Patient Positions

One primary responsibility for medical assistants is positioning the patient for procedures. There are multiple different types of positions in which a patient may need to be in. This typically depends on the specialty. The goal of patient positioning is to maintain airways, prevent any soft tissue, musculoskeletal, or nerve damage/injury to the patient, and, lastly, to get the best view of the area in focus.¹ These positions can be used for various examinations. Below is information on the patient positioning based on the procedure being performed.

The first is erect. This position involves having the patient stand with their feet together, arms by their sides, and palms pointed out. This allows the provider to survey the patient's stance or posture in this position.

The second is supine or dorsal decubitus. This position involves having the patient lie flat on their back.² The Medical Assistant can assist elderly patients in this position by helping them sit down and lie back slowly. This position is commonly used for a breast exam, palpation of the abdomen, or to take an ECG.

The third is prone, commonly known as proning, which is lying face down with the patient's arms beside their body or above their head.² The Medical Assistant can assist the patient with sitting down, lying back, and rolling over. This position can be used in a surgical setting or to better examine specific areas of interest. This is also used when a patient has low oxygen levels caused by respiratory illnesses.³

The fourth position is Fowler's position; there are different variations of Fowler’s position. Standard Fowler’s position is when the patient is seated upright at a 45-60-degree angle. There is also Low Fowler’s (15-30 degree angle), Semi-Fowler’s (30-45 degree angle), and High Fowler’s (90-degree angle).⁴ The Fowler’s position is the most common patient position in the hospital or for an inpatient; it can be used in the surgical setting for neurosurgery. 

The fifth position is most commonly used in OB/GYN offices and is known as the Lithotomy position. The patient will lie flat on their back with their knees bent at a 90-degree angle, their bottom will be scooted to the edge of the table, and their feet will be in stirrups. The Medical Assistant can assist the patient with lying back on the exam table and putting their feet into the stirrups. This position is commonly used for gynecological exams and pap smears.

The sixth position is the Trendelenburg position. In this position, the patient will be lying supine on the exam table, tilted back (so the head is lower than the waist), typically at a 15-30-degree angle. This is also used in OB/GYN offices and for procedures like in-vitro fertilization (IVF).⁵ The medical assistant will adjust the angle of the exam table once the patient is lying down.

The seventh position is the Sim’s position, also known as ‘lateral’; the patient will be lying on their left side, their left arm will be behind the body, and their right arm will be forward and flexed at the elbow. Both legs are flexed at the knee, and the right leg is sharply flexed and positioned next to the left leg, which is slightly flexed. This position is commonly used for rectal exams or enemas.¹

The eighth position is the knee-chest, also known as the genupectoral position. The patient will be lying face down with their head on a pillow, with their knees up to the chest, putting their weight onto their knees with their hips in the air. This is commonly used for proctological exams and examining the rectum for hemorrhoids or lesions.⁶

Not all patients can handle these positions, and some medical conditions may require different positioning. It is very important to communicate with the provider to determine the best position for the patient based on their needs. Understanding patient positions is an essential part of being a Medical Assistant, and knowing how to position patients correctly can help ensure that medical procedures are safe, effective, and comfortable for the patient.

 

References: 

1. Steris Healthcare (n.d.). The Complete Guide to Patient Positioning. Steris. Retrieved December 9, 2023, from https://www.steris.com/healthcare/knowledge-center/surgical-equipment/complete-guide-to-patient-positioning
2. British Columbia/Yukon Open Authoring Platform (2018, May 1). Anatomical Position. Pressbooks. Retrieved December 9, 2023, from https://pressbooks.bccampus.ca/advancedanatomy1sted/chapter/anatomical-position/
3. Cleveland Clinic (2023, May 29). Proning. Retrieved December 9, 2023, from https://my.clevelandclinic.org/health/treatments/25026-proning
4. Permobil (2017, October 19). Fowler’s Position: Beyond the Bed. Retrieved December 9, 2023, from https://hub.permobil.com/blog/fowlers-position-beyond-the-bed
5. Anesthesiology Clinics of North America (2021, February 25). Anesthesia for In Vitro Fertilization. Science Direct. Retrieved December 9, 2023, from https://www.sciencedirect.com/science/article/abs/pii/S0889853721001991
6. Tufts Medical Center (n.d.). Approaches to Abdominal Colorectal Surgery. Retrieved December 9, 2023, from https://www.tuftsmedicalcenter.org/-/media/Brochures/TuftsMC/Patient-Care-Services/Departments-and-Services/Colon-and-Rectal-Surgery/PrepProctology.ash