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Proper Patient Positioning Guidelines: Lateral Position

Lateral position is when the patient is positioned with the non-operative side placed on the surgical surface. Proper alignment, adequate stabilization and support of extremities with sufficient padding minimize integumentary, circulatory and musculoskeletal injury and are tools for good positioning. The perioperative team must be trained in good positioning techniques. However, even the most ideal techniques can result in tissue damage when poorly designed positioning equipment is purchased and used. Commercial OR table pads and positioning equipment are designed to reduce pressure and help prevent tissue injuries in surgical patients.

A positioner or contoured headrest (eg, gel or foam) can be used to position the patient’s head and protect nerves in the head and face. Use of a Horseshoe Head positioner can help reduce the risks of ocular pressure by offloading the area. The patient’s dependent leg should be flexed at the hip and knee, the upper leg should be straight and supported with an approved positioner between the legs, dependent knee, ankle, and foot should be padded. Supports should not press against the abdomen to avoid impairing venous drainage from the lower limbs. Pegboard with padding can be used to hold the patient in a lateral position. The Lateral positioning device is designed to give the security of the pegboard, but not the difficulty to clean. Beanbag immobilizer is a positioner-type device that molds around the patient and is also commonly used for lateral positioning.

Tape has been historically used on occasion to secure patients or one of their extremities into position. Another barrier should be used so that the tape does not come in direct contact with the patient’s skin. An assessment for tape allergy should precede any use of tape for any reason. It is important to understand that tape should not be utilized as an option if single-use or easy to clean straps are available. The adhesive left behind on the skin or equipment can harbor bacteria and lead to an infection risk and cause harm to sensitive skin. Positioning straps function like tape without the residue. They are also more versatile and with many commercial products, they can be easily trimmed to the desired length¹ and can often be used on tables without side rails.

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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