Trendelenburg’s Position

Positioning your patients heels over head.

Trendelenburg;s Position for nursesThe Trendelenburg Position is a position in which the patient is laid supine, with the head declined at 30-45 degrees.

The Trendelenburg position is most often used in surgical procedures of the lower abdomen, pelvis and genitourinary system as it allows gravity to pull the abdominal contents away from the pelvis. It is also very effective in reducing and prevent exacerbation of abdominal and inguinal hernias as it avoids putting further downward pressure on the hernia1. It is also often used as part of a Modified-Valsalva Maneuver in cardioversion of Supraventricular-Tachycardia2.

The effective reversal of gravity’s pull relative to the body has been useful in assisting with the placement of central venous catheters in the internal jugular or subclavian veins, due to the veins filling and distending.

Nursing Considerations

The position is often uncomfortable for patients as it can cause a sensation of falling backwards, or of sliding off the bed head first. The nurse should be vigilant in ensuring the patient is aware of the position and prepared before attempting to place them in this position. This is because the patient can lose their reference to level ground, and the declined level is often greater than many anticipate, causing them panic as their head drops further beyond their comfort levels. For this reason, it is recommended that the nurse instructs the patient to hold the bed rails for added security and peace of mind, and if possible, allow the patient to look sideways where they can see the floor or a bench to reorient themselves to level ground.

The final position is often quite uncomfortable for the patient. If they are to remain conscious in this position, the nurse should be vigilant in making sure they are comfortable and secure. Some patients may need to be sedated if they cannot relax into the position.

It is important to remember the position cannot be rapidly reversed. A common mistake of some nurses is to see the patient panicking, and immediately unlatch the bed at flip them upright, or to immediately sit the patient up. This is not recommended as it can cause severe disorientation, sudden onset of postural hypotension, nausea and fainting spells. If the patient panics, halt any movement of the bed and try to reassure them. If they continue to panic or are extremely uncomfortable, slowly return the bed to level, or the semi-fowlers position.


The Trendelenburg’s use in a variety of clinical situations has come under fire recently, mainly due to the “archaic” reasoning for its use. One such example is employing the Trendelenburg position in a patient in hypovolemic shock, simply because gravity will draw the blood to the brain. While true to an extent, the topic is still debated.

The controversy seems to centre around the American physiologist Walter Cannon who popularised the use of the Trendelenburg position to treat shock in world war 1. It was promoted as a way to increase venous return to the heart, increase cardiac output and organ perfusion. Cannon eventually reversed this opinion a decade later, but this did not deter its already widespread use.

Variants of Trendelenburg’s Position

Steep Trendelenbur’s Position (surgical) Table Break Trendelenburg Reverse Trendelenburg

Steep Trendelenburg’ Position (courtesy Sebastion Blecha et al.)

modified trendelenburg position for nurses
Modified Trendelenburg position

Reverse Trendelenburg position for nurses
Reverse Trendelenburg Position (Wikimedia)

Buchwald H. Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese. Am J Surg. 1998;175(1):63-64. [PubMed]
Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015;386(10005):1747-1753. [PubMed]
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