Proper patient positioning is an important part of ensuring that a surgical procedure is safe and effective. Determining a patient's position for a procedure is determined from a preoperative assessment and is based on factors like the type of procedure, length of procedure, patient’s ability to tolerate the procedure, exposure required by the surgical team, anesthesia access, among others.1 One of the four basic patient positions during surgery is the supine position.
The supine position is one of the four basic patient positions. The three other positions are prone, lateral, and lithotomy. In supine position, the patient is face up with their head resting on a pad positioner or pillow and their neck in a neutral position. The patient’s arms, maintained in a neutral thumb-up or supinated position, may be tucked at their sides or abducted to less than 90 degrees on armboards.2
Supine patient positioning is used for intracranial procedures as well as procedures on the anterior surface of the body. Also known as Dorsal Decubitus, procedures that typically use the supine position include:
Procedures on the neck and face are also often performed in supine position, as well as plastic surgeries and general surgeries.
As with all surgical positions, surgical staff should be aware of risks to the patient in the supine position.
One such risk involves the patient’s respiratory functions. When a patient is placed from an upright to a supine position, the intra-abdominal organs shift cephalad, compressing the adjacent lung tissue and potentially leading to decreased functional residual capacity (FRC).2
The supine position also causes extra pressure on the skin and bony prominences over the occiput, scapulae, elbows, sacrum, coccyx, and heels. Surgical table pads and patient positioning pads should be used to reduce the risk of pressure sores and ulcers. Additionally, the brachial plexus and ulnar nerves need to be protected in supine position by having armboards level with the operating table pad and a 90-degree extension of the arms with palms facing up.3
The supine position is one of the most natural positions for patients and usually allows for all patient anatomical structures to remain in natural neutral alignment. Most patients are able to maintain adequate respiratory function with no constricting external compression on the respiratory system. The supine position allows for excellent access to the anterior structures of the body. Also, the supine position is one of the safest positions for stability on the surgical table. It is easy to ensure that patient safety straps are placed and with the entire body supported the risk of injury from falling is further reduced.
Semi supine position refers to positions where the patient is lying on the surgical table but with additional articulations. These are commonly referred to as:5
Alternate positions of the Supine position typically include tilting the patient in various planes. These position alternatives include:
A very common patient position, the supine position allows for ideal surgical access for intracranial procedures and surgery on the anterior cervical spine.2 Surgical staff should consider risks and complications associated with the supine position such as decreased functional residual capacity and risk of pressure sores from increased pressure on the bony prominences on the patient’s body. Variations to the supine position include Trendelenburg position, reverse Trendelenburg position and Fowler’s position.
Regardless of what position is being used for a patient during a procedure, it’s important to follow best practices for positioning.1
Lena Elias-Fogle, BSN RN, CNOR
Director, Global Clinical Solutions
Lena is a seasoned healthcare leader with extensive experience leading complex perioperative environments as well as new program development, continuous process improvement, clinical outcomes, operational excellence, and stakeholder experience.
1 Guideline for positioning the patient. (2017). AORN Journal, 105(4), P8-P10. doi:10.1016/s0001-2092(17)30237-5
2 Patient positioning during anesthesia: Supine position. (2016, December 20). Retrieved from http://www.clinicalpainadvisor.com/anesthesiology/patient-positioning-during-anesthesia-supine-position/article/582929
3 Rothrock, J. C. (2011). Alexander's care of the patient in surgery (14th ed.). St. Louis, MO: Mosby.
4 CBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 January.
5 Armstrong M, Moore RA. Anatomy, Patient Positioning. [Updated 2020 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513320/