POSITIONING & DRAPING

Definition:
An area of localised damage to the skin and
underlying tissue caused by pressure, shear, friction
and/or a combination of these.

Commonly referred to as bed sores, pressure
damage, pressure injuries and decubitus ulcers

Stage I
Red, darkened or non-blanchable skin, which is
still present 30 minutes after pressure relieved.

Stage II
Addition of blister-like lesions; skin may
be broken
 Stage III
Skin tissue is destroyed and fatty tissue may
be involved; infection and eschar (scab) may result
 Stage IV
Skin, fatty tissue destroyed and muscle and
bone involved.

Why do we spend time on positioning?
 Patient comfort/decrease pain
 Support and stability to patient’s trunk & extremities
 Prevent development of pressure sores
 Prevent joint contractures
 To have easier access to area being treated
 Decrease edema
 Increased function
 Maintain cardiovascular pulmonary integrity by using
changes in position to assist in removal of secretion,
breathing patterns, and vascular flow

Who is at risk?
 Elderly
 Those unable to change their own position
 Those with decreased sensation
 Those who may be unable to communicate their
discomfort

Manage patient and environment properly.

Move the patient in and out in a safe and effective manner
while Lying.

Check the patient’s skin and bony area which would be pressure sites
after being placed in a new position.

Move the patient at every two hours.

Patient with fragile skin the time should be reduced.

Check the skin for colour and integrity when the patient is repositioned.
While sitting:

Patient should relieve pressure in the buttock and the
sacrum at least every 10 minutes.

Sitting push ups using the arm rest of a chair.

Leaning first in one side then to the other side.

Leaning forward.

Bed cradle

Heel and elbow protectors

Floatation pads or cushions

Pillows

Water beds, Air beds

Alternating pressure mattresses

Egg crate mattresses

Blankets

Splints, slings & braces

Seat cushions

Wedges
 Supine
 Prone
 Side- lying
 Semi-fowler
 Sitting
1. Supine Lying
 Pillow under head to keep cervical-spine neutral
 Small pillow or towel roll for cervical support
 Support under elbows to relieve pressure on bony
prominence
 Support under popliteal space to decrease lumbar lordosis
 Ankle support to relieve pressure on calcaneus
2.Prone Lying
 Pillow under head
 Pillow under lower abdomen to decrease lumbar lordosis
 Rolled towel under anterior shoulder to adduct (retract)
scapula
 Towel roll/pillow/bolster under ankles to relieve stress on
hamstrings, also allows pelvis and lumbar spine to stay
relaxed
3. Side lying
 Patient in center of bed – not near edge
 Head, trunk, pelvis in alignment
 Lower Extremities are flexed at hip & knee with pillows
between legs & top Leg slightly forward of bottom leg
 Pillow at chest &/or back for to prevent patient from
rolling
 Pillow under top arm to keep chest open
4. Semi-fowler Position
 Head of bed is elevated 30° - can use pillow, wedge or
bolster as well
 Pillow under popliteal space
 Used for breathing, eating, visiting
5.Fowler position - head of bed is elevated 45°
5. Sitting Position
 Variety of seated positions
 Remember to soften bony prominences
 Arms and legs supported (head if necessary)
 Elbows at 90°
Reasons for draping patient:
 Privacy/modesty/dignity
 Warmth
 Hygiene

If you need patient to change to gown – leave room – knock
before re-entering

If patient needs assistance suggest it, ask permission before
helping them

Only area being treated is exposed, the rest of the patient is
covered with
 Gown, blanket, sheet, towel

Patient comfort is the key to working on difficult areas

Turning from supine to side lying position and returning.

Supine to prone positioning and returning.

Moving in bed-upward, downward, side to side.

Rolling

Bridging exercises

Moving from lying to sitting.