The ability to properly and safely operate a hospital bed is a fundamental skill for caregivers, whether in a clinical setting or at home. The Trendelenburg position, while not for routine comfort, is a specific bed tilt that serves important medical purposes, such as aiding circulation or providing better access during certain medical procedures.
What is the Trendelenburg Position?
Named after the surgeon who pioneered its use, the Trendelenburg position places a patient flat on their back (supine) with the entire bed frame tilted so the head is lower than the feet. A significant medical benefit is the increase of venous return to the heart from the lower extremities due to gravity.
Common medical uses include:
- Improving blood flow to the brain and heart during critical situations like shock, although its routine use for this has been debated.
- Facilitating the placement of a central venous catheter by causing veins in the neck and upper chest to fill with blood, making them more visible and accessible.
- Providing a surgeon with better access to the pelvic and lower abdominal organs during surgery by allowing gravity to shift them towards the head.
How to Operate an Electric Hospital Bed
Electric hospital beds are equipped with remote controls that make adjusting the Trendelenburg position relatively straightforward. The controls vary by model and manufacturer, but the basic process is similar.
Before You Begin
- Read the manual: Always consult the bed's user manual to understand the specific functions and safety features. Manufacturer guidelines override general instructions.
- Clear the area: Ensure the bed's path is clear of any obstructions or cords that could become entangled during the tilt.
- Check the patient: Make sure the patient is safely positioned in the center of the bed and properly secured to prevent sliding during the adjustment.
- Confirm the patient's needs: Only use this position under a healthcare provider's guidance, as it can be contraindicated for certain conditions like head injuries.
Activating the Trendelenburg Function
On most modern electric beds, you will find a dedicated button for the Trendelenburg position, often marked with an icon showing the bed tilting feet-up. For some models, you may need to press two buttons simultaneously as a safety measure.
- Locate the controls: Find the control panel, which may be a remote on a cord, a built-in side rail panel, or both.
- Identify the button: Look for the Trendelenburg icon. It's distinct from the buttons that only raise the backrest or foot section.
- Press and hold: Press and hold the designated button. The bed will begin to tilt as a single unit, with the foot end rising and the head end lowering.
- Monitor the patient: Watch the patient carefully during the tilt. Do not leave them unattended. If they show signs of distress, immediately return the bed to a flat position.
- Return to level: Once the medical need is complete, press the same button or the 'flat' button to restore the bed to a level position, reversing the tilt smoothly.
How to Operate a Manual Hospital Bed
Manual beds require more effort and careful attention but can also be placed into the Trendelenburg position. This is achieved using hand cranks, typically located at the foot of the bed.
Using Manual Controls
Manual hospital beds usually have two or three separate cranks to control different sections of the bed. You must manipulate these in the correct sequence.
- Locate the foot crank: Find the hand crank that controls the entire bed's height and tilt. It will be different from the crank that only adjusts the foot section.
- Raise the foot end: Crank the appropriate handle to lift the entire foot end of the bed frame, including the mattress, to the required angle.
- Lower the head end: Depending on the bed's design, you may also need to use a separate crank to lower the head section relative to the frame. For a true Trendelenburg, the head should be at the lowest point.
- Lock the cranks: Once the desired angle is achieved, lock the cranks in place to prevent accidental movement. Most cranks fold or push in to lock.
Comparison: Trendelenburg vs. Reverse Trendelenburg
| Feature | Trendelenburg Position | Reverse Trendelenburg Position |
|---|---|---|
| Body Angle | Head lower than feet | Head higher than feet |
| Purpose | Surgical access (pelvis), catheter placement, circulation aid | Access to upper abdominal organs (e.g., gallbladder) |
| Physiological Effect | Increases venous return to heart, increases intracranial pressure | Decreases intracranial pressure, promotes lung expansion |
| Gravity | Organs shift toward the head | Organs shift toward the feet, away from the diaphragm |
Safety Precautions and Key Considerations
Proper operation is critical to prevent patient injury and ensure the bed functions as intended. The following safety steps are crucial for all caregivers.
- Secure the patient: Use side rails and ensure the patient's position is stable before and during the tilt. Never leave a patient unattended in the Trendelenburg position.
- Monitor vital signs: Keep a close eye on the patient's breathing, skin color, and overall comfort level. The position can increase pressure on the lungs and other organs.
- Avoid outdated practices: Do not use this position for prolonged periods or in cases of hypovolemic shock unless specifically instructed by a modern medical protocol. Its use has changed over time due to associated risks.
- Limit shoulder stress: If using an older bed, avoid relying on shoulder braces, which can cause nerve damage. Modern beds and positioning systems use better, safer methods.
- Gradual movement: Always move the bed into and out of the position slowly to allow the patient's body to adjust to the changes in blood flow and pressure.
- Be aware of eye pressure: In rare cases, the increased head pressure can affect vision. Medical professionals monitor this closely in clinical settings.
Conclusion
Mastering how to put a hospital bed in Trendelenburg is a critical skill for providing safe, effective care. Whether dealing with a sophisticated electric model or a simpler manual one, understanding the mechanics, following safety protocols, and being mindful of the patient's condition are paramount. Always follow the specific instructions for your bed model and consult with healthcare professionals to ensure the correct and safe use of this important medical position.
For more detailed medical information on the Trendelenburg position, its uses, and safety considerations, refer to this guide from the Cleveland Clinic on Trendelenburg Position.
