Understanding the Trendelenburg Position: Explanation, Uses, and Steps

Determining the correct lying position for patients is crucial in healthcare. The right position can significantly enhance a patient’s recovery process. One such position is the Trendelenburg position.

What is the Trendelenburg Position?

The Trendelenburg position is a surgical position in which the patient lies on their back with their feet elevated higher than their head. This is a variation of the supine or lying-on-the-back position. The name of this position comes from the German surgeon Friedrich Trendelenburg (1844-1924), who initially used this position to improve surgical access to the abdominal and pelvic organs by utilizing gravity.

For many years, this position was used in treating hypovolemic shock to increase cardiac output and circulation to the heart, as well as improve blood flow to vital organs. However, due to its often harmful effects, this position is no longer recommended for patients with pre-existing cardiopulmonary conditions.

Also read: What is the Orthopneic Position?

When is the Trendelenburg Position Used?

Currently, this position is frequently used in lower abdominal surgeries, including colorectal, gynaecological, and genitourinary procedures. In this position, gravity pulls the intra-abdominal organs away from the pelvis, allowing for better surgical access to pelvic organs.

Additionally, this patient lying position is sometimes recommended for certain procedures and medical conditions, such as:

• Emergency situations like shock and bleeding.
• Vaginal surgeries.
• Moving the intestines from the pelvic cavity to the upper abdomen.
• Surgeries on pelvic organs.
• Stopping bleeding from the lower extremities.

Steps to Apply the Trendelenburg Position

To assist in properly and comfortably positioning a patient in the Trendelenburg position, the following steps are typically followed:

1. Explain the procedure, along with its benefits and risks, to the patient.
2. Arrange the necessary items for the procedure beside the bed.
3. Provide privacy for the patient if needed.
4. Help the patient lie flat on their back on the bed or operating table.
5. Elevate the foot of the bed to a 45-degree angle.
6. Ensure the patient’s pelvis is positioned higher than the rest of their body.
7. Assist in bending the patient’s knees.
8. Carefully secure the patient’s body to prevent slipping.
9. Apply shoulder supports depending on the type of surgery being performed.

Variations: Reverse Trendelenburg Position

A variation of this patient lying position is the reverse Trendelenburg position, where the patient lies on their back with their head elevated and legs passively raised. This position is often used to help venous return to the heart and restore adequate brain perfusion in individuals with hypotension.

In the reverse Trendelenburg position, the patient lies on their back with the head raised higher than the feet. This position is used in laparoscopic surgeries, including procedures on the gallbladder, bile ducts, stomach, and head and neck surgeries.

Contraindications for the Trendelenburg Position

This position can increase intraocular and intracranial pressure. Therefore, it should be avoided in patients with head injuries or known intracranial hypertension. Additionally, this patient lying position is contraindicated for individuals with several medical conditions, including:

• Cardiovascular instability: Patients with cardiovascular instability may not tolerate this position, as it can worsen pre-existing conditions.
• Respiratory disorders: Patients with severe respiratory problems may be unable to tolerate the Trendelenburg position due to worsened breathing difficulties.

Important Considerations When Using the Trendelenburg Position

Several considerations should be kept in mind when using the Trendelenburg position, including:

• Hemodynamic changes, such as increased venous return and cardiac output, are temporary, with most variables returning to baseline within ten minutes.
• Respiratory changes, including upward movement of abdominal contents into the diaphragm, reduce functional residual capacity and respiratory compliance, necessitating higher airway pressure to maintain ventilation.
• Prolonged gravitational effects from the head-down position can lead to increased intracranial pressure, elevated intraocular pressure, facial, laryngeal, and tongue swelling, increasing the risk of postoperative airway obstruction.

Patients slipping and shifting in the Trendelenburg position can often be prevented by using shoulder supports. However, care must be taken to avoid undue pressure, which could result in compression or stretching injuries to the brachial plexus.

Also read: Fluid Balance: Definition, Formula and How to Calculate

Prolonged use of this position can cause significant swelling in the face and upper airway, potentially leading to airway problems after extubation. Lung function can also be affected, as the movement of abdominal organs toward the diaphragm can reduce lung expansion and lung volume.

Shoulder supports used to prevent the patient from slipping off the operating table can cause brachial plexus injuries, potentially leading to nerve damage in the upper limbs. Nowadays, other products, such as anti-slip foam pads and seatbelts, can be used to keep individuals in the Trendelenburg position without shoulder support.

Always communicate with your healthcare provider about how you feel so they can determine the most appropriate lying position for your condition.

If you require homecare assistance, Kavacare’s trusted medical team is ready to help. Contact us at 0811-1446-777 for consultations with doctors or to utilize home care services in Jakarta, Tangerang, Bekasi, Depok, and Karawang.

Source:

1. Trendelenburg Position: What Is It, Uses, and More | Osmosis. https://www.osmosis.org/answers/trendelenburg-position. Diakses 3 Januari 2024.
2. Anatomy, Patient Positioning – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513320/. Diakses 3 Januari 2024.
3. PATIENT POSITIONING – KNEE-CHEST/GENUPECTORAL & TRENDELENBURG’S POSITION – Nurse Info. https://nurseinfo.in/patient-positioning-knee-chest-genupectoral-trendelenburgs-position/. Diakses 3 Januari 2024.
4. Patient Positioning: Importance, Techniques, and Safety Considerations – NursingNotes. https://nursingenotes.com/patient-positioning-importance-techniques/. Diakses 3 Januari 2024.