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Inclined to Agree: The Trendelenburg Position, Its Uses, and the Equipment You Need

Wednesday, 22 March 2017  |  Paul

The Trendelenburg position is a long-standing and well-established method that has been used across various fields of medicine, such as surgery, shock and hypotension treatment, and respiratory treatments. In some disciplines, it’s still considered effective, but has been discontinued in others. Many pieces of the medical furniture that we sell here at Health and Care mention the Trendelenburg Position but if that's all Portuguese to you, this article will help straighten it all out.

What Is the Trendelenburg Position?

Very simply, the Trendelenburg position is placing the patient on a 15- to 30-degree incline, positioning the legs higher than the head. There’s also a modified version where only the legs are raised. The reverse Trendelenburg is where the patient is placed on the same incline, but the head is higher than the legs.

Who Invented the Trendelenburg Position?

Friedrich Trendelenburg (May 24, 1844 - December 15, 1924) was a prominent German surgeon who had a profound influence on modern surgery. Having studied both in the UK and Germany, he founded the German Surgical Society, and taught and influenced many future successful surgeons (including Martin Kirschner, who performed the first ever pulmonary embolectomy in 1924).

Because of his influence, in addition to the Trendelenburg position, there are several procedures and medical phenomena named after him, like Trendelenburg’s cannula (cannulation of the larynx during head or neck surgery to stop the patient swallowing blood), the Brodie-Trendelenburg percussion test (used to identify incompetent valves in superficial veins), and Trendelenburg’s sign (a sign of congenital dislocation of the hip), amongst many.

Uses of the Trendelenburg Position

Since it was first established, the Trendelenburg position has been to treat numerous conditions. Trendelenburg himself initially used it to improve exposure of the pelvic organs during surgery. For a long time, it was used to treat shock and hypotension, although recent studies dispute the efficacy of this treatment.

The universally-accepted uses of the Trendelenburg nowadays are mostly surgical: treating surgical air embolisms, aiding abdominal hernia reduction, and helping placement of catheters in the internal jugular or subclavian veins.

Outside surgery, it’s used to improve perfusion in respiratory patients, treat supraventricular tachycardia (in conjunction with the Valsalva manoeuvre), optimise drainage images during endoscopic retrograde cholangiopancreatography, and sometimes relieve patients of symptoms of septum postic cysts of the subarachnoid space (although this is just a short-term measure).

Reverse Trendelenburg Position

The Reverse or Anti-Trendelenburg also has its uses, mainly for the upper body, head and neck. It’s used during surgery to expose the prostate and upper organs, and to help overweight or obese patients breathe by drawing blood pressure away from the head. In care, it’s useful in helping patients with limited mobility sit right up in bed.

However, like the regular Trendelenburg, it has risks, like hypotension and hindered blood circulation. Patients in this position need constant monitoring.

What Equipment Is Best for the Trendelenburg Position?

It is imperative to have the correct equipment when using the Trendelenburg position in medical examinations and surgery. Your patient must be safe as well as comfortable, and the clinician must have his or her hands free. Many pieces of medical furniture feature an integrated tilting feature that allows you to carefully and safely utilise Trendelenburg positioning.

Choosing patient chairs, couches or plinths with a tilting facility can have its own pitfalls. Manual tilting facilities still require physical strength, and can be quite jerky and uncomfortable for the patient. If the patient is heavy or obese, it may be necessary to select something with a high safe working load capacity and possibly a wider surface as well. Where there is limited power supply access, or the environment is corrosive in the long-term (e.g. where chlorine or ammonia might be present), then hydraulic mechanisms are preferable to electric.

Whatever the specification, a tilting chair/plinth/couch needs to offer smooth movement in combination with sturdiness and stability, so the patient is comfortable and easy to access for treatment.

See our full range of Trendelenburg Furniture at Health and Care.