Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient and explain the procedure. If the patient is alert, 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, even if they are unconscious (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).
3. 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 (Aslam et al. [8], C).

Procedure

1. 4.Show
   Place one or two pillows 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/neck injury or surgery.
   To support the head in the midline position. E
2. 5.Show
   Semi‐flex the lowermost leg at the hip and the knee. Extra care should be taken with the degree of flexion for those patients who have hip or knee pain, loss of movement (including fractures), leg oedema, femoral lines or other venous access devices.
   To support the patient in a stable position. E
3. 6.Show
   Ask or assist the patient to semi‐flex the uppermost leg at the hip and knee. Place one pillow under the patient's back and one pillow under the patient's bottom.
   To prevent lumbar spine rotation. E

   To support the pelvic girdle. E

   To increase the comfort for the patient resting in side‐lying. E
4. 7.Show
   Place a pillow between the patient's knees.
   To aid pressure care. E
5. 8.Show
   Place the underneath arm in front with scapula protracted (this may 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 lines in that arm.
   To promote patient comfort. E

   To promote shoulder alignment. E

   To provide additional support and comfort. E
6. 9.Show
   Place a pillow under the uppermost arm with the elbow resting in a flexed position (Action figure 7.11).
   To support the arm and shoulder, particularly if the patient has low muscle tone and subluxation (Ada et al. [3], E).

   To promote patient comfort. E

   To reduce upper limb swelling. E

Post‐procedure

1. 10.Show
   Monitor the patient's respiratory and cardiovascular observations.
   To ensure the patient has not become unstable. E
2. 11.Show
   Monitor the colour, temperature and pulses of the limbs.
   To help preserve musculoskeletal function and prevent deep vein thrombosis (Hickey and Powers [46], E).