Patient Positioning during Surgery and Procedures

August 18, 2023 | Health System Risk Management


The patient positioning process involves collaboration among care providers on the procedural team and may require a compromise between optimal procedural access and a position the patient can tolerate (Welch). Depending on the procedure, the team may include surgeons, anesthesiologists, radiologists, other procedural physicians, perioperative nurses, and surgery or radiology technicians, among others (Last). Positioning encompasses more than just the physical process of positioning the patient on the procedure or operating table. It includes preprocedural assessments of the patient, considerations regarding the optimal position, anesthesia practice needs, and individual patient characteristics. The process involves the selection of appropriate positioning devices or equipment, careful documentation, and postprocedure follow-up of the patient to identify any injuries. Follow-up is especially important because, although some positioning-related injuries are immediately identifiable, others can take 24 to 72 hours for signs or symptoms to manifest. (Last; Spruce and Van Wicklin)

The Association of periOperative Registered Nurses' (AORN) Guideline f​or Positioning the Patient identifies patient positioning as one of the most important tasks performed by perioperative personnel.

The goals of patient positioning include the following (AORN "Guideline for Positioning"):

Complications from improper positioning can lead to (Heizenroth; Last):

Injuries can be serious, potentially resulting in (Woodfin):

Pressure injuries present another significant risk for patients. All perioperative patients have some risk of developing pressure injuries and thus must be assessed preprocedure (Spruce). In 2022, AORN published the Guideline for the Prevention of Perioperative Pressure Injury, which is relevant for patients undergoing surgery and other invasive procedures. Pressure injury risk assessment tools are specifically designed and validated for perioperative patients (see Resource List). These tools incorporate risks associated with surgical positioning, the anticipated duration of the surgery and any previous surgeries, the type of anesthesia, support surfaces, limb position, comorbidities (e.g., diabetes, hypertension, preexisting pressure injuries), patient age, patient weight, and other factors (Spruce; Stanton). Pressure injury risk assessment tools not specifically designed for perioperative patients do not take into account the same factors and thus have limited usefulness for these patients (Spruce). Assessment tools appropriate for other...

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