Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [91], C).
2. 2.Show
   Wash hands thoroughly with soap and water or use an alcohol‐based handrub.
   To reduce the risk of contamination and cross‐infection (NHS England and NHSI [83], C; WHO [132], C).

Procedure

1. 3.Show
   Ensure the bed is at the optimum height for the handlers. If two handlers are required, try to match the handlers’ heights as far as possible.
   To minimize the risk of injury to practitioners (Treadwell [123], E).
2. 4.Show
   Either:

   Place one pillow squarely under the patient's head.
   To support the head in a neutral position and to compensate for the natural lordosis (anatomical concavity) of the cervical spine (Fragala [37], E).

   To increase patient support and comfort (Fragala [37], E).
3. 5.Show
   Or:

   Use two pillows in a ‘butterfly’ position so that two layers of pillow support the head with one layer of pillow under each shoulder.
   This may be necessary for a patient with pain, breathlessness (see the section ‘Moving and positioning a patient with respiratory compromise’ below) or an existing kyphosis (anatomical convexity of the spine) (Fragala [37], E).
4. 6.Show
   Or:

   Use a folded towel under the patient's head if this provides natural spinal alignment.
   To prevent excessive neck flexion (Fragala [37], E).
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   Ensure the patient lies centrally in the bed.
   To ensure spinal and limb alignment. To reduce the risk of falls by ensuring the patient is not too close to the edge of the bed. To prevent peripheral nerve injury (Bouyer‐Ferullo [15], E).
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   Place pillows and/or towels under individual limbs to provide maximum support for a patient with painful, weak or oedematous limbs.
   To ensure patient comfort (Bouyer‐Ferullo [15], E).
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   Ensure the patient's feet are fully supported by the mattress. For taller patients, use a bed extension if required.
   To ensure patient comfort (Bouyer‐Ferullo [15], E).
8. 10.Show
   Place a pillow at the end of the bed to support the ankles at 90° of flexion if the patient has weakness or is immobile around the ankle.
   To ensure patient comfort (Fragala [37], E).

   To prevent loss of ankle movement (Bouyer‐Ferullo [15], E).

Post‐procedure

1. 11.Show
   Document the details of the procedure.
   To fulfil the legal requirements of the professional body and employing institution (NMC [91], C).