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Proper Patient Positioning: Prone Position

The prone position is where the patient lies face down and is commonly used for access to the posterior head, neck, and spine during spinal surgery, access to the retroperitoneum and upper urinary tracts and access to posterior structures when required during plastic surgery.¹

A minimum of four personnel is required to safely turn the patient into the prone position when transferring them from the stretcher to the OR table. All movements are carried out slowly and gently to allow the patient’s body time to adjust to the change from the original supine position. The anesthesia provider assists by supporting and managing the head and airway, one team member supports and rotates the torso while another team member on the other side of the bed positions the patient on the padded laminectomy frame or chest rolls. Pads and rolls are positioned lengthwise and lift the patient’s chest off the OR table to allow sufficient respiratory expansion. The fourth team member is responsible for supporting and moving the lower part of the patient’s body. During rotation, the patient’s arms should be placed at their side and their body should be maintained in an anatomically aligned manner. Caution should be taken to avoid unnecessary compression of the breasts and genitalia. The patient’s arms are brought down and forward in a normal range of motion and placed on arm boards near the head. The arms are flexed at the elbows with palms down and the elbows padded.² AliMed Arm cradles are designed to flex to the natural positioning. 

A positioner, like the AliGel Dome Positioner, should be placed under the ankles to lift the toes off the mattress and prevent stretching of the anterior tibial nerve to avoid plantar flexion and foot drop. A small pillow or foam pad is placed under the knees to prevent pressure on the patellae.  The AliLite Knee Supports are designed to offload pressure during a procedure. A table strap (covered by a sheet to protect the skin) is secured across the patient’s mid-thighs to hold the patient in position.³ The VeriClean Patient Safety Strap line is the only disinfectable strap for use in the operating room designed to comfortably and securely hold the patient during a procedure. With the head and neck in optimum alignment, the patient’s head is turned to one side or placed in a headrest designed to protect the airway. The ears should not be folded in an unnatural manner. The eyes are closed to prevent corneal abrasion and the nurse should check that they are free from the pressure that could cause permanent eye injury. Patients with iris implants or eye jewelry who are positioned in the prone position may be at increased risk for ocular injury.⁴

Visit Prone Patient Positioning Specialty Page to see more examples of how AliMed can help with proper patient positioning and reduce pressure injury risks.

References

1. Akhavan A, Gainsburg DM, Stock JA. Complications associated with patient positioning in urologic surgery. Urology. 2010;76(6):1309-16. https://doi.org/10.1016/j.urology.2010.02.060
2. Beckett AE. Are we doing enough to prevent patient injury caused by positioning for surgery? J Perioper Pract. 2010;20(1):26. PMID: 20225718.
3. 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.
4. Fritzlen T, Kremer M, Biddle C. The AANA Foundation Closed Malpractice Claims Study on nerve injuries during anesthesia care. AANA J. 2003; 71(5):347–352. PMID:14625971.

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