What is the Positioning for Bed Ridden Patients?

According to the Agency for Healthcare Research and Quality (AHRQ), most pressure ulcers can be prevented with proper care. Understanding what is the positioning for bed ridden patients is crucial for preventing complications such as pressure sores, promoting circulation, and ensuring the patient's overall comfort and well-being. This guide explains the key positioning techniques and provides essential tips for caregivers.

Quick Summary

This comprehensive guide details proper positioning techniques for bedridden patients, outlining different positions such as supine, lateral, and semi-Fowler's. It explains the critical importance of regular repositioning to prevent complications like pressure ulcers, improves blood circulation, and enhances comfort using supportive devices like pillows. Key strategies for safe movement and skin monitoring are covered.

Key Points

• Regular Repositioning is Essential: Bedridden patients must be repositioned at least every two hours to prevent pressure ulcers and improve circulation.

• Utilize the 30-Degree Lateral Position: This angled side-lying position is recommended to relieve pressure on the sacrum and hips, using pillows or wedges for support.

• Protect Pressure Points in Supine Position: When a patient is on their back, use pillows to float heels off the bed and support the head and lumbar curve to prevent pressure sores.

• Elevate the Head of the Bed Safely: For patients with breathing difficulty, the semi-Fowler's position (30-45 degrees) is helpful, but avoid prolonged elevation above 30 degrees to prevent shearing.

• Use Supportive Devices and Proper Techniques: Aids like draw sheets, pressure-relieving mattresses, and strategically placed pillows are crucial for safe, comfortable repositioning and proper alignment.

• Conduct Daily Skin Inspections: Caregivers should regularly inspect the patient's skin, especially over bony areas, for signs of redness or discoloration to catch potential pressure ulcers early.

Why Proper Positioning is Critical for Bedridden Patients

For individuals confined to a bed for extended periods, immobility is a major risk factor for several complications. Prolonged, unrelieved pressure on bony areas of the body can squeeze tiny blood vessels, restricting oxygen and nutrients and leading to skin and tissue damage, known as pressure ulcers or bedsores. Regular, proper positioning helps to distribute body weight evenly, relieve pressure points, and improve blood circulation.

Benefits of Effective Repositioning

• Prevents Pressure Ulcers: This is the primary goal of repositioning. By relieving pressure on vulnerable areas like the sacrum, heels, and hips, the risk of skin breakdown is significantly reduced.
• Improves Circulation: Changing positions encourages blood flow, which is vital for maintaining skin integrity and tissue health.
• Enhances Respiratory Function: Repositioning can help clear lung congestion and improve breathing, reducing the risk of pneumonia.
• Prevents Joint Contractures: Immobility can lead to stiff muscles and joints. Proper positioning promotes flexibility and maintains range of motion.
• Enhances Comfort and Dignity: Frequent changes of position can increase a patient's comfort and sense of well-being, improving their quality of life.

Essential Positioning Techniques for Bedridden Patients

There are several effective positions that can be used for a bedridden patient. These should be alternated on a regular schedule, typically every two hours, and should always involve the use of supportive devices like pillows or wedges. Before moving a patient, always explain what you are going to do, and if possible, enlist their help and a second caregiver.

The 30-Degree Lateral (Side-Lying) Position

The 30-degree lateral position is a widely recommended technique for preventing pressure ulcers on the sacrum and heels.

How to perform the 30-degree lateral position:

1. Raise the bed to a comfortable working height for the caregivers and lock the wheels.
2. Move the patient toward the side of the bed opposite the direction they will be turned.
3. Turn the patient gently onto their side, leaning them at a 30-degree angle using pillows or foam wedges placed behind their back for support.
4. Place a pillow between the patient's knees and ankles to prevent bony prominences from rubbing together.
5. The patient's top arm should be supported with a pillow to prevent pressure on the shoulder.
6. Ensure that the patient's weight is not resting directly on their shoulder and hip bone.

The Supine (Back-Lying) Position

In the supine position, the patient lies flat on their back. It is important to use pillows to prevent pressure on vulnerable areas.

How to perform the supine position:

1. Use a pillow to support the patient's head and upper shoulders, maintaining spinal alignment.
2. Place a small, rolled towel or pillow under the lower back for lumbar support if needed.
3. Use a pillow or foam wedge under the patient's calves to float the heels off the mattress, relieving pressure on the heels.
4. Keep the arms and hands supported with pillows at the patient's side.

The Semi-Fowler's Position

This position involves raising the head of the bed between 30 and 45 degrees, which is useful for patients with respiratory issues or for mealtimes.

How to perform the semi-Fowler's position:

1. Elevate the head of the bed to the desired angle, but no higher than 30 degrees for prolonged periods to prevent shearing forces.
2. Use pillows to support the patient's head, neck, and arms.
3. Place a pillow or foam wedge under the knees to prevent the patient from sliding down in the bed.
4. Ensure the patient's heels are elevated and free from pressure.

Comparison of Key Patient Positions

Feature	30-Degree Lateral	Supine	Semi-Fowler's
Primary Purpose	Relieve pressure on sacrum and heels	General rest, some medical procedures	Improve breathing, facilitate eating
Bed Angle	Tilted at 30 degrees to the side	Flat or head slightly elevated	Head of bed raised 30-45 degrees
Key Support Areas	Back, between knees, top arm	Head, lumbar, calves	Back, head, arms, knees
Common Risks	Pressure on hip, ear, and shoulder	Pressure ulcers on sacrum, heels, and elbows	Sliding down, shearing forces, neck flexion
Frequency	Part of a regular rotation, typically every 2 hours	Part of a regular rotation	Use as needed, avoid prolonged periods over 30°
Important Note	Avoid lying at a full 90-degree angle on the side	Elevate heels to prevent ulcers	Use footboard to prevent foot drop

Practical Tips for Caregivers

Create a Repositioning Schedule

Develop and follow a consistent schedule for turning the patient, usually every two hours. Document the position and time to ensure a regular routine is maintained.

Use Proper Equipment

• Draw Sheets: These are sheets placed under the patient from the shoulders to the thighs. They allow caregivers to lift and move the patient without dragging, which causes skin friction and damage.
• Specialized Mattresses and Cushions: Pressure-relieving mattresses, gel cushions, and foam wedges help distribute pressure more evenly across the body. Avoid donut-shaped cushions, as they can restrict blood flow.
• Positioning Aids: Pillows and foam wedges are essential for providing support, maintaining alignment, and offloading pressure from bony areas.

Monitor Skin Health

Inspect the patient's skin daily, paying special attention to bony prominences. Look for signs of pressure ulcers, such as redness, warmth, or skin that doesn't return to its normal color after pressure is relieved. Early detection is key to effective prevention.

Maintain Hygiene and Nutrition

Keep the patient's skin clean and dry, especially after instances of incontinence. Use mild cleansers and moisture barrier creams as needed. A balanced diet with adequate protein, vitamins, and fluids is vital for maintaining skin health.

Conclusion

Proper positioning is a cornerstone of care for bedridden patients, directly impacting their safety, comfort, and overall health. By implementing a systematic repositioning schedule, utilizing appropriate supportive equipment, and diligently monitoring skin health, caregivers can significantly reduce the risk of pressure ulcers and other complications associated with immobility. The 30-degree lateral, supine, and semi-Fowler's positions, when used correctly and alternated regularly, provide a comprehensive approach to managing pressure and ensuring optimal patient outcomes. For more detailed information on specific techniques and preventative care, refer to resources from organizations like the National Institutes of Health(https://www.ncbi.nlm.nih.gov/books/NBK513320/).

Frequently Asked Questions

How often should a bedridden patient be repositioned?

A bedridden patient should be repositioned at least every two hours. Some high-risk patients may need more frequent repositioning, and sitting patients should be shifted every 15-60 minutes.

What is the 30-degree lateral position?

The 30-degree lateral position is a side-lying position where the patient is tilted at a 30-degree angle. This is achieved by placing pillows or wedges behind the back, with a pillow between the knees, to relieve pressure on the hips and sacrum.

Why is it important to prevent pressure ulcers?

Pressure ulcers, or bedsores, can cause significant pain, lead to infection, and prolong recovery. Repositioning is essential to maintain skin integrity, improve circulation, and prevent tissue damage.

What should be placed under the heels of a bedridden patient?

Pillows or specialized heel suspension devices should be placed under the calves to float the heels off the mattress completely. This prevents constant pressure and reduces the risk of pressure ulcers in this vulnerable area.

What is the proper way to turn a patient to their side?

To turn a patient, use a draw sheet to lift and move them to the opposite side of the bed from the direction they will be turned. Bend the knees and turn them gently, using pillows to support their back, top leg, and arm in the 30-degree lateral position.

Can proper positioning help with breathing difficulties?

Yes, positions like the semi-Fowler's position, where the head of the bed is elevated to 30-45 degrees, can help promote lung expansion and improve oxygenation. The orthopneic (tripod) position can also help patients with severe breathing issues.

What is shearing and how can it be avoided?

Shearing is the force caused when skin and underlying tissue slide in opposite directions, which can occur when a patient slides down in a bed with the head elevated. It can be avoided by limiting the bed's head elevation to no more than 30 degrees for extended periods and using lift-and-move techniques instead of dragging.