Supine Position
The supine position is a body position in which the patient lies flat on their back, face up. It is one of the most common positions in healthcare, used for physical assessments, CPR, many medical procedures, and sleep. CNAs must know proper supine positioning, including pressure point protection and when this position is contraindicated.
Exam Tip
Supine = flat on back, face up. Pressure points: sacrum (#1), heels (#2), back of head, shoulder blades, elbows. Use trochanter rolls (prevent hip rotation), foot boards (prevent foot drop), float heels with pillows. Reposition every 2 hours.
What Is the Supine Position?
In the supine position, the patient lies horizontally on their back with the face pointing upward. This is the default position for many nursing assessments, procedures, and sleep. While common, it requires careful attention to pressure point protection and is not appropriate for all patients.
Uses for Supine Position
| Use | Reason |
|---|---|
| Physical assessment | Provides access to anterior body |
| CPR | Required position for chest compressions |
| Post-anesthesia recovery | Standard recovery position (with head elevated) |
| Bed making | Patient position for occupied bed making |
| Bathing | Access to anterior body for bed bath |
| Catheter insertion | Standard position for urinary catheterization |
| Sleep | Common sleeping position |
Pressure Points in Supine Position
| Body Part | Risk |
|---|---|
| Back of head (occiput) | Pressure injury, especially in debilitated patients |
| Shoulder blades (scapulae) | Bony prominences at risk |
| Elbows | Bony prominences |
| Sacrum/coccyx | Most common pressure injury site |
| Heels | Second most common pressure injury site |
Proper Supine Positioning
- Patient lies flat on back
- Head on a small pillow (neutral alignment)
- Arms at sides or on small pillows (slight elbow flexion)
- Small pillow or rolled towel under the knees (reduces lower back strain) - ONLY if not contraindicated
- Feet at 90-degree angle (use footboard or boots to prevent foot drop)
- Trochanter rolls along outer thighs (prevent external hip rotation)
- Heel protectors or pillows under calves to "float" heels off the mattress
Contraindications and Precautions
- Aspiration risk: Patients with dysphagia or tube feedings should NOT lie flat (use Fowler's)
- Respiratory distress: Lying flat compresses the diaphragm; use Fowler's position
- Late pregnancy: Supine position can compress the vena cava (place on left side)
- Increased intracranial pressure: Elevate head of bed
- Post-spinal surgery: Follow specific positioning orders
Exam Alert
Supine = lying on back, face up. Know the pressure points: sacrum (most common site for pressure injuries) and heels (second most common). Use trochanter rolls to prevent external hip rotation. Use foot boards or boots to prevent foot drop. Heels should be "floated" off the mattress with pillows under the calves. Reposition every 2 hours.
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Related Terms
Prone Position
The prone position is a body position in which a patient lies face down on their stomach with their head turned to one side. In healthcare, prone positioning is used for back care, certain respiratory conditions, and specific procedures, though it is less commonly used than supine or lateral positions.
Fowler's Position
Fowler's position is a standard patient positioning in which the head of the bed is elevated to a 45-90 degree angle while the patient sits semi-upright or upright. Variations include low Fowler's (15-30 degrees), semi-Fowler's (30-45 degrees), standard Fowler's (45-60 degrees), and high Fowler's (60-90 degrees).
Decubitus Ulcer (Pressure Injury)
A decubitus ulcer (also called a pressure injury, pressure sore, or bedsore) is localized damage to the skin and underlying tissue caused by prolonged pressure, friction, or shear, typically over bony prominences. Pressure injuries are classified in stages from Stage 1 (intact skin with non-blanchable redness) to Stage 4 (full-thickness tissue loss exposing bone, muscle, or tendon).
Body Mechanics
Body mechanics refers to the coordinated use of body position, movement, and alignment to prevent injury during patient care activities such as lifting, transferring, and repositioning. Proper body mechanics protect both the nurse and the patient from musculoskeletal injury.
Contracture
A contracture is a permanent tightening and shortening of muscles, tendons, or other tissues around a joint, resulting in limited range of motion and a fixed, often painful position. Contractures develop when joints are immobilized for prolonged periods without range-of-motion exercises.
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