The lateral position, commonly known as side-lying, involves an individual resting on their side, typically with knees and hips bent. This posture can be adopted for comfort or to facilitate various medical procedures. Pillows often support the head and legs to maintain alignment and reduce pressure on bony areas.
Primary Medical Applications
One primary application of the lateral position is the recovery position for unconscious individuals who are breathing. Placing someone on their side helps maintain an open airway by allowing fluids, such as vomit or blood, to drain from the mouth, preventing choking and aspiration into the lungs. This position also helps ensure the tongue does not fall back and obstruct the throat.
The lateral position is frequently used to provide optimal access for surgical procedures. Surgeons utilize this position for operations on the thorax, kidneys, hips, and parts of the back or retroperitoneal space. For example, in kidney surgeries, the patient is positioned with the non-operative side on the table, allowing clear access to the target area.
For bedridden patients, the lateral position is a common strategy to enhance comfort and prevent pressure ulcers, also known as bedsores. Turning the patient to a side-lying angle, often around 30 to 40 degrees, relieves direct pressure from bony prominences like the sacrum, hips, and heels. This helps maintain skin integrity and minimizes tissue damage from prolonged compression.
The lateral position also serves diagnostic and therapeutic purposes. It is often employed for procedures like administering enemas or performing rectal examinations. The side-lying posture with the upper leg bent allows for easier access to the rectum and promotes the gravity-assisted flow of fluids into the colon. This positioning improves patient comfort during such examinations compared to other postures.
Safe Positioning and Variations
Achieving the lateral position safely involves specific body alignment and support. The patient lies on their non-operative side, with the head elevated to align with the spine, often using a pillow or head positioner. The dependent leg, which is the one on the bottom, should be flexed at the hip and knee, while the upper leg remains straight, supported by a pad or pillow placed between the legs.
A common variation is Sims’ position, sometimes called a semi-prone lateral position. In Sims’ position, the patient lies on their side, typically the left, with the left leg straight and the right (top) leg bent at the hip and knee, brought slightly forward. The torso is tilted slightly forward, with the left arm positioned behind the body and the right arm bent in front. Proper padding, including pillows under the head, between the knees, and under the arms, is used to ensure comfort, stability, and to prevent nerve compression or skin breakdown.
Important Considerations and Precautions
The lateral position, while beneficial, has contraindications or requires careful attention. Patients with certain spinal injuries or unstable fractures should not be placed in this position, as movement could worsen their condition. Specific medical conditions, particularly those affecting circulation or respiration, may also contraindicate its use or necessitate modifications.
Potential complications can arise if the lateral position is not executed correctly. These risks include nerve compression, such as to the brachial plexus, ulnar nerve, or common peroneal nerve, which can occur from prolonged pressure on vulnerable areas like the axilla, elbow, or knee. Skin breakdown and pressure ulcers can also develop on bony prominences if adequate padding and frequent repositioning are not maintained.
Circulatory issues, such as venous pooling or impaired blood flow to limbs, are also possible, especially during extended procedures. Pulmonary compromise, characterized by diminished lung capacity, can occur due to the lateral weight of the mediastinum and abdominal contents affecting lung compliance. Therefore, healthcare professionals must conduct a thorough risk assessment and ensure proper training and continuous monitoring when positioning patients to mitigate these potential risks.