The decubitus corresponds to the positioning given to the body of a person lying horizontally. There are many variations of this installation depending on the nature of the interventions: a surgical operation, a traumatic context or an emergency intervention.
Definition: what is a decubitus position?
The decubitus corresponds to the installation of a patient in a semi-sitting position. This mainly concerns the areas of anesthesia, resuscitation, emergency medicine, pre-hospital areas (Samu, firefighters). Different variants exist depending on the intervention envisaged. “For any surgery, the patient rests on an operating table. This facility must meet the requirements of the surgical act but also the imperatives of anesthesia (maintenance of vital functions). It must be carried out with the greatest care by the team, under the responsibility of the anesthetist and the surgeon to respect the safety of the patient and his comfort.“, underlines Dr. Paola Mascitti, anesthesiologist-resuscitator.
What is a prone position?
The prone position corresponds to the installation of the patient lying on your stomach. This position allows access to the posterior part of the body for different surgical procedures. “The imperative in this position is the positioning of the head, the absence of ocular compression and the verification of the points of support at the level of the trunk and the limbs“. This position can be supported in different ways.”In the context of the Covid epidemic, certain patients hospitalized in intensive care for respiratory failure underwent mechanical ventilation sessions in prone position, lasting up to 12 hours, to improve lung recruitment and oxygenation“, she underlines.
What is a lateral decubitus position?
The lateral decubitus corresponds the positioning of the patient’s body lying on one of the sides. It is mainly used for thoracic surgeries, lumbotomies and hip surgeries.
What is a supine position?
The supine position is a positioning of the body lying on the back respecting the alignment of the head, neck and trunk with the arms along the body or positioned at 90° relative to the axis of the body. This is one of the most frequent operating positions, especially for surgical procedures. “Several variants of this position can be considered: the semi-sitting position, the inclined and inclined positions: head placed lower than the feet for the first; lower limbs lower than the head for the second“, enumerates Dr. Paola Mascitti.
Why put a patient in the decubitus position?
The decubitus position allows the patient to be positioned so as to watch his constancy and can be declined according to the patient’s condition. The lateral position of safety (or PLS) is the placing in lateral decubitus of a person who is breathing normally but presenting disorders of consciousness (stroke, postictal phase of an epileptic seizure, cranial traumatism). It can be carried out by a single person and allows maintain the patency of the airways, while ensuring the evacuation of oral secretions.
When to put a patient in prone position?
In prone position, the patient is installed gradually with the head higher than the lower limbs. This position allows the lowering of the organs to facilitate the operating field and reduce intracranial pressure. “Head elevation optimizes jugular venous return by reducing cerebral blood volume. This position is fundamental in case of cerebral oedema. Thus, by reducing abdominal pressure on the diaphragm, the forward position allows the redistribution of ventilation to the postero-basal lung areas, which are less well oxygenated in the supine position.“, notes Dr. Mascitti. This position is therefore recommended in case of breathing difficulties, especially in obese people.
When should a patient be placed in an inclined decubitus position?
In inclined decubitus, the patient is installed upside down with an inclusion that must not exceed 20° to promote the irrigation of the brain. In case of hemorrhagic shock, hypotension (fall in blood pressure), raising the limbs allows venous return: “the cardiac output is increased and helps preserve organs that are very sensitive to voltage drops: the heart and the brain”she adds.
What is the recommended position in case of trauma?
In the event of trauma (road accident), the recommended position is the supine. In case of head trauma with impaired consciousness, the PLS position is recommended but the maneuver must preferably be carried out by two people, in order to keep the head in the axis in the event of suspected injury to the cervical spine. “The person will be positioned on the side of the fractured limb to avoid mobilization”. In pregnant women and obese people, PLS should be done on the left side to avoid compression of the vena cava. In children, vigilance in carrying out the maneuver is fundamental, especially in relation to very fragile areas such as the cervical spine.
What are the risks of a decubitus position?
The characteristics and difficulties specific to each patient must be taken into account before each intervention and positioning, particularly in malnourished people, obese people, diabetics or people with arterial disease who are more at risk of complications. The risks are mainly related to immobilization “the support points must be checked before the intervention“. The recumbency and these variants can sometimes have consequences on the functioning of the patient’s organism. In some cases, peripheral nerve damage, skin damage, eye damage, or ischemic-type damage “following prolonged compression of certain vessels or persistent uncorrected hypotension” can be observed.
Thanks to Dr. Paola Mascitti, anesthesiologist-resuscitator in Paris and medical adviser to the MACSF (Mutuelle d’assurance du corps de santé français).