Trendelenburg position

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

In the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. This is a standard position used in abdominal and gynecological surgery. It allows better access to the pelvic organs as gravity pulls the intestines towards the head.

Eponym

It was named after the German surgeon Friedrich Trendelenburg.[1]

Clinical Applications

  • Hypotensive patients (patients with low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure in the brain). A 2008 review however found adverse consequences to the use of the Trendelenburg position and recommended it be avoided.[2] However, the passive leg raising test is a useful clinical guide to fluid resuscitation.
  • The Trendelenburg position used to be the standard first aid position for shock and was used for injured scuba divers. Many experienced divers still believe this position is appropriate, but current scuba first aid professionals no longer advocate elevating the feet higher than the head. The Trendelenburg position in this case increases regurgitation and airway problems, causes the brain to swell, increases breathing difficulty, and has not been proven to be of any value.[3] "Supine is fine" is a good, general rule for victims of submersion injuries unless they have fluid in the airway or are breathing, in which case they should be positioned on the side.
  • Perhaps because of its effect on breathing difficulty and airway problems, the Trendelenburg position is used in waterboarding.
  • The Trendelenburg position may be used in childbirth when a woman's cervix is too swollen and won't quite dilate to 10 centimeters, or during the incidence of a prolapsed umbilical cord to take pressure off the cord and get more oxygen to the fetus, or it can be used to help rotate a posterior fetus either during pregnancy or the birth itself.
  • Trendelenburg position in helpful in reducing an abdominal hernia.
  • The Trendelenburg position is also used when placing a Central Venous Line.[4] Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins when placing a central line in the internal jugular or subclavian veins. It is also used in the placement of a external jugular peripheral line for the same reason. It plays no role in the placement of a femoral central venous line.

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