Practical guide: Postural changes for patients in bed

The well-being of a bedridden patient should be a priority for family members and caregivers. There are various anatomical positions that can increase comfort for older adults and patients with injuries or conditions that require complete rest through therapeutic practices that ensure the patient's comfort.

Considering posture changes will be an excellent measure for preventing skin lesions, bedsores, and pressure ulcers. All positions performed in bed should facilitate the caregiver's tasks such as cleaning, feeding, distracting, treating, and managing any other tasks the patient requires.

Why are patient position changes important?

Position changes are activities and exercises that should be performed daily to mobilize the anatomy of a person who cannot do so on their own. This not only ensures comfort, but also has multiple physical, emotional, and biological benefits .

• Improves blood circulation in contact areas: legs, buttocks, back.
• Provides comfort and rest.
• Prevents and/or reduces the chances of pressure ulcers.
• Prevents inflammation and stress on joints.
• It benefits the movement and expulsion of mucus.
• Strengthens the mood.
• Avoid any blood blockage due to pressure and direct contact between the body and the layer.
• It allows the person to be moved more easily since the changes in position of the bedridden patient complement each other.

What are the basic anatomical positions?

Supine position

• This position, also known as supine , is performed with the patient lying on their back. Their legs are extended and their arms are aligned.
• It is necessary that the neck is in a neutral position and with the gaze upwards.
• The arms should be extended and attached to the trunk with the palms of the hands facing down.
• It is advisable to have several pillows and place one under your feet at a 90° angle with your legs extended.

To achieve the supine position, the following must be taken into account:

1. Avoid neck hypertension.
2. Place a small pillow under the lumbar area to maintain the anatomical curve.
3. Place a rolled towel or a small, cylindrical cushion under your hips or thighs to prevent rotation of the femur.

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When is this position used?

• For examination of the chest or upper and lower limbs.
• As a starting point for postural changes.
• It is ideal for receiving relaxation massages.

Lateral decubitus

It refers to a position adopted by a bedridden patient to relieve the pressure exerted by their body weight on their sacrum, heels, or other areas vulnerable to pressure ulcers or bedsores.

• In this anatomical position, the patient lies on his side (right or left) in a plane parallel to the floor.
• Your limbs should be partially flexed and your neck in a neutral position relative to your trunk.
• If the patient needs to be moved, this can be done with the help of a sheet tucked into the side opposite the one to which the patient will be moved.

To achieve the lateral decubitus position, the following must be taken into account:

1. Maintain proper spinal alignment by placing a pillow behind your back.
2. Bend the leg above your hip and rest it on a pillow where your thigh and calf are comfortable.
3. Install removable side rails.

When is this position used?

• For therapeutic massages.
• For the placement of suppositories.
• Administration of intramuscular injections.
• Ulcer prevention.

Prone or Ventral Decubitus

In this anatomical position, the patient will lie face down on their abdomen with their head turned slightly to one side or the other. Their limbs will be extended or flexed at the elbow.

To achieve the prone position, the following must be taken into account:

1. It is not advisable to remain in this position for long periods of time as it can be uncomfortable.
2. Soft pillows can be used in the diaphragm area to prevent extension of the lumbar curve.

When is this position used?

• It is used in unconscious or post-operative patients.
• For position changes in the elderly.
• Patients anesthetized to prevent vomiting.

Trendelenburg position

This position involves placing the patient in a supine position (face up), but with the head lower than the feet. Due to the effect of gravity, this promotes venous return of a large volume of blood from the inferior vena cava to the heart, improving blood flow to the brain.

To achieve the Trendelenburg position, the following must be taken into account:

1. The head and trunk should be aligned.
2. A wrapped towel or cylindrical pillow should be placed under the curve of the back to maintain its natural shape.
3. The limbs should be flexed from the knee.
4. Special pillows can be used for bedridden patients, or the bed can be adjustable. You can see Theramart's adjustable bedsat this link , ideal for bedridden patients.

When is this position used?

• To improve blood circulation in the brain and extremities.
• To drain mucus and bronchial secretions.
• To avoid headaches after lumbar puncture.
• Avoid internal bleeding.
• Recovery from pelvic organ surgery.

Semi-Fowler and Fowler positions

The Fowler position is one of the anatomical patient positions used for respiratory therapy. It is used to relax abdominal muscle tension, allowing for improved oxygenation in bedridden patients. It improves oral feeding in conscious patients and facilitates other care activities.

To achieve the Semi Fowler and Fowler position, you must take into account:

1. In the case of taking the Fowler position, the position of the head of the bed should be elevated 90º with respect to the feet.
2. In the semi-Fowler's position, the elevation should be 30°. In this case, the patient will lie supine on a bed or inclined table, so that their head is lower than their feet.
3. The Semi-Fowler modifies the position of the arms on the legs with a slight bend. Its incline is 30°.
4. The Fowler is the full extension of both arms.
5. The high Fowler should be 90° higher than the feet.
6. The bed has a 50cm incline to ensure comfort.

When is this position used?

• Used for otolaryngology examination.
• Used in patients with advanced respiratory problems.
• Applied during relapses due to heart problems.
• For physical examinations of the head, eyes, nose, throat, and chest.
• Ideal for eating, watching TV, reading and chatting.

Nephrectomy

The bedridden patient is placed in a lateral decubitus position, flexing the surgical table, leaving the iliac area exposed.

It should be taken into account:

1. It is not very common.
2. It is used in specific operating rooms.
3. It is used for renal or benign removal or reconstructive surgeries.

When is this position used?

• It is for surgical use only and must be supervised by a specialist.
• It is one of the most delicate anatomical positions and requires special care for the patient.

Roser or Proetz position

The objective of this anatomical position is to maintain hyperextension of the neck. It is performed with the patient lying supine with the head raised off the table or bed. It is used in surgical procedures and to clean the hair of bedridden patients.

To achieve the Roser position, the following must be taken into account:

1. The bed should be horizontal.
2. The person should be lying on the side that is needed.
3. It is important to place a pillow under your head to maintain the natural curve of your neck.
4. The arms should be slightly bent, resting one shoulder on the pillow while the other rests on the mattress.

When is this position used?

• For pharyngeal examinations.
• During neck surgery
• For tracheal intubation
• Performs patient hygiene (head wash).
• During goiter surgery.

English, Sims or Semi-prone Position

In this position, the patient should lie on their left side with their right thigh flexed and their right arm forward. The head should be turned laterally. This position is very common for patient transfers by ambulance.

To achieve the English position, the following must be taken into account:

1. Pillows should be placed under the shoulder, upper arm and thigh.
2. The body should be supported on the shoulder and hip.

When is this position used?

• It is used to place renal tubes in unconscious patients.
• Management of edema or post-operative.
• Drainage of secretions when the patient cannot be transferred.
• For muscle relaxation.

It is important to provide and guarantee care for people with reduced mobility or disabilities who cannot care for themselves. They require dedication, responsibility, and love , as their circumstances are sensitive to them and their environment.

Coordination, organization, and family and hospital logistics are the fundamental pillars for enabling patients to positively cope with the period of time they require rest, guided by qualified specialists who guarantee their total well-being.

Interested in continuing to read more about this topic? We've shared an article on the classification and stages of pressure ulcers.