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7.6 Positioning a patient: in a chair or wheelchair

Essential equipment

  • Personal protective equipment
  • Upright chair with arms that provide support from the elbow to wrist – if using a wheelchair, make certain that the chair has been measured by an occupational therapist to ensure correct fit and position of the footrests
  • Manual handling equipment (e.g. a hoist) may be required following risk assessment, depending on local policy
  • Pillows or a rolled‐up towel
  • Footstool if the patient has lower limb oedema
  • Pressure cushion

Pre‐procedure

ActionRationale

  1. 1.
    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.
    Wash hands thoroughly 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.
    Place a pressure‐relieving cushion in the chair and ask the patient to sit well back in the chair. They should have a maximum of a 90° angle at their hips and knee joints. The patient may not be able to achieve this position if they have hip, back or any other pain, or abdominal distension. It may be necessary to refer the patient to an occupational therapist for assessment of the potential need to raise the height of the chair, provide a specialized cushion or provide other seating if a comfortable or safe position cannot be achieved.
    Patients with reduced mobility are at greater risk of pressure skin damage (NPUAP, EPUAP and PPPIA [92], C).
    To provide a stable base of support for balance and reduce the risk of falls. E
    To ensure good body alignment. E
    To achieve a safe sitting position. E
  2. 4.
    Place a pillow or rolled‐up towel in the small of the patient's back according to what is comfortable for the patient.
    To allow the patient's back to be supported in a good position. E
  3. 5.
    Ensure the patient's feet are resting on the floor or a supportive surface. Use pillows or a rolled‐up towel to provide support under the feet if necessary. Make sure the patient's feet are supported on the footrests if using a wheelchair.
    To provide postural alignment and support the lumbar spine. E
  4. 6.
    If the patient has lower leg oedema, use a footstool, ensuring the whole leg and foot are supported and avoiding hyperextension (defined as excessive extension of a limb or joint) at the knees.
    To improve venous drainage (Doughty and Sparks [33], E).

Post‐procedure

  1. 7.
    Document the details of the procedure.
    To fulfil the legal requirements of the professional body and employing institution (NMC [91], C).
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