;

kept still.

Cerebral angiography After: Extremity in which contrast Apply firm pressure on site for 15
was injected is kept straight for 6 to minutes after the procedure.
8 hours. Flat, if femoral artery was
used.

Pre-op: surgical table will be moved to

Myelogram (air various positions during test.
Post-op: HOB is lower than trunk. To disperse dye.
contrast)
 Condition/Procedure Patient Position Rationale & Additional Info

Pre-op: surgical table will be moved to

various positions during test.
Myelogram (oil-based Post-op: Flat on bed for 6 to 8 To disperse dye.To prevent CSF
dye) hours leakage.

Pre-op: surgical table will be moved to

Myelogram various positions during test. To prevent dye from irritating the
(water-based dye) Post-op: HOB elevated for 8 hours. meninges.

During: Supine with RIGHT side of

upper abdomen exposed; RIGHT arm
To expose the area.
raised and extended behind and and
overhead and shoulder. To apply pressure and
Liver biopsy minimize bleeding.
After: RIGHT side-lying with pillow
under puncture site.

Flat supine with arms raised above head

To expose and provide easy
Lung biopsy and hands health together; head and arms
access to the area.
on pillow.
PRONE with pillow under the abdomen
Renal biopsy To expose the area.
and shoulders.
Don’t sleep on affected side;
encourage exercise by squeezing a
rubber ball.
Arteriovenous fistula Post-op: Elevate extremity Don’t use AV arm for BP
reading and venipuncture.

Turning facilitates drainage; check

for kinks in the tubing.
Possible to have abdominal
cramps and blood-tinged
outflow if catheter was
When outflow is inadequate: turn
Peritoneal Dialysis placed in the last 1-2 weeks.
patient from side to side.

Cloudy outflow is never

normal.

Change position slowly; bedrest during Provide protection when

Meniere’s Disease
acute phase ambulating
To promote healing and maximal
Autografting Immobilize site for 3 to 7 days.
adhesion.
 Condition/Procedure Patient Position Rationale & Additional Info

To prevent dislodgement of the

implant device.
Internal radiation, Provide own urinal or bedpan
Strict bedrest while implant is in place
during treatment to patient.

To decrease venous return and

Heart failure with
Sitting up, with legs dangling reduce congestion; promotes
pulmonary edema
ventilation and relieves dyspnea.
To help lessen chest pain and
Myocardial infarction Semi-Fowler’s
promote respiration.
Pericarditis High-Fowlers, upright leaning forward. To help lessen pain.
Depending on desired outcome.
Slight elevation of legs but not
above the heart or slightly
Peripheral artery disease dependent. To slow or increase arterial return

Dangle legs on side of the bed.

To improve or increase
circulation.
Shock Flat on bed. Trendelenburg is no longer a
recommended position.

HOB elevated 30 degrees, avoid knee To promote maximum lung

Sickle Cell Anemia
gatch and putting strain on painful joints expansion and assist in breathing.
Varicose veins, leg To prevent pooling of blood in the
ulcers, and venous Elevate extremities above heart level. legs and facilitate venous return;
insufficiency avoid prolonged standing.
Bed rest with affected limb elevated.
After 24 hours after heparin
Deep vein thrombosis therapy, patient can ambulate if To promote circulation.
pain level permits.

Tracheoesophageal
HOB elevated 30-45 degrees. To prevent reflux.
fistula (TEF)
After shunt placement: Place on
Ventriculoperitoneal non-operative side in flat position.
shunt (for HOB raised 15-30 degrees if ICP is Avoid rapid fluid drainage.
Hydrocephalus increased.
treatment)
 Condition/Procedure Patient Position Rationale & Additional Info

Do not hold infant with head

elevated.

To allow the hyphema to settle out

HyphemaBlood in HOB elevated 30-45 degrees, with night
inferiorly and avoid obstruction of
anterior chamber of eye shield.
vision and to facilitate resolution
Abdominal aneurysm Post-op: HOB no more than 45 degrees To avoid flexion of the graft.
Place in low-Fowler’s position then raise
To decrease tension on the
Dehiscence knees or instruct knees and support them
abdomen.
with a pillow.
To delay gastric emptying time.
Restrict fluids during meals,
Dumping Syndrome, Take meals in reclining position, lie low carb, low fiber diet in
prevention of down for 20-30 minutes after.
small frequent meals.

Instruct not to cough; place on

NPO; keep intestines moist and
Evisceration Place in low-Fowler’s position.
covered with sterile saline until
patient can be wheeled to OR.
Reverse Trendelenburg, slanted bed with
head higher.
Gastroesophageal reflux Pediatric: prone with HOB To promote gastric emptying and
disease (GERD) elevated. reduce reflux.

Hiatal hernia Upright position after meals. To prevent gastric content reflux.
To facilitate entry of stomach
Pyloric stenosis RIGHT side-lying position after meals.
contents into the intestines.
To reduce dependent edema and
Extremity burns Elevate extremity.
pressure.
Facial burns or trauma Head elevated To reduce edema
To reduce blood pressures below
Initially place in sitting position or high
Autonomic dysreflexia dangerous levels and provide
Fowler’s position with legs dangling.
partial symptom relief.
To prevent pressure on aneurysm
Cerebral aneurysm HOB elevated 30-45 degrees; bed rest
site
To promote venous return and
Heat stroke Supine, flat with legs elevated.
maintain blood flow to the head.
To reduce ICP and encourage
blood drainage.Avoid hip and
Hemorrhagic stroke HOB elevated 30 degrees.
neck flexion which inhibits
drainage.
Increased intracranial Elevate HOB 30-45 degrees, maintain
To promote venous drainage.
pressure (ICP) head midline and in neutral position.
 Condition/Procedure Patient Position Rationale & Additional Info

Avoid flexion of the neck,

head rotation, hip flexion,
coughing, sneezing and
bending forward.

To facilitate venous drainage and

encourage arterial blood flow.
Ischemic stroke HOB flat in midline, neutral position. Avoid hip and neck flexion
which inhibits drainage

To drain secretions and prevent

Seizure Side-lying or recovery position.
aspiration.
Immobilize on spinal backboard, head in
neutral position and immobilized with a
firm, padded cervical collar. To prevent any movement and
Spinal cord injury Must be log rolled without allowing further injury.
any twisting or bending movements

To decrease intracranial pressure

(ICP).Keep head from flexing or
Elevate HOB 30 degrees, head should be rotating.
Head injury
kept in neutral position. Avoid frequent suctioning.

Ask patient to dorsiflex foot of the

Elevate FOB for counter-traction; use
affected leg to assess function of
Buck’s Traction trapeze for moving; place pillow beneath
peroneal nerve, weakness may
lower legs.
indicate pressure on the nerve.
Casted arm Elevate at or above level of heart To minimize swelling
Delayed prosthesis Elevate foot of bed to elevate residual To hasten venous return and
fitting limb. prevent edema.
Use splints, wedge pillow, or
pillows between legs.
Avoid stooping, flexion
Hip fracture Affected extremity needs to be abducted. position during sex, and
overexertion during walking
or exercise.

On unaffected side: maintain abduction

Avoid extreme internal or external
Hip replacement when in supine position with pillow
rotation.
between legs.
 Condition/Procedure Patient Position Rationale & Additional Info

HOB raised to 30-45 degrees.

Immediate prosthesis
Elevate residual limb for 24 hours. Rigid cast acts to control swelling.
fitting
To maintain proper body
Support affected extremity with pillows
Osteomyelitis alignment; avoid strenuous
or splints
exercises.
Help to sitting position; place chair at 90
To prevent dizziness and
Total hip replacement degrees angle to bed; stand on affected
orthostatic hypotension.
side; pivot patient to unaffected side.
Acute Respiratory
To promote oxygenation via
Distress Syndrome High Fowler’s
maximum chest expansion.
(ARDS)
Patient should be immediately
Air embolism from repositioned with the right atrium
Turn to LEFT side or place in
dislodged central above the gas entry site so that
Trendelenburg.
venous line trapped air will not move into the
pulmonary circulation.
High Fowler’s
Tripod position: sitting position
while leaning forward with hands To promote oxygenation via
Asthma
maximum chest expansion.
on knees.

Chronic Obstructive High Fowler’s

Orthopneic position To promote maximum lung
Pulmonary Disease
expansion and assist in breathing.
(COPD)
High Fowler’s
Orthopneic position To promote maximum lung
Emphysema
expansion

Pleural Effusion High Fowler’s To provide maximal

To maximize breathing
High Fowler’s
mechanisms.
Lay on affected side
To splint and reduce pain.
Pneumonia
Lay with affected lung up
To reduce congestion.

To promote maximum lung

Pneumothorax High Fowler’s
expansion and assist in breathing.
Pulmonary edema High Fowler’s, legs dependent position To decrease edema and congestion
To promote maximum lung
Pulmonary embolism High Fowler’s
expansion and assist in breathing.
 Condition/Procedure Patient Position Rationale & Additional Info

Turn patient to LEFT side and lower

HOB

To provide maximal comfort and

Flail chest High Fowler’s
maximize breathing mechanisms.
To promote maximum lung
Rib fracture High Fowler’s
expansion and assist in breathing.
Contraction stress test Placed in semi-Fowler’s or side-lying
Monitor for post-test labor onset.
(CST) position
To prevent pressure on the cord. If
Shrimp or fetal position; modified Sims’
Cord prolapse cord prolapses, cover with sterile
or Trendelenburg.
saline gauze to prevent drying.
To reduce compression of the
Fetal distress Turn mother to her LEFT side.
vena cava and aorta.
Late decelerations To allow more blood flow to the
Turn mother to her LEFT side.
(placental insufficiency) placenta.
Placenta previa Sitting position. To minimize bleeding.
To remove pressure off the
Variable decelerations presenting part of the cord and
Place mother in Trendelenburg position.
(cord compression) prevent gravity from pulling the
fetus out of the body.
Spina Bifida Prone (on abdomen). To prevent sac rupture.
Position on back or in infant seat.
Hold in upright position while
Cleft lip (congenital) feeding. To prevent trauma to suture line.

Relieves pressure or gravity from

pulling the cord.
Prolapsed umbilical During labor: Knee-chest position or Hand in vagina to hold
cord Trendelenburg. presenting part of fetus off
cord.

HOB elevated no more than 30 degrees

Cardiac catheterization Affected extremity should be kept
or flat as prescribed.May turn to either
(post) straight.
side
Continuous Bladder Tape catheter to thigh; no other Prevents the catheter from being
Irrigation (CBI) positioning restrictions dislodged.
Pull outer ear upward and back
Position affected ear uppermost then lie
Ear drops for adults; upward and down for
on unaffected ear for absorption.
children.
Better visualization and drainage
During procedure: Tilt head towards
Ear irrigation of the medium to the ear canal via
affected ear.
gravity.
 Condition/Procedure Patient Position Rationale & Additional Info

After procedure: Lie on affected

side for drainage.

Drop to center of the lower

conjunctival sac; blink between
Eye drops Tilt head back and look up, pull lid down. drops; press inner canthus near
nose bridge for 1-2 min to prevent
systemic absorption.
During: Shrimp or fetal position
(side-lying with back bowed, knees To maximize spine flexion.
drawn up to abdomen, neck flexed to rest To prevent spinal headache
Lumbar puncture chin on chest). and CSF leakage.
After: Flat on bed for 4-12 hours.

Nasogastric tube Closes the trachea and opens the

High Fowler’s with head tilted forward
insertion esophagus; prevents aspiration.
HOB elevated 30 to 45 degrees; keep
elevated for 1 hour after an intermittent
feeding.
To prevent aspiration.Promotes
With decreased LOC: RIGHT emptying of the stomach and
Nasogastric tube
side-lying with HOB elevated. prevents aspiration.
irrigation and tube
feedings To prevent aspiration.
With tracheostomy: Maintain in
semi-Fowler’s position

During: Semi-Fowler’s in bed or sitting

upright on side of bed with chair; support Empty the bladder before
the feet. procedure; report elevated
Paracentesis Post: Assist into any comfortable temperature; assess for
position hypovolemia.

Lung area needing drainage

Postural Drainage Trendelenburg
should be in uppermost position
Allows gravity to work into the
Rectal enema Left side-lying (Sims’ position) with direction of the colon by placing
administration right knee flexed. the descending colon at its lowest
point.
Rectal enemas and To allow fluid to flow in the
Left side-lying, Sims’ position
irrigation natural direction of the colon.
To enhance lung expansion and
Sengstaken-Blakemore reduce portal blood flow,
HOB elevated
and Minnesota tubes permitting esophagogastric
balloon tamponade.
 Condition/Procedure Patient Position Rationale & Additional Info

Before: (1) Sitting on edge of bed while

leaning on bedside table with feet
supported by stool; or lying in bed on
unaffected side with head elevated 45
degrees.
(2) Lying in bed on unaffected side Prevent fluid leakage into the
Thoracentesis
with HOB elevated to Fowler’s. thoracic cavity.

After: Assist patient into any

comfortable position preferred.

Total Parenteral
During insertion: Trendelenburg. To prevent air embolism.
Nutrition (TPN)
Bed rest for 24 hours, keep extremity
Vascular extremity graft For maximal adhesion.
straight and avoid knee or hip flexion
For better visualization of the
Perineal procedures Lithotomy
area.
To relieve abdominal pain and
Appendectomy Post-op: Fowler’s position
ease breathing.
Sleep on unaffected side with a night
shield for 1 to 4 weeks.
Cataract surgery Semi-Fowler’s or Fowler’s on back To prevent edema.
or on non-operative side.

HOB elevated 30-45% with head in a

midline, neutral position.
Craniotomy Never put client on operative side, To facilitate venous drainage.
especially if bone was removed.

Provides better visualization of

Hemorrhoidectomy During: Prone Jackknife position.
the area.
Hypophysectomy
Surgical removal of the HOB elevated. To prevent increase in ICP.
pituitary gland.
Infratentorial surgery
Flat and lateral on either side; avoid neck
Incision at back of head, To facilitate drainage.
flexing.
above nape of neck
Post-op: Semi-Fowler’s, turn from back
Kidney transplant To promote gas exchange
to non-operative side
Back is kept straight.Patient is logrolled
Laminectomy
if turned.
 Condition/Procedure Patient Position Rationale & Additional Info

Sit straight in straight-backed chair

when out of bed or when
ambulating.

To maintain airway and decrease

Laryngectomy HOB elevated 30-45 degrees
edema.
To allow lymph drainage.
Semi-Fowler’s with arm on affected side Turn only on back and on
Mastectomy unaffected side.
elevated.

Mitral valve
Post-op: semi-Fowler’s position. To assist in breathing.
replacement
Myringotomy Post-op: Position on side of affected ear . To allow drainage of secretions
Bed rest with minimal activity and
repositioning.
Area of detachment should be in Helps detached retina fall into
Retinal detachment
the dependent position. place.

Supratentorial surgery HOB elevated 30-45 degrees; maintain

Incision front of head head/neckline in midline neutral position; To facilitate drainage.
below hairline avoid extreme hip and neck flexion.
To reduce swelling and edema in
Post-op: High Fowler’s or the neck area.
semi-Fowler’s.
To decrease tension on the
Thyroidectomy Avoid extension and movement by
suture line and support the
using sandbags or pillows.
head and neck.

To facilitate drainage and relieve

Tonsillectomy Post-op: prone or side-lying
pressure on the neck.
To expose the area.
Side lying with head tucked and legs Apply pressure to the area
Bone marrow pulled up or;
after the procedure to stop
aspiration/biopsy Prone with arms folded under chin.
the bleeding.

To prevent edema.
To provide for hip extension
Amputation: above the Elevate for first 24 hours using and stretching of flexor
knee pillow.Position prone twice daily. muscles; prevent
contractures, abduction
 Condition/Procedure Patient Position Rationale & Additional Info

Foot of bed elevated for first 24 hours. To prevent edema.

Amputation: below the Position prone daily. To provide for hip extension.
knee