Patient Positioning Guidelines & Nursing Considerations (Cheat Sheet) (2024)

BronchoscopyAfter: Semi-Fowler’sTo reduce aspiration risk from difficulty of swallowingCerebral angiographyDuring: Flat on bed with arms at sides; kept still.

After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used.

Apply firm pressure on site for 15 minutes after the procedure.Myelogram (air contrast)Pre-op: surgical table will be moved to various positions during test.

Post-op: Head of bed (HOB) is lower than trunk.

To disperse dye.Myelogram (oil-based dye)Pre-op: surgical table will be moved to various positions during test.

Post-op: Flat on bed for 6 to 8 hours

To disperse dye.To prevent CSF leakage.Myelogram (water-based dye)Pre-op: surgical table will be moved to various positions during test.

Post-op: HOB elevated for 8 hours.

To prevent dye from irritating the meninges.Liver biopsyDuring: Supine with RIGHT side of upper abdomen exposed; RIGHT arm raised and extended behind and and overhead and shoulder.

After: RIGHT side-lying with pillow under puncture site.

To expose the area.

To apply pressure and minimize bleeding.

Lung biopsyFlat supine with arms raised above head and hands health together; head and arms on pillow.To expose and provide easy access to the area.Renal biopsyPRONE with pillow under the abdomen and shoulders.To expose the area.Arteriovenous fistulaPost-op: Elevate extremityDon’t sleep on affected side; encourage exercise by squeezing a rubber ball.

Don’t use AV arm for BP reading and venipuncture.

Peritoneal DialysisWhen outflow is inadequate: turn patient from side to side.Turning facilitates drainage; check for kinks in the tubing.

Possible to have abdominal cramps and blood-tinged outflow if catheter was placed in the last 1-2 weeks.

Cloudy outflow is never normal.

Meniere’s DiseaseChange position slowly; bedrest during acute phaseProvide protection when ambulatingAutograftingImmobilize site for 3 to 7 days.To promote healing and maximal adhesion.Internal radiation, during treatmentStrict bedrest while implant is in placeTo prevent dislodgement of the implant device.

Provide own urinal or bedpan to patient.

Heart failure with pulmonary edemaSitting up, with legs danglingTo decrease venous return and reduce congestion; promotes ventilation and relieves dyspnea.Myocardial infarctionSemi-Fowler’sTo help lessen chest pain and promote respiration.PericarditisHigh-Fowlers, upright leaning forward.To help lessen pain.Peripheral artery diseaseDepending on desired outcome.

Slight elevation of legs but not above the heart or slightly dependent.

Dangle legs on side of the bed.

To slow or increase arterial returnShockFlat on bed.To improve or increase circulation.

Trendelenburg is no longer a recommended position.

Sickle Cell AnemiaHOB elevated 30 degrees, avoid knee gatch and putting strain on painful jointsTo promote maximum lung expansion and assist in breathing.Varicose veins, leg ulcers, and venous insufficiencyElevate extremities above heart level.To prevent pooling of blood in the legs and facilitate venous return; avoid prolonged standing.Deep vein thrombosisBed rest with affected limb elevated.

After 24 hours after heparin therapy, patient can ambulate if pain level permits.

To promote circulation.Tracheoesophageal fistula (TEF)HOB elevated 30-45 degrees.To prevent reflux.Ventriculoperitoneal shunt (for Hydrocephalus treatment)After shunt placement: Place on non-operative side in flat position.

HOB raised 15-30 degrees if ICP is increased.

Do not hold infant with head elevated.

Avoid rapid fluid drainage.HyphemaBlood in anterior chamber of eyeHOB elevated 30-45 degrees, with night shield.To allow the hyphema to settle out inferiorly and avoid obstruction of vision and to facilitate resolutionAbdominal aneurysmPost-op: HOB no more than 45 degreesTo avoid flexion of the graft.DehiscencePlace in low-Fowler’s position then raise knees or instruct knees and support them with a pillow.To decrease tension on the abdomen.Dumping Syndrome, prevention ofTake meals in reclining position, lie down for 20-30 minutes after.To delay gastric emptying time.

Restrict fluids during meals, low carb, low fiber diet in small frequent meals.

EviscerationPlace in low-Fowler’s position.Instruct not to cough; place on NPO; keep intestines moist and covered with sterile saline until patient can be wheeled to OR.Gastroesophageal reflux disease (GERD)Reverse Trendelenburg, slanted bed with head higher.

Pediatric: prone with HOB elevated.

To promote gastric emptying and reduce reflux.Hiatal herniaUpright position after meals.To prevent gastric content reflux.Pyloric stenosisRIGHT side-lying position after meals.To facilitate entry of stomach contents into the intestines.Extremity burnsElevate extremity.To reduce dependent edema and pressure.Facial burns or traumaHead elevatedTo reduce edemaAutonomic dysreflexiaInitially place in sitting position or high Fowler’s position with legs dangling.To reduce blood pressures below dangerous levels and provide partial symptom relief.Cerebral aneurysmHOB elevated 30-45 degrees; bed restTo prevent pressure on aneurysm siteHeat strokeSupine, flat with legs elevated.To promote venous return and maintain blood flow to the head.Hemorrhagic strokeHOB elevated 30 degrees.To reduce ICP and encourage blood drainage.Avoid hip and neck flexion which inhibits drainage.Increased intracranial pressure (ICP)Elevate HOB 30-45 degrees, maintain head midline and in neutral position.To promote venous drainage.

Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and bending forward.

Ischemic strokeHOB flat in midline, neutral position.To facilitate venous drainage and encourage arterial blood flow.

Avoid hip and neck flexion which inhibits drainage

SeizureSide-lying or recovery position.To drain secretions and prevent aspiration.Spinal cord injuryImmobilize on spinal backboard, head in neutral position and immobilized with a firm, padded cervical collar.

Must be log rolled without allowing any twisting or bending movements

To prevent any movement and further injury.Head injuryElevate HOB 30 degrees, head should be kept in neutral position.To decrease intracranial pressure (ICP).Keep head from flexing or rotating.

Avoid frequent suctioning.

Buck’s TractionElevate FOB for counter-traction; use trapeze for moving; place pillow beneath lower legs.Ask patient to dorsiflex foot of the affected leg to assess function of peroneal nerve, weakness may indicate pressure on the nerve.Casted armElevate at or above level of heartTo minimize swellingDelayed prosthesis fittingElevate foot of bed to elevate residual limb.To hasten venous return and prevent edema.Hip fractureAffected extremity needs to be abducted.Use splints, wedge pillow, or pillows between legs.

Avoid stooping, flexion position during sex, and overexertion during walking or exercise.

Hip replacementOn unaffected side: maintain abduction when in supine position with pillow between legs.

HOB raised to 30-45 degrees.

Avoid extreme internal or external rotation.Immediate prosthesis fittingElevate residual limb for 24 hours.Rigid cast acts to control swelling.OsteomyelitisSupport affected extremity with pillows or splintsTo maintain proper body alignment; avoid strenuous exercises.Total hip replacementHelp to sitting position; place chair at 90 degrees angle to bed; stand on affected side; pivot patient to unaffected side.To prevent dizziness and orthostatic hypotension.Acute Respiratory Distress Syndrome (ARDS)High Fowler’sTo promote oxygenation via maximum chest expansion.Air embolism from dislodged central venous lineTurn to LEFT side or place in Trendelenburg.Patient should be immediately repositioned with the right atrium above the gas entry site so that trapped air will not move into the pulmonary circulation.AsthmaHigh Fowler’s

Tripod position: sitting position while leaning forward with hands on knees.

To promote oxygenation via maximum chest expansion.Chronic Obstructive Pulmonary Disease (COPD)High Fowler’s

Orthopneic position

To promote maximum lung expansion and assist in breathing.EmphysemaHigh Fowler’s

Orthopneic position

To promote maximum lung expansionPleural EffusionHigh Fowler’sTo provide maximalPneumoniaHigh Fowler’s

Lay on affected side

Lay with affected lung up

To maximize breathing mechanisms.

To splint and reduce pain.

To reduce congestion.

PneumothoraxHigh Fowler’sTo promote maximum lung expansion and assist in breathing.Pulmonary edemaHigh Fowler’s, legs dependent positionTo decrease edema and congestionPulmonary embolismHigh Fowler’s

Turn patient to LEFT side and lower HOB

To promote maximum lung expansion and assist in breathing.Flail chestHigh Fowler’sTo provide maximal comfort and maximize breathing mechanisms.Rib fractureHigh Fowler’sTo promote maximum lung expansion and assist in breathing.Contraction stress test (CST)Placed in semi-Fowler’s or side-lying positionMonitor for post-test labor onset.Cord prolapseShrimp or fetal position; modified Sims’ or Trendelenburg.To prevent pressure on the cord. If cord prolapses, cover with sterile saline gauze to prevent drying.Fetal distressTurn mother to her LEFT side.To reduce compression of the vena cava and aorta.Late decelerations (placental insufficiency)Turn mother to her LEFT side.To allow more blood flow to the placenta.Placenta previaSitting position.To minimize bleeding.Variable decelerations (cord compression)Place mother in Trendelenburg position.To remove pressure off the presenting part of the cord and prevent gravity from pulling the fetus out of the body.Spina BifidaProne (on abdomen).To prevent sac rupture.Cleft lip (congenital)Position on back or in infant seat.

Hold in upright position while feeding.

To prevent trauma to suture line.Prolapsed umbilical cordDuring labor: Knee-chest position or Trendelenburg.Relieves pressure or gravity from pulling the cord.

Hand in vagin* to hold presenting part of fetus off cord.

Cardiac catheterization (post)HOB elevated no more than 30 degrees or flat as prescribed.May turn to either sideAffected extremity should be kept straight.Continuous Bladder Irrigation (CBI)Tape catheter to thigh; no other positioning restrictionsPrevents the catheter from being dislodged.Ear dropsPosition affected ear uppermost then lie on unaffected ear for absorption.Pull outer ear upward and back for adults; upward and down for children.Ear irrigationDuring procedure: Tilt head towards affected ear.

After procedure: Lie on affected side for drainage.

Better visualization and drainage of the medium to the ear canal via gravity.Eye dropsTilt head back and look up, pull lid down.Drop to center of the lower conjunctival sac; blink between drops; press inner canthus near nose bridge for 1-2 min to prevent systemic absorption.Lumbar punctureDuring: Shrimp or fetal position (side-lying with back bowed, knees drawn up to abdomen, neck flexed to rest chin on chest).

After: Flat on bed for 4-12 hours.

To maximize spine flexion.

To prevent spinal headache and CSF leakage.

Nasogastric tube insertionHigh Fowler’s with head tilted forwardCloses the trachea and opens the esophagus; prevents aspiration.Nasogastric tube irrigation and tube feedingsHOB elevated 30 to 45 degrees; keep elevated for 1 hour after an intermittent feeding.

With decreased LOC: RIGHT side-lying with HOB elevated.

With tracheostomy: Maintain in semi-Fowler’s position

To prevent aspiration.Promotes emptying of the stomach and prevents aspiration.

To prevent aspiration.

ParacentesisDuring: Semi-Fowler’s in bed or sitting upright on side of bed with chair; support the feet.

Post: Assist into any comfortable position

Empty the bladder before procedure; report elevated temperature; assess for hypovolemia.Postural DrainageTrendelenburgLung area needing drainage should be in uppermost positionRectal enema administrationLeft side-lying (Sims’ position) with right knee flexed.Allows gravity to work into the direction of the colon by placing the descending colon at its lowest point.Rectal enemas and irrigationLeft side-lying, Sims’ positionTo allow fluid to flow in the natural direction of the colon.Sengstaken-Blakemore and Minnesota tubesHOB elevatedTo enhance lung expansion and reduce portal blood flow, permitting esophagogastric balloon tamponade.ThoracentesisBefore: (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 with HOB elevated to Fowler’s.

After: Assist patient into any comfortable position preferred.

Prevent fluid leakage into the thoracic cavity.Total Parenteral Nutrition (TPN)During insertion: Trendelenburg.To prevent air embolism.Vascular extremity graftBed rest for 24 hours, keep extremity straight and avoid knee or hip flexionFor maximal adhesion.Perineal proceduresLithotomyFor better visualization of the area.AppendectomyPost-op: Fowler’s positionTo relieve abdominal pain and ease breathing.Cataract surgerySleep on unaffected side with a night shield for 1 to 4 weeks.

Semi-Fowler’s or Fowler’s on back or on non-operative side.

To prevent edema.CraniotomyHOB elevated 30-45% with head in a midline, neutral position.

Never put client on operative side, especially if bone was removed.

To facilitate venous drainage.HemorrhoidectomyDuring: Prone Jackknife position.Provides better visualization of the area.Hypophysectomy
Surgical removal of the pituitary gland. HOB elevated.To prevent increase in ICP.Infratentorial surgery
Incision at back of head, above nape of neckFlat and lateral on either side; avoid neck flexing.To facilitate drainage.Kidney transplantPost-op: Semi-Fowler’s, turn from back to non-operative sideTo promote gas exchangeLaminectomyBack is kept straight.Patient is logrolled if turned.

Sit straight in straight-backed chair when out of bed or when ambulating.

LaryngectomyHOB elevated 30-45 degreesTo maintain airway and decrease edema.MastectomySemi-Fowler’s with arm on affected side elevated.To allow lymph drainage.

Turn only on back and on unaffected side.

Mitral valve replacementPost-op: semi-Fowler’s position.To assist in breathing.MyringotomyPost-op: Position on side of affected ear .To allow drainage of secretionsRetinal detachmentBed rest with minimal activity and repositioning.

Area of detachment should be in the dependent position.

Helps detached retina fall into place.Supratentorial surgery
Incision front of head below hairlineHOB elevated 30-45 degrees; maintain head/neckline in midline neutral position; avoid extreme hip and neck flexion.To facilitate drainage.ThyroidectomyPost-op: High Fowler’s or semi-Fowler’s.

Avoid extension and movement by using sandbags or pillows.

To reduce swelling and edema in the neck area.

To decrease tension on the suture line and support the head and neck.

TonsillectomyPost-op: prone or side-lyingTo facilitate drainage and relieve pressure on the neck.Bone marrow aspiration/biopsySide lying with head tucked and legs pulled up or;

Prone with arms folded under chin.

To expose the area.

Apply pressure to the area after the procedure to stop the bleeding.

Amputation: above the kneeElevate for first 24 hours using pillow.Position prone twice daily.To prevent edema.

To provide for hip extension and stretching of flexor muscles; prevent contractures, abduction

Amputation: below the kneeFoot of bed elevated for first 24 hours.

Position prone daily.

To prevent edema.

To provide for hip extension.