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Proper Patient Positioning Guidelines: Prone Position

The prone position is a critical technique in medical procedures where the patient lies face down. This position is particularly useful in surgeries that require access to the posterior head, neck, and spine, such as spinal surgeries. Additionally, it offers vital access to the retroperitoneum, upper urinary tracts, and posterior structures, which are essential for certain plastic surgeries. 

When positioning a patient in the prone position, there are several safety concerns that healthcare providers must address to minimize the risk of pressure injuries. Specific areas at risk for pressure injuries include the orbits, optic nerve, cheek, ear, brachial plexus, thorax, breasts (in female patients), abdomen, iliac crest, genitalia (in male patients), patellae, shins, and toes. Prolonged pressure on these areas can lead to pressure ulcers, nerve damage, and other complications.  

Additionally, the prone position can compromise respiratory function if the chest is not sufficiently elevated, leading to decreased lung expansion and potential respiratory distress. Ensuring that the chest and abdomen are appropriately supported helps maintain adequate ventilation and oxygenation. Protecting the eyes and preventing facial pressure is also essential, as prolonged pressure on the face can lead to corneal abrasions or even blindness.  

Positioning the Patient in Prone: Head and Neck 

Transitioning a patient into the prone position is a complex task that requires the coordinated efforts of at least four healthcare professionals. The patient’s head is positioned in a neutral position to align with the spine, which is crucial for maintaining proper anatomical alignment. The head is either turned to one side or placed in a headrest specifically designed to protect the airway.  

It is essential to ensure that the ears are not unnaturally folded and that the eyes are protected from pressure, which helps prevent corneal abrasions. Special considerations should also be given to patients with iris implants or eye jewelry, as they may be at a higher risk for ocular injuries. 

Positioning the Patient in Prone: Arms and Upper Body 

Proper support of the torso is essential during the transition to the prone position. One team member is responsible for supporting and rotating the torso, ensuring that the patient is properly positioned on a padded frame or chest rolls. These pads are aligned to elevate the chest, which helps maintain adequate respiratory expansion.  

The patient’s arms are brought forward and placed on armboards near the head, flexed at the elbows with hands pronated. This positioning is essential for preventing nerve damage and ensuring comfort throughout the procedure. For pressure relief, armboard pads or special positioners are often used. AliMed® Arm Cradles, for example, are specifically designed to conform to this natural positioning, providing added security. 

Positioning the Patient in Prone: Legs and Lower Body 

Supporting the lower body is equally important to maintain the patient’s anatomical alignment throughout the procedure. The knees are slightly flexed, and the toes are raised and pointed down, a positioning strategy that helps prevent complications like plantar flexion and foot drop. A positioner such as the AliBlue™ Gel Dome Positioner is strategically placed under the ankles to lift the toes off the mattress, while a positioner like the AliBlue™ Gel Contoured Pad is placed under the knees to relieve pressure on the patellae.  

Finally, a table strap, covered to protect the skin, is fastened across the mid-thighs to secure the patient in place. The VeriClean™ Patient Safety Strap is recommended, as it is the only disinfectable option for the operating room, offering comfort, security, and infection prevention. 

More Resources for Supine and other Surgical Positions  

By utilizing these advanced techniques and specialized products, healthcare professionals can enhance patient safety and optimize surgical outcomes. For more detailed examples of how AliMed can assist with proper patient positioning and reduce the risk of pressure injuries, visit the Prone Patient Positioning Specialty Page.  

AliMed has a wide range of reusable and disposable surgical positioning products to aid with proper patient positioning while helping reduce pressure, shear, and nerve injuries during supine procedures.   

Explore our interactive Supine Positioning Hub or browse our comprehensive guide for more patient positioning products and resources for supine and other common surgical positions, including lateral, prone, lithotomy, fowler’s, Trendelenburg, reverse Trendelenburg, and spinal.  

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