Proper Patient Positioning Guidelines: Supine Position

May 21, 2018
supine positioning

The supine position is the most common patient position used in the OR. Typically, the head is rested on a foam pillow, keeping the neck in a neutral position. The patient is placed flat on their back with their head and spine aligned. The head is supported by a patient positioning headrest like the AliGel Head Positioner or Single-Use Head Donuts.

The arms are typically at rest at the patient’s side or on padded arm boards. When arm boards are used for patient positioning, 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. Ulnar Nerve Protectors are lightweight and single use for improved infection control. The arms can then be secured with a draw sheet.

Legs are positioned in a straight line with knees slightly at approximately 5 degrees to 10 degrees,2 and not touching. Positioning the knees in slight flexion prevents popliteal vein compression and reduces the patient’s risk for Deep Vein Thrombosis (DVT).3 A soft positioner such as the AliGel Dome Positioner may also be placed under the knees to alleviate strain on the lumbar spine.

The supine position is used in intracranial, abdominal, anterior cervical spine, most extremity procedures as well as many minimally invasive surgeries (MIS). Caution should be taken to ensure that the sheet is not so tight that it interferes with IV lines or the blood pressure (BP) cuff. A small pillow or pad, like the Azure Sacral Pad may be placed under the lumbar area to prevent postoperative back strain, as it provides support to the patient’s physiologic lordotic curvature. The legs should be parallel with ankles uncrossed. The patient’s heels should be elevated off the underlying surface as this in will increase perfusion and help prevent pressure injury. AliMed offers a variety of heel protection in our gel lines, AliGel, AliLite, Freedom and Azure.

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


  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.
  2. Huber D. Preventing deep tissue injury of the foot and ankle in the operating theatre.Wounds UK. 2013; 9(2):34-38.
  3. Huber D, Huber J, DeYoung E. The association between popliteal vein compression and deep venous thrombosis: results of a pilot study. Phlebology. 2013; 28(6):305–307.
animated positioning graphic

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