Do you use the trendelenberg position?

[wishingmary]

I am a nursing student and a nurse aide in the MICU. My last semester of nursing school requires I do an informal teaching project so I asked my manager if she could think of a teaching need in the units. She suggested the use of Trendelenberg (head down lying supine). Evidently there is some controversy about its appropriate use in the units. I have done some research and I don't find anything in nursing journals off the web specifically addressing its use. I have found Trendelenberg used when inserting a pulmonary catheter to reduce chances of a PE and of course there are some operating room instances. My clinical adviser told me I could use this board as a reference

So......

When do nurses in the units use Trendelenberg, at what angle, and how long do you maintain this position? I also want to know if you use it in cases of hypotension (along with hypotensive drugs) and whether it's benefit outweighs the risk of increased intracranial pressure in non-head trauma patients? Oh, another question I have is do your units allow its' use as a nursing intervention or is it treated as a collaborative intervention with an order from a physician?

By the way, I'm not doing an inservice since I would feel queer standing in front of seasoned ICU nurses so I'm doing a poster board. In order to evaluate the effectiveness of this teaching I'm leaving a quiz of 5 multiple choice questions. Hopefully I'll get some response by those who remember nursing school.

Thank you beforehand for all your replies to any or all questions presented here and for any criterias your units use on this subject.:)

Mary Bernhagen

[shannon8282]

I cant go into detail about it because of my lack of knowledge, but when I worked in a dialysis unit we used trendelenburg all of the time. If you know a dialysis nurse, they may be able to help you.

[Zee_RN, BSN, RN]

I wrote this down in my notes while studying for my CCRN but I'm not sure where I got it from. I'll have to look it up to find the actual reference for you:

"The Trendelenburg position, once favored in managing shock, has been abandoned because it allows the diaphragm to migrate upward, thus compromising ventilation. Also, this position may cause a reflex inhibition of the pressoreceptor activity, thereby decreasing sympathetic stimulation and further compromising arterial blood pressure."

Unfortunately, I wrote it down for my own edification and did not include the reference. I'll look further for you, though, if that helps you.

[louloubell1]

Gotta say that I have never heard of using Trendelenberg for insertion of an art line to prevent PE...are you sure you're not thinking of trendelenberg for the insertion of a central line to prevent air emboli? I also have read the same thing that Zee_RN said in regards to the position actually stimulating the baroreceptors which then leads to further compromise.

[CougRN]

I have also heard about this falling out of favor. In our ICU we don't dump them on their heads anymore. For research on this I would suggest looking in medical journals and not nursing. This had been researched in critical care medicine so I would start there. Let us know where you find it, I would like to read the research myself. Best of luck.

[Katnip, RN]

Last week, I saw them using Trendelenburg for postural therapy on a vented patient. They dumped him on his head to suction him. With the doctor's order.

[Zee_RN, BSN, RN]

From what I read, Trendelenburg is still used for pulmonary hygiene purposes, CVP insertion, etc., but not for treatment of hypotension.

[renerian, BSN, RN]

Use it for CVC insertions.renerian

[ladytraviler]

We use it in L&D if we have a cord prolapse. I have also used it for preterm labor prior to transfer to a higher level facility.

[wv_nurse 2003]

We use a "modified" approach. We don't lower the head like we used to--but just flatten the HOB and raise the feet. Just a perfusion assist until we find the cause of the hypotension.

[gwenith, BSN, RN]

There is an mirror thread of this in the Critical Care forums - I will merge the two threads.

[gwenith, BSN, RN]

Sorry folks - All those who have been following the "informatics" thread will now have to read back to the other beginning

I just thought it would be better to have all the wonderful information in one thread rather than spread out.

[wishingmary]

Zee RN,

If you happen to run across your source for

"The Trendelenburg position, once favored in managing shock, has been abandoned because it allows the diaphragm to migrate upward, thus compromising ventilation. Also, this position may cause a reflex inhibition of the pressoreceptor activity, thereby decreasing sympathetic stimulation and further compromising arterial blood pressure."

Please post it.

Thanks,

Mary