Supine Position
What Is It, Uses, and More
Author: Lily Guo
Editors: Alyssa Haag, Emily Miao, PharmD, Kelsey LaFayette, DNP, RN, FNP-C
Illustrator: Jessica Reynolds, MS
Copyeditor: Stacy Johnson, LMSW
What is the supine position?
The supine position, also known as the dorsal decubitus position, refers to one of the ways an individual can lie on a table during a surgical procedure or a physical exam. In the supine position, the individual is lying on their back, with their face and abdomen facing upwards. During a procedure, the back of their head typically rests on a pad or pillow, and their neck is in a neutral position, as if in a sleeping position. The individual’s arms are usually positioned with the palms facing up and abducted out to less than 90 degrees from the side of their body or tucked next to the body. If the arms are abducted, arm boards are used to secure and support the arms.
Other common surgical positions include Trendelenburg, reverse Trendelenburg, lithotomy, lateral decubitus, prone, and sitting. Choice of positioning depends on the procedure being performed, the length of the procedure, and the parts of the body the surgical team requires access to, among other factors.
What is the supine position used for?
The supine position is commonly used during induction of anesthesia and emergence from anesthesia during a surgical procedure. It is also used in several types of surgery, including cranial surgery, where the flexibility of the neck and the ability to rotate the torso allows access to most brain lesions. Similarly, neck and face procedures and plastic surgeries are done with the individual in the supine position.
Other surgeries where the supine position is utilized include cardiac, colorectal, thoracic, and abdominal surgeries. Additionally, surgeries involving the upper extremities (e.g., hands and wrists) and lower extremities (e.g., the hips, knees, feet, and ankles) can be performed with the individual in the supine position. Lastly, endovascular and laparoscopic surgeries, which are minimally invasive, are commonly performed while the individual is supine.
The supine position allows the surgeon to access the anterior structures of the body and provides stability to the body on the operating table. The supine position is highly versatile and is used for several procedures, allowing anatomical structures of the face, neck, abdomen, and extremities to be natural and neutral. Safety straps can be applied, and the entire body can be supported, thereby limiting the risk of falling from the table or injuring oneself.
In addition to surgical procedures, several physical examination procedures can be performed in the supine position. For example, a clinician can do a musculoskeletal examination of the hip and groin with the individual in a supine position. The clinician can inspect the skin for swelling, scars, lesions, ecchymosis, and erythema. They may compare the hips and lower extremities to assess for asymmetries and discrepancies in leg length. They may also palpate the quadrants of the abdomen and the pubic symphysis for tenderness. Several bones and soft tissue structures, such as the adductor tendon, lateral rectus abdominis muscle border, and the iliac crest, can be evaluated and palpated with the person lying supine.
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What are the disadvantages of the supine position?
While the supine position is widely used in surgery and during physical examination, risks of the prolonged supine position include effects on respiratory function, skin integrity, and circulation.
Respiratory Function
When placed in the supine position, intra-abdominal organs shift and compress lung tissue, leading to decreased functional residual capacity (FRC) (i.e., the air remaining in the lungs after a normal, passive exhalation). When standing, the typical FRC of an individual range from 2.5 to 3.5 liters. The supine position reduces the FRC by 0.8 to 1 liters while the individual is awake and further decreases by 0.4 to 0.5 liters under anesthesia. When standing, the typical FRC of an individual range from 2.5 to 3.5 liters. Most healthy individuals can maintain adequate respiratory function even during anesthesia; however, this significant decrease in FRC might be problematic for those with obesity, pulmonary disease, and those at increased age. Additionally, those in the advanced stages of pregnancy can be at risk of compressing their abdominal aorta and inferior vena cava when in the supine position.
Skin integrity
Another potential risk of being in the supine position for a prolonged period is the development of pressure sores and ulcers. This is particularly common on the bony prominences, such as the back of the skull, scapulae, elbows, sacrum, coccyx, and heels. Surgical positioning pads are often used during lengthy procedures. Additionally, the arm boards are positioned level with the table and abducted less than 90 degrees from the body to protect from nerve compression and stretching of the brachial plexus and ulnar nerves.
Circulation
Lastly, when in supine position, heart rate and peripheral vascular resistance (i.e., the resistance in the circulatory system that is used to create blood pressure) are lower when compared to sitting. Elevating the legs can increase the amount of blood that returns to the heart, thereby increasing the amount of blood supplied to the body by the heart.
What are the most important facts to know about the supine position?
The supine position refers to an individual's position on an examination or operating table. It involves the individual laying on their back with their arms at their sides or abducted to less than 90 degrees. Many individuals sleep in the supine position. It is beneficial for surgeries where access to the anterior aspect of the body is required, including cardiac, cranial, abdominal, and thoracic surgeries. Examinations of the hip and pelvis are also performed with the person in supine. Prolonged supine position can increase the risk for impaired respiratory function, including a reduction in lung volume, mainly if the individual is obese, pregnant, has pulmonary disease, or advanced age. It may also increase the risk for pressure ulcers of bony prominences and low vascular resistance.
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Assisting with ambulation (for nursing assistant training)Resources for research and reference
Britz, G. W., Winn, H. R. (2011). Positioning for Cranial Surgery. Youmans Neurological Surgery, 3737–3746. https://doi.org/10.1016/b978-1-4160-5316-3.00363-4
Cutler, J. (2010). Anesthetic considerations in Thoracic Surgery. Medical Management of the Thoracic Surgery Patient, 87–95. https://doi.org/10.1016/b978-1-4160-3993-8.00007-6
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