Patient Blood Management Guidelines: Module 2

Perioperative

3.6 Effect of perioperative strategies that minimise blood loss

3.6.3 Appropriate patient positioning

The detailed findings of the systematic review for this intervention can be found in Section 3.9.1 of Volume 1b of the technical report.4 The systematic review process identified six RCTs of fair to good quality examining the effect of appropriate patient positioning during surgery.157–162 Four studies examined the effect of patient posture on blood loss; of these, three demonstrated that lateral, reverse Trendelenburg or appropriate prone positioning reduced blood loss.158,161,162

EVIDENCE STATEMENTS – appropriate patient positioning Evidence Consistency Clinical impact Generalisability Applicability
In adult patients undergoing orthopaedic surgery, the effect of patient positioning on the incidence of allogeneic blood transfusion is uncertain. X
In adult patients undergoing orthopaedic surgery, the effect of patient positioning on the volume of allogeneic blood transfusion is uncertain. X
In adult patients undergoing certain types of surgery, the head-up and lateral patient positions are associated with reduced blood loss. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of patient positioning on mortality is unknown. NA NA NA NA NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of patient positioning on morbidity is uncertain. X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of patient positioning on quality of life is unknown. NA NA NA NA NA

3 ticks = A; 2 ticks B; 1 tick = C; X = D; NA = not applicable (See Table 2.2)

PRACTICE POINT – appropriate patient positioning

PP11

Excessive venous pressure at the site of surgery should be avoided by appropriate patient positioning, both during and after the procedure.