Patient positioning can be pretty confusing, especially when a physician or clinical instructor quickly tells you to get the patient into orthopneic position and immediately walks away to get supplies.
“What position is that again… What do I do?”
Just describing that situation may provide enough fear and frustration to elicit a rise in your heart rate, respiratory rate, and systolic blood pressure.
Never fear, nursing students! We’ve created a great guide with pictures of the top patient positions, what they look like, when to use them, as well as nursing considerations. Take a look at this resource multiple times, commit it to memory, and think back to it when you’ve got to position a patient. You’ll look like you’ve been doing this for years, you experienced nurse you.
We’ve got you covered with a nicer looking version of the chart above that includes patient positioning pictures below (you can also download this image and use in clinical with the link below).Download the Patient Positioning Chart
When referring to the document, remember that HOB means head of bed. Many hospital beds are equipped with something on the side that tells you the angle of the head of the bed. These are awesome to look at while positioning patients. For example, in the neuro ICU we frequently had the HOB at 30 degrees because it optimized venous return and lowers ICP. Therefore, whenever I was finishing up repositioning a patient, I’d look at that little indicator to make sure I had the HOB at 30 before walking out of the room.
If you’ve got a chance to check these out on an empty bed in clinical – do it! Have a nurse bud hop in, change the level of the HOB, and switch! It’s helpful to really feel what 0, 10, 15, 30, 45 degrees feels like. Sixty degrees doesn’t sound like much, but when you’re sitting in a hospital bed, 60 degrees feels like you’re sitting at 90 degrees! And 15 degrees feels like you’re completely flat, even though you’re not.
And finally, make sure you’re checking your patient’s orders. Many times the physician will order a patient position or where they want the HOB, especially if they’re critically ill or had a procedure completed recently. So check out your nursing orders! Once the patient has been positioned appropriately, don’t forget to document!
Here is a text version of the above chart:
|High-Fowlers||HOB 60-90° with the patient sitting up in bed||During episodes of respiratory distress, when inserting a nasogastric tube, during oral intake with feeding precautions||This may be uncomfortable to maintain for an extended period, a patient may slump over if they lack the strength to stay sitting upright, and must be repositioned within 2 hours to prevent skin breakdown if patient is unable to reposition themselves as High-Fowler’s places quite a bit of pressure on the coccyx|
|Fowler’s||HOB 45-60° with the patient sitting up in bed. Patient lying on their back in bed, with HOB reclined||Facilitates chest expansion so it is helpful with patients who are having difficulty breathing, during tube feeding admininstation because it facilitates peristalsis while minimizing aspiration risk, simply a comfortable position, also used in the postpartum period to facilitate excretion of lochia||Minimal|
|Semi Fowler’s||HOB 15-30° with patient lying on their back||Necessary in some neurological and cardiac conditions, after procedures or surgeries to facilitate hemostatis at the insertion site (like a cardiac cath with a femoral approach) or drainage from various drains||If a patient has continous tube feeding infusing or trouble managing secretions, aspiration is a risk with prolonged positioning|
|Supine||HOB flat, patient on back||Post procedures to maintain hemostatis at insertion site, frequent position for many surgeries||Many pressure points (including the top of toes from the sheet) therefore you must be diligent in turning patient, may be uncomfortable to maintain, increases apnea in OSA, avoid after 1st trimester due to the added pressure on vena cava and subsequent hypotension|
|Prone||HOB flat, patient on stomach with head to one side||Not used frequently; use as a therapeutic measure in advanced ARDS, during and after some surgeries||Not comfortable for long, difficult for full respiratory expansion, not easy to put a patient into this position (especially if they have multiple lines and tubes)|
|Trendelenberg||Flat on back, feet raised higher than head by 15-30°||During CVC (subclavian or IJ) placement, if an air embolism is suspected as it traps air in the right ventricle, when positioned this way with a Valsava it can convert supraventricular tachycardia, during various surgeries, respiratory distress to increase perfusion||Not ideal with increased ICP, uncomfortable, if patient is confused putting them in this position may increase fall risk,|
|Reverse Trendelenberg||Flat on back, head raised higher than feet by 15-30°||For some surgeries or procedures, pre-surgery intervention for some vascular surgeries, may be used to facilitate respirations in patients who need to lay flat post-procedure, reduces GERD symptoms||Somewhat uncomfortable, if patients are confused it might be difficult to maintain them safely in this position for long periods|
|Dorsal recumbant||Flat on back, knees bent, rotated outwards, feet flat on the bed (head/shoulders typically on a pillow)||During or after various surgeries, for comfort||Minimal|
|Lateral||On side, top knee and arm flexed and supported by pillows||Relieves pressure on saccrum, great for patients who are immobile as it is typically quite comfortable and provides good spine alignment, supporting and off-loading common pressure points||Minimal|
|Sim’s||Halfway between lateral and prone||Occasionally used with unconcious patients as it facilitates drainage of oral secretions, pregnancy, during enemas, for patients who are paralyzed as it takes pressure off of the hip and sacrum||Must remember to turn patient on schedule|
|Orthopneic||Sitting at the side of the bed, leaning over a table||Facilitates respiratory expansion, makes it easier to breath in patients with respiratory difficulty, and used during a thoracentesis||Ensure patient can safely sit back in bed; don’t leave unattended if a fall risk and sitting at the side of the bed|
Whether you’re reading a new physician order to place the patient in High-Fowler’s position, documenting the position the patient was in, or suggesting a patient position to the MD, after utilizing this resource, you’ll feel more comfortable and confident. While this is a basic aspect of nursing care, it can be confusing and difficult to remember, especially in a chaotic moment.
Always remember when you’re changing a patient’s position to use proper support, lifts, and ergonomics to prevent injury to yourself. Nurses can really hurt themselves when they’re trying to quickly move a patient. Don’t do it! Always ensure your safety first.
Click here to download this resource for your clinicals. Keep it in your pocket, save it to your tablet, or have it as your lock screen on your phone for a week or two and look at it regularly to commit it to memory. Hopefully the pictures of the positions make it easier for you to remember.
And don’t forget to share it with your nursing school buds!