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Conclusions for Supine Positioning Safest supine position, for those patients who can tolerate it, is with a HOB elevation from 0 to 20 degrees. When the nurse plans to elevate the head of the bed, the knees should first be elevated in the range of 20 to 30 degrees, according to patient condition, comfort and preference. When the goals of care include both prevention of pressure ulcers and prevention of ventilator associated pneumonia, an acceptable elevation for the HOB is most likely right at 30 degrees. Protecting the Heels in the Supine Position The calf should be supported and the heels “floated” so they are not in contact with the surface of the bed and care should be taken to avoid pressure on the Achilles tendon. The knee should be in slight flexion to avoid obstruction of the popliteal vein. 8/7/2012 16
Any particular device for heel elevation? ◦ Junkin and Gray.Journal of Wound, Ostomy & Continence Nursing, 2009 Nov-Dec; 36 (6): 602-8 systematic review of methods for preventing heel ulcers outlined a variety of issues with each of these studies concluded that there was insufficient evidence determine which surface or heel protection device should be used in clinical practice. 90 ◦ lateral vs 30 ◦ lateral Colin, et al (1996) using 20 healthy subjects • compared the effects of 90 degree and 30 degree laterally inclined positions in TcP02 and TcCO2 • demonstrated a “dramatic impairment oxygen supply” in these areas when the subjects were positioned in the 90 degree lateral position but not in the 30 degree lateral position. Moore, Cowan and Conroy, 2011 8/7/2012 17
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Page 23: Linda Laudato BSN, RN Gold STAMP Co

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