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 the practitioners (Treadwell [123], E).
2. 4.Show
   Place one or two pillows in a ‘butterfly’ position under the patient's head, ensuring the airway remains patent. Extra care should be taken for those patients with an artificial airway, central lines, or recent head or neck surgery.
   To support the head in the midline position (Yoshikawa et al. [136], E).

   To support the shoulder contours (Yoshikawa et al. [136], E).
3. 5.Show
   Ask or assist the patient to semi‐flex the lowermost leg at the hip and the knee and roll onto their side. Extra care should be taken with the degree of flexion for those patients who have hip or knee pain or loss of movement, fracture involving the femur or pelvis, leg oedema, femoral lines or other venous access devices. Ensure the patient is lying centrally in the bed.
   To support the patient in a stable position and prevent rolling (Yoshikawa et al. [136], E).

   To reduce the risk of falls by ensuring the patient is not too close to the edge of the bed (Richardson and Carter [107], E).
4. 6.Show
   Either:

   Ask or assist the patient to semi‐flex the uppermost leg at the hip and knee. Use a pillow for support under the leg placed on the bed.

   Or:

   Place a pillow between the patient's knees.
   To prevent lumbar spine rotation (Yoshikawa et al. [136], E).

   To support the pelvic girdle (Yoshikawa et al. [136], E).

   To aid pressure care. E
5. 7.Show
   Place the underneath arm in front with scapula protracted (Action figure 7.3) – that is, pushed forward (this would not be appropriate for patients with shoulder pathology). Extra care should be taken with patients with low tone in the affected arm, swollen arms or access lines in that arm.
   To promote patient comfort. E

   To promote shoulder alignment. E

   To provide additional support and comfort. E

Post‐procedure

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