1/19/23, 7:16 PM Patient Positioning Cheat Sheet & Complete Guide for 2023

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Patient Positioning: Complete

Guide and Cheat Sheet for Nurses
UPDATED ON JANUARY 11, 2023 BY MATT VERA, BSN, R.N.

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In this guide for patient positioning, learn about the common bed positions such as
Fowler’s, dorsal recumbent, supine, prone, lateral, lithotomy, Sims’, Trendelenburg’s, and
other surgical positions commonly used. Learn about the different patient positioning
guidelines, how to properly position the patient, and the nursing considerations and
interventions you need to know.

 
1. What is Patient Positioning?
2. Goals of Patient Positioning
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3. Guidelines for Patient Positioning

4. Common Patient Positions
4.1. Supine or Dorsal Recumbent Position
4.2. Fowler’s Position
4.3. Orthopneic or Tripod Position
4.4. Prone Position
4.5. Lateral Position
4.6. Sims’ Position
4.7. Lithotomy Position
4.8. Trendelenburg’s Position
4.9. Reverse Trendelenburg’s Position
4.10. Knee-Chest Position
4.11. Jackknife Position
4.12. Kidney Position
5. Support Devices for Patient Positioning
6. Documenting Patient Positioning
7. Cheat Sheet for Patient Positions
8. References and Sources

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 to the surgical/treatment site and
maintenance of the patient’s dignity by controlling unnecessary exposure. In most settings,
proper positioning of patients provides airway management and ventilation, maintains
body alignment, and provides physiologic safety.

Goals of Patient Positioning

The ultimate goal of proper patient positioning is to safeguard the patient from immobility
injury and physiological complications. Specifically, patient positioning goals include:

Provide patient comfort and safety. Support the patient’s airway and maintain
circulation throughout the procedure (e.g., surgery, 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 the perioperative phase.

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Guidelines for Patient Positioning

Proper execution is needed during patient positioning to prevent injury for both the
patient and the nurse. Remember these principles and guidelines when positioning clients:

Explain the procedure. Explain to the client why their 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 the 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 of exercise, increasing the client’s independence and self-esteem.
Get adequate help. When planning to move or reposition the client, ask for 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 the ease of changing positions.
Raise the client’s bed. Adjust or reposition the client’s bed so that the weight is at
the nurse’s center of gravity level.
Frequent position changes. Note that any correct or incorrect position can be
detrimental to the patient if maintained for a long time. Repositioning the patient
every two 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.
Proper body mechanics. Observe good body mechanics for your and your patient’s
safety.
Position yourself close to the client.
Avoid twisting your back, neck, and pelvis by keeping them aligned.
Flex your knees and keep your feet wide apart.
Use your arms and legs and not your back.
Tighten abdominal muscles and gluteal muscles in preparation for the move.
A person with the heaviest load coordinates the efforts of the nurse and initiates
the count to 3.

Common Patient Positions

The following are the commonly used patient positions, including a description of 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 (Dorsal Recumbent) 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 type of surgery.
Most commonly used position. Supine or dorsal recumbent 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
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 an 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).

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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 with cardiac, respiratory, or
neurological problems and is often optimal for patients with a nasogastric tube.
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 a 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 the 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 drops.
Etymology. Fowler’s position is named after George Ryerson Fowler, who saw it as
a way to decrease the 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.

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Orthopneic or tripod position is useful for maximum lung expansion.

Maximum lung expansion. Patients with difficulty of breathing are often placed in
this position because it allows maximum chest expansion.
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 their head turned to
one side and the hips are not flexed.

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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 is useful for unconscious clients or those recovering from surgery on 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. An increase in flexion
of the top hip and knee provides greater stability and balance. This flexion
reduces lordosis and promotes good back alignment.

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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 and comfortably position the patient in
lateral position, 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.

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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 the 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:
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.
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.
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 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

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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 head of the bed is

elevated with the foot of the bed down. It is the opposite of Trendelenburg’s
position.

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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 a lateral or prone position. In lateral knee-chest

position, the patient lies on their side, the torso lies diagonally across the table,
and the hips and knees are flexed. In prone knee-chest position, the patient
kneels on the table and lowers their shoulders onto the table, so their chest and
face rest on the table.

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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.

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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 on 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 pillows are required on the operating table to support the
body and reduce pressure on the pelvis, back, and abdomen. The jackknife position
also puts excessive pressure on the knees. While positioning, surgical staff should
put extra padding for the knee area.

Kidney Position

In the 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.
The patient is turned on their contralateral side with their back placed on the
edge of the table. The contralateral kidney is placed over the break in the table
or over the kidney body elevator (if an attachment is available). The uppermost
arm is placed in a gutter rest at no more than 90º abduction or flexion.

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Right lateral kidney position

Access to the retroperitoneal area. The kidney position allows access and
visualization of the retroperitoneal area. A kidney rest or a small pillow is placed
under the patient at the location of the lift.
Risk for falls. The patient may fall off the table at any time until the position is
secured.
Padding and stabilization support. The contralateral arm underneath the body is
protected with padding. The contralateral knee is flexed, and the uppermost leg is
left straight to improve stability. A large soft pillow is placed in between the legs. A
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 placed under the mattress’s entire
surface area and are useful for increasing back support and body alignment.
Foot Boots. Foot boots are rigid plastic or heavy foam shoes that 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 slight adduction and the wrist in slight
dorsiflexion.
Pillows. Pillows provide support, elevate body parts and 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.

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Sandbags. Sandbags are soft devices filled with substances that can be used to
shape or contour 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 increased mobility. They also assist in rolling from
side to side or sitting in bed. Check with your agency’s policies regarding the use of
side rails as they vary from state to state.
Trochanter Rolls. These rolls prevent the 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:

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 is 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, including a downloadable copy of the different
positions above.

Patient positioning cheat sheet

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Click on the image to enlarge Click on the image to enlarge

Patient positioning cheat sheet for different conditions and procedures

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.

After: Extremity in which Apply firm pressure on site for

Cerebral angiography contrast was injected is 15 minutes after the
kept straight for 6 to 8 procedure.
hours. Flat, if femoral
artery was used.

Pre-op: surgical table will

be moved to various
positions during test.
Myelogram (air contrast) To disperse dye.
Post-op: Head of bed
(HOB) is lower than trunk.

Pre-op: surgical table will

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

Pre-op: surgical table will

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

Liver biopsy During: Supine with To expose the area.

RIGHT side of upper
abdomen exposed; RIGHT To apply pressure and
arm raised and extended minimize bleeding.
behind and and overhead
and shoulder.

After: RIGHT side-lying

with pillow under puncture
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Condition/Procedure Patient Position Rationale & Additional Info

site.

Flat supine with arms

raised above head and To expose and provide easy
Lung biopsy
hands health together; access to the area.
head and arms on pillow.

PRONE with pillow under

Renal biopsy the abdomen and To expose the area.
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

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

Cloudy outflow is never

normal.

Change position slowly;

Provide protection when
Meniere’s Disease bedrest during acute
ambulating
phase

Immobilize site for 3 to 7 To promote healing and

Autografting
days. maximal adhesion.

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

To decrease venous return and

Heart failure with Sitting up, with legs reduce congestion; promotes
pulmonary edema dangling ventilation and relieves
dyspnea.
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Condition/Procedure Patient Position Rationale & Additional Info

To help lessen chest pain and

Myocardial infarction Semi-Fowler’s
promote respiration.

High-Fowlers, upright
Pericarditis To help lessen pain.
leaning forward.

Depending on desired
outcome.

Slight elevation of legs but

not above the heart or To slow or increase arterial
Peripheral artery disease
slightly dependent. 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,

To promote maximum lung
avoid knee gatch and
Sickle Cell Anemia expansion and assist in
putting strain on painful
breathing.
joints

To prevent pooling of blood in

Varicose veins, leg ulcers, Elevate extremities above the legs and facilitate venous
and venous insufficiency heart level. return; avoid prolonged
standing.

Bed rest with affected limb

elevated.

After 24 hours after

Deep vein thrombosis To promote circulation.
heparin therapy, patient
can ambulate if pain level
permits.

Tracheoesophageal HOB elevated 30-45

To prevent reflux.
fistula (TEF) degrees.

Ventriculoperitoneal After shunt placement: Avoid rapid fluid drainage.

shunt (for Place on non-operative
Hydrocephalus side in flat position.
treatment)
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Condition/Procedure Patient Position Rationale & Additional Info

HOB raised 15-30 degrees
if ICP is increased.

Do not hold infant with

head elevated.

To allow the hyphema to settle

HyphemaBlood in HOB elevated 30-45 out inferiorly and avoid
anterior chamber of eye degrees, with night shield. obstruction of vision and to
facilitate resolution

Post-op: HOB no more

Abdominal aneurysm To avoid flexion of the graft.
than 45 degrees

Place in low-Fowler’s
position then raise knees
To decrease tension on the
Dehiscence or instruct knees and
abdomen.
support them with a
pillow.

To delay gastric emptying

time.
Take meals in reclining
Dumping Syndrome,
position, lie down for 20- Restrict fluids during meals,
prevention of
30 minutes after. low carb, low fiber diet in
small frequent meals.

Instruct not to cough; place on

NPO; keep intestines moist
Place in low-Fowler’s
Evisceration and covered with sterile saline
position.
until patient can be wheeled
to OR.

Reverse Trendelenburg,
slanted bed with head
higher.
Gastroesophageal reflux To promote gastric emptying
disease (GERD) and reduce reflux.
Pediatric: prone with HOB
elevated.

Upright position after To prevent gastric content

Hiatal hernia
meals. reflux.

RIGHT side-lying position To facilitate entry of stomach

Pyloric stenosis
after meals. contents into the intestines.

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Condition/Procedure Patient Position Rationale & Additional Info

To reduce dependent edema

Extremity burns Elevate extremity.
and pressure.

Facial burns or trauma Head elevated To reduce edema

Initially place in sitting

To reduce blood pressures
position or high Fowler’s
Autonomic dysreflexia below dangerous levels and
position with legs
provide partial symptom relief.
dangling.

HOB elevated 30-45 To prevent pressure on

Cerebral aneurysm
degrees; bed rest aneurysm site

To promote venous return and

Supine, flat with legs
Heat stroke maintain blood flow to the
elevated.
head.

To reduce ICP and encourage

blood drainage.Avoid hip and
Hemorrhagic stroke HOB elevated 30 degrees.
neck flexion which inhibits
drainage.

To promote venous drainage.

Elevate HOB 30-45

Avoid flexion of the neck, head
Increased intracranial degrees, maintain head
rotation, hip flexion, coughing,
pressure (ICP) midline and in neutral
sneezing and bending
position.
forward.

To facilitate venous drainage

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

Side-lying or recovery To drain secretions and

Seizure
position. prevent aspiration.

Spinal cord injury Immobilize on spinal To prevent any movement and

backboard, head in neutral further injury.
position and immobilized
with a firm, padded
cervical collar.

Must be log rolled without

allowing any twisting or
bending movements
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Condition/Procedure Patient Position Rationale & Additional Info

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

Ask patient to dorsiflex foot of

Elevate FOB for counter-
the affected leg to assess
traction; use trapeze for
Buck’s Traction function of peroneal nerve,
moving; place pillow
weakness may indicate
beneath lower legs.
pressure on the nerve.

Elevate at or above level of

Casted arm To minimize swelling
heart

Delayed prosthesis Elevate foot of bed to To hasten venous return and

fitting elevate residual limb. prevent edema.

Use splints, wedge pillow, or

pillows between legs.

Affected extremity needs Avoid stooping, flexion

Hip fracture
to be abducted. position during sex, and
overexertion during walking or
exercise.

On unaffected side:
maintain abduction when
in supine position with
pillow between legs. Avoid extreme internal or
Hip replacement
external rotation.
HOB raised to 30-45
degrees.

Immediate prosthesis Elevate residual limb for 24 Rigid cast acts to control
fitting hours. swelling.

To maintain proper body

Support affected extremity
Osteomyelitis alignment; avoid strenuous
with pillows or splints
exercises.

Total hip replacement Help to sitting position; To prevent dizziness and

place chair at 90 degrees orthostatic hypotension.
angle to bed; stand on

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Condition/Procedure Patient Position Rationale & Additional Info

affected 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

repositioned with the right
Air embolism from
Turn to LEFT side or place atrium above the gas entry
dislodged central venous
in Trendelenburg. site so that trapped air will not
line
move into the pulmonary
circulation.

High Fowler’s

Tripod position: sitting

To promote oxygenation via
Asthma position while leaning
maximum chest expansion.
forward with hands on
knees.

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

High Fowler’s
To promote maximum lung
Emphysema
Orthopneic position expansion

Pleural Effusion High Fowler’s To provide maximal

To maximize breathing
High Fowler’s
mechanisms.

Lay on affected side

Pneumonia To splint and reduce pain.

Lay with affected lung up

To reduce congestion.

To promote maximum lung

Pneumothorax High Fowler’s expansion and assist in
breathing.

High Fowler’s, legs To decrease edema and

Pulmonary edema
dependent position congestion

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Condition/Procedure Patient Position Rationale & Additional Info

High Fowler’s
To promote maximum lung
Pulmonary embolism Turn patient to LEFT side expansion and assist in
and lower HOB breathing.

To provide maximal comfort

Flail chest High Fowler’s and 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 Monitor for post-test labor

(CST) side-lying position onset.

To prevent pressure on the

Shrimp or fetal position;
cord. If cord prolapses, cover
Cord prolapse modified Sims’ or
with sterile saline gauze to
Trendelenburg.
prevent drying.

Turn mother to her LEFT To reduce compression of the

Fetal distress
side. vena cava and aorta.

Late decelerations Turn mother to her LEFT To allow more blood flow to
(placental insufficiency) side. the placenta.

Placenta previa Sitting position. To minimize bleeding.

To remove pressure off the

presenting part of the cord
Variable decelerations Place mother in
and prevent gravity from
(cord compression) Trendelenburg position.
pulling the fetus out of the
body.

Spina Bifida Prone (on abdomen). To prevent sac rupture.

Position on back or in
infant seat.
To prevent trauma to suture
Cleft lip (congenital)
Hold in upright position line.
while feeding.

Prolapsed umbilical cord During labor: Knee-chest Relieves pressure or gravity

position or Trendelenburg. from pulling the cord.

Hand in vagina to hold

presenting part of fetus off

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Condition/Procedure Patient Position Rationale & Additional Info

cord.

HOB elevated no more

Cardiac catheterization than 30 degrees or flat as Affected extremity should be
(post) prescribed.May turn to kept straight.
either side

Tape catheter to thigh; no

Continuous Bladder Prevents the catheter from
other positioning
Irrigation (CBI) being dislodged.
restrictions

Position affected ear

Pull outer ear upward and
uppermost then lie on
Ear drops back for adults; upward and
unaffected ear for
down for children.
absorption.

During procedure: Tilt

head towards affected ear.
Better visualization and
Ear irrigation drainage of the medium to the
After procedure: Lie on
ear canal via gravity.
affected side for drainage.

Drop to center of the lower

conjunctival sac; blink between
Tilt head back and look up, drops; press inner canthus
Eye drops
pull lid down. near nose bridge for 1-2 min
to prevent systemic
absorption.

During: Shrimp or fetal

position (side-lying with
back bowed, knees drawn
To maximize spine flexion.
up to abdomen, neck
flexed to rest chin on
Lumbar puncture To prevent spinal headache
chest).
and CSF leakage.

After: Flat on bed for 4-12

hours.

Closes the trachea and opens

Nasogastric tube High Fowler’s with head
the esophagus; prevents
insertion tilted forward
aspiration.

Nasogastric tube HOB elevated 30 to 45 To prevent

irrigation and tube degrees; keep elevated for aspiration.Promotes emptying
feedings 1 hour after an of the stomach and prevents
intermittent feeding. aspiration.
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Condition/Procedure Patient Position Rationale & Additional Info

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

With tracheostomy:
Maintain in semi-Fowler’s
position

During: Semi-Fowler’s in
bed or sitting upright on
side of bed with chair; Empty the bladder before
support the feet. procedure; report elevated
Paracentesis
temperature; assess for
Post: Assist into any hypovolemia.
comfortable position

Lung area needing drainage

Postural Drainage Trendelenburg should be in uppermost
position

Allows gravity to work into the

Left side-lying (Sims’
Rectal enema direction of the colon by
position) with right knee
administration placing the descending colon
flexed.
at its lowest point.

Rectal enemas and Left side-lying, Sims’ To allow fluid to flow in the
irrigation position natural direction of the colon.

To enhance lung expansion

Sengstaken-Blakemore and reduce portal blood flow,
HOB elevated
and Minnesota tubes permitting esophagogastric
balloon tamponade.

Thoracentesis Before: (1) Sitting on edge Prevent fluid leakage into the
of bed while leaning on thoracic cavity.
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
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Condition/Procedure Patient Position Rationale & Additional Info

preferred.

Total Parenteral Nutrition During insertion:

To prevent air embolism.
(TPN) Trendelenburg.

Bed rest for 24 hours, keep

Vascular extremity graft extremity straight and For maximal adhesion.
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 To prevent edema.

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

HOB elevated 30-45% with

head in a midline, neutral
position.

Craniotomy To facilitate venous drainage.

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

During: Prone Jackknife Provides better visualization of

Hemorrhoidectomy
position. the area.

Hypophysectomy
Surgical removal of the HOB elevated. To prevent increase in ICP.
pituitary gland.

Infratentorial surgery
Flat and lateral on either
Incision at back of head, To facilitate drainage.
side; avoid neck flexing.
above nape of neck

Post-op: Semi-Fowler’s,
Kidney transplant turn from back to non- To promote gas exchange
operative side

Laminectomy Back is kept

straight.Patient is logrolled
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Condition/Procedure Patient Position Rationale & Additional Info

if turned.

Sit straight in straight-

backed chair when out of
bed or when ambulating.

HOB elevated 30-45 To maintain airway and

Laryngectomy
degrees decrease edema.

To allow lymph drainage.

Semi-Fowler’s with arm on

Mastectomy Turn only on back and on
affected side elevated.
unaffected side.

Post-op: semi-Fowler’s
Mitral valve replacement To assist in breathing.
position.

Post-op: Position on side

Myringotomy To allow drainage of secretions
of affected ear .

Bed rest with minimal

activity and repositioning.

Helps detached retina fall into

Retinal detachment Area of detachment
place.
should be in the
dependent position.

HOB elevated 30-45

degrees; maintain
Supratentorial surgery
head/neckline in midline
Incision front of head To facilitate drainage.
neutral position; avoid
below hairline
extreme hip and neck
flexion.

Post-op: High Fowler’s or To reduce swelling and edema

semi-Fowler’s. in the neck area.

Thyroidectomy Avoid extension and To decrease tension on the

movement by using suture line and support the
sandbags or pillows. head and neck.

Post-op: prone or side- To facilitate drainage and

Tonsillectomy
lying relieve pressure on the neck.

Bone marrow Side lying with head To expose the area.

aspiration/biopsy tucked and legs pulled up

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Condition/Procedure Patient Position Rationale & Additional Info

or; Apply pressure to the area
after the procedure to stop
Prone with arms folded the bleeding.
under chin.

To prevent edema.

Elevate for first 24 hours To provide for hip extension

Amputation: above the
using pillow.Position prone and stretching of flexor
knee
twice daily. muscles; prevent contractures,
abduction

Foot of bed elevated for

To prevent edema.
first 24 hours.
Amputation: below the
knee To provide for hip extension.
Position prone daily.

References and Sources

The following are the references and sources for this patient positioning study guide:

Beckett, A. E. (2010). Are we doing enough to prevent patient injury caused by

positioning for surgery?. Journal of perioperative practice, 20(1), 26-29.
Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., … &
Stanley, D. (2018). Kozier and Erb’s Fundamentals of Nursing [4th Australian
edition].
Miranda, A. B., Fogaça, A. R., Rizzetto, M., & Lopes, L. C. C. (2016). Surgical
positioning: nursing care in the transoperative period. Rev SOBECC, 21(1), 52-8.
[Link]
Ritchie, I. K. (2003). Positioning Patients for SurgeryBy Chris Servant & Shaun Purkiss
Greenwich Medical Media ISBN 1841100528£ 22.50.
Rosdahl, C. B., & Kowalski, M. T. (Eds.). (2008). Textbook of basic nursing. Lippincott
Williams & Wilkins.
Park, C. K. (2000). The effect of patient positioning on intraabdominal pressure and
blood loss in spinal surgery. Anesthesia & Analgesia, 91(3), 552-557.
Price, P., Frey, K. B., & Junge, T. L. (2004). Surgical technology for the surgical
technologist: A positive care approach. Taylor & Francis.

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Cheat Sheets, Dorsal Recumbent, Lateral Position, Lithotomy Position, Orthopneic

Position, Patient Positioning, Supine, Trendelenburg's Position
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Matt Vera, BSN, R.N.

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a
full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram
on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping
student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in
delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a
nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated
topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing
concepts effectively.

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