How to arrange pillows on a hospital bed? A Guide to Patient Comfort and Care

September 30, 2025 •

3 min read

According to the Agency for Clinical Innovation, proper positioning is essential for maintaining skin integrity and minimizing the likelihood of pressure ulcers in bedridden patients. Understanding how to arrange pillows on a hospital bed is a fundamental skill for caregivers to enhance patient comfort, improve circulation, and prevent complications.

Quick Summary

This guide details how to strategically arrange pillows on a hospital bed for various positions to ensure patient comfort and maintain proper body alignment. It covers techniques for side-lying, supine, and semi-sitting positions, highlighting the use of pillows for support and pressure sore prevention.

Key Points

Supine Position: Float the heels by placing a pillow under the calves to prevent pressure sores.
Side-Lying Position: Use a pillow between the knees and ankles to maintain proper hip and spine alignment.
Semi-Fowler's Position: Place a pillow under the knees to prevent the patient from sliding down and causing shear force.
Prevent Pressure Sores: Follow the 'Rule of 30' by keeping the bed incline at or below 30 degrees and repositioning every 1-2 hours.
Support All Limbs: Ensure arms are comfortably supported to prevent shoulder tension and nerve compression.
Use Specialized Pillows: Consider wedge or bolster pillows for more stable and targeted support in specific positions.

The Importance of Proper Pillow Arrangement

Proper pillow arrangement on a hospital bed is crucial for several aspects of patient health and comfort beyond just neck and head support. Strategic positioning aids in maintaining neutral body alignment, which reduces strain on muscles and joints. It can also significantly improve circulation and respiration by preventing compression of the chest and limbs. Furthermore, using pillows to offload pressure from bony prominences is a key strategy for preventing painful and dangerous pressure ulcers, especially in immobile individuals. For caregivers, this technique is a powerful tool to ensure a patient's well-being and overall quality of life.

Pillow Arrangements for Common Positions

Supine Position (Lying on the Back)

For a patient lying flat on their back, proper pillow placement focuses on maintaining a neutral spine and preventing pressure on the tailbone and heels. Place a pillow under the head and shoulders for neutral neck alignment and under the arms to prevent tension. Crucially, float the heels by placing a pillow or wedge under the calves to keep them off the bed surface and prevent pressure sores. A small roll or pillow can also support the arch of the foot to prevent foot drop.

Side-Lying Position (Lateral)

The 30-degree side-lying position is often recommended to reduce pressure. Place a pillow lengthwise behind the patient's back for support. A pillow or wedge between the knees and ankles maintains alignment. The top leg should be slightly bent forward. Support the top arm with a pillow at chest level.

Semi-Fowler's Position (Semi-Sitting)

This position is used for comfort and improved breathing. Elevate the head of the bed to 30-45 degrees. Place a pillow behind the head and shoulders, and under the knees to prevent sliding. Support the arms with pillows. For more upright positions (High Fowler's), use a wedge or stacked pillows for back support.

Preventing Pressure Sores with Strategic Pillow Placement

Pressure ulcers are a major risk for bedridden patients, and pillows are key for prevention by offloading pressure from bony areas. The 'Rule of 30' involves a 30-degree head elevation and a 30-degree lateral position to reduce shear forces. Floating heels with pillows is crucial; avoid donut cushions. Repositioning every one to two hours is also vital.

Essential Equipment for Hospital Bed Pillow Arrangement

Besides standard pillows, consider specialized pillows and equipment like wedge pillows, bolster rolls, draw sheets, specialized boots, and adjustable beds.

Comparison: Standard Pillows vs. Specialized Positioning Pillows


Feature	Standard Pillows (e.g., Household Pillows)	Specialized Positioning Pillows (e.g., Wedges)
Cost	Generally low to moderate	Can be more expensive
Stability	Compressible and may shift over time, requiring frequent adjustment	Designed to hold their shape and provide stable, consistent support
Versatility	Can be folded and stacked for various purposes	Shape is often specific to a particular use, though many offer multiple applications
Pressure Relief	Can provide temporary pressure relief but may not be optimal for long-term use	Specifically engineered to distribute pressure evenly and offload bony areas
Durability	Varies widely; household pillows can flatten over time	Built to withstand frequent use and maintain structural integrity

Conclusion: Maximizing Patient Comfort and Safety

Proper pillow arrangement on a hospital bed is a foundational skill for promoting patient comfort and health. Thoughtful placement of pillows supports the head, back, arms, and legs in various positions, relieving pressure and preventing complications like pressure ulcers while aiding in proper body alignment. Combined with regular repositioning, this practice effectively improves the quality of life for bedridden individuals. For more detailed information on specific techniques, consult resources like the {Link: Craig Hospital https://craighospital.org/resources/padding-in-bed}. Paying attention to these details significantly impacts a patient's recovery and well-being.

Frequently Asked Questions

To 'float the heels,' place one or two pillows lengthwise under the patient's calves, from the back of the knee to the ankle. The pillow should elevate the lower leg enough so that the heels are suspended in the air, with no contact with the mattress.

It is generally recommended to reposition a bedridden patient every one to two hours. This regular turning schedule helps to redistribute pressure and prevent skin breakdown and pressure ulcers.

For a patient with back pain, try placing a pillow under the knees when they are on their back to reduce strain on the lower back. When on their side, place a pillow between the knees and ankles to maintain spinal alignment.

Yes, standard pillows can be used, but caregivers should be aware that they may flatten or shift more easily than specialized medical positioning pillows. They should be checked and adjusted frequently to ensure continued support.

Place a pillow under each arm when the patient is lying on their back. This prevents the shoulders from rounding forward and reduces tension. In a side-lying position, place a pillow under the top arm for comfortable support.

The 'Rule of 30' is a guideline for preventing pressure sores. It recommends elevating the head of the bed no more than 30 degrees and positioning the patient at a 30-degree lateral angle. Pillows are used to maintain this specific 30-degree angle and prevent shearing forces.

When a patient is in a side-lying position, place a pillow or foam wedge lengthwise behind their back. This provides a barrier that prevents them from rolling back into a supine position and helps maintain the desired lateral angle.