❌ When the Supine Position May Not Be Used:

1. Respiratory Distress or Compromised Breathing

● In conditions like COPD, asthma, or heart failure, lying flat can:

○ Reduce lung expansion

○ Worsen shortness of breath
○ Increase the risk of hypoxia

● ✅ Alternative: Use Fowler's or semi-Fowler's position to improve ventilation.

2. Risk of Aspiration
● In patients who are:

○ Unconscious
○ Heavily sedated
○ Vomiting
○ Recovering from anesthesia

● Lying flat increases the risk of aspiration of saliva, vomit, or secretions.

● ✅ Alternative: Lateral (side-lying recovery position) is preferred.

3. Increased Intracranial Pressure (ICP)

● Supine position can worsen cerebral edema or increase intracranial pressure in brain injury or stroke patients.

● ✅ Alternative: Elevate head of bed to 30 degrees.

4. Pregnancy (Especially After 20 Weeks)

● Lying flat compresses the inferior vena cava, reducing blood return to the heart and possibly causing supine
hypotensive syndrome.

● ✅ Alternative: Left lateral position improves circulation.

5. Recent Eye or Brain Surgery

● Supine positioning may increase intraocular or intracranial pressure, risking surgical site complications.

● ✅ Alternative: Positioning per surgical orders, often with head elevated.

6. Post-Abdominal Surgery or Distension

● Flat positioning can cause pain, increase pressure on the incision, or interfere with breathing.

● ✅ Alternative: Semi-Fowler’s to relieve pressure and improve comfort.

⚠ ️When Prone Position May Not Be Used:
● Patients who cannot tolerate prone position
due to obesity, respiratory issues, or spinal
problems may be placed in a lateral decubitus
(side-lying) position instead.

● Transjugular renal biopsy (a different

technique) may be used in high-risk patients
where prone positioning or percutaneous
biopsy isn't safe.
❌ When Not to Use Sims’ Position
While Sims’ position is useful for procedures like enemas, rectal
exams, and perineal care, there are specific situations where it should
be avoided because it may pose risks or discomfort.
⚠ ️1. Spinal or Neck Injuries
● The twisting and partial prone nature of Sims’ position can
aggravate spinal injuries or cause misalignment.
● ✅ Use a more neutral side-lying (lateral) position instead.

⚠ ️2. Hip or Leg Fractures, Surgery, or Pain

● Patients with recent hip replacements, fractures, or severe joint
pain in the hips or knees should not be placed in Sims’ due to the
asymmetrical leg flexion, which can worsen the injury.
⚠ ️3. Late Pregnancy
● Lying in a left-side position may seem safe, but the forward tilt and
abdominal pressure in Sims’ can be uncomfortable or risky for pregnant
patients—especially in the third trimester.
● ✅ Use left lateral position with pillows for support instead.

⚠ ️4. Obesity or Breathing Difficulties

● The partial forward tilt can compress the chest and abdomen, making it
harder for patients to breathe—especially in obese or respiratory-
compromised patients.
● ✅ A more upright semi-Fowler’s or lateral position is better.

⚠ ️5. Decreased Level of Consciousness Without Airway Protection

● The twisting body posture can interfere with airway management if the
patient is not fully alert.
● ✅ Use the recovery position (modified lateral) instead for unconscious
patients.
❌ When Not to Use Fowler’s Position

⚠ ️1. Spinal or Cervical Injuries

● Elevating the head of the bed can destabilize the spine in patients
with suspected or confirmed spinal trauma.
● ✅ Use a flat, neutral position with spinal precautions until
cleared by a physician.
⚠ ️2. Post-Abdominal or Pelvic Surgery (Immediately After)
● Sitting up too early can increase intra-abdominal pressure,
stretch incisions, and impair healing.
● ✅ Patients are often kept flat or slightly elevated (10–20°)
initially.
⚠ ️3. Hypotension or Shock
● Raising the head of the bed can worsen low blood pressure by
reducing venous return to the heart.
⚠ ️4.Risk of Sliding or Shear Injuries
● Frail or elderly patients may slide down the bed, leading to skin
breakdown, especially at the sacrum.
⚠ ️5. After Certain Eye or Brain Surgeries
● Elevating the head too soon may interfere with pressure control or
healing.
⚠ ️6. Severe Dehydration or Blood Loss
● Upright posture can worsen symptoms by lowering cerebral
perfusion.
❌ When Not to Use Orthopneic Position

⚠ ️1. Spinal or Back Injuries

● The orthopneic position requires the patient to sit upright and lean forward, which can
strain the spine.
● In patients with spinal fractures, surgical recovery, or severe back pain, this position
could worsen pain or cause injury.

⚠ ️2. Patients at Risk of Falling

● Patients who are weak, unsteady, or have poor balance should not be placed in the
orthopneic position without adequate support (e.g., a table or pillow).
● Leaning forward without support increases the risk of falling forward or injuring
themselves.

⚠ ️3. Severe Abdominal Distention or Recent Abdominal Surgery

● The orthopneic position can put pressure on the abdomen and potentially worsen
abdominal pain or distension.
● Patients recovering from abdominal surgery, hernia, or conditions like ascites may
experience discomfort or complications with this position.
⚠ ️4. Cardiovascular Instability (e.g., Hypotension, Shock)
● Sitting upright in the orthopneic position can reduce venous
return to the heart, leading to hypotension or worsening shock
symptoms.

⚠ ️5. Severe Respiratory Distress with Weakness

● In patients with extreme respiratory distress or neuromuscular
weakness, the orthopneic position may be difficult to maintain or
cause fatigue.

⚠ ️6. Pregnancy (Especially Late Stages)

● In the third trimester, the orthopneic position could put excessive
pressure on the uterus and pelvic region.
● Additionally, it may affect circulation by compressing major
veins like the inferior vena cava, leading to low blood pressure.
❌ When Not to Use the Knee-Chest Position

⚠ ️1. Pregnancy (Especially Second and Third Trimesters)

● The knee-chest position can compress the uterus and reduce blood flow to the
placenta.
● It may also cause dizziness, nausea, or hypotension in the mother.

⚠ ️2. Spinal, Neck, or Hip Injuries

● Flexing the spine and hips in this position can aggravate injuries or cause pain.
● It's unsafe for patients with spinal instability, recent back surgery, or limited
mobility.

⚠ ️3. Cardiovascular Instability

● The posture may cause a sudden drop in blood pressure (orthostatic hypotension)
or place stress on the heart.
● Patients with shock, arrhythmias, or heart failure should avoid this position.
⚠ ️4. Elderly or Frail Patients
● It can be difficult to get into or out of the position without
assistance and there's a high risk of falls, joint strain, or
injury.
⚠ ️5. Severe Obesity
● This position may compromise breathing, circulation, and
joint mobility.
⚠ ️6. Respiratory Distress or Limited Lung Function
● The chest being compressed against the knees can restrict
lung expansion, worsening breathing in patients with
COPD, asthma, or other pulmonary issues.
❌ When Not to Use

⚠ ️1. Increased Intracranial Pressure (ICP)

● The head-down tilt increases blood flow to the brain, which can worsen cerebral
edema or raise ICP dangerously.

⚠ ️2. Congestive Heart Failure (CHF)

● Trendelenburg increases venous return to the heart, which can overload an
already failing heart and worsen pulmonary edema or dyspnea.

⚠ ️3. Respiratory Distress or Lung Conditions

● Lying with the head lower than the chest can impair lung expansion and
cause airway secretions to pool, making breathing more difficult in:
○ COPD
○ Asthma
○ Pneumonia
⚠ ️4. Obesity
● The added abdominal weight pressing against the diaphragm in Trendelenburg can
lead to severe breathing difficulties and risk of hypoventilation.

⚠ ️5. Pregnancy (Especially Second and Third Trimester)

● Trendelenburg can cause the gravid uterus to compress the inferior vena cava,
reducing blood flow back to the heart and potentially harming both mother and
fetus.

⚠ ️6. Eye or Brain Surgery Recovery

● Increased venous pressure in the head can raise intraocular or intracranial
pressure, interfering with healing.

⚠ ️7. Gastroesophageal Reflux Disease (GERD)

The head-down position can worsen acid reflux by promoting backflow into the
esophagus.