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Proper Patient Positioning Guidelines: Trendelenburg Position

Trendelenburg is a variant of the supine position in which the table is tilted with the head down so that the patient’s head is lower than their feet. This position provides additional visualization of the lower abdomen and pelvis and is also indicated for patients who develop hypovolemic shock. Patients undergoing robotic procedures are also frequently placed in this position.

The head is supported by a headrest, keeping it in a neutral position so the head and spine are aligned. The arms are typically at rest by the patient’s side or on padded arm boards. When arm boards are used, the arms should be extended at less than a 90-degree angle from the body to prevent ulnar and radial nerve compression.¹ When arms are positioned at the patient’s side the palm should rest against the patient and the elbows should be padded. The arms can then be secured with a draw sheet.

The patient is positioned with their knees over the lower break on the OR table. To maintain this position, the lower part of the table is adjusted so that the patient’s legs are parallel with the floor. All movements should be carried out slowly to allow the patient’s body enough time to adjust to the change in blood volume, respiratory exchange and displacement of abdominal contents. Respiratory and circulatory changes occur as a result of redistribution of body mass and abdominal contents press against the diaphragm, limiting expansion and decreasing profusion. Perioperative nurses should take special care when using shoulder braces in this position because they pose a risk for brachial plexus injury unless they are positioned very carefully against the acromion and spinous process of the scapula.¹ The SecureFit TPS is a reusable positioning system which secures the patient in place during Trendelenburg positioning, a Single-Use option is the Trendelenburg Stabilizer.

References

1. Burlingame B, Davidson J, Denholm B, et al. Guideline for positioning the patient. Guidelines for Perioperative Practice. 2017;1. DOI: 10.6015/psrp.17.01.e1.

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