A Guide to Reverse Trendelenburg Position

What is the reverse Trendelenburg position?  

The reverse Trendelenburg position is a commonly used positioning technique in clinical settings where the patient lies flat on their back with the entire bed tilted so that the head is elevated above the feet.  

This position is primarily employed to improve respiratory function, facilitate certain surgical procedures, and manage conditions involving increased intracranial pressure or venous return. Understanding the indications, proper positioning techniques, and safety considerations for this position is crucial for effective and safe nursing care. 

Etiology and epidemiology 

Reverse Trendelenburg positioning is utilized in a variety of medical and surgical contexts. It is commonly seen in bariatric, vascular, and abdominal surgeries to improve exposure and reduce intra-abdominal pressure. It may also be used in patients with elevated intracranial pressure or respiratory compromise, as it facilitates diaphragmatic movement and reduces pressure on the lungs. 

Management 

Nursing staff are responsible for implementing and maintaining the reverse Trendelenburg position based on provider orders. The bed should be tilted so the head is higher than the feet, ensuring the patient's back remains flat against the mattress. Frequent reassessment is necessary to monitor patient comfort, hemodynamic status, and safety. 

Nursing care plan 

Nursing considerations 

• Ensure proper body alignment to avoid nerve damage or musculoskeletal strain. 
• Monitor for signs of hypotension or discomfort due to the positional change. 
• Use side rails and call lights within reach to maintain patient safety. 

Assessment 

• Evaluate respiratory effort and oxygen saturation. 
• Monitor vital signs, especially blood pressure, in patients vulnerable to orthostatic changes. 
• Assess skin integrity and comfort level. 

Nursing diagnosis/risk for 

• Risk for impaired skin integrity related to prolonged positioning 
• Risk for falls related to elevated head position 
• Ineffective breathing pattern related to abdominal or thoracic pressure 

Interventions 

• Elevate the bed to the appropriate angle (typically 15–30 degrees). 
• Support the head and neck in a neutral position to prevent strain. 
• Position arms alongside the body or on padded armboards if surgical. 
• Keep the knees slightly flexed with a pillow under the legs if necessary for comfort. 
• Regularly reposition the patient to prevent pressure injury. 
• Document positioning and any observed patient response. 

Expected outcomes 

• Patient maintains adequate oxygenation and ventilation. 
• No signs of skin breakdown or nerve injury. 
• Patient expresses comfort and understanding of positioning purpose. 
• The patient states comfort and acknowledges understanding of the purpose of this position. 

Individual/caregiver education 

• Explain the purpose and benefits of the reverse Trendelenburg position. 
• Instruct caregivers on observing signs of distress or discomfort. 
• Encourage questions and participation in maintaining proper positioning at home (if applicable). 

Comparison with the Trendelenburg position 

Trendelenburg position involves tilting the patient so the feet are higher than the head. It is primarily used to improve venous return in hypotensive patients or during certain surgical procedures. 

Reverse Trendelenburg, in contrast, is used to promote respiratory function, reduce intracranial pressure, and facilitate upper abdominal surgeries by allowing gravity to pull organs downward. 

Alternatives to Trendelenburg 

• Supine position with leg elevation: For hypotension or shock without the risks of full Trendelenburg. 
• Semi-Fowler's or Fowler's position: For improved breathing or during feeding. 
• Prone position: For ARDS patients to improve oxygenation. 

Resources 

• American Nurses Association (ANA) 
• National Pressure Injury Advisory Panel (NPIAP) 
• IBIOM 
• AliMed