POSITIONS
Facial/head burns: elevate HOB
Circumferential extremity burns: elevate extremities above heart level
Skin graft: elevate & immobilize graft site
Mastectomy: HOB 30 degrees (semi-fowlers) w/ affected arm elevated
Perineal & vaginal procedures: lithotomy position
Hypophysectomy: elevate HOB
Thyroidectomy: semi-fowlers to Fowlers. SANDBAGS to support head or neck. Avoid neck extension.
Hemorrhoidectomy: lateral (side-lying)
GERD: Reverse Trendelenburg
Liver Biopsy:
During supine, w/ RIGHT side of abdomen exposed. RAISE RIGHT ARM & EXTEND behind the
head & over the left shoulder
After right lateral (side-lying) + small pillow or folded towel under puncture site
Paracentesis: semi-fowlers or sitting upright on side or bed or in chair w/ feet supported
(after position of comfort)
NG Tube:
Insertion- high fowlers w/ head tilted forward
Irrigations & tube feedings: elevate HOB (semi or high fowlers) + keep elevated 30 min 1 hr
after intermittent feeding or keep elevated continuously for continuous feedings
*** for continuous tube feeding: if pt needs to be supine, turn the feeding off for the time.
Rectal Enema & Irrigations: Left Sims position
Laparoscopic cholecystectomy: post-op SIMS POSITION
Sengstaken-Blakemore & Minnesota Tubes: elevate HOB
Laryngectomy (radial neck dissection): semi-fowlers or fowlers
Post-Bronchoscopy: semi-fwlers
Postural Drainage: Trendelenburg. Lung segment to be drained should be in uppermost position.
Thoracentesis: sitting at edge of bed & leaning over bedside table with feet on stool OR lying in bed High
fowlers and on the unaffected side After: position of comfort
AAA: LIMIT head elevation to 45 degrees
Amputation of lower extremity:
first 24 hours: elevate food of bed (support residual limb w/ pillows but not elevate)
PRONE 2x/day for 20 to 30 min
Arterial vascular grafting of an extremity: bed rest 24 hours; keep affected extremity straight; limit
movement & AVOID FLEXION OF HIP/KNEE
Cardiac Catheterization: keep extremity straight; do not elevate HOB more than 30 degrees
Femoral vessel accessed: bed rest 4-6 hours
Heart Failure & Pulmonary Edema: UPRIGHT w/ legs dangling over side of bed
Peripheral Arterial Disease: can elevate feet at rest, but should not raise legs above the level of the
heart. May need slightly dependent position
DVT: bed rest w/ leg elevation
Varicose veins: leg elevation above the heart
Venous insufficiency and leg ulcers: leg elevation
Cataract surgery: elevate HOB & on BACK or NONOPERATIVE SIDE
Retinal detachment: if large one, bed rest & bilateral eye patching.
Autonomic dysreflexia: elevate HOB high fowlers ***immediately***
Cerebral Aneurysm: bed rest w/ HOB elevated 30-45 degrees
Cerebral angiography: keep extremity that had contrast medium straight & immobilized for 6-8 hours
Stroke (brain attack): maintain head in a neutral, midline position; AVOID extreme hip & neck flexion
Hemorrhagic stroke: elevate HOB to 30 degrees
Ischemic stroke: HOB usually kept flat
Craniotomy: do not position on operative site; elevate the HOB 30-45 degrees; avoid hip/neck flexion
Laminectomy & other vertebral surgery: logroll client; when OOB, keep pts back straight (*Straight-
backed chair*) w/ feet on floor
Increased ICP: elevate HOB 30-45 degrees w/ head midline & neutral. Avoid extreme hip/neck flexion.
***DO NOT PLACE CLIENT W/ A HEAD INJURY IN A FLAT OR TRENDELENBURGS POSITION b/c of risk for
increased ICP
Lumbar puncture:
During: lateral (side-lying) w/ back bowed at the edge of exam table, knees flexed up to
abdomen, & neck flexed so that chin is resting on chest
After: supine 4-12 hours
SCI: immobilize on backboard w/ head in neutral position. Prevent head flexion, rotation, or extension.
Immobilize head w/ firm, padded cervical collar. Logroll- do not twist or turn any part of the body. Pt
should not assume sitting position.
Total Hip Replacement:
Avoid extreme internal & external rotation.
Avoid adduction. Can be side-lying in most cases if abduction pillow is in place.
Place wedge (abduction) pillow b/w legs.
Do not cross legs.
Devices for Proper Positioning:
- Foot boards: remove 2-3 times/day to assess skin integrity & mobility
- Sandbags: soft device that can be shaped to body contours
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