11/1/23, 9:41 PM Patient Positioning in Surgery
MEDIK BLOG
Patient Positioning in Surgery
Apr 23 2021
1. What is Patient Positioning?
Patient positioning is vital to a safe and effective surgical procedure. Proper patient positioning
depends on the type and length of the procedure, anesthesia access to the patient, devices required,
and other factors. In surgery, 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, positioning patients to provide airway management and ventilation, maintain body
alignment, and providing physiologic safety.
2. Goals of Patient Positioning
- Provide patient comfort and safety.
- Maintaining patient dignity and privacy.
- Allows maximum visibility and access.
- Prevent soft tissue or musculoskeletal and other patient injuries
3. General positioning at a glance
Fowler's position
Fowler's position, also known as the sitting position, is typically
used for neurosurgery and shoulder surgeries. Fowler’s
position is usually used in surgeries that involve neurosurgery
or the shoulders The legs and knees should be relaxed and
not overstretched. Raise the front and back stepwise,
alternating between the two to reduce shear and friction
forces. Once the patient has been placed into the sitting
position, again assess the patient’s position to eliminate any
forces that might have arisen during the positioning process.
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11/1/23, 9:41 PM Patient Positioning in Surgery
Supine position
The supine position is frequently used on procedures involving
the anterior surface of the body (e.g., abdominal area, cardiac,
thoracic area). Special attention should be given to leg positio
ning, ensuring that the knees and joints are not overstretched.
The head and cervical spine should be relaxed. Careful arm pl
acement can prevent nerve damage.
Prone position
The prone position is often used for neurosurgery, in most nec
k and spine surgeries. Used during spine surgery, the thorax
must be placed on a pad with a large opening; this allows the
stomach and breast to follow the breath and reduces intra-abd
ominal pressure. It is important to ensure that the blood vessel
s in the groin are not compressed. Knees should be bent slight
ly and well-padded. The head should be positioned so that t
he cervical spine is neutral. Pillows with lateral cut-outs enable
easy access for anesthesia tubes.
Lateral position
A patient may be positioned in a Lateral position during the
back, colorectal, kidney, and hip surgeries. It's also commonly
used during thoracic and ENT surgeries, and neurosurgery. In
lateral positioning,the patient must be secured to prevent
rolling. Good padding for the legs and heels is recommended
to relieve stress. The patient can be positioned on the
motorized joints of the tabletop to give optimum access to the
thorax or kidney area. Best practice recommends using a
pillow that offers space for the ear.
Lithotomy position
This position is typically used for gynecology, colorectal,
urology, perineal, or pelvis procedures. This positioning
requires that the pelvis is positioned to prevent a hollow back
(lordosis) and to provide the largest possible supporting
surface of the calf in the knee crutch. The popliteal fossa and
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11/1/23, 9:41 PM Patient Positioning in Surgery
heels should be freely positioned. The foot and knee should
be placed in line with the opposite
shoulder.
Genucubital position / Knee elbow position
For gynecological or rectal surgery, patients are anesthetized
in the supine position, and then repositioned into a
Trendelenburg position for surgery to prevent
sliding.Positioning aids play an important role in this position.
The thorax must be placed on a pad with a large opening to
reduce intra-abdominal pressure and aid breathing. Protect
the patella with a gel pad, and use additional padding at the
hip.
Explore our Surgical Tables
4. Support Devices for Patient Positioning
The followings are the devices or apparatus that can be used to help position the patient properly.
- Arm Supports - Waist support
- Body Restraints - Pad Positioners
- Clamps & Sockets - Patient Warming
- X-ray Tops - Tabletop Pads
- Head Rests - Disposable Surgical Accessories
- Leg Supports - Lithotomy stirrup
- Shoulder support - orthopedic traction
References
The following are the references and sources for this patient positioning study guide:
1. Ritchie, I. K. (2003). Positioning Patients for SurgeryBy Chris Servant & Shaun Purkiss Greenwich Medical Media
ISBN 1841100528£ 22.50.
2. 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.
3. 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].4.
4.Rosdahl, C. B., & Kowalski, M. T. (Eds.). (2008). Textbook of basic nursing. Lippincott Williams & Wilkins.
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