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What is the Trendelenburg position and why do we use it?

What is the Trendelenburg Position?

The Trendelenburg Position is a medical posture commonly employed during surgeries, especially lower abdominal procedures and central venous catheter placement.

In this posture, the patient is laid flat on their back on the surgical table, with their head placed lower than their feet at an approximate angle of 16°. The primary objective is to utilize gravity to shift abdominal organs towards the head, facilitating better access to pelvic organs during surgery.

It’s crucial to minimize the degree of Trendelenburg whenever possible, and periodic repositioning into the supine or reverse Trendelenburg position is recommended. In a steeper variation, known as steep Trendelenburg, the patient is positioned at a more pronounced angle of 30 to 40 degrees in a head-down orientation. This particular variant is often employed in robotic pelvic procedures.

While the Trendelenburg Position can enhance surgical access, it’s not without potential risks. Steep Trendelenburg is linked to difficulties like changed lung function, swelling of the airway, elevated pressure within the skull and eyes, and the potential for nerve damage. Therefore, its application requires careful consideration and monitoring to ensure patient safety throughout the surgical process.

What is the Trendelenburg position used for?

The Trendelenburg Position is utilized primarily in surgical settings, particularly during lower abdominal surgeries and central venous catheter placement.

This specific patient posture involves lying supine on the operating table with the head positioned below the feet at an angle, typically around 16°. The primary purpose of employing the Trendelenburg Position is to leverage gravity, causing abdominal organs to shift towards the head. This gravitational repositioning aids surgeons in achieving improved access to pelvic organs during surgical procedures.

Additionally, a steeper variation known as steep Trendelenburg, with the patient positioned at a more pronounced angle of 30 to 40 degrees in a head-down orientation, is often employed in robotic pelvic procedures.

While the Trendelenburg Position enhances surgical access, it is crucial to note that its application should be carefully considered due to associated risks, including altered pulmonary function, airway edema, increased intracranial and intraocular pressure, and the potential for nerve injury. Thus, the Trendelenburg Position is used judiciously in surgical scenarios where its benefits outweigh the potential risks, with close monitoring of the patient’s well-being throughout the procedure.

What is the Reverse Trendelenburg Position?Trendelenburg Position vs Reverse Trendelenburg Position

The Reverse Trendelenburg position, on the other hand, places a patient on an identical incline, but with the head being higher than the legs.

Widely recognized in numerous medical disciplines, this technique involves positioning a patient on an incline of 15 to 30 degrees, with the legs elevated higher than the head, A modified version exists where only the legs are lifted.

What is the Reverse Trendelenburg Position Used for?

The Reverse Trendelenburg Position is employed in medical settings to enhance surgical visibility and facilitate specific procedures.

In this position, the patient lies supine on the operating table with their head elevated above their heart. Unlike the traditional Trendelenburg Position, where the head is lowered, the reverse orientation provides advantages in surgeries involving the upper abdomen, thorax, or head.

The primary purpose of using the Reverse Trendelenburg Position is to optimize exposure and accessibility to the surgical site. This position is particularly advantageous for procedures such as upper abdominal surgeries, neurosurgery, and certain orthopaedic interventions. By positioning the patient in reverse Trendelenburg, surgeons gain improved visualization of the operative field, allowing for more precise and controlled surgical manoeuvres.

Additionally, the Reverse Trendelenburg Position is sometimes employed to mitigate complications associated with prolonged periods of head-down positioning, such as increased intracranial pressure and potential respiratory challenges. Overall, its strategic application contributes to better surgical outcomes and patient safety in a variety of medical interventions.

Who invented the Trendelenburg Position?

Friedrich Trendelenburg, a distinguished German surgeon from the late 19th to early 20th century, devised a technique primarily to enhance the visibility of pelvic organs during surgical procedures.

His significant contributions to contemporary surgery are evident, having established and instructed at the German Surgical Society, and having several procedures named in his honor.

These encompass the Brodie-Trendelenburg percussion test (a method to detect faulty valves in superficial veins) and the Trendelenburg position.

How was it used?

The Trendelenburg position, since its inception, has been utilized for the management of various ailments. In its early stages, it was employed for the treatment of shock and low blood pressure, including its use during World War I, with the expectation that it would enhance blood flow to essential organs.

However, recent studies dispute the efficiency of this treatment in that area.

Reverse Trendelenburg Position

How do we use the Trendelenburg position today?

Currently, healthcare experts are concentrating on its application for specific purposes. These encompass surgical air embolisms, assisting in the reduction of abdominal hernias, and facilitating the insertion of catheters into the internal jugular or subclavian veins.

A significant advantage of its use in contemporary healthcare is its ability to enhance blood perfusion in patients suffering from respiratory issues.

The Reverse Trendelenburg position, also referred to as the Anti-Trendelenburg position, is beneficial, particularly in relation to the head, neck, and upper body.

Laid on their back, the patient is positioned for surgeries where increased exposure is needed in areas like the prostate and upper abdominal region.

It can also be utilized to enhance lung function in overweight and obese individuals by alleviating pressure on the head.

CARRIED OUT BY TRAINED INDIVIDUALS

However, there are risks of hypotension and reduced blood flow to the brain, neck and genital area. That it is why it is essential that this method treatment should only be carried out by trained individuals to ensure safety.

As stipulated in the Critical Care Unit Planning & Design Notes by the Department of Health and Social Care, it is also important to remember that it is a requirement on ICU beds to include Trendelenburg positioning functions.

This is to make sure ICU beds can facilitate respiration and circulation to aid bodily function.

Read more about ICU Bed specifications and features.

Inclusion In Care Homes

reverse Trendelenburg positionOur Eclipse range of beds offer a perfect blend of style and safety, including options for Trendelenburg and Anti-Trendelenburg tilt.

When it comes to its inclusion in care homes, the Trendelenburg position is usually used to help residents to sit up or raise their legs whilst in bed.

Giving the user positioning control, the Trendelenburg feature is included in care beds for extra comfort and support. Individuals with restricted mobility use the Trendelenburg position daily to allow themselves to be comfortable.

Similarly, the Anti-Trendelenburg position is included in care beds to allow the individual’s legs to be lifted. This is especially useful for those who have conditions with restricted blood flow to the feet.

But, like the Trendelenburg position, these features have their downfalls, with patients advised to not spend large lengths of time in these positions.

reverse Trendelenburg position

It is important to note that when it comes to users with dementia or reduced mental ability, the Trendelenburg features are controlled by the caregiver. With that in mind, some care beds — like the Interlude — are now fitted with a locking handset that will only be activated at the carer’s authorisation.

SUMMARY

All in all, the history of the Trendelenburg position is rather fascinating!

It has developed and changed quite radically from its initial use in healthcare, and now focuses on long-term postural care and those with restricted mobility.

Healthcare professionals do see this position (or its reverse option) being used every day, but in controlled doses.

In care homes, it can be useful to improve comfort for residents, whether that is helping them get out of bed, or for those with issues with restricted blood flow.

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To learn how to use a Trendelenburg bed safely, book a product training session with our experts.





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